Amila S. Ratnayake, Dinesh Bagaria, April B. Llaneta, Ratrawee Pattanarattanamolee · 18 authors
Abstract Background Well-designed and functioning emergency medical service (EMS) can provide equitable access to emergency care to improve health issues, especially in low- and middle-income countries where the majority of deaths are due to conditions that could be treated with emergency care. To address this gap, this study explored the contextually appropriate development process in addition to the system architecture, which is lacking in Global South EMS research. Method This study was a thematic analysis of the development of EMS systems in six Asian countries. Experts in emergency care were selected through convenience sampling. Each country described and evaluated its EMS system using a standardized form with 102 EMS items that cover the emergency care system in terms of leadership, governance, financing, community-based activities, prehospital care, and quality assessment. From the descriptions, various themes were extracted focusing on the developmental perspective of EMS in Asia. Result The study identified the domain of the developmental focus, best practices, and future strategies for EMS in the Asian region. The identified areas for developmental focus are governance, multidisciplinary collaboration, communication/coordination, community participation, decentralization, equitable access, supply-demand balance, and quality assurance activities. Conclusion Countries under investigation achieved progress in planning, implementing, and sustaining EMS through varied strategies in the mentioned focal areas that can be emulated by other countries in this region. Further, their development levels varied according to the extent to which each country realized the development principles identified in this study.
on behalf of the Neonatal Transport Study Group of the Italian Society of Neonatology (SIN), Maurizio Gente, Roberto Aufieri, Massimo Agosti · 8 authors
BACKGROUND: Despite regionalization of perinatal care provides for the "in utero" transfer of high-risk pregnancies, there will always be a number of neonates who undergo acute inter-facility transport. The presence of a well-organized Neonatal Emergency Transport Service (NETS) can prevent and reduce risks of transportation, especially for very preterm infants, and is therefore mandatory for any program of regionalization of perinatal care. Italian National Health System is highly decentralized and Regions are autonomous to structure, plan and delivery their regional health services. Consequently, organization models and resources available vary widely and significant regional differences in access and quality of health services have been reported in the past years. A national survey was conducted in 2015 by the neonatal transport study group of the Italian Society of Neonatology with the aim to describe neonatal transfer practices and to assess the Neonatal Emergency Transport Services (NETS) status in the 20 Italian regions. METHODS: A questionnaire regarding neonatal transfer practices and NETS activity for the previous year (2014) was sent to the 44 NETS operating in the 20 Italian regions. Demographic data were obtained from the Italian National Statistical Institute (ISTAT). RESULTS: The overall survey response rate was 100%. In 2014, only 12 (60%) of the 20 Italian regions were fully covered by NETS, 3 (15%) regions were partially covered, while neonatal transport was not available in 5 (25%) regions. Overall, in 2014, the 44 NETS operating in Italy transported a total of 6387 infants, including 522 (8.17%) having a gestational age < 28 weeks. CONCLUSIONS: The organization of NETS in Italy is devolved on a regional basis, resulting in a large heterogeneity of access and quality to services across the country. Where available, NETS are generally well-equipped and organized but limited volume of activities often cannot guarantee adequate levels of skills of personnel or an appropriate cost-efficiency ratio. The regions reported with lack of NETS have managed, or are trying, to fill the gap, but continuing efforts to reduce regional differences in the availability and quality of services are still needed.
А. К. Дулаев, V. A. Manukovskiy, D. I. Kutyanov, Yu. Yu. Bulakhtin · 6 authors
OBJECTIVE. The authors developed the management strategy of emergency care for patients with acute spinal surgical pathology in conditions of megapolis. MATERIAL AND METHODS. A comparative statistical analysis was made in 2627 patients. The patients (n =777) underwent treatment in multicenter hospitals of emergency care of the spine (decentralized system). The other patients (n = 1850) were treated in Municipal Center of Emergency Surgery of the Spine (centralized system). RESULTS. It is appropriate to establish departments of emergency surgery of the spine on the base of separate multicenter hospitals in megapolis. These hospitals should be properly equipped and they should have specially trained doctors and nurses, stable financing, effective management on admission to hospital. CONCLUSIONS. The efficacy of proposed measures allowed authors to recommend them to wide practical application.
Cardiac arrests claim millions of lives each year. The condition can often be treated with a de\nfibrillator,buttimeisaverycriticalfactor. Asaconsequence,survivalratesarelow.\nRecent developments in drone technology have made civilian drones both cheap, easy to\noperate, and reliable. This paper looks into opportunities to use drones to deliver defibrilla\ntors to cardiac arrest victims faster than an ambulance, and focuses on unifying the needs of\nemergencyresponsewiththerulesandregulationsrequiredtooperatethedronessafely.\nThe study is performed as a literature study combined with interviews. The primary stake\nholderswereidentifiedasemergencyresponseandtheCivilianAviationAuthority.\nThe results showed that there was both a perceived use for ambulance drones and a way to\nlegally use them. The suggested approach involves using ambulance drones at sporting events\nsuch as "Birkebeinerrennet" as a proof of concept, before more advanced or permanent pro\ngramsareconsidered.
BACKGROUND: Injury is the number one public health problem in Lithuania in terms of disability adjusted life years lost. The trauma system plays an important role in injury statistics. The objective of this article is to describe and assess the performance of Lithuanian trauma sector. METHODS: The framework for assessing the performance of health systems proposed by Murray and Frenk (2000) was employed. RESULTS: The primary intention criterion--to reduce the number of trauma cases, injury related mortality and disability rates by 30% by 2010-is well defined. The Lithuanian whole-trauma sector does not substantially contribute to improving the health of the population. The legitimate expectations of the community--respect of persons in terms of dignity, autonomy, confidentiality, client orientation--do not correspond with the responsiveness of the trauma service. Financing of the trauma sector does not correspond with the magnitude of the injury problem. Lithuanian trauma service is decentralized. There is no trauma leadership in the country. There is no national policy for unintentional injury prevention and control, no specialized injury research institute, no system of trauma centres, and no Injury Surveillance System in Lithuania. There is no such specialty as Emergency Medicine as of 2009. A political and public will to reform the trauma sector is not sound. CONCLUSION: The performance of the decentralized Lithuanian trauma sector does not match with the primary intention criterion and does not correspond to the needs of people. Lithuanian trauma service has to be conceptualized and changed to inclusive.
The Family Division of the High Court exercises jurisdiction in family proceedings in England and Wales. A broadly similar jurisdiction is exercised under the Children Act in care proceedings and in private law disputes between parents by county courts and family proceedings courts. It should be emphasised that this article is about civil, not criminal, proceedings in which the burden of proof is diVerent and the practice which I describe does not apply. 2 The most recent example is the acknowledgment by the Court of Appeal that paediatricians and child psychiatrists are entitled in family proceedings to express opinions on child abuse which are based on or take into account the expert's assessment of the child's truthfulness: see Re M and R (Child Abuse: Evidence) [1996] 2 FLR 195, CA. Equally, I do not have space to address the duties of experts generally, as to which there is agreement across all the divisions of the High Court that expert evidence presented to the court should be and should be seen to be the independent product of the expert uninfluenced as to form or content by the exigencies of litigation. In Re J [1991] FCR 191 at 226/7, Cazalet J said that in children's cases the duty to be objective and not to mislead is as vital as in any case, because the child's welfare is at stake, and his/her interests are paramount. He added that an absence of objectivity may result in a child being wrongly placed and thereby unnecessarily at risk. It must also be borne in mind that a misleading opinion from an expert may well inhibit a proper assessment of a particular case by the non-medical professional advisers and may also lead parties, and in particular parents, to false views and hopes. 3 By section 12 of the Administration of Justice Act 1960, as amended by Schedule 13, para 14 of the Children Act 1989, it is a contempt of court to publish information relating to proceedings brought (inter alia) under the Children Act. 4 Oxfordshire County Council v M [1994] Fam 151, CA: Re L (A Minor) (Police Investigation) [1996] 2 WLR 395, HL. 5 By section 1(2) the court is required to have regard to the general principle that any delay in determining questions relating to the upbringing of children is likely to prejudice their welfare. 6