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Laparidou D, Curtis F, Wijegoonewardene N, Akanuwe J, Weligamage DD, Koggalage PD, Siriwardena AN. Emergency medical service interventions and experiences during pandemics: A scoping review. PLoS One 2024; 19:e0304672. [PMID: 39088585 PMCID: PMC11293743 DOI: 10.1371/journal.pone.0304672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 05/15/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND The global impact of COVID-19 has been profound, with efforts to manage and contain the virus placing increased pressure on healthcare systems and Emergency Medical Services (EMS) in particular. There has been no previous review of studies investigating EMS interventions or experiences during pandemics. The aim of this scoping review was to identify and present published quantitative and qualitative evidence of EMS pandemic interventions, and how this translates into practice. METHODS Six electronic databases were searched from inception to July 2022, supplemented with internet searches and forward and backward citation tracking from included studies and review articles. A narrative synthesis of all eligible quantitative studies was performed and structured around the aims, key findings, as well as intervention type and content, where appropriate. Data from the qualitative studies were also synthesised narratively and presented thematically, according to their main aims and key findings. RESULTS The search strategy identified a total of 22,599 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 90 studies were included. The quantitative narrative synthesis included seven overarching themes, describing EMS pandemic preparedness plans and interventions implemented in response to pandemics. The qualitative data synthesis included five themes, detailing the EMS workers' experiences of providing care during pandemics, their needs and their suggestions for best practices moving forward. CONCLUSIONS Despite concerns for their own and their families' safety and the many challenges they are faced with, especially their knowledge, training, lack of appropriate Personal Protective Equipment (PPE) and constant protocol changes, EMS personnel were willing and prepared to report for duty during pandemics. Participants also made recommendations for future outbreak response, which should be taken into consideration in order for EMS to cope with the current pandemic and to better prepare to respond to any future ones. TRIAL REGISTRATION The review protocol was registered with the Open Science Framework (osf.io/2pcy7).
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Affiliation(s)
- Despina Laparidou
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, United Kingdom
| | - Ffion Curtis
- Department of Health Data Science, Liverpool Reviews & Implementation Group (LRiG), Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Nimali Wijegoonewardene
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, United Kingdom
- Ministry of Health, Colombo, Sri Lanka
| | - Joseph Akanuwe
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, United Kingdom
| | - Dedunu Dias Weligamage
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, United Kingdom
- Ministry of Health, Colombo, Sri Lanka
| | - Prasanna Dinesh Koggalage
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, United Kingdom
- Ministry of Health, Colombo, Sri Lanka
| | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, United Kingdom
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Yoshida T, Chude-Sokei R, Araji T, Adra S. Impact of COVID-19 Pandemic Surge on Surgical Outcomes: A Retrospective Study. Am Surg 2024; 90:1224-1233. [PMID: 38215308 DOI: 10.1177/00031348241227213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND The COVID-19 pandemic posed significant challenges to healthcare systems worldwide, including surgical care. While many studies examined the effect of the pandemic on different patient outcomes, there are none to date examining the impact of the pandemic surge on surgical outcomes. Our aim is to evaluate the impact of the COVID-19 surges on surgical outcomes using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS A single-center retrospective analysis of 7436 patients who underwent surgery between February 2020 and December 2022 was conducted. Patients were divided into those who underwent surgery during the surge of the pandemic (n = 1217) or outside that period (n = 6219). Primary outcomes were 30-day mortality and morbidity. Secondary outcomes included 30-day mortality, operation time, transfusion, reoperation, and specific postoperative complications. Multivariable logistic regression was used in our analysis. All analyses were conducted using the software "R" version 4.2.1. Statistical significance was set at α = .05 level. RESULTS After adjusting for confounders, we found no significant difference in 30-day mortality and morbidity (OR: 1.06, 95% CI: .89-1.226, P = .5173) or 30-day mortality only (OR: 1.39, 95% CI: .788-2.14, P = .1364) between the two groups. No significant differences were observed in secondary outcomes. Sensitivity analyses yielded similar results to the multivariable logistic regression. CONCLUSION We found no evidence of increased 30-day mortality and morbidity in patients undergoing surgery during the COVID-19 surges compared to those undergoing surgery outside that period. Our results suggest that surgical care was maintained despite the challenges of the pandemic surges.
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Affiliation(s)
- Takuto Yoshida
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Tarek Araji
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Souheil Adra
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Cárdaba-García RM, Soto-Cámara R, García-Santa-Basilia N, Matellán-Hernández MP, Onrubia-Baticón H, Martínez-Caballero CM, Thuissard-Vasallo IJ, Navalpotro-Pascual S. Impact of the COVID-19-pandemic and perception of self-efficacy on the mental health of out-of-hospital emergency healthcare professionals by modality of care. J Adv Nurs 2024. [PMID: 38444126 DOI: 10.1111/jan.16119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/19/2023] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To analyse the influence of the COVID-19 pandemic and the perception of self-efficacy on the health professionals of the Spanish out-of-hospital emergency services. DESIGN Observational, cross-sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February-30 April, 2021). METHODS The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self-efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self-efficacy on mental health. RESULTS The means of the sample for stress, anxiety, depression and self-efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self-efficacy. Self-efficacy had a direct effect on the mental health for working in patient care. CONCLUSIONS Healthcare workers showed moderate stress, severe anxiety, mild depression and good self-efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self-efficacy is a determining factor of mental health in the direct care modality. IMPLICATIONS The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out-of-hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self-efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk. REPORTING METHOD We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros - ASISA Foundation (Spain). PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.
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Affiliation(s)
- Rosa María Cárdaba-García
- Nursing Department, Faculty of Nursing, University of Valladolid, Valladolid, Spain
- Nursing Care Research (GICE), Faculty of Nursing, University of Valladolid, Valladolid, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
| | - Raúl Soto-Cámara
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Department of Health Sciences, University of Burgos, Burgos, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | - Noemi García-Santa-Basilia
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | - María Paz Matellán-Hernández
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | - Henar Onrubia-Baticón
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | - Carmen María Martínez-Caballero
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Emergency Medical Service of Castilla y León-Sacyl, Valladolid, Spain
| | | | - Susana Navalpotro-Pascual
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), Madrid, Spain
- Department of Nursing, Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
- Emergency Medical Service of Madrid-SUMMA 112, Madrid, Spain
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Dax F, Waibel M, Kneißl K, Prückner S, Lazarovici M, Hoffmann F, Hegenberg K. Analyzing emergency call volume, call durations, and unanswered calls during the first two waves of the COVID-19 pandemic compared to 2019: An observational study of routine data from seven bavarian dispatch centres. Heliyon 2024; 10:e24839. [PMID: 38333836 PMCID: PMC10850415 DOI: 10.1016/j.heliyon.2024.e24839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/07/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Background The spread of the COVID-19 pandemic and the corresponding implementation of measures such as stay-at-home orders and curfews had a major impact on health systems, including emergency medical services. This study examined the effect of the pandemic on call volumes, duration of calls and unanswered calls to the emergency number 112. Method For this retrospective, descriptive study, 986,650 calls to seven emergency dispatch centres in Bavaria between January 01, 2019 and May 31, 2021 were analysed. The absolute number of calls and calls per 100,000 inhabitants as well as the number of unanswered calls are reported. The Mann‒Whitney U test was used to compare mean call durations between 2019 and 2020/2021 during several periods. Results Call volume declined during the pandemic, especially during periods with strict lockdown restrictions. The largest decline (-12.9 %) occurred during the first lockdown. The largest reduction in the number of emergency calls overall (-25.3 %) occurred on weekends during the second lockdown. Emergency call duration increased, with the largest increase (+13 s) occurring during the "light" lockdown. The number of unanswered calls remained at a similar level as before the pandemic. Conclusion This study showed that the studied Bavarian dispatch centres experienced lower call volumes and longer call durations during the first two waves of the COVID-19 pandemic (up to May 2021). Longer call durations could be the result of additional questions to identify potentially infectious patients. The fact that the number of unanswered calls hardly changed may indicate that the dispatch centres were not overwhelmed during the study period.
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Affiliation(s)
- Florian Dax
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Germany
| | - Moritz Waibel
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Germany
| | - Katharina Kneißl
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Germany
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Germany
| | - Marc Lazarovici
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Germany
| | - Florian Hoffmann
- Dr. von Haunersches Kinderspital, Kinderklinik und Kinderpoliklinik, Klinikum der Universität München, LMU München, Lindwurmstr. 4, 80337, München, Germany
| | - Kathrin Hegenberg
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Germany
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Apiratwarakul K, Cheung LW, Pearkao C, Gaysonsiri D, Ienghong K. "Smart Emergency Call Point" Enhancing Emergency Medical Services on University Campuses. Prehosp Disaster Med 2024; 39:32-36. [PMID: 38047357 PMCID: PMC10882551 DOI: 10.1017/s1049023x23006647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
INTRODUCTION The "Smart Emergency Call Point" is a device designed for requesting assistance and facilitating rapid responses to emergencies. The functionality of smart emergency call points has evolved to include features as real-time photo transmission and communication capabilities for both staff and emergency personnel. These devices are being used to request Emergency Medical Services (EMS) on university campuses. Despite these developments, there has been a lack of previous studies demonstrating significant advantages of integrating smart emergency call points into EMS systems. STUDY OBJECTIVE The primary goal of this study was to compare the response times of EMS between traditional phone calls and the utilization of smart emergency call points located on university campuses. Additionally, the study aimed to provide insights into the characteristics of smart emergency call points as a secondary objective. METHODS This retrospective database analysis made use of information acquired from Thailand's EMS at Srinagarind Hospital. The data were gathered over a period of four years, specifically from January 2019 through January 2022. The study included two groups: the first group used the phone number 1669 to request EMS assistance, while the second group utilized the smart emergency call point. The primary focus was on the response times. Additionally, the study documented the characteristics of the smart emergency call points that were used in the study. RESULTS Among the 184 EMS operations included in this study, 60.9% (N = 56) involved females in the smart emergency call point group. Notably, the smart emergency call point group showed a higher frequency of operations between the hours of 6:00am and 6:00pm when compared to the 1669 call group (P = .020). In dispatch triage, the majority of emergency call points were categorized as non-urgent, in contrast to the phone group for 1669 which were primarily cases categorized as urgent (P = .010). The average response time for the smart emergency call point group was significantly shorter, at 6.01 minutes, compared to the phone number 1669 group, which had an average response time of 9.14 minutes (P <.001). CONCLUSION In the context of calling for EMS on a university campus, the smart emergency call points demonstrate a significantly faster response time than phone number 1669 in Thailand. Furthermore, the system also offers the capability to request emergency assistance.
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Affiliation(s)
- Korakot Apiratwarakul
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lap Woon Cheung
- Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong
- Department of Emergency Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chatkhane Pearkao
- Department of Adult Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Dhanu Gaysonsiri
- Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kamonwon Ienghong
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Jafari-Oori M, Dehi M, Ebadi A, Moradian ST, Sadeghi H, Jafari M. Lived experience of Iranian pre-hospital medical staff during the COVID-19 pandemic: a descriptive phenomenological study. Front Psychol 2023; 14:1230892. [PMID: 38235282 PMCID: PMC10793261 DOI: 10.3389/fpsyg.2023.1230892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024] Open
Abstract
Background Pre-hospital medical staff faced numerous challenges during the COVID-19 pandemic. However, these challenges specific to pre-hospital services have not been thoroughly explored in Iran. This qualitative study aimed to examine the essence of pre-hospital care during the COVID-19 pandemic. Methods This phenomenological study was conducted from June to August 2021 in Tehran, Iran. Semi-structured interviews were conducted with pre-hospital medical staff. Data analysis was performed using Colaizzi's approach, and rigor was ensured by adhering to the consolidated criteria for qualitative reporting research. Results A total of 17 pre-hospital medical staff were interviewed, and five themes were extracted from the data: workload and resilience, damage, lack of control, under preparedness, and post-traumatic growth. These themes highlight the resilience demonstrated by pre-hospital medical staff, who faced an unprecedented crisis with limited preparedness and significant damage. Conclusion The findings of this study indicate that pre-hospital medical staff in Iran encountered challenges during the COVID-19 pandemic due to a lack of preparedness and substantial damage. Despite these adversities, the participants exhibited resilience and experienced post-traumatic growth. The study emphasizes the importance of proper planning and preparedness to enhance the resilience of emergency medical services during pandemics. Furthermore, the results underscore the need to address the challenges faced by pre-hospital medical staff and improve the quality of care provided to patients during crises such as the COVID-19 pandemic.
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Affiliation(s)
- Mehdi Jafari-Oori
- Atherosclerosis Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Manigeh Dehi
- Maragheh University of Medical Sciences, Maragheh, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hajar Sadeghi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Kim K, Oh B. Prehospital triage in emergency medical services system: A scoping review. Int Emerg Nurs 2023; 69:101293. [PMID: 37150145 DOI: 10.1016/j.ienj.2023.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/10/2023] [Accepted: 03/26/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND During the prehospital phase, paramedics consider patients' condition according to illness, injury, disease and decide on transport to an appropriate hospital according to severity. This can affect patient survival and treatment prognosis, because despite intervention at this early stage, problems such as incorrect triage of severity and inappropriate hospital selection may occur, indicating a need for improvement in the process. PURPOSE The aim of this review is to identify the overall trend of research conducted on prehospital triage by analyzing the emergency medical services system and presenting future studies to practitioners and researchers. METHODS A scoping review was conducted of existing literature on research trends in relation to prehospital triage. The studies reviewed were identified using electronic databases such as PubMed, CINAHL, Cochrane Library, Web of Science, and Scopus. RESULTS Ninety-eight documents were finally selected and analyzed that focused on prehospital triage status, process accuracy, tools, guidelines, and protocols. CONCLUSION Research is proposed that focuses on various non-traumatic patient types, prehospital triage education, and development of training programs to reduce errors in the emergency patient handover process between prehospital and hospital health professionals and to improve patient health and quality of life.
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Affiliation(s)
- Kisook Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjack-Gu, Seoul, Republic of Korea.
| | - Booyoung Oh
- Department of Nursing, Chung-Ang University, 84 Heukseok-Ro, Dongjack-Gu, Seoul, Republic of Korea.
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Ziebart C, Kfrerer ML, Stanley M, Austin LC. A Digital First Healthcare Approach to Managing Pandemics: A Scoping Review of Pandemic Self-Triage Tools. J Med Internet Res 2023; 25:e40983. [PMID: 37018543 DOI: 10.2196/40983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, many patient-facing digital self-triage tools were designed and deployed to alleviate demand for pandemic virus triage in hospitals and doctors' offices by providing a way for people to self-assess health status and get advice on whether to seek care. These tools, provided via websites, apps, or patient portals allow people to answer questions, e.g., about symptoms and contact history, and receive guidance to appropriate care, which might be self-care. OBJECTIVE The purpose of this scoping review was to explore the state of literature on digital self-triage tools that direct or advise care for adults during a pandemic, and to explore what has been learned about intended purpose, use, and quality of guidance, tool usability, impact on providers, and ability to forecast health outcomes or care demand. METHODS A literature search was conducted in July 2021 using MEDLINE, Embase, Scopus, PsycINFO, CINAHL and Cochrane databases. Using Covidence, 1227 titles and abstracts were screened by two researchers, with 83 reviewed via full text screening. 22 articles met inclusion criteria: they allowed adults to self-assess for pandemic virus and directed to care. Using Microsoft Excel, we extracted and charted the following data: authors, publication year and country, country the tool was used in, whether the tool was integrated into a healthcare system, research question/purpose, direction of care provided, and key findings. RESULTS All but two studies reported on tools developed since early 2020 during the COVID-19 pandemic. Studies reported on tools were developed in 17 countries. Direction of care advice included directing to an ER, seek urgent care, contact/see a doctor, be tested, or to stay at home/self-isolate. Only two studies evaluated tool usability. One used 52 use-cases to evaluate quality of advice by tools in four countries, finding advice varied, e.g., tools in the US and UK often advising staying home when clinical assessment was warranted, while tools in Japan and Singapore advised seeking care. No study demonstrated that the tools reduce demand on the health care system, although at least one suggests data can predict demand for care and data allows monitoring public health. CONCLUSIONS While self-triage tools developed and used around the world have similarities in directing to care (ER, physician, self-care), they also differ in important ways. Some collect data to predict healthcare demand. Some are for use when concerned about health status; others are intended to be used repeatedly by users to monitor public health. Quality of triage may vary. The high use of such tools during the COVID-19 pandemic suggests research is needed to assess and ensure quality of advice given by self-triage tools, and to assess intended or unintended consequences on public health and health care systems. CLINICALTRIAL
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Affiliation(s)
| | | | | | - Laurel C Austin
- Western University, 1201 Western Rd, London, CA
- Ivey Business School, London, CA
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Ebrahimian A, Keshavarz‐Tork A, Akbari‐Shahrestanaki Y, Tourdeh M, Fakhr‐Movahedi A. Changes in the prehospital emergency technician's resilience during the COVID-19 pandemic: A web-based cross-sectional study. Health Sci Rep 2023; 6:e1223. [PMID: 37091356 PMCID: PMC10113882 DOI: 10.1002/hsr2.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
Background and Aims Resilience is a process that enables people to control the stressors of their lives. During the COVID-19 crisis, work stress increased among prehospital emergency technicians. So, it was possible to reduce their resilience. This study aimed to investigate the changes in the prehospital emergency technicians' resilience during the pandemic of COVID-19. Methods A cross-sectional study was conducted at the prehospital emergency department in Qazvin province. For 6 months, 234 emergency technicians participated in this study. Data collection tools included a demographic questionnaire and the emergency medical services resilience scale (EMSRS). Results The Friedman test indicated no significant difference between the mean scores of EMS employees' resilience during 6 months (p > 0.05). However, the correlation matrix between the scores of EMSRS during 6 months indicated that the resilience scores of EMS employees were positively correlated during the study (p < 0.01). Conclusions The EMS technicians' resilience was almost constant and moderate during the 6 months of care for patients with COVID-19 and their transfer to the hospital, indicating that the COVID-19 crisis could suppress the emergency medical technicians ability to increase resilience.
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Affiliation(s)
- Abbasali Ebrahimian
- Health in Emergencies and Disasters Group, Faculty of ParamedicalQom University of Medical SciencesQomIran
- Nursing Care Research CenterSemnan University of Medical SciencesSemnanIran
| | | | - Yousof Akbari‐Shahrestanaki
- Department of Prehospital Emergency Medical Care, School of Paramedical SciencesQazvin University of Medical SciencesQazvinIran
| | - Maedeh Tourdeh
- Anesthesia Department, Faculty of ParamedicalQom University of Medical SciencesQomIran
| | - Ali Fakhr‐Movahedi
- Nursing Care Research CenterSemnan University of Medical SciencesSemnanIran
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Kim YS, Lee SH, Lim HJ, Hong WP. Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea. J Korean Med Sci 2023; 38:e92. [PMID: 36974401 PMCID: PMC10042732 DOI: 10.3346/jkms.2023.38.e92] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/20/2022] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database. METHODS We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC. RESULTS The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96-1.09]). CONCLUSION This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.
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Affiliation(s)
- Young Su Kim
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
| | - Seung Hyo Lee
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
| | - Hyouk Jae Lim
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Won Pyo Hong
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
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Pre-hospital prediction of adverse outcomes in patients with suspected COVID-19: Development, application and comparison of machine learning and deep learning methods. Comput Biol Med 2022; 151:106024. [PMID: 36327887 PMCID: PMC9420071 DOI: 10.1016/j.compbiomed.2022.106024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/02/2022] [Accepted: 08/20/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND COVID-19 infected millions of people and increased mortality worldwide. Patients with suspected COVID-19 utilised emergency medical services (EMS) and attended emergency departments, resulting in increased pressures and waiting times. Rapid and accurate decision-making is required to identify patients at high-risk of clinical deterioration following COVID-19 infection, whilst also avoiding unnecessary hospital admissions. Our study aimed to develop artificial intelligence models to predict adverse outcomes in suspected COVID-19 patients attended by EMS clinicians. METHOD Linked ambulance service data were obtained for 7,549 adult patients with suspected COVID-19 infection attended by EMS clinicians in the Yorkshire and Humber region (England) from 18-03-2020 to 29-06-2020. We used support vector machines (SVM), extreme gradient boosting, artificial neural network (ANN) models, ensemble learning methods and logistic regression to predict the primary outcome (death or need for organ support within 30 days). Models were compared with two baselines: the decision made by EMS clinicians to convey patients to hospital, and the PRIEST clinical severity score. RESULTS Of the 7,549 patients attended by EMS clinicians, 1,330 (17.6%) experienced the primary outcome. Machine Learning methods showed slight improvements in sensitivity over baseline results. Further improvements were obtained using stacking ensemble methods, the best geometric mean (GM) results were obtained using SVM and ANN as base learners when maximising sensitivity and specificity. CONCLUSIONS These methods could potentially reduce the numbers of patients conveyed to hospital without a concomitant increase in adverse outcomes. Further work is required to test the models externally and develop an automated system for use in clinical settings.
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Riera-López N, Gaetano-Gil A, Martínez-Gómez J, Rodríguez-Rodil N, Fernández-Félix BM, Rodríguez-Pardo J, Cuadrado-Hernández C, Martínez-González EP, Villar-Arias A, Gutiérrez-Sánchez F, Busca-Ostolaza P, Montero-Ruiz E, Díez-Tejedor E, Zamora J, Fuentes-Gimeno B. The COVID-19 pandemic effect on the prehospital Madrid stroke code metrics and diagnostic accuracy. PLoS One 2022; 17:e0275831. [PMID: 36215281 PMCID: PMC9550046 DOI: 10.1371/journal.pone.0275831] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/24/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Only very few studies have investigated the effect of the COVID-19 pandemic on the pre-hospital stroke code protocol. During the first wave, Spain was one of the most affected countries by the SARS-CoV-2 coronavirus disease pandemic. This health catastrophe overshadowed other pathologies, such as acute stroke, the leading cause of death among women and the leading cause of disability among adults. Any interference in the stroke code protocol can delay the administration of reperfusion treatment for acute ischemic strokes, leading to a worse patient prognosis. We aimed to compare the performance of the stroke code during the first wave of the pandemic with the same period of the previous year. METHODS This was a multicentre interrupted time-series observational study of the cohort of stroke codes of SUMMA 112 and of the ten hospitals with a stroke unit in the Community of Madrid. We established two groups according to the date on which they were attended: the first during the dates with the highest daily cumulative incidence of the first wave of the COVID-19 (from February 27 to June 15, 2020), and the second, the same period of the previous year (from February 27 to June 15, 2019). To assess the performance of the stroke code, we compared each of the pre-hospital emergency service time periods, the diagnostic accuracy (proportion of stroke codes with a final diagnosis of acute stroke out of the total), the proportion of patients treated with reperfusion therapies, and the in-hospital mortality. RESULTS SUMMA 112 activated the stroke code in 966 patients (514 in the pre-pandemic group and 452 pandemic). The call management time increased by 9% (95% CI: -0.11; 0.91; p value = 0.02), and the time on scene increased by 12% (95% CI: 2.49; 5.93; p value = <0.01). Diagnostic accuracy, and the proportion of patients treated with reperfusion therapies remained stable. In-hospital mortality decreased by 4% (p = 0.05). CONCLUSIONS During the first wave, a prolongation of the time "on the scene" of the management of the 112 calls, and of the hospital admission was observed. Prehospital diagnostic accuracy and the proportion of patients treated at the hospital level with intravenous thrombolysis or mechanical thrombectomy were not altered with respect to the previous year, showing the resilience of the stroke network and the emergency medical service.
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Affiliation(s)
- Nicolás Riera-López
- Stroke Commission, Emergency Medical Service of Madrid (SUMMA 112), Madrid, Spain
- * E-mail:
| | - Andrea Gaetano-Gil
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - José Martínez-Gómez
- IT Department, Emergency Medical Service of Madrid (SUMMA 112), Madrid, Spain
| | | | - Borja M. Fernández-Félix
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jorge Rodríguez-Pardo
- Department of Neurology and Stroke Centre, IdiPAZ Health Research Institute (La Paz University Hospital, Autonomous University of Madrid), Madrid, Spain
| | | | | | - Alicia Villar-Arias
- Management Department, Emergency Medical Service of Madrid (SUMMA 112), Madrid, Spain
| | | | - Pablo Busca-Ostolaza
- Management Department, Emergency Medical Service of Madrid (SUMMA 112), Madrid, Spain
| | | | - Exuperio Díez-Tejedor
- Department of Neurology and Stroke Centre, IdiPAZ Health Research Institute (La Paz University Hospital, Autonomous University of Madrid), Madrid, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Blanca Fuentes-Gimeno
- Department of Neurology and Stroke Centre, IdiPAZ Health Research Institute (La Paz University Hospital, Autonomous University of Madrid), Madrid, Spain
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Ekşi A, Gümüşsoy S, Utanır Altay S, Kirazlı G. Effect of the COVID-19 pandemic on violence against pre-hospital emergency health workers. Work 2022; 73:1103-1108. [DOI: 10.3233/wor-220147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Violence against pre-hospital emergency health workers is a growing problem worldwide and negatively impacts the effectiveness of emergency services. The social distancing, isolation and quarantine measures that have been employed to reduce the spread of COVID-19 have also had economic and psychosocial effects. Therefore, it is important to explore how the negative repercussions of the COVID-19 pandemic have influenced these violent incidents that interfere with the work of emergency medical services (EMS). OBJECTIVE: This study aims to evaluate how violence against EMS workers has been impacted by the effects of the COVID-19 pandemic. METHODS: This study takes an interpretive social science approach, using the qualitative method of in-depth semi-structured interviewing. Audio of the interviews was recorded with the interviewee’s consent. Sound recordings were transcribed and their content was categorised into themes. Categorised texts were then evaluated using descriptive analysis. RESULTS: Participants reported that, during the COVID-19 pandemic, they encountered more violence than usual on EMS assignments to non-emergency situations, though a sense of gratitude towards health workers at the beginning of the pandemic and positives attitudes towards health workers also contributed to reduced violence towards them. The data indicate that workplace violence among EMS employees has increased as the problems caused by the pandemic have intensified, suggesting that additional measures need to be taken to protect them. CONCLUSION: In parallel with an increase in social violence during the COVID-19 pandemic, violence against EMS workers also increased in prevalence. A multidimensional approach should now be taken to determine how violence against EMS employees will be affected by risks such as the intergenerational transmission of social violence, a psychosocial repercussion of the COVID-19 pandemic, especially considering the increasing workplace violence among EMS employees.
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Affiliation(s)
- Ali Ekşi
- Medicine Department, Institute of Health Sciences, Atatürk Health Care Vocational School, Ege University, Izmir, Turkey
| | - Süreyya Gümüşsoy
- Medicine Department, Institute of Health Sciences, Atatürk Health Care Vocational School, Ege University, Izmir, Turkey
| | | | - Gülce Kirazlı
- Atatürk Health Care Vocational School, Ege University, Izmir, Turkey
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14
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Hadian M, Jabbari A, Abdollahi M, Hosseini E, Sheikhbardsiri H. Explore pre-hospital emergency challenges in the face of the COVID-19 pandemic: A quality content analysis in the Iranian context. Front Public Health 2022; 10:864019. [PMID: 36062086 PMCID: PMC9428312 DOI: 10.3389/fpubh.2022.864019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/25/2022] [Indexed: 01/21/2023] Open
Abstract
Background pre-hospital emergency is a community-oriented system that responds to the medical needs of the injured or patients with acute and emergency illnesses outside of health care facilities until they are transferred to a medical center. This study aimed to explore pre-hospital emergency challenges in the face of the COVID-19 pandemic. Material and methods This study was conducted as a qualitative content analysis in Iran. Using the purposive sampling method, data were collected through in-depth individual interviews with 28 prehospital paramedic personnel from November 2020 to November 2021. Graneheim and Lundman's conventional content analysis methods were used to analyze the data and for the trustworthiness of the data, this study used Lincoln and Guba's recommendations. Results After multiple rounds of analyzing and summarizing the data and taking into consideration similarities and differences, four main categories and 10 subcategories were created based on the results of the data analysis and including (1) Culture and Community. (2) Service delivery (3) Human resources; (4) Medical supplies and equipment. Conclusion According to the findings of this study emergency medical system employees are suffering from a range of psychiatric problems as a result of a lack of equipment and job overload, which has a detrimental impact on the quality of pre-hospital emergency care. Therefore, emergency care senior management should develop comprehensive guidelines, provide more equipment and minimize professional challenges to improve the quality and safety of pre-hospital emergency care services.
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Affiliation(s)
- Marziye Hadian
- Health Services Management, Student Research Committee of School of Management and Medical Information, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Jabbari
- Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdieh Abdollahi
- Department of Nursing, Zarand Branch, Islamic Azad University, Zarand, Iran
| | - Elaheh Hosseini
- Health Services Management, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hojjat Sheikhbardsiri
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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15
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Effects of COVID-19 lockdown strategies on emergency medical services. Am J Emerg Med 2022; 60:40-44. [PMID: 35905600 PMCID: PMC9186951 DOI: 10.1016/j.ajem.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The aim of this study is to evaluate the change in the number of EMS cases by comparing the lockdown period, the non-lockdown period, and the pre-pandemic period. Methods In our study, 3 periods of EMS cases were compared to evaluate the effect of lockdown. The first period (Period A) included in the study was the lockdown period (01-12-2020 and 31–01–2021. The second period (period B) is the period between 01 and 10-2020 and 30–11–2020, where there was no lockdown despite the pandemic. The third period (period C) in the study is the period between 01 and 12-2019 and 31–01–2020 before the pandemic. Results A total of 120,989 cases in 3 periods were included in the study. It was determined that the highest number of patients were in period C (42,703, 35.3%), while the least was in period A (39,054, 32.2%). On the other hand, it was found that the number of calls was highest in period A (246,200, 35.1%), while the least was in period C (212,267, 30.2%). Response times were longer in the pandemic period than in the pre-pandemic period. Mean talk time were longer during the pandemic period. The most frequent diagnosis in period A (21.6%) and B (42.2%) was COVID-19. The second most frequent disease group in these two periods was cardiovascular diseases. Conclusion While the number of EMS cases decreased during the pandemic period, it decreased even more during the lockdown period. However, the number of calls increased significantly during the lockdown period, and the response times and talk times increased accordingly.
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16
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Marincowitz C, Stone T, Hasan M, Campbell R, Bath PA, Turner J, Pilbery R, Thomas BD, Sutton L, Bell F, Biggs K, Hopfgartner F, Mazumdar S, Petrie J, Goodacre S. Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: an observational cohort study. BMJ Open 2022; 12:e058628. [PMID: 35577471 PMCID: PMC9114316 DOI: 10.1136/bmjopen-2021-058628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess accuracy of emergency medical service (EMS) telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy. DESIGN Observational cohort study. SETTING Emergency telephone triage provided by Yorkshire Ambulance Service (YAS) National Health Service (NHS) Trust. PARTICIPANTS 12 653 adults who contacted EMS telephone triage services provided by YAS between 2 April 2020 and 29 June 2020 assessed by COVID-19 telephone triage pathways were included. OUTCOME Accuracy of call handler decision to dispatch an ambulance was assessed in terms of death or need for organ support at 30 days from first contact with the telephone triage service. RESULTS Callers contacting EMS dispatch services had an 11.1% (1405/12 653) risk of death or needing organ support. In total, 2000/12 653 (16%) of callers did not receive an emergency response and they had a 70/2000 (3.5%) risk of death or organ support. Ambulances were dispatched to 4230 callers (33.4%) who were not conveyed to hospital and did not deteriorate. Multivariable modelling found variables of older age (1 year increase, OR: 1.05, 95% CI: 1.04 to 1.05) and presence of pre-existing respiratory disease (OR: 1.35, 95% CI: 1.13 to 1.60) to be predictors of false positive triage. CONCLUSION Telephone triage can reduce ambulance responses but, with low specificity. A small but significant proportion of patients who do not receive an initial emergency response deteriorated. Research to improve accuracy of EMS telephone triage is needed and, due to limitations of routinely collected data, this is likely to require prospective data collection.
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Affiliation(s)
- Carl Marincowitz
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Tony Stone
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Madina Hasan
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Richard Campbell
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Peter A Bath
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Janette Turner
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Benjamin David Thomas
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Laura Sutton
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Katie Biggs
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Frank Hopfgartner
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Suvodeep Mazumdar
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Jennifer Petrie
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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17
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Ventura CAI, Denton EE, David JA, Schoenfelder BJ, Mela L, Lumia RP, Rudi RB, Haldar B. Emergency Medical Services Prehospital Response to the COVID-19 Pandemic in the US: A Brief Literature Review. OPEN ACCESS EMERGENCY MEDICINE 2022; 14:249-272. [PMID: 35669176 PMCID: PMC9165654 DOI: 10.2147/oaem.s366006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
This study aimed to analyze prehospital Emergency Medical Services (EMS) response to the COVID-19 pandemic in the US through a brief systematic review of available literature in context with international prehospital counterparts. An exploration of the NCBI repository was performed using a search string of relevant keywords which returned n=5128 results; articles that met the inclusion criteria (n=77) were reviewed and analyzed in accordance with PRISMA and PROSPERO recommendations. Methodical quality was assessed using critical appraisal tools, and the Egger’s test was used for risk of bias reduction upon linear regression analysis of a funnel plot. Sources of heterogeneity as defined by P < 0.10 or I^2 > 50% were interrogated. Findings were considered within ten domains: structural/systemic; clinical outcomes; clinical assessment; treatment; special populations; dispatch/activation; education; mental health; perspectives/experiences; and transport. Findings suggest, EMS clinicians have likely made significant and unmeasured contributions to care during the pandemic via nontraditional roles, ie, COVID-19 testing and vaccine deployment. EMS plays a critical role in counteracting the COVID-19 pandemic in addition to the worsening opioid epidemic, both of which disproportionately impact patients of color. As such, being uniquely influential on clinical outcomes, these providers may benefit from standardized education on care and access disparities such as racial identity. Access to distance learning continuing education opportunities may increase rates of provider recertification. Additionally, there is a high prevalence of vaccine hesitancy among surveyed nationally registered EMS providers. Continued rigorous investigation on the impact of COVID-19 on EMS systems and personnel is warranted to ensure informed preparation for future pandemic and infectious disease responses.
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Affiliation(s)
- Christian Angelo I Ventura
- Department of Graduate Medical Sciences, Boston University School of Medicine Boston, Boston, MA, USA
- Department of Health, Behavior and Society (Incoming), Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD, USA
- EMS Pandemic Response Research Laboratory Lawrenceville, Lawrenceville, NJ, USA
- Correspondence: Christian Angelo I Ventura, Tel +1 (732) 372-2141, Email ;
| | - Edward E Denton
- EMS Pandemic Response Research Laboratory Lawrenceville, Lawrenceville, NJ, USA
- Department of Emergency Medicine, University of Arkansas for Medical Sciences Little Rock, Little Rock, AR, USA
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Little Rock, Little Rock, AR, USA
| | - Jessica Anastacia David
- Department of Biochemistry and Microbiology, Rutgers University New Brunswick, Brunswick, NJ, USA
| | | | - Lillian Mela
- Department of Nursing, Simmons University Boston, Boston, MA, USA
| | - Rebecca P Lumia
- Department of Biology, Northeastern University Boston, Boston, MA, USA
| | - Rachel B Rudi
- EMS Pandemic Response Research Laboratory Lawrenceville, Lawrenceville, NJ, USA
| | - Barnita Haldar
- EMS Pandemic Response Research Laboratory Lawrenceville, Lawrenceville, NJ, USA
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham School of Medicine Birmingham, Birmingham, AL, USA
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Karunathilake I, Edirisinghe S, Weerasinghe M, Perera BJC, Hamdani A, Mudiyanse R, Randenikumara S, de Silva D, Senanayake D, Gamini De Silva S, Guruge K, Ragunathan MK, Sumathipala A, Abeykoon P. An Innovative Telemedicine Initiative From Sri Lanka: The Value of Volunteerism in a Resource-Constrained Scenario During the COVID-19 Pandemic. Asia Pac J Public Health 2022; 34:557-560. [PMID: 35435008 DOI: 10.1177/10105395221090348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The unprecedented rise in COVID-19 cases in Sri Lanka since July 2021 led to a situation where the health system was getting overwhelmed. The priority shifted toward triaging patients and identifying those who need immediate medical intervention and managing the rest in home settings. An integrated patient management system where patients could access a medical professional through a short messages service (SMS) and calling system was established. This service provided telephone triage, patient advice, and coordinated with the national ambulance system to evacuate ill patients. This integrated helpline system had a major impact on the management of the recent surge of COVID-19 pandemic in Sri Lanka by patients needing urgent care were directed for hospitalization and the rest managed at home with support, reassurance, and guidance. The numbers of oxygen-dependent patients and deaths declined rapidly and the number of available beds increased. The system played a major role in bringing the crisis under control. Despite many challenges, this innovative integrated system is a unique example of medical volunteerism. The pandemic catalyzed the utilization of information and communication technologies effectively by providing healthcare with a reduction of the burden on healthcare institutions and professionals.
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Affiliation(s)
- Indika Karunathilake
- Asia Pacific Academic Consortium for Public Health and Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sajith Edirisinghe
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Manuj Weerasinghe
- Asia Pacific Academic Consortium for Public Health and Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - B J C Perera
- Sri Lanka Medical Association, Colombo, Sri Lanka
| | | | | | | | - Dulmini de Silva
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Dulanja Senanayake
- Asia Pacific Academic Consortium for Public Health and Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Xie Y, Kulpanowski D, Ong J, Nikolova E, Tran NM. Predicting Covid-19 emergency medical service incidents from daily hospitalisation trends. Int J Clin Pract 2021; 75:e14920. [PMID: 34569674 DOI: 10.1111/ijcp.14920] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The aim of our retrospective study was to quantify the impact of Covid-19 on the temporal distribution of emergency medical services (EMS) demand in Travis County, Austin, Texas and propose a robust model to forecast Covid-19 EMS incidents. METHODS We analysed the temporal distribution of EMS calls in the Austin-Travis County area between 1 January 2019 and 31 December 2020. Change point detection was performed to identify the critical dates marking changes in EMS call distributions, and time series regression was applied for forecasting Covid-19 EMS incidents. RESULTS Two critical dates marked the impact of Covid-19 on the distribution of EMS calls: March 17th, when the daily number of non-pandemic EMS incidents dropped significantly, and 13 May, by which the daily number of EMS calls climbed back to 75% of the number in pre-Covid-19 time. The new daily count of the hospitalisation of Covid-19 patients alone proves a powerful predictor of the number of pandemic EMS calls, with an r2 value equal to 0.85. In particular, for every 2.5 cases, where EMS takes a Covid-19 patient to a hospital, one person is admitted. CONCLUSION The mean daily number of non-pandemic EMS demand was significantly less than the period before the Covid-19 pandemic. The number of EMS calls for Covid-19 symptoms can be predicted from the daily new hospitalisation of Covid-19 patients. These findings may be of interest to EMS departments as they plan for future pandemics, including the ability to predict pandemic-related calls in an effort to adjust a targeted response.
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Affiliation(s)
- Yangxinyu Xie
- Department of Computer Science, University of Texas at Austin, Austin, Texas, USA
| | - David Kulpanowski
- Department of Emergency Medical Services, City of Austin, Austin, Texas, USA
| | - Joshua Ong
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, Texas, USA
| | - Evdokia Nikolova
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, Texas, USA
| | - Ngoc M Tran
- Department of Mathematics, University of Texas at Austin, Austin, Texas, USA
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20
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Levy MJ, Chizmar TP, Alemayehu T, Sidik MM, Garfinkel E, Stone R, Wendell J, Vesselinov R, Margolis AM, Delbridge TR. A Statewide EMS Viral Syndrome Pandemic Triage Protocol: 24 Hour Outcomes. PREHOSP EMERG CARE 2021; 26:623-631. [PMID: 34550053 DOI: 10.1080/10903127.2021.1983091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Early during the COVID-19 pandemic, Emergency Medical Services (EMS) systems encountered many challenges that prompted crisis-level strategies. Maryland's statewide EMS system implemented the Viral Syndrome Pandemic Triage Protocol which contained a decision tool to help identify patients potentially safe for self-care at home. Objectives: This study assessed the effects of the Maryland Viral Syndrome Pandemic Triage Protocol and the safety of referring patients for self-care at home. Methods: This is a retrospective statewide analysis of EMS patients from March 19 thru September 4, 2020, who were not transported and had documentation of the Viral Syndrome Pandemic Triage Protocol's decision support tool completed, as well as a random sample of 150 patients who were not transported and did not have documentation of the decision tool. Descriptive statistics were performed as well as a two-stage multivariable logistic regression model for the outcomes of ED presentation within 24 hours and subsequent hospitalization. Results: 301 EMS patients were documented as triaged to home using the protocol and outcomes data were available for 282 (94%). 41(14.5%) patients presented to an ED within 24 hours and 14 (5% of 282) required inpatient hospitalization. Nine (3.2%) patients were subsequently hospitalized with a diagnosis of COVID-19 illness. Of those patients for whom the decision tool was not documented, 35 (23%) had an ED visit within 24 hours and 15 (10%) were hospitalized (p = 0.075). Multivariate logistic regression model results (N = 432) suggest that those with documentation of triage protocol use had some advantage over those patients without documentation. The 95% CIs of the estimated effect of Triage/No Triage protocol documented were wide and crossed the 1.0 limit but overall, all effects Odds Ratios and Adjust Odds Ratios were consistently over 1.0 with the lowest value of 1.3 and the highest value of 2.1. Conclusion: Most patients (95%) who were triaged to self-care at home with home documented decision support tool use did not require hospitalization within 24 hours following EMS encounter and this appears to be safe. Future opportunity exists to incorporate such tools into comprehensive pandemic preparedness strategies along with appropriate follow up and quality improvement mechanisms.
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21
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Al Amiry A, Maguire BJ. Emergency Medical Services (EMS) Calls During COVID-19: Early Lessons Learned for Systems Planning (A Narrative Review). Open Access Emerg Med 2021; 13:407-414. [PMID: 34522146 PMCID: PMC8434918 DOI: 10.2147/oaem.s324568] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/05/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Over the course of the COVID-19 progress, reports from many locations around the world indicated major increases in EMS call volume, which imposed great pressure on EMS dispatch centers (EMSDC) globally. No studies yet have been done to examine this phenomenon. OBJECTIVE This paper examines the interrelated effects of the unprecedented global increase of EMS call, the effect of the COVID-19 crisis on responding to non-COVID-19 emergencies, and the concurrent effects of having overwhelmed dispatch centers. It tries to explain the current evidence of the bottleneck of EMS calls during the early phase of the worldwide pandemic. ELIGIBILITY CRITERIA We examine the numbers of EMS calls internationally between March and June 2020, derived from published literature and news media. Only articles in English were selected, with certain keywords related to EMS calls, ambulance delay, stroke and cardiac arrest. SOURCE OF EVIDENCE Google Scholar was the main searching source. RESULTS After applying the selection criteria, a total of 29 citations were chosen, and a pattern of knowledge resulted in the emergence of five themes: EMS calls during COVID-19, Reduced EMS operator response time, Ambulance response delays, Collateral mortality and morbidity among non-COVID-19 cases, and Total ambulance call time. CONCLUSION Over the course of COVID-19 progress, there was a global phenomenon of exponential increases in EMS calls, which is expected to impose a great pressure on EMS dispatch centers. Several factors contributing to the bottleneck of EMS calls are identified and explained.
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Affiliation(s)
- Alaa Al Amiry
- Department of Clinical Studies, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Brian J Maguire
- Leidos (Research Laboratory), Groton, CT, USA
- Central Queensland University in Australia, Rockhampton, Queensland, Australia
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22
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Apiratwarakul K, Suzuki T, Celebi I, Tiamkao S, Bhudhisawasdi V, Gaysonsiri D, Ienghong K. Emergency Medical Services amid New Wave of Coronavirus Disease 2019 Outbreak in Khon Kaen, Thailand. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: COVID-19 outbreaks occurring in many countries around the world have had a significant impact on emergency medical services (EMS) in terms of the number of operations and procedures performed, including those on ambulances. However, the number of EMS amid the rising number of COVID-19 cases in Khon Kaen, Thailand has not been well studied.
AIM: The aim of this study was to identify and analyze the relationship between the use of EMS and the outbreak of COVID-19.
METHODS: A cross-sectional study was done in Srinagarind Hospital, Khon Kaen, Thailand with a single EMS centered. Data was collected between March 27, 2021 and April 9, 2021 and designated as (Day-7 to Day 7 of pandemic services) as well as normal services which collected data between March 27 and April 9, 2019 (Day-7 to Day 7 of normal services).
RESULTS: Three hundred eight EMS operations were examined. A total of 77.9% (n = 95) of pandemic services were for males and the mean age of the patients was 32.1 ± 5.4 years. During the normal services in 2019, the average number of EMS operations was 13.3 ± 2.4 times per day over the two weeks of the study. In 2021, before the outbreak (Day-7 to Day 1), the average number of EMS operations was 13.2 ± 1.8 times/day. After Day 1, there was a drop in the number of EMS operations which was associated with an increase in COVID-19 infections (p < 0.001).
CONCLUSIONS: The number of EMS users during the COVID-19 outbreak decreased considerably compared to the pre-epidemic levels and normal service intervals, including the severity of the users, were more severe than normal.
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Moeller AL, Mills EHA, Collatz Christensen H, Gnesin F, Blomberg SNFN, Zylyftari N, Jensen B, Ringgren KB, Broccia MD, Bøggild H, Torp-Pedersen C. Symptom presentation of SARS-CoV-2-positive and negative patients: a nested case-control study among patients calling the emergency medical service and medical helpline. BMJ Open 2021; 11:e044208. [PMID: 34031110 PMCID: PMC8149264 DOI: 10.1136/bmjopen-2020-044208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Currently effective symptom-based screening of patients suspected of COVID-19 is limited. We aimed to investigate age-related differences in symptom presentations of patients tested positive and negative for SARS-CoV-2. DESIGN SETTING: Calls to the medical helpline (1-8-1-3) and emergency number (1-1-2) in Copenhagen, Denmark. At both medical services all calls are recorded. PARTICIPANTS We included calls for patients who called for help/guidance at the medical helpline or emergency number prior to receiving a test for SARS-CoV-2 between April 1st and 20th 2020 (8423 patients). Among these calls, we randomly sampled recorded calls from 350 patients who later tested positive and 250 patients tested negative and registered symptoms described in the call. OUTCOME RESULTS: After exclusions, 544 calls (312 SARS-CoV-2 positive and 232 negative) were included in the analysis. Fever and cough remained the two most common of COVID-19 symptoms across all age groups and approximately 42% of SARS-CoV-2 positive and 20% of negative presented with both fever and cough. Symptoms including nasal congestion, irritation/pain in throat, muscle/joint pain, loss of taste and smell, and headache were common symptoms of COVID-19 for patients younger than 60 years; whereas loss of appetite and feeling unwell were more commonly seen among patients over 60 years. Headache and loss of taste and smell were rare symptoms of COVID-19 among patients over 60 years. CONCLUSION Our study identified age-related differences in symptom presentations of SARS-CoV-2-positive patients calling for help or medical advice. The specific symptoms of loss of smell or taste almost exclusively reported by patients younger than 60 years. Differences in symptom presentation across age groups must be considered when screening for COVID-19.
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Affiliation(s)
- Amalie Lykkemark Moeller
- Department of Clinical Investigation, Norsjaellands Hospital, Hilleroed, Capital Region, Denmark
| | | | - Helle Collatz Christensen
- Danish Clinical Quality Program (RKKP) National Clinical Registries, Frederiksberg Hospital, Copenhagen, Denmark
- Emergency Medical Services Copenhagen, Ballerup, Capital Region, Denmark
| | - Filip Gnesin
- Department of Clinical Investigation, Norsjaellands Hospital, Hilleroed, Capital Region, Denmark
| | | | - Nertila Zylyftari
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Britta Jensen
- Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Marcella Ditte Broccia
- Department of Clinical Investigation, Norsjaellands Hospital, Hilleroed, Capital Region, Denmark
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation, Norsjaellands Hospital, Hilleroed, Capital Region, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Nordsjaellands Hospital, Hillerod, Capital Region, Denmark
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Yasmin F, Bin Zafar MD, Salman A, Farooque U, Asghar MS, Khan AA, Mohiuddin O, Hassan SA. Exploring the impact of the COVID-19 pandemic on pediatric surgical services: a scoping review. Minerva Pediatr (Torino) 2021; 73:460-466. [PMID: 33845565 DOI: 10.23736/s2724-5276.21.06146-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inevitably, along with other healthcare specializations, pediatric surgery was affected by the Coronavirus disease-19 (COVID-19) pandemic. Children were reported to manifest mild to moderate symptoms and mortality was primarily observed in patients aged <1 year and having underlying comorbidities. The majority of the cases were asymptomatic in children, hence, posing a challenge for pediatric surgery centers to take drastic measures to reduce the virus transmission. Telemedicine was introduced and outpatient consultations were conducted online as out-patient clinics were closed. Elective surgeries were postponed with delayed appointments while the healthcare sector was diverted towards tackling COVID-19. Case urgency was classified and triaged, leading to limited surgeries being performed only in COVID-19 negative patients following an extensive screening process. The screening process consisted of online history taking and RT-PCR tests. Newer practices such as mouth rinse, video laryngoscopy, and anesthesia were introduced to restrict patients from crying, coughing, and sneezing, as an attempt to avoid aerosolization of viral particles and safely conduct pediatric surgeries during the pandemic. Surgical trainees were also affected as the smaller number of surgeries conducted reduced the clinical experience available to medical enthusiasts. There is still room for advanced practices to be introduced in pediatric surgery, and restore all kinds of surgeries to improve the quality of life of the patient.
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Affiliation(s)
- Farah Yasmin
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan -
| | - Muhammad D Bin Zafar
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ariba Salman
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Umar Farooque
- Department of Neurology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad S Asghar
- Department of Internal Medicine, Dow University Hospital (Ohja Campus), Karachi, Pakistan
| | - Anosh A Khan
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Osama Mohiuddin
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed A Hassan
- Department of Cardiovascular Medicine, University of Louisville, Louisville, KY, USA
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25
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Krösbacher A, Kaiser H, Holleis S, Schinnerl A, Neumayr A, Baubin M. [Evaluation of measures to reduce the number of emergency physician missions in Tyrol during the COVID-19 pandemic]. Anaesthesist 2021; 70:655-661. [PMID: 33569715 PMCID: PMC7875434 DOI: 10.1007/s00101-021-00915-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/24/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund und Fragestellung Die COVID-19-Hochphase im österreichischem Bundesland Tirol war für den Rettungs- und Notarztdienst sehr herausfordernd. Hauptziel war, unter Aufrechterhaltung der Versorgungsqualität die Personenkontakte am Einsatzort zu reduzieren. Diese Arbeit soll zum einen die getroffenen Maßnahmen evaluieren, zum anderen das Einsatzaufkommen während der ersten Monate der Pandemie beschreiben. Studiendesign und Untersuchungsmethoden Ab dem 17.03.2020 wurden zu Notrufabfrageergebnissen, zu denen vormals sowohl Rettungswagen (RTW) wie auch ein Notarzt (NA) alarmiert wurden, nur noch ein RTW alarmiert. Diese reduzierten Einsätze sowie die allgemeine Einsatzentwicklung wurden im Zeitraum vom 15.03.2020 bis 15.05.2020 analysiert und mit Daten der Jahre 2017–2019 im gleichen Zeitraum verglichen. Ergebnisse Besonders durch den Wegfall von Touristen wird von einer Reduktion der zu versorgenden Bevölkerung um bis zu 30 % ausgegangen, trotzdem wurden zum Einsatzstichwort „Atemnot“ ein Anstieg um 18,7 % (1533 vs. 1291) bzw. bei Verkehrsunfällen ein Rückgang von 26,4 % (2937 vs. 2161) beobachtet. Notarzteinsätze verzeichneten einen Rückgang von 38,5 % (1511 vs. 2456,3), wobei die NACA-Scores III und IV mit über 40%igem Rückgang besonders auffielen. Die Notarztnachforderungsrate der reduzierten Einsatzcodes betrug 14,5 %, wobei die Krankheitsbilder „Bewusstlosigkeit“ und „Krampfanfall“ mit über 40%iger Nachforderung höher lagen. Diskussion Es zeigt sich eine absolute Reduktion des gesamten Einsatzaufkommens; zählt man die durch die Reduktion der Ausrückorder eingesparten Notarzteinsätze hinzu, wäre es zu einer Steigerung der notärztlichen Einsätze im Vergleich zu den Vorjahren gekommen. Betrachtet man zur Beurteilung der Versorgungsqualität ausschließlich die Notarztnachforderungsrate zeigt die Reduktion eine hohe Trefferquote, jedoch konnten die endgültigen Diagnosen aus den nachversorgenden Krankenhäusern/Arztpraxen in dieser Studie nicht erhoben werden, womit eine gesicherte Beurteilung der Versorgungsqualität nicht möglich ist. Fazit Das primäre Ziel der Minimierung von Patientenkontakten unter Wahrung der Versorgungsqualität konnte erreicht werden. Vor Überführung der reduzierten Einsätze in den Routinebetrieb sind jedoch Anpassungen und eine Evaluierung unter Einbindung der Nachversorger nötig. Auch alternative Strategien zur Reduktion von Personenkontakten sollten geprüft werden.
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Affiliation(s)
- Armin Krösbacher
- Universitätsklinik für Anästhesie und Intensivmedizin Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | | | | | - Adolf Schinnerl
- Team Ärztlicher Leiter Rettungsdienst des Landes Tirol, Innsbruck, Österreich
| | - Agnes Neumayr
- Team Ärztlicher Leiter Rettungsdienst des Landes Tirol, Innsbruck, Österreich
| | - Michael Baubin
- Universitätsklinik für Anästhesie und Intensivmedizin Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.,Team Ärztlicher Leiter Rettungsdienst des Landes Tirol, Innsbruck, Österreich
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26
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Haase CB, Bearman M, Brodersen J, Hoeyer K, Risor T. 'You should see a doctor', said the robot: Reflections on a digital diagnostic device in a pandemic age. Scand J Public Health 2020; 49:33-36. [PMID: 33339468 PMCID: PMC7859581 DOI: 10.1177/1403494820980268] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS In three days at the beginning of the COVID-19 pandemic, the Copenhagen Emergency Medical Services developed a digital diagnostic device. The purpose was to assess and triage potential COVID-19 symptoms and to reduce the number of calls to public health-care helplines. The device was used almost 150,000 times in a few weeks and was described by politicians and administrators as a solution and success. However, high usage cannot serve as the sole criterion of success. What might be adequate criteria? And should digital triage for citizens by default be considered low risk? METHODS This paper reflects on the uncertain aspects of the performance, risks and issues of accountability pertaining to the digital diagnostic device in order to draw lessons for future improvements. The analysis is based on the principles of evidence-based medicine (EBM), the EU and US regulations of medical devices and the taxonomy of uncertainty in health care by Han et al. RESULTS Lessons for future digital devices are (a) the need for clear criteria of success, (b) the importance of awareness of other severe diseases when triaging, (c) the priority of designing the device to collect data for evaluation and (d) clear allocation of responsibilities. CONCLUSIONS A device meant to substitute triage for citizens according to its own criteria of success should not by default be considered as low risk. In a pandemic age dependent on digitalisation, it is therefore important not to abandon the ethos of EBM, but instead to prepare the ground for new ways of building evidence of effect.
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Affiliation(s)
- Christoffer Bjerre Haase
- Department of Public Health, University of Copenhagen, Denmark.,Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Australia
| | - John Brodersen
- Department of Public Health, University of Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Denmark
| | - Klaus Hoeyer
- Department of Public Health, University of Copenhagen, Denmark
| | - Torsten Risor
- Department of Public Health, University of Copenhagen, Denmark.,Department of Community Medicine, UiT The Arctic University of Norway, Norway
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