ABSTRACTS
Insights into Collapse in Ambulances: A Retrospective Time-Series Analysis from EMS of Sindh, PakistanAuthor: Zeeshan Noor Shaikh, Zainab Mubeen, Kamran Idris, Lutaf Ali Mangrio, Mazhar Iqbal, Ali Kashan | | Associate Authors:
Introduction: Emergency medical services (EMS), being the initial point of contact in health emergencies, is one of the cornerstones of healthcare delivery, especially in low- and middle-income countries (LMICs). The literature is lacking on information on patient collapse in ambulances (CIA). The concept of CIA in this study is aligned with patient deaths occurring in ambulances and subsequently confirmed by a healthcare facility. Objective: To determine the rate of patient CIA in association with patient condition and other possible contributing factors. Methods: A retrospective approach using the data obtained from an EMS based in Sindh, Pakistan, was used to determine the patient CIA rate between July 2023 and February 2024. Data collected via ambulance response reports, critical transfer reports, and care transfer reports were analyzed to determine the rate of CIA, response time, types of cases, types of transfers, need for transfers, patient condition, diagnosis, and procedures conducted en route to transfer. Results: Out of 195,638 cases, 37 (0.019%) cases of CIA were found, reflecting the positive performance of EMS. The average response time for all cases was less than 10 minutes, which complies with international standards. In line with the common presenting complaints of patients, most CIAs resulted from abnormal breathing and cardiac/respiratory arrest, as per priority codes. All cases resulting in CIA were either serious or life-threatening, with the need for a higher level of care. In addition, all transfer requests were made from the public-sector secondary health facility to either a similar setup or tertiary care in some cases, which highlights the shortcomings of the healthcare service delivery model in Sindh. Conclusion: To prevent CIA of patients with serious or life-threatening medical conditions, regardless of uncontrolled risks, it is vital to address health inequities through a systems approach to improve health outcomes at both the prehospital and hospital levels through the provision of essential care before patient transfer.
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