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Abstract Background Stroke management require rapid identification, assessment, and transport of patients to qualified health care centers. However, there is little description in the literature on the multiple challenges associated with the pre-hospital transport of suspected stroke patients. Objective To characterize the pre-hospital care provided to suspected stroke patients by the Brazilian Emergency Medical Service (SAMU in Portuguese), by means of a descriptive case study. Methods This is a descriptive study of a series of cases. Data from the SAMU regarding the responses to emergency calls from suspected stroke patients were collected. Independent reviewers confirmed the diagnostic hypothesis and all discordances were assessed using kappa statistics. Clinical data and transport times were described as frequency and proportion or central tendency and dispersion measures. Normality of continuous variable distribution was assessed using the Kolmogorov-Smirnov test. The Mann-Whitney U test was used for comparison of medians, with a 5% significance level. Results During the studied period, 556 suspected stroke patients were treated. The kappa index was 0.82 (95% CI 0.737 to 0.919) CI. In 74.7% of the cases, the symptom onset time was not recorded. The median time elapsed between the call for emergency services and the ambulance arrival was 18 minutes, and the median transport time was 38 minutes. A total of 34% of the patients were taken to referral hospitals for stroke. Conclusion This study revealed a low level of knowledge regarding the need to determine the exact time of symptom onset of suspected stroke patients. Also, the study showed the low rate of patients taken to referral hospitals. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

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BACKGROUND: Road traffic injuries (RTIs) are the eighth leading cause of death worldwide, with an estimated 90% of RTIs occurring in low- and middle-income countries (LMICs) like Brazil. There has been minimal research in evaluation of delays in transport of RTI patients to trauma centers in LMICs. The objective of this study is to determine specific causes of delays in prehospital transport of road traffic injury patients to designated trauma centers in Maringá, Brazil. METHODS: A qualitative method was used based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) approach. Eleven health care providers employed at prehospital or hospital settings were interviewed with questions specific to delays in care for RTI patients. A thematic analysis was conducted. RESULTS: Responses to primary causes of delay in treatment to RTI patients fell into the following categories: 1) lack of public education, 2) traffic, 3) insufficient personnel/ambulances, 4) bureaucracy, and 5) poor location of stations. Suggestions for improvement in delays fell into the categories of 1) need for centralized station/avoid traffic, 2) improving public education, 3) Increase personnel, 4) increase ambulances, 5) proper extrication/rapid treatment. CONCLUSION: Our study found varied responses between hospital and SAMU providers regarding specific causes of delay for RTI patients; SAMU providers cited primarily traffic, bureaucracy, and poor location as primary factors while hospital employees focused more on public health aspects. These results mirror prehospital system challenges in other developing countries, but also provide solutions for improvement with better infrastructure and public health campaigns.

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Esta tesis intenta ser descriptiva sobre la situación actual de un servicio de EMERGENCIA privado con nueve años de historia. Actualmente, dicho servicio se encuentra en un período de amesetamiento en cuanto a la incorporación de más afiliados. Por tal motivo, los integrantes de la S.A. deciden analizar la situación institucional de la empresa, por medio de estrategias de diversificación y profundización de servicios, con el propósito de reconvertir y refuncionalizar la misma. Y de esta forma, encontrar la mejor manera de captar la mayor cantidad de afiliados para salir del estancamiento actual y poder fortalecer la empresa. La estrategia se basa en cuatro puntos básicos: 1. Mejorar la eficiencia de la organización. 2. Mejorar la aparatología y equipamiento. Compra de más ambulancias. 3. Infraestructura edilicia totalmente nueva, moderna y funcional. 4. Diversificación en la oferta de servicios nuevos a prestar.(AU)

SUMMARY: This thesis is intended to be descriptive of the current situation of a private EMERGENCY service nine-year history. Currently, this service is in a period of leveling off in terms of adding more members. For this reason, members of the SA decide to analyze the institutional situation of the company, through strategies of diversification and deepening of services, for the purpose of converting and refunctioning it. And so, the best way to capture the largest number of members to break the current deadlock and to strengthen the company. The strategy is based on four basic points: 1.Improve the efficiency of the organization. 2. Improve the appliances and equipment. urchase more ambulances. 3. Building infrastructure completely new, modern and functional. 4. Diversification in offering new services to provide.(AU)

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Esta tesis intenta ser descriptiva sobre la situación actual de un servicio de EMERGENCIA privado con nueve años de historia. Actualmente, dicho servicio se encuentra en un período de amesetamiento en cuanto a la incorporación de más afiliados. Por tal motivo, los integrantes de la S.A. deciden analizar la situación institucional de la empresa, por medio de estrategias de diversificación y profundización de servicios, con el propósito de reconvertir y refuncionalizar la misma. Y de esta forma, encontrar la mejor manera de captar la mayor cantidad de afiliados para salir del estancamiento actual y poder fortalecer la empresa. La estrategia se basa en cuatro puntos básicos: 1. Mejorar la eficiencia de la organización. 2. Mejorar la aparatología y equipamiento. Compra de más ambulancias. 3. Infraestructura edilicia totalmente nueva, moderna y funcional. 4. Diversificación en la oferta de servicios nuevos a prestar.

SUMMARY: This thesis is intended to be descriptive of the current situation of a private EMERGENCY service nine-year history. Currently, this service is in a period of leveling off in terms of adding more members. For this reason, members of the SA decide to analyze the institutional situation of the company, through strategies of diversification and deepening of services, for the purpose of converting and refunctioning it. And so, the best way to capture the largest number of members to break the current deadlock and to strengthen the company. The strategy is based on four basic points: 1.Improve the efficiency of the organization. 2. Improve the appliances and equipment. urchase more ambulances. 3. Building infrastructure completely new, modern and functional. 4. Diversification in offering new services to provide.

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OBJETIVO: Verificar a influência do local de nascimento e do transporte sobre a morbimortalidade de recém-nascidos prematuros na Região Sul do Brasil. MÉTODOS: Estudo de coorte com recém-nascidos prematuros transferidos para a unidade de tratamento intensivo de referência (grupo transporte = 61), tendo sido acompanhados até a alta. Os dados sobre o atendimento no hospital de origem e transporte foram obtidos no momento da internação. Esse grupo foi comparado com neonatos da maternidade de referência, pareados por idade gestacional (grupo controle = 123), tendo como desfecho primário o óbito e desfechos secundários as alterações da glicemia, temperatura e saturação de oxigênio no momento da internação e a incidência de enterocolite necrosante, displasia broncopulmonar e sepses. Na associação entre as variáveis e o desfecho, foi utilizado o risco relativo. Foi adotado um nível de significância de α = 5 por cento e β = 90 por cento. RESULTADOS: A distância média percorrida foi de 91 km. A idade gestacional média foi de 34 semanas. Entre os recém-nascidos transferidos, 23 por cento (n = 14) não tiveram atendimento pediátrico na sala de parto. No transporte, 33 por cento dos recém-nascidos foram acompanhados por pediatra, e os equipamentos utilizados foram: incubadora (57 por cento), bomba de infusão (13 por cento), oxímetro (49 por cento) e aparelho para aferição da glicemia (21 por cento). O grupo transporte apresentou maior incidência de hiperglicemia, risco relativo (RR) = 3,2 (2,3-4,4), hipoglicemia, RR = 2,4 (1,4-4,0), hipertermia, RR = 2,5 (1,6-3,9), e hipoxemia, RR = 2,2 (1,6-3,0). Foram observados 18 por cento de óbitos no grupo dos transferidos e 8,9 por cento no grupo controle, RR = 2,0 (1,0-2,6). CONCLUSÕES: A pesquisa expõe deficiências no atendimento e transporte dos recém-nascidos, sendo necessária uma melhor organização do atendimento perinatal e do transporte na região nordeste do Rio Grande do Sul.

OBJECTIVE: To evaluate the effect of place of birth and transport on morbidity and mortality of preterm newborns in the southern region of Brazil. METHODS: This cohort study included preterm newborns transported to a reference intensive care unit (transport group = 61) and followed up until discharge. Data about care in hospital of origin and transport were obtained at admission. This group was compared with infants born in the maternity ward of the reference hospital paired according to gestational age (control group = 123). Primary outcome was death, and secondary outcomes were changes in blood glucose, temperature and oxygen saturation at admission and the incidence of necrotizing enterocolitis, bronchopulmonary dysplasia and sepsis. Relative risk (RR) was used to evaluate the association between variables and outcome. The level of significance was set at α = 5 percent and β = 90 percent. RESULTS: Mean travel distance was 91 km. Mean gestational age was 34 weeks. Of the neonates in the transport group, 23 percent (n = 14) did not receive pediatric care in the delivery room. During transportation, 33 percent of newborns were accompanied by a pediatrician, and the equipment available was: incubator (57 percent), infusion pump (13 percent), oximeter (49 percent) and device for blood glucose test (21 percent). The transport group had a greater incidence of hyperglycemia (RR = 3.2; 2.3-4.4), hypoglycemia (RR = 2.4; 1.4-4.0), hyperthermia (RR = 2.5; 1.6-3.9), and hypoxemia (RR = 2.2; 1.6-3.0). The percentage of deaths was 18 percent in the transport group and 8.9 percent in the control group (RR = 2.0; 1.0-2.6). CONCLUSIONS: This study revealed deficiencies in neonatal care and transport. Perinatal care and transport should be better organized in the northeastern region of Rio Grande do Sul, Brazil.

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OBJECTIVE: To evaluate the effect of place of birth and transport on morbidity and mortality of preterm newborns in the southern region of Brazil. METHODS: This cohort study included preterm newborns transported to a reference intensive care unit (transport group = 61) and followed up until discharge. Data about care in hospital of origin and transport were obtained at admission. This group was compared with infants born in the maternity ward of the reference hospital paired according to gestational age (control group = 123). Primary outcome was death, and secondary outcomes were changes in blood glucose, temperature and oxygen saturation at admission and the incidence of necrotizing enterocolitis, bronchopulmonary dysplasia and sepsis. Relative risk (RR) was used to evaluate the association between variables and outcome. The level of significance was set at α = 5% and ß = 90%. RESULTS: Mean travel distance was 91 km. Mean gestational age was 34 weeks. Of the neonates in the transport group, 23% (n = 14) did not receive pediatric care in the delivery room. During transportation, 33% of newborns were accompanied by a pediatrician, and the equipment available was: incubator (57%), infusion pump (13%), oximeter (49%) and device for blood glucose test (21%). The transport group had a greater incidence of hyperglycemia (RR = 3.2; 2.3-4.4), hypoglycemia (RR = 2.4; 1.4-4.0), hyperthermia (RR = 2.5; 1.6-3.9), and hypoxemia (RR = 2.2; 1.6-3.0). The percentage of deaths was 18% in the transport group and 8.9% in the control group (RR = 2.0; 1.0-2.6). CONCLUSIONS: This study revealed deficiencies in neonatal care and transport. Perinatal care and transport should be better organized in the northeastern region of Rio Grande do Sul, Brazil.

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O objetivo com este estudo é descrever a estrutura e o funcionamento do serviço de transporte sanitário público de Belo Horizonte como experiência pioneira em um grande centro urbano do país e sua importância para o acesso da população aos serviços. Trata-se de um estudo de caso cujos dados foram coletados em protocolos, relatórios e estatísticas de atendimento, sendo a última organizada em gráficos e analisada de acordo com a legislação sobre urgências. Nos resultados, aponta-se uma experiência que viabiliza o transporte de usuários entre os serviços de saúde de acordo com suas necessidades, facilita o acesso, organiza a integração entre os serviços e racionaliza custos.É importante observatório de saúde do município ao possibilitar a identificação de novas morbidades, visão da rede,oferecendo subsídios para propostas e gestão municipal da saúde.

This study aims to describe the structure and functioning of the public health transport in the city of Belo Horizonte. It is a pioneering experience in a large urban center and it is extremely important to ensure the citizen’s access to health services. This is a case study and all data were collected using protocols, reports and hospital assistance statistics which were organized in a graphic format and analyzed according to emergency medicine legislation. The results show that this experience facilitates access, organization and integration of health services, as well as reduces overall costs. In summary, health transport is an important issue as it allows the identification of new morbidities, offers a network vision and provides subsidies for proposals regarding health management.

El objetivo del presente estudio ha sido de describir la estructura y funcionamiento del servicio de Transporte Sanitario Público de Belo Horizonte como experiencia pionera en un gran centro urbano del país y su importancia para el acceso de la población a los servicios. Se trata de un estudio de caso cuyos datos fueron recogidos en protocolos, informes yestadística de atención organizada en gráficos y analizada de acuerdo con la legislación sobre urgencias. Los resultados señalan una experiencia que hace viable el transporte de usuarios entre los servicios de salud en conformidad con sus necesidades, facilita el acceso, organiza la integración entre los servicios y racionaliza costos. En síntesis, el Transporte Sanitario es un importante observatorio de salud del municipio porque permite identificar nuevas morbidades y tener una visión de la red y, además, ofrece subsidios para propuestas de la gestión municipal de la salud.

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Planificacion de un sistema de transporte y comunicacion para atender urgencias medicas en el gran Resistencia, optimizando la infraestructura actual y la utilizacion del personal, edificio y equipos ya existentes en los Centros de atencion de salud

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Planificacion de un sistema de transporte y comunicacion para atender urgencias medicas en el gran Resistencia, optimizando la infraestructura actual y la utilizacion del personal, edificio y equipos ya existentes en los Centros de atencion de salud

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Relatamos as condiçöes de transporte a que säo submetidos os pacientes pediátricos de alto risco, transferidos para a UTI do HMARS. O objetivo do trabalho é transcrever uma realidade médica vivida diariamente, a qual compromete o prognóstico deste tipo de pacientes. Foram estudados o transporte de 45 casos: 4.4% transportados sem oxigênio na ambulância; 15.5% sem médico acompanhante; 21,4% näo tinham veia disponível; 40% sem material de ressuscitaçäo; 52,9% das entubaçöes foram inadequadas ("entubaçöes" - esôfago e seletivas, extubaçöes no transporte, material inadequado); 52% sem aspirador; nenhuma das ambulâncias possuiam aparelho de ventilaçäo mecânica. Dos 4 pacientes que apresentaram parada cardíaca e/ou respiratória, durante o trajeto, 3 evoluiram para óbito. Faleceram nas primeiras 24 horas de internaçäo 22,2% dos pacientes, relacionando-se com as precárias condiçöes de transferência. Sugerimos a criaçäo de um serviço de transporte de pacientes pediátricos graves na rede municipal, com a finalidade de diminuir o risco destes pacientes em trânsito e a mortalidade dos mesmo

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Planificacion de un sistema de transporte y comunicacion para atender urgencias medicas en el gran Resistencia, optimizando la infraestructura actual y la utilizacion del personal, edificio y equipos ya existentes en los Centros de atencion de salud

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Planificacion de un sistema de transporte y comunicacion para atender urgencias medicas en el gran Resistencia, optimizando la infraestructura actual y la utilizacion del personal, edificio y equipos ya existentes en los Centros de atencion de salud

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