The transfer rate for patients from an Alternate Care Site (ACS) back to a hospital may serve as a metric of appropriate patient selection and the ability of an ACS to treat moderate to severely ill patients accepted from overwhelmed health-care systems. During the coronavirus infectious disease 2019 (COVID-19) pandemic, hospitals worldwide experienced acute surges of patients presenting with acute respiratory failure.

An ACS in Imperial County, California was re-established in November 2020 to help decompress 2 local hospitals experiencing surges of COVID-19 cases. The patients treated often had multiple comorbid illnesses and required a median supplemental oxygen of 3 L/min (LPM) on admission. Numerous interventions were initiated during a 2-wk period to improve clinical care delivery.

The objectives of this retrospective observational study are to evaluate the impact of these clinical and staff interventions at an ACS on the transfer rate and to provide issues to consider for future ACS sites managing COVID-19 patients.

The data suggest that continuous, real-time process-improvement interventions helped reduce the transfer rate back to hospitals from 36.7% to 14.5% and that an ACS is a viable option for managing symptomatic COVID-19 positive patients requiring hospital-level care when hospitals are overburdened.

The public ambulance system in Ukraine is the primary deliverer of prehospital care for trauma patients in this Eastern European country, but no national assessment has previously been made to ensure the presence of essential medical equipment on these ambulances.

Working with the Ukraine Ministry of Health, our aim was to assess the availability of public ambulances of medical equipment essential for managing traumatic injury using an internationally recognized standard for prehospital care.

We identified 53 Advanced Life Support (ALS) ambulances from randomly selected cities for evaluation. We performed an inventory of available medical equipment and supplies on these ambulances against a matrix of essential equipment for prehospital providers developed by the World Health Organization (WHO).

Essential medical equipment in the categories of personal protection, patient monitoring, hemorrhage control, and immobilization were generally available in the ALS public ambulances surveyed. Deficiencies were noted in equipment and supplies for basic and advanced airway monitoring and management.

Public ALS ambulances across Ukraine are adequately equipped with many essential medical supplies to manage traumatic injury, but have deficiencies in both basic and advanced airway management. Correcting these deficiencies may improve prehospital survival of the traumatically injured patient. The results of this study will enable the Ukraine Ministry of Health to develop requirements of essential medical equipment for all public ALS ambulances in the country, to inform resource allocation decisions, and to guide public health policy regarding prehospital trauma care.

Current methods to evaluate the delivery of urgent prehospital care often rely on inadequate surrogate measures or unreliable self-reported data. A workplace-based strategy may be feasible to assess the delivery of prehospital care by ambulances in selected populations.

To perform a nationwide assessment of the psychomotor performance of public ambulance workers in Ukraine, we created a plan of workplace-based observation. We conducted a post-hoc analysis of this strategy to assess feasibility, strengths, and limitations for future use in assessing prehospital ambulance performance.

With support from the Ministry of Health, we sent teams of trained observers to 30 ambulance substations across Ukraine. Using data collection tools on mobile devices, these observers accompanied Advanced Life Support ambulances on urgent calls for periods of 72 hours. We evaluated this program for collecting patient encounter data against the investment of time, personnel, and financial resources.

Over a two-month period, we directly observed 524 patient encounters by public ambulances responding to urgent calls at 30 ambulance substations across Ukraine. We employed 6 observers and 2 administrators over this time period. Collecting our observations required 2,160 person-hours at the ambulance substations. The total distance traveled to these sites was 11,375 kilometers. Project costs amounted to 37,000 USD, equating to 71 USD per observed patient encounter.

Workplace-based assessments are a cost-effective strategy to collect data on the delivery of prehospital care in select populations. This data can be useful for identifying the current state of EMS care delivered and evaluating compliance with established treatment protocols. Successful implementation depends on effective planning and coordination with a commitment of time, personnel, and financial resources. Issues of patient privacy, legal permission, and observer training must be considered.