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      EMS in Taiwan: Past, present, and future ☆

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Taiwan is a small island country located in East Asia. From around 1995 modern concepts of the EMS were imported and supported by legislation. Considerable progress has since been made towards the construction of an effective pre-hospital care system. This article introduces the current status of the EMS in Taiwan, including the systems, response configurations, funding, personnel, medical directorship, and outcome research. The features and problems of in-hospital emergency care are also discussed. Key areas for further development in the country vary depending on regional differences in available resource and population density. An analysis of the strength, weakness, opportunity, and threats of the evolving EMS in Taiwan could be an example for other countries where the EMS is undergoing a similar process of development and optimisation.

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          Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis.

          Yih-Sharng Chen, Jou-Wei Lin, Hsi-Yu Yu … (2008)
          Extracorporeal life-support as an adjunct to cardiac resuscitation has shown encouraging outcomes in patients with cardiac arrest. However, there is little evidence about the benefit of the procedure compared with conventional cardiopulmonary resuscitation (CPR), especially when continued for more than 10 min. We aimed to assess whether extracorporeal CPR was better than conventional CPR for patients with in-hospital cardiac arrest of cardiac origin. We did a 3-year prospective observational study on the use of extracorporeal life-support for patients aged 18-75 years with witnessed in-hospital cardiac arrest of cardiac origin undergoing CPR of more than 10 min compared with patients receiving conventional CPR. A matching process based on propensity-score was done to equalise potential prognostic factors in both groups, and to formulate a balanced 1:1 matched cohort study. The primary endpoint was survival to hospital discharge, and analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00173615. Of the 975 patients with in-hospital cardiac arrest events who underwent CPR for longer than 10 min, 113 were enrolled in the conventional CPR group and 59 were enrolled in the extracorporeal CPR group. Unmatched patients who underwent extracorporeal CPR had a higher survival rate to discharge (log-rank p<0.0001) and a better 1-year survival than those who received conventional CPR (log rank p=0.007). Between the propensity-score matched groups, there was still a significant difference in survival to discharge (hazard ratio [HR] 0.51, 95% CI 0.35-0.74, p<0.0001), 30-day survival (HR 0.47, 95% CI 0.28-0.77, p=0.003), and 1-year survival (HR 0.53, 95% CI 0.33-0.83, p=0.006) favouring extracorporeal CPR over conventional CPR. Extracorporeal CPR had a short-term and long-term survival benefit over conventional CPR in patients with in-hospital cardiac arrest of cardiac origin.
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            ED overcrowding in Taiwan: facts and strategies.

            R-Y Shyu, Harris Wang, Chien-Chou Chen … (1999)
            The objective of this study was to quantity the extent of emergency department (ED) overcrowding in Taiwan and to identify possible solutions. The ED log was reviewed for all patients who presented to the National Taiwan University Hospital's ED from January 16, 1996 through February 15, 1996. Charts from patients held longer than 72 hours were reviewed. Among 5,810 patients, 213 (3.6%) were held in the ED for more than 72 hours (7.1 patients per day). In 149 (70.0%) of them, admission was indicated but delayed (42 because more than one subspecialty were involved, 57 because of unavailability of bed, and 50 because of the disparity in admission priority between the emergency physicians and house staffs). Eighteen (8.4%) patients did not meet admission criteria (13 could have been treated in outpatient clinics, 3 needed placement in nursing homes, 2 because of personal problems). The others (22%) recovered while waiting. Significant overcrowding exists in EDs in Taiwan. Four solutions are proposed: (1) creation of a holding unit; (2) flexible ward assignment; (3) pre-established rules for admission priority-setting; and (4) active interfacility transfer. Only through these efforts can EDs in Taiwan guarantee an optimal level of care in the face of a growing patient demand.
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              Video-recording and time-motion analyses of manual versus mechanical cardiopulmonary resuscitation during ambulance transport.

              Wei Yang, Yue-Zhi Lin, Pei Lua … (2007)
              The quality of cardiopulmonary resuscitation (CPR) plays a crucial role in saving lives from out-of-hospital cardiac arrest (OHCA). Previous studies have identified sub-optimal CPR quality in the prehospital settings, but the causes leading to such deficiencies were not fully elucidated. This prospective study was conducted to identify operator- and ambulance-related factors affecting CPR quality during ambulance transport; and to assess the effectiveness of mechanical CPR device in such environment. A digital video-recording system was set up in two ambulances in Taipei City to study CPR practice for adult, non-traumatic OHCAs from January 2005 to March 2006. Enrolled patients received either manual CPR or CPR by a mechanical device (Thumper). Quality of CPR in terms of (1) adequacy of chest compressions, (2) instantaneous compression rates, and (3) unnecessary no-chest compression interval, was assessed by time-motion analysis of the videos. A total of 20 ambulance resuscitations were included. Compared to the manual group (n=12), the Thumper group (n=8) had similar no-chest compression interval (33.40% versus 31.63%, P=0.16); significantly lower average chest compression rate (113.3+/-47.1 min(-1) versus 52.3+/-14.2 min(-1), P<0.05), average chest compression rate excluding no-chest compression interval (164.2+/-43.3 min(-1) versus 77.2+/-6.9 min(-1), P<0.05), average ventilation rate (16.1+/-4.9 min(-1) versus 11.7+/-3.5 min(-1), P<0.05); and longer no-chest compression interval before getting off the ambulance (5.7+/-9.9s versus 18.7+/-9.1s, P<0.05). The majority of the no-chest compression interval was considered operator-related; only 15.3% was caused by ambulance related factors. Many unnecessary no-chest compression intervals were identified during ambulance CPR, and most of this was operator, rather than ambulance related. Though a mechanical device could minimise the no-chest compression intervals after activation, it took considerable time to deploy in a system with short transport time. Human factors remained the most important cause of poor CPR quality. Ways to improve the CPR quality in the ambulance warrant further study.
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                Author and article information

                Contributors
                Matthew Huei-Ming Ma
                Journal
                Journal ID (nlm-ta): Resuscitation
                Journal ID (iso-abbrev): Resuscitation
                Title: Resuscitation
                Publisher: Elsevier Ireland Ltd.
                ISSN (Print): 0300-9572
                ISSN (Electronic): 1873-1570
                Publication date PMC-release: 6 December 2008
                Publication date (Print): January 2009
                Publication date (Electronic): 6 December 2008
                Volume: 80
                Issue: 1
                Pages: 9-13
                Affiliations
                [a ]National Taiwan University Hospital, Taipei, Taiwan
                [b ]National Taiwan University Hospital, Yun-Lin Branch, Dou-Liou City, Taiwan
                [c ]Taipei City Fire Department, Taipei, Taiwan
                Author notes
                [* ]Corresponding author. Tel.: +886 2 23562831; fax: +886 2 23223150. mattma.tw@ 123456gmail.com
                Article
                Publisher ID: S0300-9572(08)00714-4
                DOI: 10.1016/j.resuscitation.2008.10.010
                PMC ID: 7115806
                PubMed ID: 19059690
                SO-VID: eeaec6e8-7e8d-4917-910e-706b3f70ff67
                Copyright statement: Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 15 August 2008
                Date accepted : 3 October 2008
                Categories
                Subject: Article

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: emergency medical service system,taiwan
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: emergency medical service system, taiwan

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