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A review on ambulance offload delay literature
Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency department (ED). This is typically due to emergency department congestion. This problem has become a significant concern for many health care providers and has attracted the attention of many researchers and practitioners. This article reviews literature which addresses the ambulance offload delay problem. The review is organized by the following topics: improved understanding and assessment of the problem, analysis of the root causes and impacts of the problem, and development and evaluation of interventions. The review found that many researchers have investigated areas of emergency department crowding and ambulance diversion; however, research focused solely on the ambulance offload delay problem is limited. Of the 137 articles reviewed, 28 articles were identified which studied the causes of ambulance offload delay, 14 articles studied its effects, and 89 articles studied proposed solutions (of which, 58 articles studied ambulance diversion and 31 articles studied other interventions). A common theme found throughout the reviewed articles was that this problem includes clinical, operational, and administrative perspectives, and therefore must be addressed in a system-wide manner to be mitigated. The most common intervention type was ambulance diversion. Yet, it yields controversial results. A number of recommendations are made with respect to future research in this area. These include conducting system-wide mitigation intervention, addressing root causes of ED crowding and access block, and providing more operations research models to evaluate AOD mitigation interventions prior implementations. In addition, measurements of AOD should be improved to assess the size and magnitude of this problem more accurately.
Journal Article
The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research
Background
High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce.
Methods
This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being.
Results
Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports.
Conclusions
Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level.
Journal Article
Ambulances : a first look
\"Ambulances make lots of noise and have flashing lights, but they also help people. Full-color photographs and easy text give young readers a front-row seat into these life-saving vehicles\"-- Provided by publisher.
BOOK
Most Patients Undergoing Ground And Air Ambulance Transportation Receive Sizable Out-Of-Network Bills
\"Surprise\" out-of-network bills have come under close scrutiny, and while ambulance transportation is known to be a large component of the problem, its impact is poorly understood. We measured the prevalence and financial impact of out-of-network billing in ground and air ambulance transportation. For members of a large national insurance plan in 2013-17, 71 percent of all ambulance rides involved potential surprise bills. For both ground and air ambulances, out-of-network charges were substantially greater than in-network prices, resulting in median potential surprise bills of $450 for ground transportation and $21,698 for air transportation. Though out-of-network air ambulance bills were larger, out-of-network ground ambulance bills were more common, with an aggregate impact of $129 million per year. Out-of-network air ambulance bills averaged $91 million per year, rising from $41 million in 2013 to $143 million in 2017. Federal proposals to limit surprise out-of-network billing should incorporate protections for patients undergoing ground or air ambulance transportation.
Journal Article
Rescue vehicles
Describes the many types of vehicles used by first responders and emergency workers.
Book
Association of ambulance and helicopter response times with patient survival: A systematic literature review and meta-analysis
Only sparse scientific evidence supports the notion that the shortest possible response time relates to improved patient outcomes in acute conditions, other than out-of-hospital cardiac arrest and trauma. Confounders such as bidirectional causality and confounding by indication may influence patient-centered outcomes, which may prevent actionable conclusions from literature reviews. The purpose of the systematic literature review was to assess current evidence on association, if any, between ambulance and helicopter response times and survival in all patient categories treated by ambulance or helicopter services.
The systematic search was conducted in MEDLINE, Cochrane Library, EMBASE, CINAHL, Scopus, and Clinical Trial Registries. All study designs and settings identified as relevant to the topic were eligible. The investigators retrieved data from a predefined template and extracted data from a predefined template. Two reviewers worked independently, and conflicts were resolved by a third reviewer. The researchers used PRISMA guidelines for abstracting data and GRADE methodology for assessing data quality and validity. As per study protocol, the primary study outcome was patient survival, and the main measurement was response time for emergency medical services vehicles.
The investigators included 115 studies that in total included 691,056 patients, comprising patients with out-of-hospital cardiac arrest, trauma, drownings, and including both adults and children in various settings. The overall median survival rate was 11.5% (IQR 5.2; 25.8). Response time varied between 1.10 and 48.62 minutes. The predefined domains and items of interest were accounted for in 46.7% of the included literature. In a meta-analysis of sub-groups, there was a positive correlation in selected populations. Certainty of evidence was very low as per GRADE methodology.
This systematic review and meta-analysis found lack of evidence to infer an association between the EMS response time and patient survival, with very low certainty of evidence. The investigators found substantive research and knowledge gaps. Therefore, no actionable conclusions can be made from this systematic review.
Journal Article
Trauma junkie : memoirs of an emergency flight nurse
Is there an afterlife? Janice Hudson, who's seen her share of death, ventures an assuring yes in this memoir about her years as a trauma nurse. In May 1987, newlywed intensive-care nurse Hudson was recruited to join a helicopter ambulance service and \"fly out to accidents, scrape up the patients and try to get them to qualified care in that first 'golden hour,' when they'd have the best chance for meaningful survival after traumatic injuries.\" Hudson hits on the usual suspects: barroom brawls, failed suicide attempts, and grisly car wrecks. She also recounts what are likely to be some of the more unusual cases, including a call from a woman who insisted that her mountaintop home was being overrun by an army of mountain lions (which turned out to be a single housecat, amplified thanks to the caller's diet of alcohol and crystal meth). Death is a constant in her pages, but so is Hudson's belief that something interesting awaits us afterward, as a few of her eerie anecdotes attest. -Amazon
Book
The Ambulance: Toward a Labor Theory of Poverty Governance
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.
Journal Article