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Background Ineffective communication of infection control requirements during transitions of care is a potential cause of non-compliance with infection control precautions by healthcare personnel. In this study, interventions to enhance communication during inpatient transfers between wards and radiology were implemented, in the attempt to improve adherence to precautions during transfers. Methods Two interventions were implemented, comprising (i) a pre-transfer checklist used by radiology porters to confirm a patient’s infectious status; (ii) a coloured cue to highlight written infectious status information in the transfer form. The effectiveness of the interventions in promoting adherence to standard precautions by radiology porters when transporting infectious patients was evaluated using a randomised crossover trial at a teaching hospital in Australia. Results 300 transfers were observed over a period of 4 months. Compliance with infection control precautions in the intervention groups was significantly improved relative to the control group (p < 0.01). Adherence rate in the control group was 38%. Applying the coloured cue resulted in a compliance rate of 73%. The pre-transfer checklist intervention achieved a comparable compliance rate of 71%. When both interventions were applied, a compliance rate of 74% was attained. Acceptability of the coloured cue was high, but adherence to the checklist was low (40%). Conclusions Simple measures to enhance communication through the provision of a checklist and the use a coloured cue brought about significant improvement in compliance with infection control precautions by transport personnel during inpatient transfers. The study underscores the importance of effective communication in ensuring compliance with infection control precautions during transitions of care.

Older patients who fall may call Emergency Medical Services (EMS) for assistance, then refuse transport to the Emergency Department (ED). We sought to describe the characteristics of such patients, and to identify predictors of the need within 30 days for a repeat EMS call, ambulance transport and/or hospitalization. The records of a single urban EMS service were reviewed for one year concluding in October 2024 to identify cases where a geriatric patient (age > 64) refused transport after a fall. Multivariable logistic regression was used to evaluate dichotomous endpoints of repeat EMS call and hospitalization. Of 19,694 overall calls, there were 7329 for geriatric patients, 931 of whom refused transport. Of these 931 geriatric refusals, 433 were refusals after a fall. 142 (32.8 %, 95 % CI 28.4–37.4 %) had at least one same-month repeat EMS call and 101 of those (71.1 %, 95 % CI 62.9–78.4 %) were transported, with 65.9 % of transports resulting in hospitalization. Multivariable analysis identified no patient factors predictive of repeat EMS call. Admission was predicted by advancing age (OR 1.08 for each year, with 95 % CI 1.01–1.14, p = .016). Nearly a third of falls with transport refusals are associated with a same-month repeat EMS call, a majority (71.1 %) of which result in transport to the ED, usually followed by hospital admission. We identified no predictors of repeat EMS call or hospitalization. Geriatric patients who refuse transport after a fall are at high risk for repeat EMS calls and hospitalizations, but predictors of such needs are elusive. [Display omitted] •Nearly 6 % of geriatric calls in a 911 system were for falls where the patient refused transport.•About one third of them had to call 911 again within 30 days.•Most of them (71 %) were then transported to the Emergency Department.•Of those transported, most (65.9 %) then required hospitalization.•A geriatric fall who declines EMS may still be in short-term need of hospital care.

Whether rapid transportation can benefit patients with trauma remains controversial. We determined the association between prehospital time and outcome to explore the concept of the \"golden hour\" for injured patients. We conducted a retrospective cohort study of trauma patients transported from the scene to hospitals by emergency medical service (EMS) from January 1, 2016, to November 30, 2018, using data from the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital time intervals were categorized into response time (RT), scene to hospital time (SH), and total prehospital time (TPT). The outcomes were 30-day mortality and functional status at hospital discharge. Multivariable logistic regression was used to investigate the association of prehospital time and outcomes to adjust for factors including age, sex, mechanism and type of injury, Injury Severity Score (ISS), Revised Trauma Score (RTS), and prehospital interventions. Overall, 24,365 patients from 4 countries (645 patients from Japan, 16,476 patients from Korea, 5,358 patients from Malaysia, and 1,886 patients from Taiwan) were included in the analysis. Among included patients, the median age was 45 years (lower quartile [Q1]-upper quartile [Q3]: 25-62), and 15,498 (63.6%) patients were male. Median (Q1-Q3) RT, SH, and TPT were 20 (Q1-Q3: 12-39), 21 (Q1-Q3: 16-29), and 47 (Q1-Q3: 32-60) minutes, respectively. In all, 280 patients (1.1%) died within 30 days after injury. Prehospital time intervals were not associated with 30-day mortality. The adjusted odds ratios (aORs) per 10 minutes of RT, SH, and TPT were 0.99 (95% CI 0.92-1.06, p = 0.740), 1.08 (95% CI 1.00-1.17, p = 0.065), and 1.03 (95% CI 0.98-1.09, p = 0.236), respectively. However, long prehospital time was detrimental to functional survival. The aORs of RT, SH, and TPT per 10-minute delay were 1.06 (95% CI 1.04-1.08, p < 0.001), 1.05 (95% CI 1.01-1.08, p = 0.007), and 1.06 (95% CI 1.04-1.08, p < 0.001), respectively. The key limitation of our study is the missing data inherent to the retrospective design. Another major limitation is the aggregate nature of the data from different countries and unaccounted confounders such as in-hospital management. Longer prehospital time was not associated with an increased risk of 30-day mortality, but it may be associated with increased risk of poor functional outcomes in injured patients. This finding supports the concept of the \"golden hour\" for trauma patients during prehospital care in the countries studied.

Infants requiring interhospital transfer for a higher level of care in the neonatal period are at increased risk of adverse outcomes. Optimising respiratory management is an important priority. The aim of this survey was to investigate current respiratory support strategies in neonatal transport and identify opportunities for the optimisation of clinical care and future research. A survey of all 18 transport groups in Ireland and the UK was performed. A 10-item structured questionnaire was administered through consultant neonatologists or lead nurses from each transport group between May and June 2024. There was a 100% response rate. There was variation in the types of neonatal ventilator used, and they differed from those on NICUs. A variety of invasive strategies were used, but volume-targeted ventilation was the most common, although different ventilators can deliver different volumes despite apparently the same settings. Non-invasive strategies were used by all, with humidified high flow nasal cannula (HHFNC) being the most common. Continuous carbon dioxide (CO 2 ) monitoring was used by most teams (94%): endotracheal CO 2 assessments by 94% and transcutaneous monitoring by 70%. Only two teams employed closed loop automated oxygen control (CLAC). Conclusion : There is heterogeneity in the ventilators and respiratory strategies used by transport groups. Future research opportunities should include the comparison of those strategies on short- and long‐term outcomes, as well as whether continuous CO 2 monitoring and CLAC have important benefits. What is Known: • Nearly one quarter of neonatal transfers in the UK and Ireland are in infants mechanically ventilated. • Optimising respiratory support strategies and reporting respiratory outcomes are research priorities in neonatal transport. What is New: • Volume targeted ventilation is the most common respiratory support strategy used in neonatal transport groups in the UK and Ireland, with a heterogeneity of ventilators in use in neonatal transport versus in NICUs. • There is a paucity of data reporting respiratory outcomes following neonatal transport including outcomes related to mode of ventilation, continuous carbon dioxide monitoring and closed loop automated oxygen control.

Rural townships without immediate emergency services may rely on handover dispatch based upon prehospital EMS personal judgment for transport. To evaluate rendezvous in the rural pre-hospital setting and the impact on clinical decline, acuity, and mortality on arrival. This single-center Trauma Registry study was conducted from (23 years) January 1, 2000, to December 31, 2023. The data collected patient demographics, injury details, pre-hospital transport, morbidity, and mortality. The inclusion criteria were all trauma patients who were directly transported and were grouped into categories based upon the number of EMS rendezvous. This analysis utilized regression models with the primary outcomes; emergency department (ED) disposition to the intensive care unit (ICU) or morgue; Glasgow Coma Scale (GCS) and shock index ratio (SIR) on arrival. Each model controlled for age, sex, payor, injury type, and injury severity score (ISS). 11,937 patients were included in the initial sample; 49 % experienced rendezvous. Patients who experienced one or two rendezvous were more likely to ED disposition to the ICU (OR 2; OR 3) or the morgue (OR 5.6; OR 5.97) when compared to direct transport. The more rendezvous the lower the GCS and higher the SIR was reported when compared to direct transports (all models p values < .01). Trauma patients who experienced pre-hospital rendezvous were more likely to arrive in clinical decline with high acuity and ED mortality. This research highlights the need for improving access to definitive trauma care and coordinating key transport components in a regional trauma system. •Multiple EMS rendezvous increase trauma patient mortality risk.•Patients with two rendezvous have highest ICU admission and ED mortality.•Direct transport linked to lower mortality and improved patient stability.•Rural trauma patients face longer transport times and higher acuity.•Study highlights need for optimized rural trauma transport systems.

ObjectiveTo explore the trends and changes in the transport of children to paediatric intensive care units (PICUs) between 2013 and 2022.DesignRetrospective analysis of routinely collected data.PatientsChildren transported for care in a PICU in the UK and Ireland aged<16 years.InterventionsNone.Measurements and main resultsThere were 43 058 transports to a PICU involving 36 438 children from 2013 to 2022 with the majority of children requiring only one transport. The number of transports increased from 4131 (2013) to 4792 (2022). Over the study period the percentage of children aged under 1 year who were transported decreased from 50.2% to 45.2% and similarly, the percentage who were invasively ventilated also decreased from 81.1% to 70.2%. Conversely, the use of non-invasive ventilation during transports increased slightly from 4.0% to 7.0%. The percentage of transports where a parent was able to accompany the child increased over time (2013: 66.2% to 2019: 74.9%), although there were reductions due to the COVID-19 pandemic and requirements for social distancing (2020: 52.4%).ConclusionsWe have demonstrated an increased use of specialist paediatric transport services and changes in the PICU population over time. Routine data collection from the transport services provide a means to measure improvements and changes over time in the service provided to critically ill children and young people who need transport to the PICU.

This study was to examine characteristics concerning frequent users of emergency medical services (EMS) transport by comparing patients who used EMS transport frequently for one year and those who used EMS transport for more than two years consecutively. A retrospective review for frequent use of EMS transport was conducted. The patients from the fire stations that transported more than 70% of all EMS transport to the study hospital emergency department (ED) were included. The study subjects were divided into consecutive group (frequent EMS transport for ≥ two years consecutively) and non-consecutive group (frequent EMS transport for only one year). Characteristics of patients who were frequent users of EMS transport and those of all cases with EMS transport were examined. Of the total 205 patients and 1204 cases of frequent EMS transport, 85 (42%) patients and 755 (63%) cases were in the consecutive group. Patients in the consecutive group were more likely to have risky alcohol use, unemployed state, and medical aid type of payment for ED treatment than those in the non-consecutive group. More patients had previous experience of EMS transport to the study hospital ED in the consecutive group and the number of cases with alcohol ingestion was higher in the consecutive group. Elapsed time from EMS call to ED arrival was longer for the consecutive group. Risky alcohol use, unemployed state, and previous experience of EMS transport were associated with consecutive and frequent use of EMS transport in frequent users of EMS transport.

Ambulance services around the world vary according to regional, cultural and socioeconomic conditions. Many countries apply different health policies locally. In Turkey, transportation from hospital to home has started to form an important part of ambulance services in recent years. The increase in the number of patients whose treatment has been completed and waiting to be referred may hinder the work of the emergency services. The aim of this study was to examine the costs, indications, and impact on workload of patients sent home by ambulance. Patients were divided into two groups according to the reasons for referral. The distance to home, transport time and cost were calculated according to the reasons for transport. Patients who were transferred to other clinics or hospitals by ambulance were excluded from the study. The findings showed that the hospital-to-home transfer rate during the study period was 11.4%. Although 9.7% of all cases transferred from our hospital to home were due to social indications, these cases accounted for 16.26% of the total costs. These results suggest that providing home transport services to selected patient groups for medical reasons should be seen as part of the treatment. However, the indications for home transport should not be exceeded and an additional burden should not be placed on the fragile health service.

Background Rapid diagnosis and treatment of stroke is important for good outcome. In some cases, patients with ischemic stroke arrive at hospital too late for reperfusion therapy. This may be the case especially in rural areas where time spent during transport may delay or even preclude thrombolytic treatment after hospital arrival. We aimed to estimate the extent and clinical relevance of this problem in the Norwegian population. Methods We collected data for all reported acute ischemic strokes for the years 2017 and 2018. Transport times from home to hospital were calculated from geographical data and related to frequency of thrombolysis, thrombectomy and clinical outcome after 3 months. Results The frequency of reperfusion therapy decreased significantly as transport time increased. Six percent (564) of 9 428 patients were classified as having a prolonged time in transport. In this group, frequency of intravenous thrombolysis was 10,5% as opposed to 28,2% when prolonged transport was not present. Thrombectomy was performed in 2.1% versus 4.9% in the two groups respectively. We did not find a statistically significant difference between the two groups with regard to clinical outcome as judged by the modified Rankin Scale. Conclusion In the years 2017 and 2018 a relatively small group of Norwegian patients with prolonged time in transport was disfavored concerning access to reperfusion therapy for ischemic stroke. In such cases a prehospital solution for diagnostic work up and treatment might improve access to acute stroke treatment.

Objectives. We examined whether urban patients who suffered gunshot wounds (GSWs) farther from a trauma center would have longer transport times and higher mortality. Methods. We used the Illinois State Trauma Registry (1999–2009). Scene address data for Chicago-area GSWs was geocoded to calculate distance to the nearest trauma center and compare prehospital transport times. We used multivariate regression to calculate the effect on mortality of being shot more than 5 miles from a trauma center. Results. Of 11 744 GSW patients during the study period, 4782 were shot more than 5 miles from a trauma center. Mean transport time and unadjusted mortality were higher for these patients (P < .001 for both). In a multivariate model, suffering a GSW more than 5 miles from a trauma center was associated with an increased risk of death (odds ratio = 1.23; 95% confidence interval = 1.02, 1.47; P = .03). Conclusions. Relative “trauma deserts” with decreased access to immediate care were found in certain areas of Chicago and adversely affected mortality from GSWs. These results may inform decisions about trauma systems planning and funding.