Explore the vast range of titles available.

The use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (ARF) in adults is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with sufficient experience, volume, and expertise to ensure it is used safely. This position paper represents the consensus opinion of an international group of physicians and associated health-care workers who have expertise in therapeutic modalities used in the treatment of patients with severe ARF, with a focus on ECMO. The aim of this paper is to provide physicians, ECMO center directors and coordinators, hospital directors, health-care organizations, and regional, national, and international policy makers a description of the optimal approach to organizing ECMO programs for ARF in adult patients. Importantly, this will help ensure that ECMO is delivered safely and proficiently, such that future observational and randomized clinical trials assessing this technique may be performed by experienced centers under homogeneous and optimal conditions. Given the need for further evidence, we encourage restraint in the widespread use of ECMO until we have a better appreciation for both the potential clinical applications and the optimal techniques for performing ECMO.

Background Primary care access can be challenging for older, rural, socio-economically disadvantaged populations. Here we report the I-ACT cluster feasibility trial which aims to assess the feasibility of trial design and context-sensitive intervention to improve primary care access for this group and so expand existing theory. Methods Four general practices were recruited; three randomised to intervention and one to usual care. Intervention practices received £1500, a support manual and four meetings to develop local, innovative solutions to improve the booking system and transport. Patients aged over 64 years old and without household car access were recruited to complete questionnaires when booking an appointment or attending the surgery. Outcome measures at 6 months included: self-reported ease of booking an appointment and transport; health care use; patient activation; capability; and quality of life. A process evaluation involved observations and interviews with staff and participants. Results Thirty-four patients were recruited (26 female, eight male, mean age 81.6 years for the intervention group and 79.4 for usual care) of 1143 invited (3% response rate). Most were ineligible because of car access. Twenty-nine participants belonged to intervention practices and five to usual care. Practice-level data was available for all participants, but participant self-reported data was unavailable for three. Fifty-six appointment questionnaires were received based on 150 appointments (37.3%). Practices successfully designed and implemented the following context-sensitive interventions: Practice A: a stacked telephone system and promoting community transport; Practice B: signposting to community transport, appointment flexibility, mobility scooter charging point and promoting the role of receptionists; and Practice C: local taxi firm partnership and training receptionists. Practices found the process acceptable because it gave freedom, time and resource to be innovative or provided an opportunity to implement existing ideas. Data collection methods were acceptable to participants, but some found it difficult remembering to complete booking and appointment questionnaires. Expanded theory highlighted important mechanisms, such as reassurance, confidence, trust and flexibility. Conclusions Recruiting older participants without access to a car proved challenging. Retention of participants and practices was good but only about a third of appointment questionnaires were returned. This study design may facilitate a shift from one-size-fits-all interventions to more context-sensitive interventions. Trial registration ISRCTN18321951 , Registered on 6 March 2017.

Transportation is an underrecognized, but modifiable barrier to accessing cancer care, especially for clinical trials. Clinicians, insurers, and health systems can screen patients for transportation needs and link them to transportation. Direct transportation services (i.e., ride-sharing, insurance-provided transportation) have high rates of patient satisfaction and visit completion. Patient financial reimbursements provide necessary funds to counteract the effects of transportation barriers, which can lead to higher trial enrollment, especially for low socioeconomic status and racially and ethnically diverse patients. Expanding transportation interventions to more cancer patients, and addressing knowledge, service, and system gaps, can help more patients access needed cancer care.

You can attribute most helicopter EMS (emergency medical service) accidents and many ground ambulance accidents to human factors and systems designs that lead to poor decision-making. Management commitment is vital to maintain a culture that supports risk assessment, accountability, professionalism and organizational dynamics. This volume by The Commission on Accreditation of Medical Transport Systems (CAMTS) addresses this need. It offers insights and solutions that can be used by EMS, Fire and Rescue, public and private services, and professional emergency and transport professionals worldwide.

The smooth operation and then evacuation of NYU's hospitals during and after Hurricane Sandy were remarkable. But for the future, it's important to understand what medical and public health challenges are to be expected after such megadisasters. Within hours after Hurricane Sandy's landfall, doctors and staff at one of New York City's premier medical centers realized that something was going terribly wrong. Lights were flickering, critical devices essential to life support for more than 200 patients, many in intensive care units, were malfunctioning. A decision had to be made by hospital leaders, senior public health officials, and emergency responders: tough it out in a hospital without power or attempt a perilous patient evacuation as an epic disaster unfolded. With little time to lose, the “go” order was given, followed by frantic calls to high-ground hospitals identifying beds . . .

ObjectiveTo investigate the factors contributing to or hindering intrahospital transport preparation and management projects using the consolidated framework for implementation research (CFIR) framework.DesignSemistructured interviews were used in a qualitative descriptive study.SettingThis study was conducted in the emergency room of a tertiary hospital in Beijing, China, between December 2023 and January 2024.ParticipantsPurposive sampling was employed to recruit 22 doctors and nurses involved in intrahospital transport.Primary and secondary outcome measuresA content analysis technique was employed to transcribe and analyse all gathered data. Iterative methods were used for the data collection and analysis.Results39 implementation determinants—11 barriers, 25 facilitators and 3 neutral factors—were identified. These determining factors aligned with 23 of the 26 CFIR constructs and 5 CFIR domains. Facilitators were identified in four primary domains: ease of implementation, scientific and project completion, patient advantages and enhanced capacity for safe and professional transfer. Additionally, hurdles were identified in the CFIR domains of intervention characteristics, outer settings and inner settings. These barriers include inadequate training and mobilisation, insufficient information systems, unclear reward and punishment policies, a shortage of labour and material resources and the absence of established reward and punishment laws.ConclusionThis study identified the factors influencing the emergency department’s intrahospital transport planning and management project implementation. Despite numerous obstacles, the project provides a clear pathway for advancing intrahospital transport planning and management.

ObjectivesInterhospital patient transfers have become routine. Known drivers are access to specialty care and non-clinical reasons, such as limited capacity. While emergency medical services (EMS) providers act as main patient transfer operators, the impact of interhospital transfers on EMS service demand and fleet management remains understudied. This study aims to identify patterns in regional interhospital patient transfer volumes and their spatial distribution, and to discuss their potential implications for EMS service demand and fleet management.DesignA retrospective study was performed analysing EMS transport data from the province of Drenthe in the Netherlands between 2013 and 2019 and public hospital listings. Yearly volume changes in urgent and planned interhospital transfers were quantified. Further network analysis, including geomapping, was used to study how transfer volumes and their spatial distribution relate to hospital specialisation, and servicing multihospital systems. Organisational data were considered for relating transfer patterns to fleet changes.SettingEMS in the province of Drenthe, the Netherlands, 492 167 inhabitants.ParticipantsAnalyses are based on routinely collected patient data from EMS records, entailing all 248 114 transports (137 168 patients) of the Drenthe EMS provider (2013–2019). From these interhospital transports were selected (24 311 transports).ResultsInterhospital transfers represented a considerable (9.8%) and increasing share of transports (from 8.6% in 2013 to 11.3% in 2019). Most transfers were related to multihospital systems (47.3%, 11 509 transports), resulting in a considerable growth of planned EMS transports (from 2093 in 2013 to 3511 in 2019). Geomapping suggests increasing transfer distances and diminishing resource efficiencies due to lacking follow-up rides. Organisational data clarify how EMS fleets were adjusted by expanding resources and reorganising fleet operation.ConclusionsEmerging interhospital network transfers play an important role in EMS service demand. Increased interhospital transport volumes and geographical spread require a redesign of current EMS fleets and management along regional lines.

ObjectiveA vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are recognised methods to show where efficiencies can be made. We aimed to understand the process and information flows used by the prehospital emergency service in transporting community emergencies in Rwanda in order to identify areas for improvement.DesignTwo facilitated process/information mapping workshops were conducted. Process maps were produced in real time during discussions and shared with participants for their agreement. They were further validated by field observations.SettingThe study took place in two prehospital care settings serving predominantly rural and predominantly urban patients.Participants24 healthcare professionals from various cadres. Field observations were done on 49 emergencies across both sites.ResultsTwo maps were produced, and four main process stages were described: (1) call triage by the dispatch/call centre team, (2) scene triage by the ambulance team, (3) patient monitoring by the ambulance team on the way to the health facility and (4) handover process at the health facility. The first key finding was that the rural site had multiple points of entry into the system for emergency patients, whereas the urban system had one point of entry (the national emergency number); processes were otherwise similar between sites. The second was that although large amounts of information were collected to inform decision-making about which health facility to transfer patients to, participants found it challenging to articulate the intellectual process by which they used this to make decisions; guidelines were not used for decision-making.DiscussionWe have identified several areas of the prehospital care processes where there can be efficiencies. To make efficiencies in the decision-making process and produce a standard approach for all patients will require protocolising care pathways.

Aid workers have welcomed the launch of a unique medical air bridge to transport Yemeni patients abroad for specialised treatment as a confidence-building exercise, even if only a fraction of those in need in the war-torn country will benefit. Médecins Sans Frontières had been unable to transport any patients by aeroplane to its reconstructive surgery hospital in Amman, Jordan's capital, because the Saudi-led coalition had forbidden it, Caroline Seguin, manager of Médecins Sans Frontières’ programmes in Yemen, told The Lancet. A statement from the Norwegian Refugee Council (NRC) said that at least 32 000 Yemenis are estimated to have died while waiting to get specialised medical treatment abroad, according to the Ministry of Health in Sana'a.