Oxygenation Status, Prehospital Communication, and Mode of Transportation for Critically Ill Patients: A Cross-Sectional Study in Addis Ababa Hospitals

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Management of critically ill patients in emergency settings is highly dependent on prehospital care provision. Therefore, this study aimed to assess clinical profile of critically ill patients' oxygen saturation status, mode of transportation and prehospital communication upon arrival at the emergency department. Methods A prospective cross-sectional study was conducted at two large Addis Ababa governmental hospitals from August 20 to October 20/2023; 202 patients were recruited via convenient technique. The data were collected using a structured questionnaire which was obtained from the previous study, and analyzed using chi-square test and simple descriptive statistics such as frequencies, percentages, and means by SPSS version 27 software. The result has been explained in sentences, graphs, and tables. Results Among 202 study participants, the pattern of prehospital communication and hypoxia were 34/202 (16.8%) and 174/202 (86%) respectively. Ambulance usage was 94/202 (46%), with no statistically significant relationship between mode of arrival and oxygenation status. Conclusion and Recommendation This study highlights the inadequacy of prehospital activation and airway management emphasizing the need for real-time care and prearrival notification to optimize patient outcomes. The evidence of this paper indicated an urge for the Ministry of Health to implement well-equipped emergency medical care systems that ensure advanced resuscitation at the scene and during ambulance transfers and facilitate central prehospital communication to activate the accepting team. Critical Care & Emergency Medicine Critical illness Oxygenation status Prehospital communication Mode of arrival Figures Figure 1 Introduction Critical illness is any sickness or injury characterized by the failure of an important organ and a high risk of life-threatening conditions that necessitate prompt action beginning on the scene( 1 ). It has gained much attention in industrialized nations where sophisticated emergency medical services have been established to provide the best prehospital care to reduce mortality and morbidity( 2 ). However, little has changed in developing countries despite the rising burden due to increased urbanization, the appearance of new diseases, higher life expectancies, trauma, human-made disasters, and greater access to hospitals leading to a high number of preventable premature deaths and disabilities( 3 – 15 ). Therefore, the number of ED visits requiring critical care is periodically increasing at a rate disproportionate to the overall number of ED visits, necessitating the provision of prehospital care to reduce bad clinical outcomes( 16 , 17 ). According to the ABCDE approach, airway resuscitation and maintaining oxygen saturation is the cornerstone of initial care for patients with life-threatening conditions in both prehospital and hospital settings to have better prognosis and outcome( 18 ). In addition, for patients with potentially life-threatening vital parameters who are seriously ill or injured, effective communication between prehospital and in-hospital healthcare workers is crucial to improve the patient’s clinical condition in the emergency treatment pathway( 19 – 21 ). Hence EMS optimizes prehospital treatment provision by providing optimal ventilation oxygenation, and prearrival activation, it has been linked to a decrease in morbidity and premature death related to emergency circumstances of impaired airways, making it a preventive core value of the health system ( 22 , 23 ). However, prehospital care in Ethiopia remains immature and is not well-established despite of limited number of private ambulance services in Addis Ababa ( 4 , 5 , 7 ). Due to suboptimal EMS provision, emergency patients are arriving at medical facilities with poor outcomes( 3 , 5 , 9 , 24 , 24 – 27 ). However, inadequate prehospital treatment resulting hypoxia and airway mishandling being pushed to the ED. The extent of pre-arrival communication and the level of contemporary avoidable hypoxia, which is anticipated to be addressed in the prehospital setup, were not examined in any study. Therefore, this study aimed to assess the actual oxygen saturation status, prehospital communication, and mode of transportation of critically ill patients upon arrival at the emergency department and to determine whether the gap at the prehospital setup and/or the ED. Methodology Study design, setting, and period A hospital-based prospective cross-sectional study design was conducted at the EDs of TASH and ZMH which are located in Addis Ababa, Ethiopia. Both of them are large tertiary hospitals in the country. The study was conducted from August 20 to October 20/2023. Source population All patients were seen at TASH and ZMH adult emergency departments during the study period. A total of 5118 individuals were evaluated at ED over the study period. Study population All critically ill patients were seen at the adult emergency department during the study period. 509 cases had been triaged to the red zone. Sample population The study recruited critically ill patients with a high risk of life-threatening conditions, such as a TEWS ≥ 7 and admission to the resuscitation room (red zone); a GCS ≤ 8; and compromised airways, breathing, and circulation. An oxygen saturation level < 94% is considered as hypoxia( 27 ). In this study, 202 critically ill patients were involved Inclusion criteria All adult (age ≥ 14 years) patients who presented to emergency departments and were critically ill and were triaged in the red zone during the study period were included. Exclusion criteria Terminal patients with poor prognosis (only if the patient had a compromised airway and definitive air had been deferred upon arrival to the ED) and COPD patients were excluded to minimize confounding factors. Sample size determination The sample size was calculated by using the formula for cross-sectional study design. Standard deviation corresponding to the 95% confidence interval = 1.96, Proportion of the study population = 0.05, Degree of accuracy required or desired precision (maximum allowable error of the estimate) = 0.03 202 participants have been calculated after Adjusted sample for nonresponse rate. Sampling technique During the study period, all critically ill adult patients who met the inclusion criteria and visited the ED on a week working day were included in the sample by using a convenient method. Data Collection tools and Procedures Data were collected on patient ED arrival on a prospective basis after preparing a structured questionnaire in English, which was prepared using prior related literature ( 27 ). The structured format was filled out by trained data collectors and reviewed by the principal investigator (PI). Data Quality Assurance The accuracy and consistency of the data were checked daily by the PI during data collection. Data analysis Data taken from patients were coded, and the registry was entered into the computer using Epi Info 7.2.4 and then transferred to the SPSS version 27 software program for further analysis. The chi-square test and simple descriptive statistics such as frequencies, percentages and means were employed to characterize the variables. Study Variables Independent variables The independent variables were age, sex, site of the scene, comorbid illness, prehospital treatment provision, mode of arrival, prearrival communication, and referral. Dependent (outcome) variables These included the prevalence of patients who presented to the ED with hypoxia, prehospital communication, and the mode of transportation upon ED arrival. The relationship between oxygen saturation status and mode of arrival was also another outcome variable. Ethical considerations This study was approved by the Institutional Review Board (IRB Ref.No.EM/SM/558/2016 dated 22-August-2023). The IRB of the department granted ethical approval before the study could begin. Then, the staff of the documentation was briefed on the purpose of the study. Results In this study, the majority of critically sick patients 174 (86%) were hypoxic up on ED arrival. During the prehospital transfer, 63 (31.2%) of the patients received oxygen therapy through endotracheal intubation 3 (1.5%), face mask 6 (3%), FM via reservoirs 2 (1%), and nasal pronging 52 (25.7%). Up on the time of arrival at the ED, 43 (21.3%) of patients required invasive ventilation. Emergency airway management at the ED was employed, as shown in Fig. 1. Less than half 94 (46.5%) of the seriously ill patients were transported via ambulances . A chi-square test of independence was performed to evaluate the relationship between the mode of transportation and oxygen saturation status. The relationships between these variables were not significant, x2(1, N = 202) = 2.520, P = 0.112). However, the ambulance mode of arrival (44.1%) was less likely to be hypoxic than other means of transportation (55.9%) on ED arrival from the cross-tabulation table. Prehospital communication between the treating team and the prehospital system about the clinical condition of the patients accounted for only 34 (16.8%) of the patients. The baseline characteristics upon arrival at the emergency department are shown in Table 1 . There were no comorbidities in 51 (25%) of the patients. Table 1 Baseline characteristics Characteristics Number (%) Male 117 (57.9%) Female 85 (42.1%) Trauma victims 23 (11.4%) Nontrauma victims 179 (88.6%) Prehospital oxygen support status No oxygen treatment was given Oxygen therapy during prehospital transfer INO2 Facemask Facemask with reservoir Intubation 138 (68.3%) 63 (29.7%) 52 (25.7%) 6 (3%) 2 (1%) 3 (1.5%) Mode of transportation to the ED Ambulance Taxi Police car Man supported On foot 94 (46.5%) 95 (47%) 2 (1%) 3 (1.5%) 8 (4%) Oxygen saturation status 93–100% ≤ 93% 28 (13.9%) 174 (86.1%) TEWS Minimum 5, maximum 14, mean 7.5 Chronic illness No comorbidity With comorbidity 51 (25.2%) 151 (74.8%) Status of Referral Home Police Health center Hospital 84 (41.6%) 3 (1.5%) 80 (39.6%) 35 (17.3%) Discussion According to the findings of the current study, there was a high prevalence of hypoxia and poor prehospital activation for the participants when they arrived at the ED. The relationship between mode of arrival and oxygen saturation status was not statistically significant(P = 0.112). In this study, overall hypoxia for the participants was 174/202 (86%) and invasive ventilation requirement was 43/202 (21.3%) upon ED arrival. While Comparing the finding of current study with a related study conducted in India, the latter found that patients were less desaturated and demanded intubation upon arriving at the ED ( 27 ). Among all patients, only 55% were hypoxic, and 19.7% were requiring invasive ventilation in the previous study. Moreover, the percentage of patients who received oxygen therapy during prehospital transfer was only 20.9% in the previous study, lower than that in the current investigation 63/202 (31.2%). The possible reason for the observed difference could be our observational study may be focused on a group of patients who were especially sicker than those in other studies. Unlike the present study, the study population in India may have a chance to be included in the study despite of low triage early warning score. According to their method of transportation , a superior ambulance mode of arrival was observed in the current study (46.5%) compared to India( 27 ). Nevertheless, in a prior study, only 31% of patients were transported in ambulances with a reminder using different modes of transportation. Besides, the current study has been also compared with the previous study conducted in Ethiopia's large cities. Ambulance mode of transportation was 20.3% and 22.7% in Addis Ababa and Mekelle city respectively( 4 , 7 ). Ambulance mode of arrival was increased in the current study. The possible reason may be because more expanding awareness of the community, and the availability of private wing ambulances increased the chance of ambulance utilization. The study has also examined the oxygen saturation status of participants who arrived through ambulance means of transportation. According to a previous study conducted in India, two-thirds (94/141) of the patients brought by ambulance received oxygen therapy, and many (70/94) remained hypoxic( 27 ). However, in patients who were transported by ambulance in the current study, fewer participants (60/95 [63%]) received oxygen therapy and a larger number of individuals (50/60 [83%]) remained hypoxic compared to the previous. The explanation may be ambulance transportation was not well organized with prehospital resuscitation and oxygen was given without considering the demand for ventilation and oxygenation strategy. Of the 202 critical patients, only 34 [16.8%] had prehospital communication in the current study. A related study has been conducted about the quality of prehospital notifications and teleconsultation involving patients in life-threatening conditions significantly improved patients’ vital parameters( 19 – 21 , 28 ). However, none of them stated about the status of prearrival activation. This is the first study of its kind in Ethiopia to evaluate prehospital activation at ED arrival. Although there is no global standard for appropriate prehospital notification rate, the proportion of prehospital communication was lower than expected in the current study. The lack of a robust liaison office and an organized EMS establishment are possible explanations for the scarcity of clear communication on patients' clinical conditions between the prehospital system and the treating staff within the facility. As an implication , even though prehospital care of critically ill patients was extensively studied, there is a paucity of data on the clinical profile of oxygenation status, prearrival communication, and mode of arrival upon presentation at ED in Ethiopia. Therefore, the findings could be used to predict the extent of time-sensitive preventable hypoxia, which is expected to be addressed in the prehospital setup. It could be also the basis for alerting responsible bodies to establish well-equipped centralized EMS to maximize the prognosis and outcome of critical patients. Moreover, the evaluation of prehospital communication influences the course of care for critically ill patients by allowing for on-site optimization, streamlining interfacility transit, directing destinations based on the availability of service, and providing warnings to prepare essential logistics at the accepting ED. strength and limitation of the study The present study has strengths. This study was conducted prospectively at 2 large governmental hospitals, which allowed for comprehensive analyses. This study is pioneer in our setup making it possible to evaluate airway status and prehospital communication, which serves as a foundation for future research. There was limitation in this study. It was challenging to write up a discussion because there were no more papers on the subject of oxygen saturation status and prehospital communication. Conclusion Most critically sick patients including those transported by ambulances were hypoxic upon arrival at the ED triage. Approximately 1 in 5 patients who developed an airway impairment required invasive ventilation. The study illustrated suboptimal prehospital airway management, which was time-sensitive and expected to be addressed starting at the instant of occurrence everywhere to maximize patient outcomes. Prehospital activation between the treating team and the prehospital system about the clinical status of the patient was also limited. Recommendations To health sectors to have robust liaison offices and well-prepared ED Health care providers to be trained for the provision of prehospital care MOH to establish well-equipped centralized EMS Abbreviations AAFEPCA: Addis Ababa Fire and Emergency Prevention and Control Authority AAU: Addis Ababa University ABCDE: Airway Breathing Circulation Disability Exposure COPD: Chronic obstructive pulmonary disease ECCM: Emergency and Critical Care Medicine ED: Emergency Department EMS: Emergency medical service HSTP-II: Ethiopian Health Sector Transformation Plane II PI: Principal Investigator TASH: Tikur Anbessa Specialized Hospital TEWS: Triage early warning sign ZMH: Zewditu Memorial Hospital Declarations Acknowledgment I would like to express my sincere gratitude to my advisors Dr. Merahi Kefyalew and Dr. Tigist Worku for their input and thorough evaluation in preparing this article. I would also like to thank Addis Ababa University for the opportunity given and approval to conduct this research. Conflict of interest statement and funding This study was funded by Addis Ababa University. The author declined that there is no conflicts of interest. References Towards definitions of critical illness and critical care using concept analysis | BMJ. [cited 2023 Jun 1]. Available from: https://bmjopen.bmj.com/content/12/9/e060972.long Jacobs P, Grabinsky A (2014) Advances in prehospital airway management. Int J Crit Illn Inj Sci 4(1):57–64 Emergency medical care in developing countries: is it worthwhile? - PubMed [Internet]. [cited 2023 Jun 2]. Available from: https://pubmed.ncbi.nlm.nih.gov/12481213/ Menbeu Sultan Y, Abebe YT et al Trends and barriers of emergency medical service use in Addis Ababa; Ethiopia. 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Prehospital notification for major trauma patients requiring emergency hospital transport: A systematic review. Journal of evidence-based medicine [Internet]. Aug [cited 2024 Nov 5];10(3). Available from: https://pubmed.ncbi.nlm.nih.gov/28467026/ Amadi-Obi A, Gilligan P, Owens N, O’Donnell C (2014) Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment. Int J Emerg Med 7:29 B M, Ap VKGOPCAG P, Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study. BMJ open [Internet]. 2020 Jun 21 [cited 2024 Nov 5];10(6). Available from: https://pubmed.ncbi.nlm.nih.gov/32565447/ Sasser S, Varghese M, Kellermann A, Lormand JD (2005) Prehospital Trauma Care Systems. World Health Organization, Geneva. - Google Search [Internet]. [cited 2023 Jun 1] Mahama MN, Kenu E, Bandoh DA, Zakariah AN (2018) Emergency response time and pre-hospital trauma survival rate of the national ambulance service, Greater Accra (January - December 2014). BMC Emerg Med 18(1):33 Germa F, Balegh T, Kebede T, Bartolomeous K (2013) Emergency medicine development in Ethiopia:Challenges,progress and possibilities. Afr J Emerg Med Sultan M, Abebe Y, Tsadik AW, Jennings CA, Mould-Millman NK (2018) Epidemiology of ambulance utilized patients in Addis Ababa, Ethiopia. BMC Health Serv Res [Internet] Nielsen K, Mock C, Joshipura M, Rubiano AM, Zakariah A, Rivara F (2012) Assessment of the status of prehospital care in 13 low- and middle-income countries. Prehosp Emerg Care 16(3):381–389 Murugan S, Kurien AS, Abhilash KPP Airway status at arrival to the Emergency department among patients with life threatening emergencies. Journal of Family Medicine and Primary Care [Internet]. 2020 Dec 31 [cited 2023 Jun 2];9(12):6000. Available from: https://journals.lww.com/jfmpc/Fulltext/2020/09120/Airway_status_at_arrival_to_the_Emergency.32.aspx Handolin LE, Jääskeläinen J (2008) Pre-notification of arriving trauma patient at trauma centre: a retrospective analysis of the information in 700 consecutive cases. Scand J Trauma Resusc Emerg Med 16:15 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5742088","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":396198641,"identity":"3a501af1-b60f-4121-9645-b8766ba5a478","order_by":0,"name":"Mayete Endale Birhane","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYFCDA8wNDB8gTAMiVIMJxgbGGXAtCURqYeYhRotu+xnDxx8YbPL4jh9sfGxTY5fYwN68geHjD9xazM7kGBscYEgrljyT2Gyccyw5sYHnWAHjDDy2mB3IMZM4wHA4ccOBxDbpHDbmxAaJHANmHnxazr8x/3GA4X/ihvMP239b/KtPbJB/Y8D8B5+WGzlmQO8fSNxwI7GNmbHtMNAWHgNmfN43u/GsWOKMQXLizBsPmyV7+44bt/GkFRzsScPnsOSNHyoq7BL7zicf/PDjW7VsP/vhjQ9+2ODWwsDAYYAa3WwM0IjCDdgf4JcfBaNgFIyCUQAAfdBbPHGFWWsAAAAASUVORK5CYII=","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Mayete","middleName":"Endale","lastName":"Birhane","suffix":""}],"badges":[],"createdAt":"2024-12-31 13:03:25","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5742088/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5742088/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72740609,"identity":"18c62f38-0034-4067-b422-2a8778900626","added_by":"auto","created_at":"2025-01-01 09:33:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30644,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5742088/v1/21ac58e710ba4daeba1defa4.png"},{"id":72741297,"identity":"432f3b2e-0f02-4e61-ba98-d255cb6b78ac","added_by":"auto","created_at":"2025-01-01 09:41:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":426614,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5742088/v1/e6e839b9-f650-47ef-a8a3-29af5c42c472.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eOxygenation Status, Prehospital Communication, and Mode of Transportation for Critically Ill Patients: A Cross-Sectional Study in Addis Ababa Hospitals\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCritical illness is any sickness or injury characterized by the failure of an important organ and a high risk of life-threatening conditions that necessitate prompt action beginning on the scene(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It has gained much attention in industrialized nations where sophisticated emergency medical services have been established to provide the best prehospital care to reduce mortality and morbidity(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). However, little has changed in developing countries despite the rising burden due to increased urbanization, the appearance of new diseases, higher life expectancies, trauma, human-made disasters, and greater access to hospitals leading to a high number of preventable premature deaths and disabilities(\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, the number of ED visits requiring critical care is periodically increasing at a rate disproportionate to the overall number of ED visits, necessitating the provision of prehospital care to reduce bad clinical outcomes(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). According to the ABCDE approach, airway resuscitation and maintaining oxygen saturation is the cornerstone of initial care for patients with life-threatening conditions in both prehospital and hospital settings to have better prognosis and outcome(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In addition, for patients with potentially life-threatening vital parameters who are seriously ill or injured, effective communication between prehospital and in-hospital healthcare workers is crucial to improve the patient\u0026rsquo;s clinical condition in the emergency treatment pathway(\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHence EMS optimizes prehospital treatment provision by providing optimal ventilation oxygenation, and prearrival activation, it has been linked to a decrease in morbidity and premature death related to emergency circumstances of impaired airways, making it a preventive core value of the health system (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, prehospital care in Ethiopia remains immature and is not well-established despite of limited number of private ambulance services in Addis Ababa (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Due to suboptimal EMS provision, emergency patients are arriving at medical facilities with poor outcomes(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, inadequate prehospital treatment resulting hypoxia and airway mishandling being pushed to the ED. The extent of pre-arrival communication and the level of contemporary avoidable hypoxia, which is anticipated to be addressed in the prehospital setup, were not examined in any study. Therefore, this study aimed to assess the actual oxygen saturation status, prehospital communication, and mode of transportation of critically ill patients upon arrival at the emergency department and to determine whether the gap at the prehospital setup and/or the ED.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, setting, and period\u003c/h2\u003e \u003cp\u003eA hospital-based prospective cross-sectional study design was conducted at the EDs of TASH and ZMH which are located in Addis Ababa, Ethiopia. Both of them are large tertiary hospitals in the country. The study was conducted from August 20 to October 20/2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSource population\u003c/h3\u003e\n\u003cp\u003eAll patients were seen at TASH and ZMH adult emergency departments during the study period. A total of 5118 individuals were evaluated at ED over the study period.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eAll critically ill patients were seen at the adult emergency department during the study period. 509 cases had been triaged to the red zone.\u003c/p\u003e\n\u003ch3\u003eSample population\u003c/h3\u003e\n\u003cp\u003eThe study recruited critically ill patients with a high risk of life-threatening conditions, such as a TEWS\u0026thinsp;\u0026ge;\u0026thinsp;7 and admission to the resuscitation room (red zone); a GCS\u0026thinsp;\u0026le;\u0026thinsp;8; and compromised airways, breathing, and circulation. An oxygen saturation level\u0026thinsp;\u0026lt;\u0026thinsp;94% is considered as hypoxia(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In this study, 202 critically ill patients were involved\u003c/p\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003eAll adult (age\u0026thinsp;\u0026ge;\u0026thinsp;14 years) patients who presented to emergency departments and were critically ill and were triaged in the red zone during the study period were included.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003eTerminal patients with poor prognosis (only if the patient had a compromised airway and definitive air had been deferred upon arrival to the ED) and COPD patients were excluded to minimize confounding factors.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated by using the formula for cross-sectional study design.\u003c/p\u003e \u003cp\u003eStandard deviation corresponding to the 95% confidence interval\u0026thinsp;=\u0026thinsp;1.96, Proportion of the study population\u0026thinsp;=\u0026thinsp;0.05, Degree of accuracy required or desired precision (maximum allowable error of the estimate)\u0026thinsp;=\u0026thinsp;0.03\u003c/p\u003e \u003cp\u003e202 participants have been calculated after Adjusted sample for nonresponse rate.\u003c/p\u003e\n\u003ch3\u003eSampling technique\u003c/h3\u003e\n\u003cp\u003eDuring the study period, all critically ill adult patients who met the inclusion criteria and visited the ED on a week working day were included in the sample by using a convenient method.\u003c/p\u003e \u003cp\u003eData Collection tools and Procedures\u003c/p\u003e \u003cp\u003eData were collected on patient ED arrival on a prospective basis after preparing a structured questionnaire in English, which was prepared using prior related literature (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The structured format was filled out by trained data collectors and reviewed by the principal investigator (PI).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Quality Assurance\u003c/h2\u003e \u003cp\u003eThe accuracy and consistency of the data were checked daily by the PI during data collection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData taken from patients were coded, and the registry was entered into the computer using Epi Info 7.2.4 and then transferred to the SPSS version 27 software program for further analysis. The chi-square test and simple descriptive statistics such as frequencies, percentages and means were employed to characterize the variables.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStudy Variables\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003eThe independent variables were age, sex, site of the scene, comorbid illness, prehospital treatment provision, mode of arrival, prearrival communication, and referral.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDependent (outcome) variables\u003c/h2\u003e \u003cp\u003eThese included the prevalence of patients who presented to the ED with hypoxia, prehospital communication, and the mode of transportation upon ED arrival. The relationship between oxygen saturation status and mode of arrival was also another outcome variable.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eThis study was approved by the Institutional Review Board (IRB Ref.No.EM/SM/558/2016 dated 22-August-2023). The IRB of the department granted ethical approval before the study could begin. Then, the staff of the documentation was briefed on the purpose of the study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, the majority of critically sick patients 174 (86%) were \u003cstrong\u003ehypoxic\u003c/strong\u003e up on ED arrival. During the prehospital transfer, 63 (31.2%) of the patients received oxygen therapy through endotracheal intubation 3 (1.5%), face mask 6 (3%), FM via reservoirs 2 (1%), and nasal pronging 52 (25.7%). Up on the time of arrival at the ED, 43 (21.3%) of patients required invasive ventilation. Emergency airway management at the ED was employed, as shown in Fig. 1.\u003c/p\u003e\n\u003cp\u003eLess than half 94 (46.5%) of the seriously ill patients were transported \u003cstrong\u003evia ambulances\u003c/strong\u003e. A chi-square test of independence was performed to evaluate the relationship between the mode of transportation and oxygen saturation status. The relationships between these variables were not significant, x2(1, N\u0026thinsp;=\u0026thinsp;202)\u0026thinsp;=\u0026thinsp;2.520, P\u0026thinsp;=\u0026thinsp;0.112). However, the ambulance mode of arrival (44.1%) was less likely to be hypoxic than other means of transportation (55.9%) on ED arrival from the cross-tabulation table. \u003cstrong\u003ePrehospital communication\u003c/strong\u003e between the treating team and the prehospital system about the clinical condition of the patients accounted for only 34 (16.8%) of the patients. The baseline characteristics upon arrival at the emergency department are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. There were no comorbidities in 51 (25%) of the patients.\u0026nbsp;\u003c/p\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117 (57.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 (42.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrauma victims\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (11.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNontrauma victims\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e179 (88.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrehospital oxygen support status\u003c/p\u003e\n \u003cp\u003eNo oxygen treatment was given\u003c/p\u003e\n \u003cp\u003eOxygen therapy during prehospital transfer\u003c/p\u003e\n \u003cp\u003eINO2\u003c/p\u003e\n \u003cp\u003eFacemask\u003c/p\u003e\n \u003cp\u003eFacemask with reservoir\u003c/p\u003e\n \u003cp\u003eIntubation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e138 (68.3%)\u003c/p\u003e\n \u003cp\u003e63 (29.7%)\u003c/p\u003e\n \u003cp\u003e52 (25.7%)\u003c/p\u003e\n \u003cp\u003e6 (3%)\u003c/p\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003cp\u003e3 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMode of transportation to the ED\u003c/p\u003e\n \u003cp\u003eAmbulance\u003c/p\u003e\n \u003cp\u003eTaxi\u003c/p\u003e\n \u003cp\u003ePolice car\u003c/p\u003e\n \u003cp\u003eMan supported\u003c/p\u003e\n \u003cp\u003eOn foot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e94 (46.5%)\u003c/p\u003e\n \u003cp\u003e95 (47%)\u003c/p\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003cp\u003e3 (1.5%)\u003c/p\u003e\n \u003cp\u003e8 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOxygen saturation status\u003c/p\u003e\n \u003cp\u003e93\u0026ndash;100%\u003c/p\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;93%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e28 (13.9%)\u003c/p\u003e\n \u003cp\u003e174 (86.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTEWS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimum 5, maximum 14, mean 7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic illness\u003c/p\u003e\n \u003cp\u003eNo comorbidity\u003c/p\u003e\n \u003cp\u003eWith comorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e51 (25.2%)\u003c/p\u003e\n \u003cp\u003e151 (74.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStatus of Referral\u003c/p\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003cp\u003ePolice\u003c/p\u003e\n \u003cp\u003eHealth center\u003c/p\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e84 (41.6%)\u003c/p\u003e\n \u003cp\u003e3 (1.5%)\u003c/p\u003e\n \u003cp\u003e80 (39.6%)\u003c/p\u003e\n \u003cp\u003e35 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to the findings of the current study, there was a high prevalence of hypoxia and poor prehospital activation for the participants when they arrived at the ED. The relationship between mode of arrival and oxygen saturation status was not statistically significant(P\u0026thinsp;=\u0026thinsp;0.112).\u003c/p\u003e \u003cp\u003eIn this study, overall hypoxia for the participants was 174/202 (86%) and invasive ventilation requirement was 43/202 (21.3%) upon ED arrival. While Comparing the finding of current study with a related study conducted in India, the latter found that patients were less desaturated and demanded intubation upon arriving at the ED (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Among all patients, only 55% were hypoxic, and 19.7% were requiring invasive ventilation in the previous study. Moreover, the percentage of patients who received oxygen therapy during prehospital transfer was only 20.9% in the previous study, lower than that in the current investigation 63/202 (31.2%). The possible reason for the observed difference could be our observational study may be focused on a group of patients who were especially sicker than those in other studies. Unlike the present study, the study population in India may have a chance to be included in the study despite of low triage early warning score.\u003c/p\u003e \u003cp\u003eAccording to their \u003cb\u003emethod of transportation\u003c/b\u003e, a superior ambulance mode of arrival was observed in the current study (46.5%) compared to India(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Nevertheless, in a prior study, only 31% of patients were transported in ambulances with a reminder using different modes of transportation. Besides, the current study has been also compared with the previous study conducted in Ethiopia's large cities. Ambulance mode of transportation was 20.3% and 22.7% in Addis Ababa and Mekelle city respectively(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Ambulance mode of arrival was increased in the current study. The possible reason may be because more expanding awareness of the community, and the availability of private wing ambulances increased the chance of ambulance utilization.\u003c/p\u003e \u003cp\u003eThe study has also examined the oxygen saturation status of participants who arrived through ambulance means of transportation. According to a previous study conducted in India, two-thirds (94/141) of the patients brought by ambulance received oxygen therapy, and many (70/94) remained hypoxic(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, in patients who were transported by ambulance in the current study, fewer participants (60/95 [63%]) received oxygen therapy and a larger number of individuals (50/60 [83%]) remained hypoxic compared to the previous. The explanation may be ambulance transportation was not well organized with prehospital resuscitation and oxygen was given without considering the demand for ventilation and oxygenation strategy.\u003c/p\u003e \u003cp\u003eOf the 202 critical patients, only 34 [16.8%] had prehospital communication in the current study. A related study has been conducted about the quality of prehospital notifications and teleconsultation involving patients in life-threatening conditions significantly improved patients\u0026rsquo; vital parameters(\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, none of them stated about the status of prearrival activation. This is the first study of its kind in Ethiopia to evaluate prehospital activation at ED arrival. Although there is no global standard for appropriate prehospital notification rate, the proportion of prehospital communication was lower than expected in the current study. The lack of a robust liaison office and an organized EMS establishment are possible explanations for the scarcity of clear \u003cb\u003ecommunication\u003c/b\u003e on patients' clinical conditions between the prehospital system and the treating staff within the facility.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAs an implication\u003c/b\u003e, even though prehospital care of critically ill patients was extensively studied, there is a paucity of data on the clinical profile of oxygenation status, prearrival communication, and mode of arrival upon presentation at ED in Ethiopia. Therefore, the findings could be used to predict the extent of time-sensitive preventable hypoxia, which is expected to be addressed in the prehospital setup. It could be also the basis for alerting responsible bodies to establish well-equipped centralized EMS to maximize the prognosis and outcome of critical patients. Moreover, the evaluation of prehospital communication influences the course of care for critically ill patients by allowing for on-site optimization, streamlining interfacility transit, directing destinations based on the availability of service, and providing warnings to prepare essential logistics at the accepting ED.\u003c/p\u003e \u003cp\u003estrength and limitation of the study\u003c/p\u003e \u003cp\u003eThe present study has strengths. This study was conducted prospectively at 2 large governmental hospitals, which allowed for comprehensive analyses. This study is pioneer in our setup making it possible to evaluate airway status and prehospital communication, which serves as a foundation for future research. There was limitation in this study. It was challenging to write up a discussion because there were no more papers on the subject of oxygen saturation status and prehospital communication.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMost critically sick patients including those transported by ambulances were hypoxic upon arrival at the ED triage. Approximately 1 in 5 patients who developed an airway impairment required invasive ventilation. The study illustrated suboptimal prehospital airway management, which was time-sensitive and expected to be addressed starting at the instant of occurrence everywhere to maximize patient outcomes. Prehospital activation between the treating team and the prehospital system about the clinical status of the patient was also limited.\u003c/p\u003e"},{"header":"Recommendations","content":" \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTo health sectors to have robust liaison offices and well-prepared ED\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHealth care providers to be trained for the provision of prehospital care\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMOH to establish well-equipped centralized EMS\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAAFEPCA: Addis Ababa Fire and Emergency Prevention and Control Authority\u003c/p\u003e\n\u003cp\u003eAAU: Addis Ababa University\u003c/p\u003e\n\u003cp\u003eABCDE: Airway Breathing Circulation Disability Exposure\u003c/p\u003e\n\u003cp\u003eCOPD: Chronic obstructive pulmonary disease\u003c/p\u003e\n\u003cp\u003eECCM: Emergency and Critical Care Medicine\u003c/p\u003e\n\u003cp\u003eED: Emergency Department\u003c/p\u003e\n\u003cp\u003eEMS: Emergency medical service\u003c/p\u003e\n\u003cp\u003eHSTP-II: Ethiopian Health Sector Transformation Plane II\u003c/p\u003e\n\u003cp\u003ePI: Principal Investigator\u003c/p\u003e\n\u003cp\u003eTASH: Tikur Anbessa Specialized Hospital\u003c/p\u003e\n\u003cp\u003eTEWS: Triage early warning sign\u003c/p\u003e\n\u003cp\u003eZMH: Zewditu Memorial Hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgment\u003c/h2\u003e \u003cp\u003eI would like to express my sincere gratitude to my advisors Dr. Merahi Kefyalew and Dr. Tigist Worku for their input and thorough evaluation in preparing this article. I would also like to thank Addis Ababa University for the opportunity given and approval to conduct this research.\u003c/p\u003e \u003cp\u003eConflict of interest statement and funding\u003c/p\u003e \u003cp\u003eThis study was funded by Addis Ababa University.\u003c/p\u003e \u003cp\u003eThe author declined that there is no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTowards definitions of critical illness and critical care using concept analysis | BMJ. [cited 2023 Jun 1]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmjopen.bmj.com/content/12/9/e060972.long\u003c/span\u003e\u003cspan address=\"https://bmjopen.bmj.com/content/12/9/e060972.long\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacobs P, Grabinsky A (2014) Advances in prehospital airway management. 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Scand J Trauma Resusc Emerg Med 16:15\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Addis Ababa University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Critical illness, Oxygenation status, Prehospital communication, Mode of arrival","lastPublishedDoi":"10.21203/rs.3.rs-5742088/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5742088/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of critical illness is increasing, posing a time-sensitive challenge to healthcare systems globally. Management of critically ill patients in emergency settings is highly dependent on prehospital care provision. Therefore, this study aimed to assess clinical profile of critically ill patients' oxygen saturation status, mode of transportation and prehospital communication upon arrival at the emergency department.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective cross-sectional study was conducted at two large Addis Ababa governmental hospitals from August 20 to October 20/2023; 202 patients were recruited via convenient technique. The data were collected using a structured questionnaire which was obtained from the previous study, and analyzed using chi-square test and simple descriptive statistics such as frequencies, percentages, and means by SPSS version 27 software. The result has been explained in sentences, graphs, and tables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 202 study participants, the pattern of prehospital communication and hypoxia were 34/202 (16.8%) and 174/202 (86%) respectively. Ambulance usage was 94/202 (46%), with no statistically significant relationship between mode of arrival and oxygenation status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study highlights the inadequacy of prehospital activation and airway management emphasizing the need for real-time care and prearrival notification to optimize patient outcomes. The evidence of this paper indicated an urge for the Ministry of Health to implement well-equipped emergency medical care systems that ensure advanced resuscitation at the scene and during ambulance transfers and facilitate central prehospital communication to activate the accepting team.\u003c/p\u003e","manuscriptTitle":"Oxygenation Status, Prehospital Communication, and Mode of Transportation for Critically Ill Patients: A Cross-Sectional Study in Addis Ababa Hospitals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-01 09:33:21","doi":"10.21203/rs.3.rs-5742088/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"43bddc42-4e0d-4235-8d2c-c0b23c478bb8","owner":[],"postedDate":"January 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":42224894,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2025-01-04T11:08:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-01 09:33:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5742088","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5742088","identity":"rs-5742088","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}