Ambulance Services

Introduction:Traumas that give symptoms of severe pains could lead to stress induced pain if not given an immediate pain relief. Penthroxinhaler an immediate pain reliever, can be given in pre-hospital services by ambulance officers (paramedics or ambulance nurses). Penthroxinhaler is a low-dose Methoxyflurane single-use inhaler, and has been used for more than 40 years in the medical field in managing trauma pain.

Aim:The purpose of this study was to explore the original research related to the prospects of trauma pain management with Penthrox Inhaler, the benefits of using Penthrox inhaler in pre-hospital trauma pain management, and to identify the side effects from using Penthrox Inhaler based on researches published in international journals.

Method:The method used in this literature review is the PICO method a type of systematic literature review. Problem/patient: Severe pain. Intervention: Penthrox Inhaler, Comparison: none. Outcome: Pain relief, Keyword : Pain relief.

Result: The administration of Low Dose Methoxyflurane in cases of trauma pain showed a very significant effect. Giving Low Dose Methoxyflurane was given faster to the patient compared to other drugs. With the provision of LDM, the pain reduction was with a VAS value, which stated very satisfying by 42.8% and satisfying 67.3%. The side effects of using gas drugs are generally seen, whether it causes neprotoxicity and the level of tolerability by the patient himself. Before giving Methoxyflurane to patients, must ensure that the oxygen saturation level is above 90% and the maximum dosage given must be 6 ml in the span of 2 hours to reduce side effects. Ambulance officers can be safe with an exposure time of 8 hours while administering Penthrox to patients.

Cet article propose une contribution à la sociologie du travail et à la sociologie des professions. L’auteure s’est livrée à une observation participante directe du quotidien des ambulanciers privés français dont le travail reste un angle mort des travaux sociologiques consacrés aux métiers de la santé. Au-delà des représentations sociales dominantes de l’ambulancier « transporteur », l’enquête révèle les multiples tâches de soins qu’il réalise et notamment, les soins techniques pratiqués dans le cadre de transports sanitaires d’urgence. En 2007, la création du diplôme d’État d’ambulancier, qui prévoit un élargissement de leur mandat sanitaire dans ce domaine, marque un tournant dans l’histoire de ce groupe professionnel. Il constitue une opportunité de satisfaire les revendications d’un segment du groupe qui cherche à conquérir le statut de spécialiste de l’urgence en s’appuyant sur l’exemple des ambulanciers paramedics européens et américains. Toutefois, en dépit de facteurs technologiques et scientifiques favorables, l’aboutissement de ce processus de segmentation reste aujourd’hui incertain au regard des obstacles internes au groupe professionnel, mais aussi des freins politiques et corporatistes qu’il rencontre.

Se identifica la intervención de las ambulancias civiles de la Cruz Roja peruana y de su equivalente militar boliviana en las inmediaciones de la ciudad de Tacna en mayo de 1880 y su participación en la batalla del Alto de la Alianza (26 de mayo) en el contexto de la Guerra del Pacífico 1879-1884. Se precisa los orígenes de estas ambulancias y revela la intervención directa y humanitaria que desplegaron estas instituciones en aminorar los estragos de la guerra. Se muestra la adhesión de los tres países en guerra al Convenio de Ginebra de 1864 y 1868; así como la vulneración a dicho convenio por parte de algunas tropas chilenas en perjuicio de los médicos, cirujanos, practicantes y heridos que se encontraban en las ambulancias peruanas y bolivianas durante el desarrollo de la batalla. Se señala algunos esfuerzos de la oficialidad chilena por evitar esta vulneración a los heridos y médicos aliados. Partimos de la premisa que uno de los aspectos menos estudiados en la guerra de 1879, es el aporte y accionar de la sociedad civil peruana, chilena o boliviana frente a este.

Jika terjadi keadaan gawat darurat pada tempat kerja, rumah tangga atau di jalanan maka
penolong tercepat yang bisa memberikan pertolongan adalah mereka yang terdekat dengan korban,
bukan hanya petugas kesehatan.
Untuk mempercepat  response time (< 10 menit ) dikembangkan :
Pada Tigkat Kab/Kota Public Safety Center  ( PSC ) sebagai ujung tombak safe community yang merupakan  sarana publik yang menjadi  perpaduan  dari unsur ambulans gawat darurat 118 , kepolisian 110  , dan pemadam kebakaran 113 .
Tingkat Desa, sesuai  dengan konsep Desa Siaga yang memprioritaskan pemberdayaan masyarakat melalui Polkesdes dengan petugas yang telah  mendapatkan pengetahuan dan keterampilan untuk melakukan pertolongan pertama pada kecelakaan (first responder) sebelum penderita tersebut mendapatkan  bantuan lanjutan diinstansi kesehatan terdekat (Puskesmas dan atau RS).

L'aide médicale urgente est un type de secours monopolisé par les services d’urgence médicale officiels dans la plupart des pays. Pourtant, nous voyons que deux acteurs majeurs sont présents dans le domaine : les services d’aide médicale urgente (le SAMU) et les services de santé et de secours médical (le SSSM). (il existe d’autres acteurs que nous pouvons regrouper sous le titre de « Transports sanitaires privés » mais leur rôle est limité, et ils ne constituent pas l’objet de notre travail.) Tous les deux sont dispersés sur le territoire national, les premiers sont attachés aux directions départementales des affaires sanitaires et sociales (DDASS), les seconds attachés aux services départementaux d’incendie et de secours (SDIS). Pour simplifier, le secours médical aux personnes est assuré par deux groupes d’acteurs : les médecins et les sapeurs- pompiers.

Comme c’est le cas pour tous les groupes professionnels qui partagent le même champ d’action, il s’agit parfois de situations conflictuelles, même si une concurrence ouverte n’est pas présente, entre ces deux groupes. Nous pouvons poser ainsi plusieurs questions : comment les membres des deux groupes se perçoivent-ils ? Est-ce que les médecins qui subissent une formation beaucoup plus difficile et longue que les sapeurs-pompiers sont gênés par l’investissement de ces derniers dans le secours aux personnes ? Y a-t-il une tentative d’éxclusion des médecins du SAMU par le recrutement des médecins-pompiers ? Ou bien, les efforts de réforme aboutissent-ils et les deux équipes travaillent-elles en coopération et en entente mutuelle ?

Emergency medical aid is a type of aid monopolized by the official medical emergency services in most countries. However, we see that two major players are present in the field: emergency medical services (SAMU) and health and medical rescue services (SSSM). (There are other actors that we can group under the title of “Private medical transport” but their role is limited, and they do not constitute the object of our work.) Both are dispersed on the national territory, the first is attached to the departmental directorates of health and social affairs (DDASS), the second attached to the departmental fire and rescue services (SDIS). To put it simply, medical aid to people is provided by two groups of actors: doctors and firefighters.

As is the case for all professional groups which share the same field of action, these sometimes create conflictual situations, even if an open competition is not present, between these two groups. We can ask several questions: How do the members of the two groups perceive themselves? Are doctors who undergo much more difficult and lengthy training than firefighters embarrassed by the latter's investment in helping people? Is there an attempt to exclude doctors from the SAMU by recruiting firefighters? Or are the reform efforts successful and are the two teams working in cooperation and mutual understanding?

Application of big data in healthcare has enhanced efficiency and decision making. This is of critical benefit to patients, healthcare professionals and the healthcare institution. Although various research studies have examined the application of big data analytics in healthcare, few studies have explored its application in emergency medicine. This research study explored the application of big data in emergency medicine in facilitating decision making among paramedics and other healthcare practitioners. Appropriate research studies were identified and reviewed systematically to explore the theme of the study. The study found that big data promoted decision making in emergency medicine through the predictor models, which enabled the healthcare practitioners make informed judgments concerning patient care.

Study objective: To determine the risk associated with rapid response driving in the delivery of emergency medical care to patients, and identify contributing factors to ambulance collisions in the City of Cape Town.
Methods: In this retrospective survey, ambulance collision data was captured over a period of one year. The data was individually analyzed and categorized according to the severity of the collision. Two categories, major and minor collisions, were then further analyzed according to contributing factors associated with the collision and injuries sustained. Contributing factors included: Responding with lights and siren, weather conditions, peak traffic time, traffic location, collisions associated with parking and community violence related vehicle damage.
Results: A total of 119 collisions were documented by the Provincial Government Western Cape Emergency Medical Service (EMS) in the City of Cape Town, during the period of 1 January – 31 December 2012. From this total, 62 collisions were classified as major collisions and 45 as minor collisions. Major collisions are defined as substantial damage to at least two vehicles and minor collisions as slight vehicle damage to one or two of the vehicles. From the 62 major collisions, 36 (58%) occurred while responding with lights and sirens. A total of 40 injuries and one fatality occurred. Twenty six injuries and one fatality occurred during response driving and 14 injuries during non-response driving. Most major collisions occurred at an intersections with a total of 28 (45%) from which 19 (68%) occurred while responding with lights and siren. Contributing factors included: Responding with lights and siren, weather conditions, peak traffic time, party at fault, responsible for the collision, traffic location.
Conclusion: Responding to emergencies resulted in more major collisions compared to non-responding. The majority of collisions occurred during ambulance response through intersections without right of way. Collisions were not associated with high speed, but rather the public’s unawareness of the approaching ambulance. ECP, public road users and pedestrians are at an increased risk during responding.

Sosyal Güvenlik Kurumu Başkanlığı'nın 30.04.2013 tarih ve 68072577-7.475.010 sayılı yazısına istinaden Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü koordinatörlüğünde yürütülen çalışmada Acil Sağlık Hizmetleri Genel Müdürlüğü olarak tarafımızdan "Acil Sağlık Hizmetlerinin sunumuna ilişkin ICD10 kod listesinin oluşturulması" talep edilmektedir. Bu talepten kasıt; SGK tarafından ödemeye esas oluşturmak üzere 112 Acil Sağlık Hizmetleri İstasyonlarında ve Hastane Acil Servislerinde kabul edilen hangi hastalara sarı, hangi hastalara kırmızı kod verileceğine dair 10.000 Başlıklı ICD-10 Listesinden, kullanışlı olabilmesi adına 1000 tanı kodunun belirlenmesidir.

Głównym celem pracy jest nakreślenie aktualnej kondycji transportowej części systemu państwowego ratownictwa medycznego. Według obowiązującego prawa kierowcą pojazdu uprzywilejowanego w opiece zdrowotnej może zostać osoba spełniająca szereg wymogów dotyczących predyspozycji i uprawnień. Funkcje kierowcy ambulansu powierzane są coraz częściej, głównie z pobudek ekonomicznych, członkom zespołów ratowniczych -najczęściej ratownikom medycznym. Celem dodatkowym jest próba nakreślenia ograniczeń i możliwych rozwiązań w omawianej tematyce.

This article reimagines poverty governance as a labor process. Extending theories of bureaucratic fields and street-level bureaucracies, the proposed model suggests that the state manages the poor through fragmented activities embedded in horizontal and vertical relations of production. I use an ethnography of 911 ambulance operations in a single California county to advance this perspective. From plugging gunshot wounds to moving sidewalk slumberers, ambulance crews interact with a mostly impoverished clientele base by transforming spaces in bodies and bodies in spaces. This two-sided governance puts the ambulance in recurrent contact with the hospital emergency department and the police squad car. Across these institutions, ambulance crews struggle with their nurse and police counterparts over the horizontal shuffling of burdensome work, shaping the life chances of their subjects in the process. At the same time, bureaucratic and capitalistic forces from above activate a lean ambulance fleet that is minimally wasteful and highly flexible. This verticality structures clientele processing through the ambulance and fuels tensions across the frontlines of governance. In an effort to advance theory and fill an empirical gap, this article proposes a new model for understanding the management of marginality and highlights an overlooked case of poverty regulation.

Introduction There is a compelling need to develop clinical performance indicators for ambulance services in order to move from indicators based primarily on response times and in light of the changing clinical demands on services. We report on progress on the national pilot of clinical performance indicators for English ambulance services. Method Clinical performance indicators were developed in five clinical areas: acute myocardial infarction, cardiac arrest, stroke (including transient ischaemic attack), asthma and hypoglycaemia. These were determined on the basis of common acute conditions presenting to ambulance services and in line with a previously published framework. Indicators were piloted by ambulance services in England and results were presented in tables and graphically using funnel (statistical process control) plots. Results Progress for developing, agreeing and piloting of indicators has been rapid, from initial agreement in May 2007 to completion of the pilot phase by the end of March 2008. The results of benchmarking of indicators are shown. The pilot has informed services in deciding the focus of their improvement programme in 2008e2009 and indicators have been adopted for national performance assessment of standards of prehospital care. Conclusion The pilot will provide the basis for further development of clinical indicators, benchmarking of performance and implementation of specific evidencebased interventions to improve care in areas identified for improvement. A national performance improvement registry will enable evaluation and sharing of effective improvement methods as well as increasing stakeholder and public access to information on the quality of care provided by ambulance services.

Around 20 ambulance services operated in Karachi; however, the network of Edhi, Chhipa and Aman ambulance services provides the bulk of patient transport. The study aims to compare the quality of ambulance service delivery with international standards. With a mixmethod approach, 357 patients/attendants and key stakeholders participated in the study. The results revealed a wide range of differences in service quality. Aman services delivery quality is rated 72% compliant, but it constitutes less than 20% of the share of inpatient transportation due to limited ambulances while Edhi and Chhipa contribute 80% of patient transportation, but their service delivery quality is rated only 13%. In the subset of monitoring, infection control, and medicine, Edhi & Chhipa services meet 0% standards. The thematic analysis revealed that the primary reasons for the poor quality are lack of legislation & minimum standards, Poor or no monitoring, financial constraints, and lack of awareness. In conclusion, the ambulances services operating in the city lacks minimum service quality standards, thus pose a constant threat to patient life using these services.

In this paper, an Offline Drone Instrumentalized Ambulance (ODIA) mechanism has been discussed. The rapid increase in the urban population directly influences every sector of society. The sectors are maybe food, health care, education, transportation, etc. Normally, it has been observed that when any accidents happen on the urban road or any remote places then, the availability of immediate medical help is very rare. It is not because of the unaware or unavailability of medical facilities rather it happens because of overcrowding on the urban road and geographical odd-isolation of places. Hence, here an ODIA concept has been discussed which uses offline maps and offline first-aid medical videos through which immediate medical help can be made available at the patient end. This model helps to save the life of an accident victim by providing immediate medical attention. The key strength of ODIA is, it is independent of internet service that’s why it is more suitable for harsh and hostile environments.

Background: One-fifth of Australia's population do not speak English at home. International studies have found emergency calls with language barriers (LB) result in longer delays to out-of-hospital cardiac arrest (OHCA) recognition, and lower rates of bystander cardiopulmonary resuscitation (CPR) and survival. This study compared LB and non-LB OHCA call time intervals in an Australian emergency medical service (EMS). Methods: The retrospective cohort study measured time intervals from call commencement for primary outcomes: (1) address acquisition; (2) OHCA recognition; (3) CPR initiation; (4) telecommunicator CPR (t-CPR) compressions, in all identified LB calls and a 2:1 random sample of non-LB EMS calls from January to June 2019. Results for time intervals #1, 2, and 4 were benchmarked against the American Heart Association's (AHA) t-CPR minimal acceptable time standards. Patient survival outcomes were compared. Results: We identified 50 (14%) LB calls from a cohort of 353 calls. LB calls took longer than non-LB calls (n=100) for: address acquisition (median 29 vs 14 secs, p<0.001), OHCA recognition (103 vs 85 secs, p=0.02), and CPR initiation (206 vs 164 secs, p=0.01), but not for t-CPR compressions (292 vs 248 secs, p=0.12). Rates of OHCA recognition and 30-day-survival did not differ but smaller proportions of LB calls met the AHA standards. Conclusion: Time delays found in LB calls point to phases of the call which need further qualitative investigation to understand how to improve communication. Overall, training call-takers for LB calls may assist caller understanding and cooperation during OHCAs.

Background We aimed to investigate patients' and practitioners' views and experiences of prehospital pain management to inform improvements in care and a patient centred approach to treatment. Methods This was a qualitative study involving a single emergency medical system. Data were gathered through focus groups and semi-structured interviews. Participants were purposively sampled from patients transported by ambulance to hospital with a painful condition during past six months, ambulance service and emergency department (ED) clinicians. Interviews were audiotaped, transcribed and thematic analysis was conducted. Results We interviewed 55 participants: 17 patients, 25 ambulance clinicians and 13 ED clinicians. Key themes included: (a) consider beliefs of patients and staff in pain management (b) widen pain assessment strategies (c) optimise non-drug treatment (d) increase drug treatment options and (e) enhance communication and coordination along the prehospital pain management pathway. Patients and staff expected pain to be relieved in the ambulance; however, refusal of or inadequate analgesia were common. Pain was commonly assessed using a verbal score but practitioners' views of severity were sometimes discordant with this. Morphine and Entonox ® were commonly used to treat pain. Reassurance, positioning and immobilization were used as alternatives to drugs. Prehospital pain management could be improved by addressing practitioner and patient barriers, increasing available drugs and developing multiorganizational pain management protocols supported by training for staff. Conclusions Pain is often poorly managed and undertreated in the prehospital environment. Our findings may be used to inform guidance, education and policy to improve the prehospital pain management pathway.

Emergency medical response in India is lagging behind other countries. This is partially because of lack of technology implementation at ground zero. To address the issue, we are introducing smart ambulance system. It would take India to competitive position in emergency services around the globe. Over the last few years, there is a revolutionary development in the field of Internet of Things (IoT). It can be used seamlessly & widely in large number of end system where subset of a large amount of data can be accessed and processed easily and powerfully. This is a mini project & this project is a desktop application. The project titled AMBULANCE ALERT CELL the emergency response wing. We available in 24/7, in any case of emergency admin make an alert to the difficult to search the records manually. This also requires a lot of hard work and time consumption to complete the task. Such situations may include human errors. In4 this existing system, the security of the information is also a risk. All the records are stored manually and it is not easy to prevent it falling into the wrong hands. As a result, the security of these records is always a challenging task.

The quality of service and efficiency of labour utilization in emergency service fleets, such as police, fire departments, and emergency medical services (EMS), depends, among other things, on the efficiency of work break scheduling. The workload of such fleets usually cannot be forecasted with certainty and its urgency requires an immediate response. However, prolonged focused work periods decrease efficiency with related decline of attention and performance. Therefore, break schedule should be regularly updated as the work shift progresses to allow frequent and sufficiently long time for rest. In this paper, we propose a distributed and dynamic work break scheduling algorithm for crews in emergency service vehicle fleets. Based on the historical intervention data, the algorithm rearranges vehicles' crews' work breaks in a manner considering individual crews' preferences. Moreover, it dynamically reallocates stand-by vehicles for best coverage of a region of interest. We analyze the proposed algorithm and show its performance on a simple use-case.

The present study explores the links between personality factors and the professional performance of four different categories of ambulance workers: doctors, nurses, ambulance drivers and dispatchers. The 458 participants’ scores for personality factors (according to the Big Five Model), sensation seeking and time perspective scales were compared among professional and performance based groups. Results revealed significant differences among professional groups regarding neuroticism, openness to experience and time perspectives. Also, significant differences were found between high-level and low-level performance groups of nurses and dispatchers.

Lack of safety culture awareness in the ambulance services affects not only locally but internationally in different countries, including at "XYZ" a company in Qatar. Many studies mentioned about risks and hazards associated with ambulance services that result from illnesses, accidents, or property damaged because of a lack of safety culture. The results of the safety culture survey in ambulance service of XYZ Company were showing less of commitment and involvement of ambulance personnel to safety 52.6% and less motivation 57.9%. It supports by the achievement of key performance index of ambulance services that was 85 %-96 % from the target. This paper discussed a strategy to improve safety culture in ambulance services. The authors conducted a research study utilizing the AHP method to select the best approach by following the real condition. This study compares the essential factors in improving safety culture based on eight criteria and three strategies safety climate which the result shows that (a) The commitment of senior Original Research Article Hadian et al.; CJAST, 37(2): 1-12, 2019; Article no.CJAST.51044 2 management with a value of 0.247 or (247%), and (b) Operational approach strategy with a value of 0.386 or (38.6%), with CR of 0.03 are among the top priorities needed in the operational of ambulance services to run optimally.

This study aimed to review the layout of the patient compartment in a UK ambulance for paramedic efficiency and safety using (1) link analysis; (2) postural analysis. Paramedics were observed over 16 shifts (130 hours) carrying out a range of clinical tasks. The most frequently occurring clinical tasks were checking blood oxygen saturation, oxygen administration, monitoring the heart and checking blood pressure. Access to the equipment and consumables to support these tasks had been designed for the attendant seat (head end of the stretcher) however a link analysis found that paramedics preferred to sit along side the stretcher which resulted in increased reach distances. The higher frequency tasks were found to include over 40% of working postures which required corrective measures. It was concluded that future ambulance design should be based on an ergonomics analysis (including link analysis and postural analysis) of clinical activities.

Due to the urgent, time-sensitive nature of interactions in emergency ambulance phone calls, dealing with repairs (communication trouble) can be challenging. We investigate a critical medical emergency known as out-of-hospital cardiac arrest (OHCA) and focus on how ambulance call-takers handle repairs during an interactive sequence concerning the retrieval of automatic external defibrillators (AED). Clear communication about AEDs is vital, because the device can deliver a life-saving shock to an OHCA patient’s heart. We examined repair initiations, and their subsequent trajectories, during the defibrillator sequences in 58 OHCA emergency calls. We found evidence of competing influences in resolving such repairs: (1) providing a repair solution (including ensuring caller comprehension of what a defibrillator is) to achieve intersubjectivity that could resolve the question of defibrillator availability; or (2) progressing the call as swiftly as possible to an immediately applicable life-saving intervention such as cardiopulmonary resuscitation. The findings suggest that in certain institutional contexts, such as emergency medical service dispatch, the resolution of repairs in communication can take varying trajectories in order to achieve the most feasible goal in immediate time. We suggest that emergency medical services consider these trajectories in helping ambulance call-takers anticipate repairs in OHCA calls.

INTRODUCTION: Emergency calls to ambulance services are frequent for older people who have fallen, but ambulance crews often leave patients at the scene without ongoing care. Evidence shows that when left at home with no further support older people often experience subsequent falls which result in injury and emergency-department attendances. SAFER 2 is an evaluation of a new clinical protocol which allows paramedics to assess and refer older people who have fallen, and do not need hospital care, to community-based falls services. In this protocol paper, we report methods and progress during trial implementation. SAFER 2 is recruiting patients through three ambulance services. A successful trial will provide robust evidence about the value of this new model of care, and enable ambulance services to use resources efficiently. DESIGN: Pragmatic cluster randomised trial. METHODS AND ANALYSIS: We randomly allocated 25 participating ambulance stations (clusters) in three services to inte...

Our main aim is to avoid the use of a separate lane for emergency uses and to enhance the exigency transport in our country .The maintenance need for this method is very minimal. This technique composed of a PC fixed inside an ambulance along with a GSM device and an RF transmitter. When a patient is taken to a hospital through ambulance it is better to know about the shortest way to reach. Here the software installed in the PC acts likes a tom-tom device which report the driver about the nearer path and the time takes to reach the hospital. The main design of this paper is to clear the traffic in the chosen shortest path in advance. When the driver chooses the destination the system instantly informs the display boards that are placed in the nearer path to apprise the vehicles in that path that an ambulance is going to use the lane shortly. These display boards are placed in every traffic signal indicator or we can alert by establishing a new signal color(blue). The signal stations in the path are set to red color simultaneously to control the traffic flow. Then, if a vehicle uses the lane during the approach of the ambulance it will be alerted with a beep sound. If the driver further refrains from stopping the vehicle, a tracking server is used to track the vehicle‘s identity.

care in prehospital settings ambulance services: research for better health Supporting research and development in http://emj.bmj.com/content/27/4/324.full.html Updated information and services can be found at: These include: References http://emj.bmj.com/content/27/4/324.full.html#ref-list-1

Introduction:Traumas that give symptoms of severe pains could lead to stress induced pain if not given an immediate pain relief. Penthroxinhaler an immediate pain reliever, can be given in pre-hospital services by ambulance officers (paramedics or ambulance nurses). Penthroxinhaler is a low-dose Methoxyflurane single-use inhaler, and has been used for more than 40 years in the medical field in managing trauma pain. Aim:The purpose of this study was to explore the original research related to the prospects of trauma pain management with Penthrox Inhaler, the benefits of using Penthrox inhaler in pre-hospital trauma pain management, and to identify the side effects from using Penthrox Inhaler based on researches published in international journals. Method:The method used in this literature review is the PICO method a type of systematic literature review. Problem/patient: Severe pain. Intervention: Penthrox Inhaler, Comparison: none. Outcome: Pain relief, Keyword : Pain relief. Result:...

The health system’s response characteristics to any refugee crises have special characteristics. Optimal and flexible use of health services is essential in order to meet the needs that arise. Greece has been at the center of such crisis in the last 3 years. The purpose of this study is to record the emergency refugees' transports carried out by the National Center of Emergency Care (EKAB) of Thessaloniki during a 6 months period. In a retrospective study, selected data for the use of emergency care service by the refugees’ camps around Thessaloniki were recorded and analyzed. Parameters included the date, time and location of the incident, patient demographics, callers’ status and incident type. Data on refugee flow in Greece was also included for the same period. Data from 1916 records were analyzed, the majority of which were ages up to 45 years (>70%). Time distribution of the data displayed increased transport during the first 3 months of the study, followed by a steady decrease. Most of the transports were carried out during the last 3 days of the week. In comparison with the general population, high incident of pediatric cases were recorded. Trauma cases were also high, (35%)-with equally high rates of crime-related injuries. Finally, many ambulance transports were carried out due to delivery or early pregnancy-related problems. Young people and children are the most frequently users of ambulances’ transport from refugee hosting camps. However, due to the complexity of the problem and the dynamic nature of the camps’ population composition, more studies are needed in order to properly evaluate the use of each sector of the health system by refugees.

Background: Prehospital emergency medical services (PEMS) are becoming more and more sophisticated as more point-of–care advanced medical technology is available in the field. Yet, the literature around the subject is limited, as data come mainly from Northern Europe, USA, Canada and New Zealand. The aim of this analysis was to describe time trends of PEMS activity in a region of northern Greece.

Trailer video for the online course Healing Spaces (ME.150.728), a research seminar in the Johns Hopkins Online Program in the History of Medicine. For more information about the Johns Hopkins Online Program in the History of Medicine, visit http://www.hopkinshistoryofmedicine.org/content/online-program-history-medicine

Abstract
In this study, data from Batman city ambulance
system are taken and categorized according to
ambulance groups, regions, types of illness and
rural and urban areas. Response time of each ambulance
group is found to compare groups within
each other. Locations of hospitals and ambulance
stations are analyzed whether they are at suitable
places or not. Graphical and statistical models
such as ANOVA are used to check the validity of
data and to get some results. The current ambulance
performance system shown in Appendix
section is criticized based on the findings from
that study. It is found that the number of ambulances
is not enough for Batman city and their
locations is to be redesigned according to management
objectives. Ambulances can be grouped as
rural and urban ambulances and some ambulances
are to be located in rural areas in defined places. All
hospitals are mainly located at city centre and it
takes long time to reach to some cases’ locations
in the city. New hospitals or branch of hospitals
are to be opened in some areas of city with most
urgent cases.
Keywords: EMSs, Performance of Ambulance
Groups, Batman City

You know fine well they're not going to have a very good peak flow if they're not puttin g a senten ce togeth er. 'We don't do becau se the patien t physi cally hasn't got time, becau se they are gettin g very exhau sted. If they get too exhau sted somet imes it's game over.' 'I've neve r had a doct or ask for a peak flow .' '… a lot of them won't do a pre but I alwa ys do a post . Som etim es you can do it and some time s you can't but gene rally I do beca use that 's anot her reas on why you woul d leave them at home beca use if their peak flow come back at 150 you woul d be dubi ous to leave some body at home in case they dete riora ted furth er.'

INTRODUCTION: Emergency calls to ambulance services are frequent for older people who have fallen, but ambulance crews often leave patients at the scene without ongoing care. Evidence shows that when left at home with no further support older people often experience subsequent falls which result in injury and emergency-department attendances. SAFER 2 is an evaluation of a new clinical protocol which allows paramedics to assess and refer older people who have fallen, and do not need hospital care, to community-based falls services. In this protocol paper, we report methods and progress during trial implementation. SAFER 2 is recruiting patients through three ambulance services. A successful trial will provide robust evidence about the value of this new model of care, and enable ambulance services to use resources efficiently. DESIGN: Pragmatic cluster randomised trial. METHODS AND ANALYSIS: We randomly allocated 25 participating ambulance stations (clusters) in three services to inte...

In two previous articles, I explored the issues around rising unscheduled demand, and whether outbreaks of a new type of infectious disease may be in some way implicated. In this respect, a further outbreak of this agent occurred during 2016 and unusually high workload during the winter of 2016/17 had already been predicted.
This update will focus on the trends in deaths as a proxy for the rising health service demand over the last weeks of life. It has been known for many years that the majority of a person’s lifetime acute utilization (up to 55%) occurs in the last year of life, and more specifically in the last 22 weeks of life. Hospital admissions (and ambulance journeys) reach a crescendo in the last month of life. However, this occurs irrespective of the age at death, i.e. it is a fundamental biological process of deterioration resulting in functional, cognitive and biochemical decline.