When Every Minute Counts: Predicting Pre-Hospital Deliveries and Neonatal Risk in Emergency Medical Services Using Data-Driven Models.

Out-of-hospital cardiac arrest (OHCA) is a challenge for medical personnel, especially in the current COVID-19 pandemic, where medical personnel should perform resuscitation wearing full personal protective equipment. This study aims were to assess the characteristics and outcomes of adults who suffered an OHCA in the COVID-19 pandemic treated by emergency medical service (EMS) teams. All EMS-attended OHCA adults over than 18 years in the Polish EMS registry were analyzed. The retrospective EMS database was conducted. EMS interventions performed between March 1, and April 30, 2020 were retrospectively screened. In the study period EMS operated 527 times for OHCA cases. The average age of patients with OHCA was 67.8 years. Statistically significantly more frequently men were involved (64.3%). 298 (56.6%) of all OHCA patients had resuscitation attempted by EMS providers. Among resuscitated patients, 73.8% were cardiac etiology. 9.4% of patients had return of spontaneous circulation, 27.2% of patients were admitted to hospital with ongoing chest compression. In the case of 63.4% cardiopulmonary resuscitation was ineffective and death was determined. The present study found that OHCA incidence rate in the Masovian population (central region of Poland) in March-April 2020 period was 12.2/100,000 adult inhabitants. Return of spontaneous circulation in EMS was observed only in 9.4% of resuscitated patients. The presence of shockable rhythms was associated with better prognosis. The prehospital mortality, even though it was high, did not differ from those reported by other studies.

Emergency medical services (EMS) teams are first responders providing urgent medical care to severely ill or injured patients in the field. Despite their criticality, EMS work is one of the very few medical domains with limited technical support. This paper describes a study conducted to examine technology opportunities for supporting EMS data work and decision-making. We transcribed and analyzed 25 simulation videos. Using the distributed cognition framework, we examined EMS teams' work practices that support information acquisition and sharing. Our results showed that EMS teams leveraged various mechanisms (e.g., verbal communication and external cognitive aids) to distribute cognitive labor in managing, collecting, and using patient data. However, we observed a set of prominent challenges in EMS data work, including lack of detailed documentation in real time, situation recall issues, situation awareness problems, and challenges in decision making and communication. Based on the results, we discuss implications for technology opportunities to support rapid information acquisition, integration, and sharing in time-critical, high-risk medical settings.

Background: The aim of this study was to present the rationale behind field interventions aimed at enhancing the functioning of emergency medicine services by analyzing field visits conducted by Emergency Medical Service (EMS) teams of Health Center Barajevo (HCB), Belgrade, Serbia. It also aims to assess the adequacy of current telephone triage in determining the need for field interventions. Other objectives include identifying the most common diagnoses and the most commonly prescribed drugs in order to aid in disease prevention and improve the overall healthcare system. Together, these aims also serve an important educational purpose. Methods: For the purposes of this study, patient field protocols for 2023 were used, which include data about the patients, mainly their medical history, diagnoses, and therapy administered during the visit. Data on interventions by EMS teams from January 1, 2023 at 00:00:00 hours to December 31, 2023 at 23:59:59 hours were used. Patients were divided into eight age groups. Statistical data were analyzed using SPSS v. 21. Results: EMS HCB made 3,345 field interventions in 2023. The total number of patients consisted of 1,501 males (44.9%) and 1,803 females (53.9%). The patients’ mean age was 67.54 years, with a median age of 72 years. The age range was 0–98 years. The total number of diagnoses was 5,776, with an average of 1.7 diagnoses per patient. Conclusions: The results of our research partially align with those of other studies available in the literature. The most common individual reason for the intervention by EMS HCB teams was arterial hypertension (I10).

Prolongation of active second stage of labor: Associated factors and perinatal outcomes

Objective: To investigate the perinatal maternal and fetal adverse outcomes of cesarean section in the different duration of the second stage of labor. Methods: A retrospective cohort study was conducted on the clinical data of 154 pregnant women with singleton head pregnancy who underwent cesarean section at different times of the second stage of labor due to maternal and fetal factors in the First Affiliated Hospital of Nanjing Medical University from January 1, 2019 to December 31, 2021. According to the duration of the second stage of labor, they were divided into <2 h group (54 cases), 2-<3 h group (61 cases), and ≥3 h group (39 cases). The general data of pregnant women and neonates, preoperative maternal and neonatal conditions related to labor stages, surgical indications, surgical procedures, and perioperative maternal and neonatal adverse outcomes were compared among the three groups. Results: (1) General Information: there were no significant differences in maternal age, gravidity and parity, proportion of primipara, gestational age at delivery, body mass index before delivery, pregnancy complications, labor analgesia rate and the duration of the first stage of labor among the three groups (all P>0.05). The differences of the gender composition, birth weight and incidence of macrosomia of the three groups were also not statistically significant (all P>0.05). (2) Maternal and fetal status and surgical indications: the incidence of intrapartum fever and type Ⅱ and Ⅲ fetal heart rate monitoring in the <2 h group were higher than those in the 2-<3 h group and the ≥3 h group, and the preoperative fetal head position in the ≥3 h group was lower than that in the 2-<3 h group, with statistically significant differences (all P<0.05). The proportion of cesarean section due to "fetal distress" was 40.7% (22/54) in the <2 h group, which was higher than that in the 2-<3 h group (4.9%, 3/61) and the ≥3 h group (2.6%, 1/39). The proportions of surgical indication of "relative cephalo-pelvic disproportion" were 98.4% (60/61) and 94.9% (37/39) in the 2-<3 h group and ≥3 h group, respectively, and the surgical indication of "fetal head descent arrest" were 41.0% (25/61) and 59.0% (23/39), respectively. Compared with <2 h group [63.0% (34/54), 13.0% (7/54)], the differences were statistically significant (all P<0.05). There were no significant difference in surgical indications between 2-<3 h group and ≥3 h group (all P>0.05). (3) Intraoperative conditions and perioperative complications of cesarean section: the puerperal morbidity rate of <2 h group was 37.0% (20/54), which was higher than those of 2-<3 h group (18.0%, 11/61) and ≥3 h group (7.7%, 3/39), the difference was statistically significant (P<0.05). There were no significant differences in operation time, intraoperative blood loss, incidence of fetal head inlay, uterine incision tear, modified B-Lynch suture for uterine atony, postpartum hemorrhage, perioperative blood transfusion, preoperative hemoglobin (Hb) level, perioperative Hb change, and postoperative hospital stay among the three groups (all P>0.05). (4) Adverse neonatal outcomes: non-hemolytic neonatal hyperbilirubinemia in ≥3 h group was 35.9% (14/39), which was significantly higher than that in <2 h group (13.0%, 7/54; P<0.05). Among the neonates admitted to neonatal intensive care unit (NICU) within 1 week after birth, the proportion of neonates admitted to NICU due to neonatal hyperbilirubinemia in ≥3 h group (15/19) was significantly higher than that in <2 h group (9/17) and 2-<3 h group (10/19), and the differences were statistically significant (all P<0.05). However, there was no significant difference between the <2 h group and the 2-<3 h group (P>0.05). There was no perinatal death in the three groups. Conclusions: The rate of puerperal morbidity is higher in patients who were transferred to cesarean section within 2 hours of the second stage of labor. In the early stage of the second stage of labor, the monitoring of fetal heart rate and amniotic fluid characteristics should be strengthened, especially the presence or absence of prenatal fever. In good maternal and neonatal conditions, conversion to cesarean section after 2 hours of the second stage of labor does not significantly increase the incidence of serious adverse maternal and neonatal outcomes. For the second stage of labor more than 3 hours before cesarean section, it is necessary to strengthen the monitoring of neonatal bilirubin.

Acute Ischemic Stroke (AIS) with an onset while running a marathon is a rare but time-sensitive medical emergency that requires navigation of event medical resources. The Bank of America Chicago Marathon is a 26.2-mile city-wide race supported by emergency medical services (EMS) teams and course medical stations with centralized event medical direction to direct prehospital patient care and transport destination. We present a case report of a runner that experienced sudden onset of neurologic deficit while running a marathon that required event EMS medical direction and coordinated EMS transport to a stroke center during a city-wide race. A 58-year-old male runner without medical history experienced an acute onset of right sided visual deficit at mile 22 of the Chicago Marathon. He completed the race and presented to a medical tent an hour after onset with persistent visual symptoms and confusion. His blood glucose was 66 mg/dL and he received dextrose. After consultation with event EMS medical direction, he was transported by ambulance to a Comprehensive Stroke Center. His computed tomography (CT) scan showed a left occipital lobe hypodensity and thrombus of the left middle cerebral artery M3 segment. The CT angiography showed an atherosclerotic plaque in the left common carotid artery. He received Tenecteplase with improvement in symptoms. He was admitted to the neurological intensive care unit on a heparin drip and discharged three days later with complete resolution of symptoms on atorvastatin and rivaroxaban. Endurance running or other physical activities with excessive exercise over an extended period can increase the risk of stroke due to multiple underlying vascular effects. Studies have shown that marathon running increases circulating endothelial and thrombocyte derived microparticles which is consistent with an acute pro-thrombotic and pro-inflammatory state. Additionally, exercise-induced hypertension increases morbidity and is a risk factor for cardiac and cerebral vascular diseases. Acute ischemic stroke can result from vascular events during physical exertion of a marathon. The EMS and event medical teams in collaboration with centralized marathon medical direction should identify stroke symptoms and transport patients to an appropriate stroke center for time critical diagnosis and intervention within a system of care.

263 Does Failure to Activate Stroke Resources from the Out-of-Hospital Setting Delay Stroke Recognition by Emergency Department Staff?

Stroke is a serious condition and the stroke chain of care is a complex. The present study aims to explore the impact of a computerised decision support system (CDSS) for the prehospital stroke process, with focus on work processes and performance. The study used an exploratory approach with a randomised controlled crossover design in a realistic contextualised simulation experiment. The study compared clinical performance among 11 emergency medical services (EMS) teams of 22 EMS clinicians using (1) a computerised decision support system (CDSS) and (2) their usual paper-based process support. Data collection consisted of video recordings, postquestionnaires and post-interviews, and data were analysed using a combination of qualitative and quantitative approaches. In this experiment, using a CDSS improved patient assessment, decision making and compliance to process recommendations. Minimal impact of the CDSS was found on EMS clinicians’ self-efficacy, suggesting that even though the system was found to be cumbersome to use it did not have any negative effects on self-efficacy. Negative effects of the CDSS include increased on-scene time and a cognitive burden of using the system, affecting patient interaction and collaboration with team members. The CDSS’s overall process advantage to the prehospital stroke process is assumed to lead to a prehospital care that is both safer and of higher quality. The key to user acceptance of a system such as this CDSS is the relative advantages of improved documentation process and the resulting patient journal. This could improve the overall prehospital stroke process.

Teammate Familiarity, Teamwork, and Risk of Workplace Injury in Emergency Medical Services Teams

BackgroundHypothermia is common in trauma victims and is associated with increased mortality, however its causes are little known. The objective of this study was to identify the risk factors associated with hypothermia in prehospital management of trauma victims.MethodsThis was an ancillary analysis of data recorded in the HypoTraum study, a prospective multicenter study conducted by the emergency medical services (EMS) of 8 hospitals in France. Inclusion criteria were: trauma victim, age over 18 years, and victim receiving prehospital care from an EMS team and transported to hospital by the EMS team in a medically equipped mobile intensive care unit. The following data were recorded: victim demographics, circumstances of the trauma, environmental factors, patient presentation, clinical data and time from accident to EMS arrival. Independent risk factors for hypothermia were analyzed in a multivariate logistic regression model.ResultsA total of 461 trauma patients were included in the study. Road traffic accidents (N = 261; 57%) and falls (N = 65; 14%) were the main causes of trauma. Hypothermia (<35 °C) was present in 136/461 cases (29%). Independent factors significantly associated with the presence of hypothermia were: a low GCS (Odds Ratio (OR) = 0,87 ([0,81-0,92]; p < 0.0001), a low air temperature (OR = 0,93 [0,91-0,96]; p < 0.0001) and a wet patient (OR = 2,08 [1,08-4,00]; p = 0.03).ConclusionThe incidence of hypothermia was high on EMS arrival at the scene. Body temperature measurement and immediate thermal protection should be routine, and special attention should be given to patients who are wet.Level of evidenceProspective, multicenter, open, observational study; Level IV.

To assess maternal, newborn, and obstetric risk factors associated with anal sphincter tear in multiparous women. This case-control study identified 18,779 multiparous vaginal deliveries from 1992 to 2004 from an obstetric automated record database at the University of Alabama at Birmingham. Two hundred eighty-four patients were selected, 145 cases and 139 controls. Variables from the index pregnancy and prior pregnancies were analyzed, and multivariable logistic regression models were constructed to determine significant predictor variables for anal sphincter tear in multiparous women. One hundred forty-five multiparous women with no history of cesarean delivery sustained a sphincter tear. Multivariable logistic regression showed a significant association with episiotomy (odds ratio [OR] 16.3, 95% confidence interval [CI] 7.7-34.4), shoulder dystocia (OR 7.9, CI 1.6-38), forceps delivery (OR 4.7, CI 2.0-11.2), and being married (OR 2.2, CI 1.1-4.6). A second exploratory model that included variables from previous pregnancies, showed that in addition to episiotomy (OR 34.6, CI 8.8-136), shoulder dystocia (OR 11.1, CI 1.3-95.2), forceps delivery (OR 6.1, CI 1.6-23.5), previous sphincter tear (OR 7.7, CI 1.2-48.7), and second stage of labor greater than 1 hour (OR 6.7, CI 1.1-42.5) were associated with tear. The strongest clinical risk factors for anal sphincter tear in multiparous women are episiotomy, shoulder dystocia, previous sphincter tear, prolonged second stage of labor, and forceps delivery. II-2.

The issue of preserving the health of the woman in labor and the fetus, and later – the newborn, is one of the most priority tasks of modern obstetric service. Today, a feature of modern obstetric care in Ukraine is its transition to patient orientation, which determines not only a modification of management of pregnancy and childbirth, but also the creation of comfortable and safe conditions for the mother and newborn. There is also a tendency to increase the demand from future pregnant women and women in labor for “non-traditional” non-medicinal methods of pain relief and alternative approaches to childbirth, which are focused on reducing the severity of labor pain without the use of medical devices, ensuring free movement during childbirth, creating psychological comfort and a positive childbirth experience for the woman in labor and her partner.The objective: to evaluate the course of childbirth in women in labor who were involved in an attempt to give birth in water.Materials and methods. The study involved 150 pregnant women, who, depending on the proposed delivery method, were divided into:main group (MG) – 66 pregnant women, in whom delivery took place with the use of hydrotechnologies in the first and second stages of labor;comparison group (CompG) – 34 pregnant women, in whom delivery took place with the use of hydrotechnologies only in the first stage of labor;control group (CG) – 50 pregnant women, in whom childbirth took place according to generally accepted standards.Additionally, in the dynamics of the first stage of labor, all women in labor were assessed for the intensity of labor pain using a visual analog scale (VAS).Results. In the dynamics of labor, rupture of the fetal membranes occurred with greater cervical dilation against the background of satisfactory progress of labor in women in labor with the use of hydrotechnologies (MG – 8.6±0.3 cm, CompG – 8.1±0.4 cm, CG – 5.6±0.3 cm; p&lt;0.05). Moderate intensity of labor pain persisted in the first stage of labor when the cervix was dilated by 6–7 cm in women in labor with the use of hydrotechnologies (MG – 56 (84.8%) women in labor, CompG – 29 (85.3%), CG – 15 (30.0%); p&lt;0.05). Women in labor with CG had severe pain – 14 (28.0%) and unbearable pain – 11 (22.0%), which was an indication for the use of pharmacological analgesia methods in the first stage of labor.At the end of the first stage of labor, the vast majority of women who chose water birth as an alternative approach to labor management had a tendency to maintain the intensity of labor pain, which was assessed by VAS at 4–6 points: MG – 48 (96.0%), CompG – 24 (96.0%), CG – 34 (68.0%) women; p&lt;0.05. Severe labor pain, assessed at 6–8 points, was complained of by 31 (32.0%) CG women, 2 (4.0%) women in MG, 1 (4.0%) – CompG (p&lt;0.05).Conclusions. The positive effect of the use of hydrotechnologies during childbirth is confirmed by the presence of a significantly lower number of complications requiring surgical delivery in the first (MG – 3 (5.6%) women, CompG – 2 (7.4%), CG – 20 (28.6%) and second stages of labor (fetal distress: MG – 2 (4.0%) women, CompG – 4 (16.0%), CG – 8 (16.0%); p&lt;0.05); weakness of labor activity that is not amenable to medical correction was not detected among parturients in MG (CompG – 2 (8.0%) persons, CG – 4 (8.0%) women; p&gt;0.05). Due to existing complications during the second stage of labor, there was a need to use surgical delivery by applying a vacuum extractor (MG – 2 (4.0%), CompG – 6 (24.0%), CG – 12 (24.0%) women; p&lt;0.05). The results of the study demonstrate the effectiveness of childbirth with the use of hydrotechnologies in low-risk pregnant women in reducing the level of obstetric complications, and, as a result, this is reflected in a significantly higher number of cases of physiological delivery (MG – 39 (78.0%), CopmG – 14 (56.0%), CG – 27 (54.0%) women in labor; p&lt;0.05).

Objective: While emergency medical service (EMS) response times (ERT) remain a leading measure of system performance in many developed countries, relatively few studies have explored the factors associated with meeting benchmark performance for potentially time critical incidents. The purpose of this study was to identify system-level and patient-level factors associated with ERT, which are readily available at the time of ambulance dispatch. Methods: Between July 2009 and June 2014, we included data from 1,000,458 EMS responses to time critical “lights and sirens” incidents in Melbourne, Australia. The primary outcome measure was ERT, defined as the time from emergency call to the arrival of the first EMS team on scene. Quantile regression models were used to identify system-level and patient-level factors associated with 10-percentile intervals of ERT. Results: The median ERT was 10.6 minutes (IQR: 8.1–14.0), increasing from 9.6 minutes (IQR: 7.6–12.5) in 2009/10 to 11.0 minutes (IQR: 8.4–14.7) in 2013/14 (p < 0.001). System-level factors independently associated with the 90th percentile ERT were distance to scene, activation time, turnout time, case upgrade, hour of day, day of week, workload in the previous hour, ambulance skill set, priority zero case (e.g., suspected cardiac or respiratory arrest), and average hospital delay time in the previous hour. Patient-level factors such as age, gender, chief medical complaint, and severity of complaint were also significantly associated with ERT. Conclusions: System-level and patient-level factors available at the time of ambulance dispatch are useful predictors of ERT performance, which could be used to improve the timeliness of EMS response.

Objective: Assessment of fetal head station is of importance before instrumental vaginal delivery. We have established a simple method of performing intrapartum infrapubic ultrasound (iiUS). Relating the fetal skull to the symphysis in laboring women during pushing and prior to vacuum extraction, we defined sonographic criteria for successful instrumental vaginal delivery. Methods: Sonographic assessment of the female pelvis in term pregnancies was performed in women with singleton pregnancies in the second stage of labor and after rupture of membranes. Anatomic landmarks were determined sonographically from sagittal infrapubic insonation with a curved array transducer. A 3D CT volume was used to correlate the normal anatomy of the female pelvis with these iiUS-derived landmarks. 20 women with singleton fetuses were studied immediately before vacuum extraction. Results: With a transducer placed infrapubically in a median sagittal orientation (‘infrapubic plane’), landmarks are: (1) the infrapubic line, placed perpendicular to the long axis of the pubic symphysis; (2) the widest fetal head diameter and its movement with regard to the infrapubic line during pushing; and (3) the ‘head direction’ as the angle between the long axis of the symphysis and a line perpendicular to the widest head diameter. CT reconstruction demonstrated the infrapubic line to be 3 cm cranial to the parallel interspinous plane. In 20 vacuum deliveries, the ‘head up’ sign (head pointing ventrally) and objective descent of the fetal head below the infrapubic line, both noted at the height of pushing, were associated with successful delivery. Lack of decent/lack of passage below the infrapubic line and horizontal or even downward head direction were poor prognostic signs. Conclusions: Intrapartum infrapubic ultrasound (iiUS) can provide information about the dynamics of the second stage of labor, head station and head direction. It may be used to assess prognosis for instrumental vaginal delivery.

BackgroundPrelabor rupture of membranes (PROM) complicates 8% of pregnancies, often necessitating labor induction to prevent maternal and neonatal complications. Misoprostol, a cost-effective prostaglandin, has been proposed as an alternative to oxytocin for labor induction in PROM cases, but its efficacy and safety remain debated.MethodsThe PubMed, Web of science, Embase, Google scholar, ClinicalTrials.gov, and Cochrane Library databases were searched on January 25, 2025. Randomized controlled trials (RCTs) comparing misoprostol and oxytocin for labor induction in term PROM were eligible. The primary outcomes were vaginal birth within 24 h and the induction to delivery interval. Secondary outcomes included the duration of second stage of labor, the induction to active labor, cesarean section, postpartum hemorrhage (PPH), and other maternal/neonatal complications.ResultsData from 20 RCTs involving 2,980 participants were analyzed. Misoprostol significantly reduced the induction-to-delivery interval and the duration of the second stage of labor compared to oxytocin (WMD = -62.82, 95% CI (-110.56, -15.08); WMD = -4.29, 95% CI (-8.05, -0.52), respectively). It also lowered the risk of PPH (OR = 0.63, 95% CI (0.41, 0.98)). However, no significant differences were found in other outcomes between misoprostol and oxytocin.ConclusionsMisoprostol is a viable alternative to oxytocin for labor induction in PROM, offering shorter labor durations and reduced PPH risk without compromising maternal and neonatal outcomes. Further researches are needed to optimize dosing, administration routes, and assess maternal satisfaction.