BACKGROUND:Access to emergency care is becoming increasingly challenging due to rising demand and limited resources, such as shortage of general practitioners (GP). In France, emergency medical services (EMS) have experienced a 23% increase in call volume over the past decade. To address this, French dispatch systems are evolving, with Emergency Medical Dispatchers (EMDs) empowered to make certain medical decisions through Autonomous Decision Protocols (ADP). These ADP were designed for most frequent and simple emergency situations such as low back pain, epistaxis, head and limb injury, anxiety, and allowed EMDs to recommend medical advice, send an ambulance or refer the caller to a dispatching doctor. AIM:This study aimed to assess callers' satisfaction with decisions made by EMDs using ADPs compared to decisions made by medical doctors with similar chief complaint. MATERIAL & METHOD:The study was prospective, involving all ADP calls from September to October 2023. All calls concerning ADPs and dispatched by EMDs were included. Callers were called back within a few days of the call in order to obtain their experience using a questionnaire. Retrospective patient files concerning similar chief complaints handled in the traditional way, over the same period in the previous year, were used for comparison. RESULTS:A total of 358 calls were analyzed, with 217 (61%) callers completing a satisfaction survey. The results showed high satisfaction, with an average score of 8.6/10. The most common chief complaints were head and limb injuries, and the vast majority (90%) of callers felt their expectations were met. Only a small percentage (4%) required a second opinion or follow up due to worsening symptoms. CONCLUSION:The findings suggest that ADPs improved efficiency by providing standardized medical advice, reducing unnecessary ambulance dispatches, and saving medical resources. Callers who benefited from ADPs were generally satisfied with the service, with satisfaction rates comparable to those found in international studies. Expanding ADPs to cover additional medical conditions could further enhance emergency dispatch systems, especially in light of increasing demand and reduced medical resources.

BACKGROUND:The use of personal protective equipment (PPE) by emergency medical services (EMS) providers requires specific attention, as it takes place in out-of-hospital unsecured settings. The aim of this study was to evaluate which PPE gown was less contaminating during doffing procedures in an EMS setting. Six well-trained healthcare worker (HCW) subjects tested 4 different gowns: (1) surgical gowns (SG), (2) full body coveralls (FBC), (3) self-made alternative PPEs (SMP), and (4) non-surgical isolation gowns (NSIG). An invisible tracer was sprayed on the gown after donning each subject. After doffing, each HCW was photographed under UV lights to show areas of fluorescent "contamination" on their clothes. The number, size, and intensity level of contaminated areas were noted, as well as observational deviation from the procedure and doffing time. In addition, the subjects were asked to take a questionnaire about their perception of the level of comfort, ease of doffing, and overall safety for each gown.RESULTS:Despite a well-trained team of HCW subjects, contamination while doffing was observed with every type of PPE gown, and with each HCW subject. All body areas were contaminated at least once, except the face. Contamination was more frequent while doffing FBCs. On the other hand, the removal of SG was found to be the least contaminating. The mean doffing time was significantly shorter with SG 1:29 and longer with FBC 2:26 (p=0.005).CONCLUSION:Results of this study converge towards the selection of surgical gowns over other types of PPE gowns, which met both contamination criteria as well as staff appreciation in this context. Specific attention should be paid to the legs and abdomino-pelvic areas. Additional protection such as protective trousers or aprons could be added.

Background During the COVID-19 pandemic, as the number of available Intensive Care beds in France did not meet the needs, it appeared necessary to transfer a large number of patients from the most affected areas to the less ones. Mass transportation resources were deemed necessary. To achieve that goal, the concept of a Collective Critical Care Ambulance (CCCA) was proposed in the form of a long-distance bus re-designed and equipped to accommodate up to six intensive care patients and allow Advanced Life Support (ALS) techniques to be performed while en route. Methods The expected benefit of the CCCA, when compared to ALS ambulances accommodating a single patient, was to reduce the resources requirements, in particular by a lower personnel headcount for several patients being transferred to the same destination. A foreseen prospect, comparing to other collective transportation vectors such as airplanes, was the door-to-door capability, minimalizing patients’ handovers for safety concerns and time efficiency. With the project of a short-distance transfer of several Intensive Care Unit (ICU) patients together, the opportunity came to test the CCCA under real-life conditions and evaluate safely its technical feasibility and impact in time and resources saving, before it could be proposed for longer distances. Results Four COVID-19 patients were transported over 37 km. All patients were intubated and under controlled ventilation. One of them was under Norepinephrine support. Mean loading time was 1 min 39 s. Transportation time was 29 min. At destination, the mean unloading time was 1 min 15 s. No serious adverse effect, in particular regarding hemodynamic instability or ventilation disorder, has been observed. No harmful incident has occurred. Conclusions It was a very instructive test. Collective medical evacuation by bus for critically ill patients under controlled ventilation is suitable and easy to implement. Design, ALS equipment, power autonomy, safety and resources saving, open the way for carrying up to 6 ICU-patients over a long distance. The CCCA could bring a real added-value in an epidemic context and could also be helpful in many other events generating multiple victims such as an armed conflict, a terrorist attack or a natural disaster.

Introduction Emergency Medical Services (EMS) organise simulation exercises in near real conditions. In this exercises, volunteers usually act as victims. We set up a large-scale simulation exercise. The scenario was a terrorist attack causing 153 victims. Victims were played by nurse students. The aim of our study was to evaluate if playing a role of victim could generate stress and anxiety. Methods The exercise took place at night on September 26, 2016. Fifteen days after, a questionnaire was sent to nurse students who took part as victims. Descriptive results are given in percentages and averages. Result 126 participants did answer (82.4%). The average age was 23 years and 86% were women. 20.7% considered themselves as anxious or very anxious and 5.9% reported poor or very poor sleep. Their roles were assigned to severely injured (30%), involved (25%), deceased (21%), moderately injured (14%) and hostages (10%). During terrorist attack, 56.9% found that they were in a uncomfortable situation. 85% of the participants considered the attack as fairly or very impressive and 79% were afraid at some point during the exercise. For those who were scared, half said that this fear remained after the end of the exercise. 21 participants felt necessary to have an interview with a psychologist. More than 23% of participants felt that this exercise had been fairly or very disruptive and would deny or hesitate to participate again in a similar exercise. Discussion Acting as a simulated victim, in a hyper-realistic live exercise, generate stress, fear or anxiety. In order not protect from unnecessary stress, it is essential for organisers to take this in consideration and offer to those who play victims acceptable conditions of comfort. Further studies are required to recognise factors that cause a predisposition of stress in such situations and set aside those with risks.

Introduction: to fulfill the needs to maintain professional skills, mainly procedures in unusual on scene situations in the EMS setting, workshops on maintaining and improving professional skills have been set up (MPAP). These workshops are proposed every day to the whole EMS staff (Nurses, physicians, paramedics) The aim of this work is to evaluate the attendees’ satisfaction. Methodology: Since November 2015, MPAP are proposed. The attendees’ satisfaction was estimated using an anonymous questionnaire. 9 questions were asked and each answer was quantified on a scale ranging from 1 (total disagreement) to 4 (total agreement). Results: 104 sessions took place with an average of 11 sessions per month. The average participation was 12 people. Among the 108 questionnaires, 52 physicians, 29 paramedics and 27 nurses answered (53%). Table 1 summarizes the answers to the questions depending on professional category of the attendees. Results are shown as average. Conclusion: the excellent average grades confirm the satisfaction of the EMS’ personnel regarding the MPAP session; Maintaining these workshops for continuous education is now one of the EMS main objectives.

Introduction: Feed-back on quality of CPR is an important aspect to consider on cardiac arrest management. This has been pointed out during trainings organized for emergency medicine residents. In parallel, RéAC registry (registry on cardiac arrests in France) showed some difficulties in following guidelines of VF.The aim of this study was to evaluate the performance of Emergency Medical Service (EMS) in the management of patients in cardiac arrest through the use of external chest compression (CC) data from the Resusci Anne Simulator manikin from Laerdal (SimMan®), equipped with SimPad SkillReporter. Methodology: During 2nd to 6th of March 2015, 18 EMS teams (1 physician, 1 paramedic and 1 nurse) were asked to manage a VF on a Resusci Anne Simulator manikin. This allowed the direct measurement of CC quality parameters and the evaluation of decision algorithm, through the use of a same scenario. The scenario was introduced to each team at the beginning of each session. At first, the “patient” was still conscious, on a stretcher and had a ST-segment elevation myocardial infarction. While the patient was installed in the ambulance, he suddenly had a FV cardiac arrest that could be detected on monitoring devices (time 0 of simulation). VF lasted for 10 minutes, followed by 5 minutes of asystole. The manikin software displayed the different parameters as the scenario progressed. The simulation was performed on a stretcher in an EMS premise, with the same equipment and monitoring devices as in an advanced life support ambulance (ALS). Results: CC were performed 71% of CPR time. CC depth was considered as non-compliant to guidelines in 28% of cases, with a mean depth of 4.4 cm, compressions with complete release in 37% of cases. Mean compression rate was 122/minute and was correct in 49% of cases. One third used Amiodarone after the third shock. 13/18 teams resumed chest compressions immediately after defibrillation attempts. Conclusion: This study shows the difficulty to strictly follow guidelines. According to participants, the massage was considered as more difficult with a manikin rather than on a real patient. Although cardiac arrest occurring during transportation is quite rare, quality of CPR at pre-hospital level should be improved.

Introduction: In case of no return of spontaneous circulation (ROSC) after conventional cardio-pulmonary resuscitation (CPR), out-of-hospital cardiac arrest (OHCA) patients could be referred for extracorporeal life support (ECLS). Guidelines have been published concerning this specific situation (1). The aim of our study was to describe the prognosis of OHCA patients and verify if referral to ECLS was compliant with these recommendations mainly studying time intervals (no-flow < 5 min, low-flow < 100 min). Methods: A prospective survey on OHCA referred to ECLS was implemented from 03/01/12 until 06/11/15 in an Emergency Medical Service (EMS) located in Paris area (France). This survey included 43 patients referred to hospital for ECLS. Variables were given as means and percentages. Results: Patients referred to ECLS were more often men (77%), with a mean age of 51 years old. Most of 43 OHCA occurred at home (51%), although 26% occurred on public area and 16% at workplace. In 40% of cases, CPR was performed by a witness and in 33% by a health professional. A first Basic Life Support ambulance arrived on scene within 7 min 50 sec, whereas EMS ambulance arrived on scene within 18 min 27 sec after OHCA. At EMS arrival on scene, patients were on asystole (44%), ventricular fibrillation (37%), and on spontaneous circulation (12%). The no-flow time interval was 4 min 10 sec on average (6 patients had a no-flow over 5 min) with 43% of patients with no no-flow. Low-flow time-interval was 44 min. External electric shock was delivered before EMS arrival on 21% of cases, and EMS itself delivered a shock in 40% of cases. Epinephrine was used for all patients, 10.35 mg on average. No patient survived OHCA after referral to ECLS. Discussion: Although this is a small series of 43 patients, no OHCA patient referred to ECLS survived. These results are mainly due to a non-shockable initial condition or too long no-flow time intervals. In order to improve the outcome and bring benefit to the proper expected patients through a cost-effective pathway, we released a reminder of the right recommendations in our EMS. (1) Riou B., Adnet F., Baud F et al. A. Recommandation sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires. Ann Fr Anesth Réanim 2009 ; 28 : 182-6.

Objectives: In an effort to increase the proportion of victims who receive bystander cardiopulmonary resuscitation (CPR) in case of out-of-hospital cardiac arrest (OHCA), it is now clearly recommended to propose t-CPR. However, very few studies have demonstrated, in real life conditions, the clinical benefits of such recommendations. The aim of this study was to assess the survival benefit of t-CPR on OHCA, compared with no bystander CPR. Materials and methods: This study was conducted over a seven-month period in 2011. It included all incoming calls to an Emergency Medical Service dispatch center in which t-CPR was instructed to non-priorly trained bystanders. The comparison group was matched on the date of occurrence; we enrolled incoming calls for witnessed OHCA with no bystander-CPR performed before rescuers arrival. Variables were given as means or percentages. Data were compared using Chi-square tests and Student’s t-test Results: The results appear in Table 1. Conclusion : This study showed that in OHCA, when bystanders initiated t-CPR, despite 1- a younger age population 2- more advanced life support and 3- higher rates of ROSC prior to hospital arrival, there was no improvement in survival rate after ICU discharge. As t-CPR does not seem sufficient to improve outcome, training citizens in CPR remains a top priority.