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      Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges

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          Abstract

          Clinical decision support systems are interactive computer systems for situational decision making and can improve decision efficiency and safety of care. We investigated the role of these systems in enhancing prehospital care. This narrative review included full-text articles published since 2000 that were available in databases/e-journals including Web of Science, PubMed, Science Direct, and Google Scholar. Search keywords included “clinical decision support system,” “decision support system,” “decision support tools,” “prehospital care,” and “emergency medical services.” Non-journal articles were excluded. We revealed 14 relevant studies that used such a support system in prehospital emergency medical service. Owing to the dynamic nature of emergency situations, decision timing is critical. Four key factors demonstrated the ability of clinical decision support systems to improve decision-making, reduce errors, and improve the safety of prehospital emergency activity: computer-based, offer support as a natural part of the workflow, provide decision support in the time and place of decision making, and offer practical advice. The use of clinical decision support systems in prehospital care resulted in accurate diagnoses, improved patient triage and patient outcomes, and reduction of prehospital time. By improving emergency management and rescue operations, the quality of prehospital care will be enhanced.

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          Most cited references49

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          Ambulance location and relocation models

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            Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective.

            Little is known about temporal trends in survival and prognostic characteristics of patients with out-of-hospital cardiac arrest treated by emergency medical services (EMS). We hypothesized that an evolving combination of beneficial and adverse factors may contribute to temporal patterns of survival. We evaluated a population-based cohort of EMS-treated adult patients with cardiac arrest (n=12 591) from 1977 to 2001 in King County, Washington. Time was grouped into an initial 5-year period and 5 successive 4-year periods. We sought to determine the potential impact of temporal changes in prognostic factors typically beyond EMS control termed "fate" factors (for example, patient age) and factors implemented by EMS termed "program" factors (programs of dispatcher-assisted cardiopulmonary resuscitation and basic life support defibrillation). Several characteristics associated with survival changed over time. Observed survival did not change over time among all patients with cardiac arrest (OR=0.98 [0.95, 1.01], trend for each successive time period) and improved over time among patients with witnessed ventricular fibrillation (OR=1.05 [1.01, 1.09]). In models that included all patients with cardiac arrest and controlled for fate factors, advancing time period was associated with an increase in survival (OR=1.08 [1.05, 1.11]). Conversely, in models that controlled for program factors, advancing time period was associated with a decrease in survival (OR=0.95 [0.93, 0.98]). Results were similar among patients with witnessed ventricular fibrillation. The static temporal pattern of survival from cardiac arrest appeared to result from an evolving balance of prognostic factors. Programs implemented by EMS appeared to counter adverse temporal trends in prognostic factors typically beyond EMS control.
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              Emergency Medical Service (EMS) systems in developed and developing countries.

              To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries. We collated de-identified patient-level data from national or local trauma registries in Australia, Austria, Canada, Greece, Germany, Iran, Mexico, New Zealand, the Netherlands, the United Kingdom and the United States. Patient and injury-related characteristics of trauma victims with injury severity score (ISS) >15 and the pre-hospital trauma care provided to these patients were compared among different countries. A total of 30,339 subjects from one or several regions in 11 countries were included in this analysis. Austria (51%), Germany (41%) and Australia (30%) reported the highest proportion of air ambulance use. Monterrey, Mexico (median 10.1min) and Montreal, Canada (median 16.1min) reported the shortest and Germany (median: 30min) and Austria (median: 26min) reported the longest scene time. Use of intravenous fluid therapy among advanced EMS systems without physicians as pre-hospital care providers, varied from 30% (in the Netherlands) to 55% (in the US). The corresponding percentages in advanced EMS systems with physicians actively involved in pre-hospital trauma care, excluding Montreal in Canada, ranged from 63% (in London, in the UK) to 75% in Germany and Austria. Austria and Germany also reported the highest percentage of pre-hospital intubation (61% and 56%, respectively). This study provides an early look at international variability in patient mix, process of care, and performance of different pre-hospital trauma care systems worldwide. International efforts should be devoted to developing a minimum standard data set for trauma patients.
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                Author and article information

                Journal
                Clin Exp Emerg Med
                Clin Exp Emerg Med
                CEEM
                Clinical and Experimental Emergency Medicine
                The Korean Society of Emergency Medicine
                2383-4625
                December 2019
                31 December 2019
                : 6
                : 4
                : 288-296
                Affiliations
                [1 ]Department of Health Information Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
                [2 ]Department of Medical Informatics, School of Management & Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [3 ]Department of Health Information Management, School of Allied-Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence to: Marjan Ghazisaeedi Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, No. 17, Farredanesh Alley, Ghods St, Enghelab Ave, Tehran 14177-44361, Iran E-mail: Ghazimar@ 123456tums.ac.ir
                Author information
                http://orcid.org/0000-0002-2400-209X
                Article
                ceem-18-032
                10.15441/ceem.18.032
                6952626
                31910499
                69a7adea-46b5-4599-9015-99bc958ea604
                Copyright © 2019 The Korean Society of Emergency Medicine

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/).

                History
                : 14 July 2018
                : 10 September 2018
                : 12 October 2018
                Categories
                Review Article

                decision support systems, clinical,decision making,emergency medical services

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