Planners and policymakers significantly consider providing suitable living environments for marginalized households, beyond creating affordable homes. Previous studies have explored various socioeconomic attributes of neighborhoods with public rental housing (PRH), particularly regarding education, job, and transportation opportunities; however, we have a limited understanding of health opportunities among such subsidized households. This study, therefore, explores the accessibility and spatial equity of emergency medical services (EMS) and primary health care (PHC) for PRH residents in Seoul, Korea. The findings show that neighborhoods with PRHs are associated with lower odds ratios for EMS and PHC accessibility. In particular, the relationships between the locations of PRHs and medical services accessibility in neighborhoods varied across the types of PRHs. While neighborhoods with large-scale PRHs are associated with lower PHC access, those with small-scale PRHs are associated with lower EMS access. In addition, our findings show that PRHs tend to be located in neighborhoods with lower walkability. These results may help in empirically determining the spatial accessibility of PHC and EMS, as well as neighborhood walkability, which may affect the health status of individuals in subsidized households.

UNASSIGNED: Education for the lay public in basic life support (BLS) is critical for increasing bystander cardiopulmonary resuscitation (CPR) rates and improving survival from out-of-hospital cardiac arrest (OHCA). Despite years of implementation, the BLS training rate in China has remained modest. The aim of this study was to investigate the factors influencing the implementation of BLS training programs in emergency medical service (EMS) centers in China and to identify specific barriers and enablers.
UNASSIGNED: Qualitative interviews were conducted with key informants from 40 EMS centers in Chinese cities. The participants included 11 directors/deputy directors, 24 training department leaders, and 5 senior trainers. The interview guide was based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Thematic content analysis was used to identify themes and patterns across the interviews.
UNASSIGNED: We identified 16 factors influencing the implementation of BLS training programs encompassing the outer content, inner context, innovation and bridging factors. Some factors acted as either barriers or enablers at different EPIS stages. The main implementation barriers included limited external leadership, insufficient government investment, low public awareness, a shortage of trainers, an absence of incentives, an absence of authoritative courses and guidelines, a lack of qualification to issue certificates, limited academic involvement, and insufficient publicity. The main enablers were found to be supportive government leaders, strong public demand, adequate resources, program champions, available high-quality courses of high fitness within the local context, the involvement of diverse institutions, and effective publicity and promotion.
UNASSIGNED: Our findings emphasize the diversity of stakeholders, the complexity of implementation, and the need for localization and co-construction when conducting BLS training for lay public in city EMS centers. Improvements can be made at the national level, city level, and EMS institutional level to boost priority and awareness, promote legislation and policies, raise sustainable resources, and enhance the technology of BLS courses.

UNASSIGNED: Health care workers (HCW) in Emergency Medical Services (EMS) frequently come into contact with carriers of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) strains and may acquire and transmit them to patients. However, there is little data on MSSA and MRSA colonization of medical personnel in the emergency services. Additionally, few studies have analyzed the association between personal hygiene of staff and colonization. Therefore, we examined the prevalence of MSSA and MRSA in EMS staff of two German regions and evaluated their personal hygiene behavior.
UNASSIGNED: Throat and nasal swabs from 300 EMS workers were analyzed. Both direct and pre-enriched cultures of the swabs were cultivated on culture media to identify MSSA and MRSA. Results were analyzed together with questionnaires about sociodemographic data and a self-assessment of hygiene behavior. Statistical analysis was done using the R statistical software.
UNASSIGNED: Of the total 300 swabs, 55% were from paramedics, 39% were from emergency medical technicians (EMT) and 5% were from emergency physicians. With 1%, the MRSA prevalence was comparable to that of the German population, while the MSSA rate - 43.7% - was higher than expected. Colonization with MSSA was significantly associated with poor hand hygiene and male sex, and was inversely correlated to time on the job in EMS.
UNASSIGNED: The sample size of 300 and a MRSA prevalence of 1% made a meaningful analysis of potential influencing factors on the prevalence of MRSA infeasible. The comparatively high prevalence of MSSA and the association with decreasing frequency of hand antisepsis suggests an influence of personal hygiene on MSSA colonization. HCW in EMS should be encouraged to make use of their personal protective equipment and practice frequent hand hygiene. The implementation of diagnostic tools such as the Hand Hygiene Self-Assessment Framework of the WHO could be utilized to reveal problems in organizations, followed by an individual program to promote hand hygiene.
UNASSIGNED: : Beschäftigte in Rettungsdiensten und Krankentransporten haben häufig mit Trägern von Methicillin-empfindlichen Staphylococcus aureus-Stämmen (MSSA) und Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) Kontakt, können diese erwerben und auf Patienten übertragen. Allerdings gibt es nur wenige Daten über die MSSA- und MRSA-Kolonisierung von medizinischem Personal im Rettungsdienst. Darüber hinaus haben nur wenige Studien den Zusammenhang zwischen der persönlichen Hygiene des Personals und der Kolonisierung mit MSSA bzw. MRSA analysiert. Daher wurde die Prävalenz von MSSA und MRSA bei Rettungsdienstpersonal in zwei deutschen Regionen untersucht und ihr persönliches Hygieneverhalten bewertet.
UNASSIGNED: Es wurden Rachen- und Nasenabstriche von 300 Mitarbeitern von Rettungsdiensten untersucht. Sowohl direkte als auch angereicherte Kulturen der Abstriche wurden auf Nährböden kultiviert, um MSSA und MRSA zu identifizieren. Die Ergebnisse wurden zusammen mit Fragebögen zu soziodemografischen Daten und einer Selbsteinschätzung des Hygieneverhaltens ausgewertet. Die statistische Analyse wurde mit der Statistiksoftware R (Version 4.1.3) durchgeführt.
UNASSIGNED: Von den 300 Abstrichen stammten 55% von Notfallsanitätern, 39% von Rettungssanitätern und 5% von Notärzten. Die MRSA-Prävalenz war mit 1% vergleichbar mit der der deutschen Bevölkerung, während die MSSA-Rate mit 43,7% höher war als erwartet. Die Besiedlung mit MSSA stand in signifikantem Zusammenhang mit schlechter Händehygiene, männlichem Geschlecht und umgekehrt mit der Dauer der Tätigkeit im Rettungsdienst.
UNASSIGNED: Die Stichprobengröße von 300 und eine MRSA-Prävalenz von 1% erlauben keine aussagekräftige Analyse potenzieller Einflussfaktoren auf die MRSA-Prävalenz. Die vergleichsweise hohe Prävalenz von MSSA und der Zusammenhang mit der abnehmenden Häufigkeit der Händedesinfektion lässt auf einen Einfluss der persönlichen Hygiene auf die MSSA-Kolonisierung schließen. Die Mitarbeiter des Gesundheitswesens im Rettungsdienst sollten dazu angehalten werden, ihre persönliche Schutzausrüstung zu benutzen und die Indikationen der Händedesinfektion einzuhalten. Die Anwendung von Diagnoseinstrumenten wie dem Händehygiene-Selbstbewertungsrahmen der WHO könnte genutzt werden, um Probleme in Organisationen aufzudecken, gefolgt von einem individuellen Programm zur Förderung der Händehygiene.

BACKGROUND: A challenge to pre-hospital emergency care is any barrier or obstacle that impedes quality pre-hospital care or impacts community pre-hospital utilization. The Addis Ababa Fire and Disaster Risk Management Commission (AAFDRMC) provides pre-hospital emergency services in Addis Ababa, Ethiopia. These services operate under a government-funded organization that delivers free emergency services, including out-of-hospital medical care and transportation to the most appropriate health facility. This study aimed to assess the challenges of pre-hospital emergency care at the Addis Ababa Fire and Disaster Risk Management Commission in Addis Ababa, Ethiopia.
METHODS: A qualitative descriptive study was conducted from November 20 to December 4, 2022. Data were collected through in-depth, semi-structured interviews with 21 experienced individuals in the field of pre-hospital emergency care, who were selected using purposeful sampling. A thematic analysis method was used to analyze the data.
RESULTS: This study includes twenty-one participants working at the Addis Ababa Fire and Disaster Risk Management Commission. Three major themes emerged. The themes that arose were the participants\' perspectives on the challenges of pre-hospital emergency care in Addis Ababa, Ethiopia.
CONCLUSIONS: The Fire and Disaster Risk Management Commission faces numerous challenges in providing quality pre-hospital emergency care in Addis Ababa. Respondents stated that infrastructure, communication, and resources were the main causes of pre-hospital emergency care challenges. There has to be more focus on emergency management in light of infrastructure reform, planning, staff training, and education, recruiting additional professional power, improving communication, and making pre-hospital emergency care an independent organization in the city.

BACKGROUND: Increasing numbers of ambulance calls, vacant positions and growing workloads in Emergency Medicine (EM) are increasing the pressure to find adequate solutions. With telemedicine providing health-care services by bridging large distances, connecting remote providers and even patients while using modern communication technologies, such a technology seems beneficial. As the process of developing an optimal solution is challenging, a need to quantify involved processes could improve implementation. Existing models are based on qualitative studies although standardised questionnaires for factors such as Usability, Acceptability and Effectiveness exist.
METHODS: A survey was provided to participants within a German county. It was based on telemedical surveys, the System Usabilty Scale (SUS) and earlier works describing Usability, Acceptability and Effectiveness. Meanwhile a telemedical system was introduced in the investigated county. A comparison between user-groups aswell as an exploratory factor analysis (EFA) was performed.
RESULTS: Of n = 91 included participants n = 73 (80,2%) were qualified as emergency medical staff (including paramedics n = 36 (39,56%), EMTs n = 28 (30,77%), call handlers n = 9 (9,89%)) and n = 18 (19,8%) as emergency physicians. Most participants approved that telemedicine positively impacts EM and improved treatment options with an overall Usabilty Score of 68,68. EFA provided a 3-factor solution involving Usability, Acceptability and Effectiveness.
CONCLUSIONS: With our results being comparable to earlier studies but telemedicine only having being sparsely introduced, a positive attitude could still be attested. While our model describes 51,28% of the underlying factors, more research is needed to identify further influences. We showed that Usability is correlated with Acceptability (strong effect), Usability and Effectiveness with a medium effect, likewise Acceptability and Effectiveness. Therefore available systems need to improve. Our approach can be a guide for decision makers and developers, that a focus during implementation must be on improving usability and on a valid data driven implementation process.

OBJECTIVE: Despite participating in scenario training, many medical first responders (MFRs) perceive themselves as inadequately prepared to respond to mass casualty incidents (MCIs). The objective of this study was to conduct a comprehensive examination of traditional MCI scenario training methods, focusing on their inherent strengths and limitations. An investigation into the perceptions of MFRs who had participated in MCI scenario training was carried out to identify potential areas for improvement and provide recommendations for refining MCI training protocols.
METHODS: Qualitative inductive approach using semistructured interviews that took place between October 2021 and February 2022. Data were analysed with qualitative content analysis.
METHODS: MCI scenario training involving four organisations (three emergency medical services and one search-and-rescue organisation) tasked with responding to MCIs, collectively representing four European Union countries.
METHODS: 27 MFRs (17 emergency medical services personnel and 10 search-and-rescue volunteers) were recruited to participate in the study.
RESULTS: Two categories and seven associated subcategories (shown in parentheses) were identified as influencing the learning outcomes for MFRs: Training in a context mirroring real-world incidents (conducting incident scene risk assessment, realistic representation in casualties, incorporating scenario variety into the curriculum, interagency collaboration, role alignment when training incident site management) and use of a pedagogical framework (allowing for mistakes, the importance of post-training evaluation).
CONCLUSIONS: This study reaffirms the value of traditional MCI scenario training and identifies areas for enhancement, advocating for realistic scenarios, interagency collaboration, improved incident site management skills and thorough post-training evaluation. It suggests a shift in MCI training conceptualisation and delivery. The potential of virtual reality technologies as a valuable addition to training methods is explored, with a note on the need for further research to ascertain the long-term effectiveness of these technologies. However, the selection of a training method should consider programme goals, target population and resources.

Emergency Medical Services (EMS) are crucial for immediate medical assistance during life-threatening situations. However, insufficient public awareness about EMS services can impede their effectiveness. This study aimed to assess EMS knowledge and trust among the population of Eastern Saudi Arabia while identifying factors contributing to low awareness. A cross-sectional study was conducted in Eastern Saudi Arabia from September 2022 to September 2023. The study included participants aged 18 to 60 from diverse backgrounds. Using a convenience sampling approach, data was collected using a validated questionnaire covering demographics, hypothetical scenarios, EMS knowledge, and trust in EMS. We conducted the Chi-square tests and logistic regression using Jamovi software, with significance levels set at p < 0.05. Our study yielded 435 participants; 55% were males. Gender-based analysis showed significant differences in responses regarding first aid provision and EMS services (P < 0.001). Expectations for EMS response times also varied by gender (P = 0.01). Knowledge-based analysis revealed that age and education significantly influenced EMS knowledge (P < 0.001). Respondents with EMS knowledge were more likely to know how to provide first aid, understand the importance of emergency number 112, and trust EMS (P < 0.001). Trust-based analysis showed age and education-related differences in EMS trust (P < 0.001). Respondents with EMS knowledge and awareness of emergency numbers displayed higher trust in EMS (P < 0.001). This study underscores the need for enhanced public awareness of EMS services in Eastern Saudi Arabia. Age, education, and gender emerged as critical factors affecting EMS knowledge and trust. Bridging this awareness gap necessitates tailored educational campaigns and continuous monitoring. Policymakers should prioritise EMS awareness within broader healthcare strategies, contributing to improved public health outcomes and community well-being.

UNASSIGNED: The WHO Emergency Medical Teams (EMT) Initiative coordinates the deployment of qualified medical teams who promptly respond to public health emergencies (PHEs) and provide quality service during emergencies whilst strengthening capacity. Globally, 40 EMTs have been classified between 2016 and the present (as of the writing of this article in December 2023) and are from across all the WHO regions except the WHO Africa Region (AFRO). However, WHO Africa has prioritised the implementation of EMTs in 10 priority countries to address the public health emergencies (PHEs) affecting the region.
UNASSIGNED: This article describes the development and progress of national EMTs in the WHO African Region over the past 7 years and elucidates the main lessons learned and the complexity and challenges in the process.
UNASSIGNED: This study employed a case study approach because of its appropriateness in examining a complex social phenomenon in a socio-political context in depth, using multiple lenses simultaneously. Data and information were obtained through document reviews and key informant interviews (KIIs) (n = 5) with the members of the EMT Initiative on shared field experiences. Data were systematically analysed using the Stages of Implementation Completion (SIC) framework, and the lessons learnt were presented using components of a framework from Adini et al.
UNASSIGNED: The Initiative commenced in the WHO African Region following its launch in December 2017 in Senegal. The assessments of the concept\'s engagement (involved learning and deciding), feasibility (reviewing expectation and capacity), and readiness planning (collaborating and preparing) showed that the context-specific (African context) challenges, lessons from different emergency response actions mainly guided the Initiative\'s pre-implementation phase in the region and prompted the WHO emergency leadership on the urgency and need for the EMT concept in the region. The assessment of the implementation processes showed progress in key areas, with staff demonstrating improved competency, EMT services maintaining high fidelity, effective consultation launching critical components, and ongoing services providing successful support and monitoring. Creating the N-EMTs and revitalising the EMT concept required an aligned strategy with other regional emergency programmes and a futuristic vision. Proposed sustainability and governance components include creating N-EMT, developing a coordination structure, collaborating with partners, and finalising the N-EMT.
UNASSIGNED: The Initiative is an imperative component that would allow better-targeted management of health emergencies in the region. The continuous refinement of the EMT initiative is crucial. There is a need to work on additional components, such as a context-specific framework for collaborations and partnerships that would enhance deployment and procurement modalities and the complementarity between other regional initiatives to improve the work. Emphasis should be placed on strengthening local health systems, enhancing training and capacity-building programmes, and fostering regional and international collaborations. Additionally, sustainable funding and resource allocation are essential to ensure the resilience of EMTs in the African region and their long-term success.

BACKGROUND: Overcrowding in the emergency department (ED) is a global problem. Early and accurate recognition of a patient\'s disposition could limit time spend at the ED and thus improve throughput and quality of care provided. This study aims to compare the accuracy among healthcare providers and the prehospital Modified Early Warning Score (MEWS) in predicting the requirement for hospital admission.
METHODS: A prospective, observational, multi-centre study was performed including adult patients brought to the ED by ambulance. Involved Emergency Medical Service (EMS) personnel, ED nurses and physicians were asked to predict the need for hospital admission using a structured questionnaire. Primary endpoint was the comparison between the accuracy of healthcare providers and prehospital MEWS in predicting patients\' need for hospital admission.
RESULTS: In total 798 patients were included of whom 393 (49.2%) were admitted to the hospital. Sensitivity of predicting hospital admission varied from 80.0 to 91.9%, with physicians predicting hospital admission significantly more accurately than EMS and ED nurses (p < 0.001). Specificity ranged from 56.4 to 67.0%. All healthcare providers outperformed MEWS ≥ 3 score on predicting hospital admission (sensitivity 80.0-91.9% versus 44.0%; all p < 0.001). Predictions for ward admissions specifically were significantly more accurate than MEWS (specificity 94.7-95.9% versus 60.6%, all p < 0.001).
CONCLUSIONS: Healthcare providers can accurately predict the need for hospital admission, and all providers outperformed the MEWS score.

BACKGROUND: Substance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse.
METHODS: We conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status.
RESULTS: Among 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 - 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events.
CONCLUSIONS: Individuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.