Kamonwon Ienghong

Purpose: Point-of-care ultrasound (POCUS) serves as a critical diagnostic tool in emergency medicine; however, a persistent gap remains between competency acquired during training and consistent clinical application. This study sought to identify barriers and facilitators influencing POCUS examination frequency among emergency medicine (EM) residents and emergency nurse practitioners after institutional training, and to examine the association between individual-level factors and the frequency of POCUS examinations. Patients and Methods: This retrospective study was conducted in the Department of Emergency Medicine at Srinagarind Hospital, Khon Kaen University, Thailand, from January 2024 to December 2025. Cohort 1 included 76 providers (16 EM residents and 60 nurse practitioners) who completed institutional POCUS training between January 2024 and December 2025. Data collected included provider characteristics, competency scores, workload, and responses to a 5-point Likert-scale survey assessing perceived barriers and facilitators. Cohort 2 consisted of 2,097 documented, archived POCUS examinations performed by these providers during a standardized 1-month post-training observation period per provider. Associations were evaluated using correlation coefficients and multivariable linear regression. Results: EM residents demonstrated significantly higher competency scores than nurse practitioners (86.3± 5.7 vs 78.9± 7.4, p=0.002). The most prevalent barriers identified were high workload and time constraints, limited equipment availability, and reduced interpretive confidence. Nurse practitioners expressed greater concern regarding insufficient institutional support (3.88± 0.72 vs 3.06± 0.89, p=0.001) and medicolegal risk (3.65± 0.79 vs 2.94± 0.93, p=0.004), whereas residents rated structured feedback more favorably (p=0.012). Multivariable regression identified competency score (adjusted β = 3.97 per 10-point increase, p < 0.001) and provider type (adjusted β = 9.64, p = 0.007) as independently associated with higher documented POCUS examination frequency, while patient volume per shift was negatively associated (adjusted β = − 1.89 per 5-patient increase, p = 0.010). Conclusion: The findings indicate that formal training alone may be insufficient to achieve equitable competency or utilization. Additional multi-center studies are required to validate these results. The competency score showed a more consistent association with POCUS examination frequency than other variables examined, suggesting it may represent an important, though not exclusive, factor influencing real-world use. As examination quality, interpretive accuracy, and clinical impact were not assessed in this study, higher frequency should not be interpreted as better implementation.

Purpose: Climate extremes are a catastrophic manifestation of climate change. Motorcycle ambulances are an emerging sort of vehicle that is intended to offer quick access in large cities. This study evaluated the effect of extreme weather events on the accessibility of emergency motorcycle ambulance services. Patients and Methods: We conducted a retrospective analysis of motorcycle ambulance operation data from January 2020 to December 2024. Data on motorcycle ambulance operating times, rainfall levels in the operational area, and ground temperatures at the Emergency medical services (EMS) unit were collected. Continuous data were presented as means and standard deviations (SD), while categorical data were reported as frequencies and percentages. Associations between categorical variables were evaluated using the chi-square test. A two-tailed p-value of less than 0.05 was considered statistically significant. Results: With a total of 569 operations documented over the five years, services were postponed during rainy weather and when ground temperatures exceeded 40°C. The availability of operational motorcycle ambulances declined from 81.28% to 34.03%. Increased rainfall (hours lost increased from 1065.1 to 2711.7; p< 0.001) and rising temperatures exceeding 40°C (hours lost increased from 574.9 to 3067.3; p< 0.001) were the main causes of service interruptions. This occurred despite increased utilization of motorcycle ambulances for emergency responses (65 to 165 operations annually; p=0.022) and a growing use of AED-equipped units for cardiac emergencies (4.6% to 23.6% of operations; p=0.014). Conclusion: This quantitative evidence of the impact of climate extremes on emergency healthcare access due to reduced motorcycle ambulance availability. The gradual reduction in operational hours was caused by rising rainfall and elevated temperatures.

Background: Emergency medical services (EMS) encounters with palliative care patients present unique operational challenges. As EMS providers increasingly care for individuals with life-limiting illnesses, understanding the intersection of emergency care and palliative medicine has become essential to optimizing healthcare delivery. Objective: This study examines EMS operational metrics, resource allocation patterns, and clinical outcomes among palliative care patients in Thailand. Methods: This retrospective analysis study investigated operational times, resource utilization, and clinical outcomes in palliative care patients utilizing EMS services, derived from electronic medical records and EMS documentation. This study was conducted at the Srinagarind Hospital EMS unit from October 2019 to September 2024. All patients diagnosed with palliative care (ICD-10 code Z51.5) who utilized EMS services were included. Results: Palliative care patients represented 6.9% ( N = 340) of total EMS utilization ( N = 4520), with cases increasing from 51 patients (15.0%) in 2019–2020 to 89 patients (26.2%) in 2023–2024. The median age was 72 years, with 62.9% male patients. Palliative care patients demonstrated significantly prolonged EMS operational times: activation (1.51 min vs 1.27 min), response (10.21 min vs 9.35 min), and scene time (22.05 min vs 10.02 min, p < 0.001). Resource utilization showed higher rates of pain medication administration (30.88% vs 7.79%) and exclusive use of comfort-focused interventions. Patient outcomes revealed significantly higher discharge rates. Conclusion: Palliative care patients utilizing EMS services represent a distinct population requiring specialized operational approaches. Extended scene times reflect appropriate symptom-focused care delivery rather than rapid transport protocols. Higher discharge rates validate the EMS role as a symptom management bridge.

Purpose: This study evaluates the effectiveness of motorcycle ambulances (motorlances) in delivering emergency medical response at the Khon Kaen International Marathon (KKIM), Thailand, over a three-year period (2023– 2025). Patients and Methods: We conducted a retrospective analysis of emergency medical service (EMS) data from three consecutive annual Khon Kaen International Marathons held on January 28– 29, 2023; January 13– 14, 2024; and January 11– 12, 2025. Data including EMS operation intervals, clinical interventions carried out, and patient outcomes were collected from EMS patient care documents, organized by Srinagarind Hospital, Khon Kaen University, Thailand during the marathon events. A comparative analysis was carried out to evaluate year-over-year operational improvements utilizing IBM SPSS version 27.0, with continuous data expressed as means ± standard deviations, categorical data as frequencies and percentages, chi-square tests employed for associations among categorical variables, and p< 0.05 considered statistically significant. Results: Among 20,681 marathon participants, 132 cases (6.38%) required emergency intervention with motorlance support. The use of motorlances significantly increased from 25 cases in 2023 to 65 in 2025 (p=0.011), with consistently rapid mean response times (5.3– 5.6 minutes each year). Clinical capabilities improved over the study period, evidenced by a rise in advanced interventions such as intravenous glucose administration and pain management (from 0% to 23.1%, p=0.010). Scene time increased in parallel with this expanded clinical scope (from 8.2 to 18.6 minutes, p< 0.001). Importantly, over 90% of patients treated by motorlance were able to continue the race following on-scene care. Conclusion: Motorcycle ambulances significantly enhance the efficiency of emergency medical responses during large marathon events. Notable results indicate a constant increase in motorlance utilization, consistently rapid response times, and enhanced clinical competencies with advanced interventions. Extended scene duration indicated enhanced on-site treatment delivery. Significantly, over 90% of patients treated by motorlance resumed to racing after treatment, indicating the efficacy of prehospital intervention.

Purpose: To implement smart glasses with augmented reality distance measuring technologies in conventional self-assessment techniques, to improve ambulance location accuracy during simulated emergency scenarios. Patients and Methods: Eighty-two emergency medical services professionals participated in this simulation-based study at Srinagarind Hospital, Thailand. Participants positioned ambulances in simulated chemical, biological, radiological, nuclear, and explosives (CBRNE) and non-CBRNE scenarios using traditional self-assessment methods, followed by positioning using smart glasses technology after a 120-minute training session. Smart glasses equipped with a measurement-augmented reality application were utilized. Positioning accuracy was assessed. Results: The participants had a median age of 36.1 years, with males comprising the majority (63.4%). Emergency nurse practitioners and students constituted the largest group (56.1%). Most participants (51.1%) reported over a decade of EMS experience. Smart glasses technology significantly improved positioning accuracy in both scenario types (p< 0.001). In CBRNE scenarios, accuracy increased from 47.6% with self-assessment to 83.3% with smart glasses. In non-CBRNE scenarios, accuracy improved from 66.7% to 83.8%. Conclusion: Smart glasses technology with augmented reality distance measurement capabilities substantially enhances ambulance positioning accuracy, particularly in complex CBRNE scenarios. The technology’s ability to standardize performance across emergency types, and potentially across responder experience levels, suggests significant value for improving emergency medical service delivery, patient care, and responder safety.

Sepsis significantly impacts the circulatory system and is associated with high mortality rates, particularly in patients with septic shock who require urgent treatment. Non-invasive cardiac output monitoring is a critical bedside tool for assessing fluid responsiveness. This study aimed to evaluate the agreement between cardiac output measurements obtained from the carotid artery and the left ventricular outflow tract (LVOT) in patients with septic shock in the emergency department (ED). A prospective observational study was conducted on adult patients diagnosed with septic shock and admitted to the ED between October 2023 and October 2024. Cardiac output was calculated using the standard formula (CO = VTI × cross-sectional area × heart rate) for both LVOT and carotid measurements. Agreement between LVOT-derived and carotid-derived cardiac output was assessed using Lin’s concordance correlation coefficient, intraclass correlation coefficient, Bland-Altman analysis, and percentage error. Forty patients with septic shock were included in the study. The mean carotid blood flow was 0.855 L/min, while the mean cardiac output measured by LVOT echocardiography was 5.329 L/min. Cardiac output measurements derived from carotid artery VTI and LVOT VTI showed a moderate agreement, as demonstrated by Lin’s Concordance Correlation Coefficient of 0.527 (p < 0.001) and an Intraclass Correlation Coefficient (absolute agreement) of 0.695 (p < 0.001). Bland–Altman analysis revealed a bias of − 0.47 (95% CI: −2.11 to 1.17), with a concordance interval ranging from − 10.51 (95% CI: −13.35 to − 7.67) to 9.58 (95% CI: 6.74 to 12.42). Non-invasive cardiac output measurements from the carotid artery exhibited only moderate agreement with those derived from the LVOT, accompanied by wide limits of agreement. This indicates that the two methods should not be utilized interchangeably for clinical decision-making in individual patients. Carotid artery measurements should not be regarded as a direct replacement for LVOT examinations.

Smart glasses with an augmented reality workflow have emerged as a new tool for triage in mass casualty incidents (MCIs). This study aimed to investigate the accuracy and time efficiency of smart glasses in MCIs triage. A retrospective field exercise study was conducted in November 2024 at EMS Srinagarind Hospital, Thailand. All participants performed self-assessments and used smart glasses for triage sieve. Data were recorded in terms of accuracy and time required for triage. A total of 108 participants were enrolled, with a mean age of 33.4 years, of whom 57.4% were female. The smart glasses group achieved the highest accuracy in triage level 1, with 98.3% compared to 79.3% in the self-assessment group (P < 0.001). The smart glasses group also completed triage significantly faster than the self-assessment group, with a time of 23.5 versus 72.4 seconds for triage level 1 and 31.3 versus 89.1 seconds for level 2. The use of smart glasses with an augmented reality workflow for triage sieve in MCIs is beneficial, improving both accuracy and evaluation time for patients in triage levels 1 and 2.

Purpose: Unscheduled return visits to the emergency department (ED) were categorized into physician-related, illness-related, and patient-related factors, which are associated with an increased risk of adverse health outcomes, including patient dissatisfaction, infections, hospitalization, transfer to another facility, and mortality. Individuals within 48– 72 hours of the initial visit are deemed at elevated risk for diagnostic or management-related errors. The Point-of-care ultrasound (POCUS) may serve as a bedside tool to reduce medical errors by enhancing diagnostic precision. This study aims to determine the diagnostic accuracy of POCUS for detecting various illnesses in revisited patients in the emergency department. Patients and Methods: A retrospective observational study was conducted on unplanned revisits by patients to the emergency department within 72 hours, spanning the period from January 2023 to September 2024. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were evaluated based on electronic emergency department medical records and ultrasound documentation. Results: Five hundred seventy patients were included in this study. POCUS demonstrated a diagnostic accuracy of 75.61% (95% CI 71.87, 79.09), a sensitivity of 81.87% (95% CI 77.65, 85.58), a specificity of 62.50% (95% CI 55.08, 69.51), a positive likelihood ratio of 2.18 (95% CI 1.80, 2.65), and a negative likelihood ratio of 0.29 (95% CI 0.23, 0.37). Conclusion: POCUS demonstrated greater diagnostic accuracy, which may enhance diagnostic precision in revisited patients with various illnesses.

Multiple casualty incident (MCI) are critical situations mandating an immediate response. Traditionally, members of emergency medical services (EMS) are notified about MCI through radio signals. However, communication failures can lead to delays in activation time of EMS operations. The use of bell signals is proposed as a solution to address these issues. This study uses a retrospective pre-post design evaluating the impact of the bell and radio signal on activation times for EMS operation in MCI. Data were collected from January 2020 to December 2023 and divided into two phases: radio signal use during 2020–2021 (pre-design), and bell signal use during 2022–2023 (post-design). In the event of MCI, the bell or radio is used primarily to alert medical personnel. After the MCI was recognized during the pre-design phase, the dispatcher utilized the radio signal, calling out all EMS personnel twice via radio at 171.425 MHz, with a one-minute interval between communication to notify them of the incident. The ED staff would be informed of these incidents through radio or telephone communication by EMS personnel. In the post-design phase, the dispatcher utilized the bell signal, ringing it three times to alert all staff. Activation time and equipment used by EMS during MCI operations was recorded for both phases. A total of 105 MCI with EMS operations were recorded. In the bell signal group, 52.1% (n = 199) of the participants were male. Mass transportation incidents accounted for the most of the MCI, comprising 73.6% in the bell signal group and 73.1% in the radio signal group. The average activation time was significantly shorter for the bell signal (1.54 min) compared to the radio signal (3.60 min) (P < 0.001). The average response time for the bell signal was 13.20 min, while the radio signal response time averaged 16.10 min (P = 0.042). Early activation time (less than 2 min after EMS dispatch) was significantly more likely in the Bell signal group (adjusted odds ratio, 1.25; 95% confidence interval, 1.10–2.45) than in the Radio signal group. The activation and response times for EMS operations during MCI were significantly reduced by using bell signals to alert EMS staff.