Aeromedical retrieval diagnostic trends during a period of Coronavirus 2019 lockdown

A novel COVID-19 program, delivering vaccines throughout rural and remote Australia

Background

The Royal Flying Doctor Service of Australia (RFDS) established a unique SARS-CoV-2 vaccination program for vaccinating Australians that live in rural and remote areas. This paper describes the preparation and response phases of the RFDS response.

Methods

This study includes vaccinations conducted by the RFDS from 01 January 2021 until 31 December 2021 when vaccines were mandatory for work and social activities. Prior to each clinic, we conducted community consultation to determine site requirements, patient characteristics, expected vaccination numbers, and community transmission rates.

Findings

Ninety-five organizations requested support. The majority (n = 60; 63.2%) came from Aboriginal Community Controlled Health Organizations. Following consultation, 360 communities were approved for support. Actual vaccinations exceeded expectations (n = 70,827 vs. 49,407), with a concordance correlation coefficient of 0.88 (95% CI, 0.83, 0.93). Areas that reported healthcare workforce shortages during the preparation phase had the highest population proportion difference between expected and actual vaccinations. Areas that reported high vaccine hesitancy during the preparation phase had fewer than expected vaccines. There was a noticeable increase in vaccination rates in line with community outbreaks and positive polymerase chain reaction cases [r (41) = 0.35, p = 0.021]. Engagement with community leaders prior to clinic deployment was essential to provide a tailored response based on community expectations.

Effects of the COVID-19 Pandemic on Prehospital Emergency Care for Adults with Stroke and Transient Ischaemic Attack: A Systematic Review and Meta-Analysis

INTRODUCTION

COVID-19 has challenged global health care systems and resulted in prehospital delays for time-sensitive emergencies, like stroke and transient ischemic attacks (TIA). However, there are conflicting international reports on the level of effect of the pandemic on ambulance response intervals and emergency call volumes for these conditions.

OBJECTIVES

The purpose of this study was to synthesize the international evidence on the effect of COVID-19 on ambulance response intervals and emergency call volume for suspected stroke and TIA.

METHODS

Following a published protocol, we conducted a systematic search of six databases through May 31, 2022. We re-ran this search on April 14, 2023, to check for any new papers. We considered for inclusion peer-reviewed quantitative studies comparing prehospital emergency care for adults with suspected stroke/TIA before and during the COVID-19 pandemic. Two authors screened title/abstract and full text articles. One author carried out data extraction, with a random selection of articles being checked by another author. We calculated overall pooled estimates of ambulance intervals (activation, response, patient care, and total prehospital intervals) and stroke/TIA emergency call volume. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Two authors assessed study quality using the appropriate Joanna Briggs Institute tool. We worked with patient and public involvement contributors and clinical and policy stakeholders throughout the review.

RESULTS

Of 4,083 studies identified, 52 unique articles met the inclusion criteria. Mean response interval (-1.29 min [-2.19 to -0.38]) and mean total prehospital interval (-6.42 min [-10.60 to -2.25]) were shorter in the pre-COVID-19 period, compared to the COVID-19 period. Furthermore, there was a higher incidence rate of emergency call volume for suspected stroke/TIA per day pre-COVID-19 compared with the COVID-19 period (log IRR = 0.17 [0.02 to 0.33]). Ambulance response interval definitions and terminology varied between regions and countries.

CONCLUSIONS

Our review indicates that prehospital delays for suspected stroke/TIA increased during the COVID-19 pandemic. Furthermore, emergency call volume for suspected stroke/TIA decreased during this period. In order to minimize delays in future pandemics or other health care emergencies future research may involve understanding the potential reasons for these delays.

Aeromedical retrieval services characteristics globally: a scoping review

BACKGROUND

Aeromedical emergency retrieval services play an important role in supporting patients with critical and often life-threatening clinical conditions. Aeromedical retrieval services help to provide fast access to definitive care for critically ill patients in under-served regions. Typically, fixed-wing aeromedical retrieval becomes the most viable transport option compared with rotary-wing aircraft when distances away from centres of definitive care extend beyond 200 kms. To our knowledge, there are no studies that have investigated fixed-wing aeromedical services in the member countries of the organisation for economic cooperation and development (OECD). A description of the global characteristics of aeromedical services will inform international collaboration to optimise clinical outcomes for patients.

AIM

In this scoping review, we aimed to describe the features of government- and not-for-profit organisation-owned fixed-wing aeromedical retrieval services in some of the member countries of the OECD.

METHODS

We followed scoping review methodology based on the grey literature search strategy identified in earlier studies. This mostly involved internet-based searches of the websites of fixed-wing aeromedical emergency retrieval services affiliated with the OECD member countries.

RESULTS

We identified 460 potentially relevant records after searching Google Scholar (n = 24) and Google search engines (n = 436). After removing ineligible and duplicate information, this scoping review identified 86 government-and not-for-profit-operated fixed-wing aeromedical retrieval services as existing in 17 OECD countries. Concentrations of the services were greatest in the USA followed by Australia, Canada, and the UK. The most prevalent business models used across the identified OECD member countries comprised the government, not-for-profit, and hybrid models. Three-quarters of the not-for-profit and two-fifths of the hybrid business models were in the USA compared to other countries studied. The government or state-funded business model was most common in Australia (11/24, 46%), Canada (4/24, 17%), and the UK (4/24, 17%). The frequently used service delivery models adopted for patients of all ages included primary/secondary retrievals, secondary retrievals only, and service specialisation models. Of these service models, primary/secondary retrieval involving the transportation of adults and children from community clinics and primary health care facilities to centres of definitive care comprised the core tasks performed by most of the aeromedical retrieval services studied. The service specialisation model provided an extra layer of specialist health care dedicated to the transportation of neonates and paediatrics. At least eight aeromedical retrieval services catered solely for children from birth to 16 years of age. One aeromedical service, the royal flying doctor service in Australia also provided primary health care and telehealth services in addition to primary retrieval and interhospital transfer of patients. The doctor and registered nurse/paramedic (Franco-German model) and the nurse and/or paramedic (Anglo-American model) configurations were the most common staffing models used across the aeromedical services studied.

CONCLUSIONS

The development and composition of fixed-wing aeromedical emergency retrieval services operated by not-for-profit organisations and governments in the OECD countries showed diversity in terms of governance arrangements, services provided, and staffing models used. We do not fully understand the impact of these differences on the quality of service provision, including equitable service access, highlighting a need for further research.

Analysis of the Activities of a Physician-Staffed Helicopter in the Coronavirus Disease 2019 Pandemic Phase

Objective

The purpose of this study was to investigate changes in the duration of activity of a physician-staffed helicopter emergency medical service (HEMS) in Eastern Shizuoka Prefecture before and during the coronavirus disease 2019 pandemic.

Methods

We retrospectively investigated the duration of dispatch activities from February 2020 to June 2021 (pandemic group, n = 1,032) and from April 2016 to January 2020 (control group, n = 3,054).

Results

There were no significant differences in the average age, percentage of male patients, interval from the request of HEMS dispatch to arrival, interval from arrival at the scene to leaving the scene, interval from leaving the scene to arrival at the hospital, or the ratio of requests for HEMS dispatch from the local fire department between the control and pandemic groups. In contrast, the interval from the first call to HEMS dispatch in the control group was significantly shorter than that in the pandemic group, and the ratio of requests for HEMS dispatch before contacting patients in the control group was significantly greater than that in the pandemic group.

Conclusion

The interval from the first call to HEMS dispatch was prolonged in the COVID-19 pandemic period. However, the actual activity time of the HEMS was not affected.

Deep Learning Approach for Assessing Air Quality During COVID-19 Lockdown in Quito

Weather Normalized Models (WNMs) are modeling methods used for assessing air contaminants under a business-as-usual (BAU) assumption. Therefore, WNMs are used to assess the impact of many events on urban pollution. Recently, different approaches have been implemented to develop WNMs and quantify the lockdown effects of COVID-19 on air quality, including Machine Learning (ML). However, more advanced methods, such as Deep Learning (DL), have never been applied for developing WNMs. In this study, we proposed WNMs based on DL algorithms, aiming to test five DL architectures and compare their performances to a recent ML approach, namely Gradient Boosting Machine (GBM). The concentrations of five air pollutants (CO, NO₂, PM_2.5, SO₂, and O₃) are studied in the city of Quito, Ecuador. The results show that Long-Short Term Memory (LSTM) and Bidirectional Recurrent Neural Network (BiRNN) outperform the other algorithms and, consequently, are recommended as appropriate WNMs to quantify the effects of the lockdowns on air pollution. Furthermore, examining the variable importance in the LSTM and BiRNN models, we identify that the most relevant temporal and meteorological features for predicting air quality are Hours (time of day), Index (1 is the first collected data and increases by one after each instance), Julian Day (day of the year), Relative Humidity, Wind Speed, and Solar Radiation. During the full lockdown, the concentration of most pollutants has decreased drastically: −48.75%, for CO, −45.76%, for SO₂, −42.17%, for PM_2.5, and −63.98%, for NO₂. The reduction of this latter gas has induced an increase of O₃ by +26.54%.

The impact of COVID-19 restrictions on pathology service utilisation

Background

Isolation and social distancing restrictions due to COVID‐19 have the potential to impact access to healthcare services.

Aims

To assess the use of pathology services during the COVID‐19 pandemic initial restrictions.

Methods

Repeated cross‐sectional study of pathology tests utilisation during a baseline time period early in 2020 compared with pre‐lockdown and lockdown due to COVID‐19 in South Australia. The outcome measure was changed in a number of pathology tests compared to baseline period, particularly change in the number of troponin tests to determine potential impacts of lockdown on urgent care presentations.

Results

In the community setting, the ratio of a number of pathology tests pre‐lockdown and post‐lockdown versus baseline period decreased from 1.02 to 0.53 respectively. The exception was microbiology molecular tests, where the number of tests was more than three times higher in the lockdown period. The number of troponin tests in emergency departments decreased in the lockdown period compared to the baseline time period; however, there was no evidence of an association between tests result (positive vs negative) and time period (odds ratio (OR) 1.09; 95% confidence interval (CI) 0.97–1.22). There was an inverse relationship between age and time period (OR 0.995; 95% CI 0.993–0.997), indicating that fewer troponin tests were conducted in older people during the lockdown compared with the baseline period.

Conclusion

COVID‐19 restrictions had a significant impact on the use of pathology testing in both urgent and non‐urgent care settings. Further studies are needed to investigate the effect on health outcomes as a result of the COVID‐19 restrictions.

Repatriations of Ill and Injured Travelers and Emigrants to Switzerland: A Retrospective Analysis at a Tertiary Emergency Department from 2013-2018

Background: As more and more people are travelling abroad, there are also increasing numbers who fall ill or have accidents in foreign countries. Some patients must be repatriated. While it has been reported that the number of repatriations is rising steadily, little is known about patients' characteristics, calling for in depth investigations of this patient group. Methods: We have conducted a retrospective study including 447 patients repatriated to the Emergency Department at the University Hospital (Inselspital) in Bern, Switzerland from 2013-2018. Results: Between 2013 and 2018, the number of repatriated patients increased by 42.6%, from 54 to 77 cases. In total, 59% of these patients were male and the median age was 60 years. Overall, 79% of patients were repatriated from European countries, with the top five countries being Italy, France, Spain, Germany and Austria. About half the cases (51.9%) were caused by illness, the other half by accidents. In total, 127 patients had to undergo surgical intervention abroad; another 194 patients underwent surgery after repatriation. The hospitalization rate was 81.4%, with a median length of in-hospital stay of 9 days (IQR 5-14) at the Inselspital. The mortality rate of at the Inselspital hospitalized patients was 4.4%, with 16 patients dying within the first 30 days after repatriation. The median cost per case was 12,005.79 CHF (IQR 4717.66-24,462.79). A multiple regression analysis showed a significant association of total costs with hospitalization (p = 0.001), surgical intervention (p = 0.001), as well as treatment in the intensive care unit (p = 0.001). Conclusions: The number of repatriations has been continuously increasing in recent years and reached a mean value of more than one case per week at the Inselspital (77 cases per year in 2018). The 30 day-mortality rate of 4.4% and the median cost per case are relatively high, demonstrating a neglected Public Health concern. These findings may provide impetus-not only for further research into repatriations but also for Public Health Promotion strategies.