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Mitura KM, Celiński D, Snarska J, Szajda SD. Impact of COVID-19 Pandemic on Health and Life Emergencies Resulting from Illness Cases and Injuries-A Preliminary Study. J Clin Med 2024; 13:3552. [PMID: 38930081 PMCID: PMC11205222 DOI: 10.3390/jcm13123552] [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: 05/28/2024] [Revised: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Despite organised efforts, the COVID-19 pandemic had a significant impact on the health status of the population and health services including the emergency medical system. The objective of the study was to investigate, based on the Emergency Medical Teams' (EMT) interventions, the impact of the COVID-19 pandemic on health and life emergencies resulting from illness cases and injuries of Polish females and males. Material and Methods: The data under analysis concern EMT interventions carried out in central and eastern Poland from 1 January 2017 to 31 December 2022 (n = 226,038). The study used descriptive statistics, the Mann-Whitney U Test, and the Chi-square test. Results: A significant increase was observed in the proportion of EMT interventions (p < 0.001) to patients with illness cases (80.30% vs. 83.17%) and a decrease in interventions to patients with injuries (19.70% vs. 16.83%) during the pandemic as compared to the pre-pandemic period. As for illness cases, the patients' ages during both periods were similar (Me = 66.00 vs. 66.00, p = 0.071). On the other hand, during the pandemic, injuries mainly affected elderly patients as compared to the pre-pandemic period (Me = 50.00 vs. 47.00, p < 0.001). The increase in the proportion of EMT interventions to patients with illness cases and the decrease in patients with injuries during the pandemic, as compared to the pre-pandemic period, concerned the area of intervention, patient's sex, and age. During the pandemic period, a significantly lower proportion of patients transported to the hospital (p < 0.001) and an increase in the proportion of patients left at the place of call (p < 0.001) were noted. Conclusions: The restrictions aimed at preventing the spread of the SARS-CoV-2 virus contributed to a reduced number of injuries without, however, reducing the number of illness cases. During the pandemic, the elderly were affected by injuries. The study indicates the need for further in-depth analyses to prepare the pre-hospital care system in Poland for the occurrence of other or similar emergencies.
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Affiliation(s)
- Krzysztof Marek Mitura
- Independent Public Health Care Center RM-MEDITRANS Emergency Station and Sanitary Transport in Siedlce, 08-110 Siedlce, Poland
| | - Daniel Celiński
- Department of Emergency Medical Service, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Jadwiga Snarska
- Department of Surgery, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | - Sławomir Dariusz Szajda
- Department of Emergency Medical Service, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
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Karmali S, Saxena S, Richards O, Thompson W, McFaull SR, Pike I. What was the impact of COVID-19 restrictions on unintentional injuries, in Canada and globally? A scoping review investigating how lockdown measures impacted the global burden of unintentional injury. Front Public Health 2024; 12:1385452. [PMID: 38887259 PMCID: PMC11180821 DOI: 10.3389/fpubh.2024.1385452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Background Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, including increasing rates of certain injuries. These differences in trends have been reported internationally however the evidence is scattered and needs to be better understood to identify opportunities for public education and to prepare for future outbreaks. Objective A scoping review was conducted to synthesize evidence regarding the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries. Methods Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus), and a gray literature search was also conducted. Results The search yielded 3,041 results, and 189 articles were selected for extraction. A total of 41 reports were included from the gray literature search. Final studies included research from: Europe (n = 85); North America (n = 44); Asia (n = 32); Oceania (n = 12); Africa (n = 8); South America (n = 4); and multi-country (n = 4). Most studies reported higher occurrence of injuries/trauma among males, and the average age across studies was 46 years. The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 134), falls (n = 104), sports/recreation (n = 65), non-motorized vehicle (n = 31), and occupational (n = 24). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased. Overall, decreases were observed in occupational injuries and those resulting from sport/recreation, pedestrian-related, and crush/trap incidents. Decreases were also seen in MVCs and burns, however the severity of injury from these causes increased during the pandemic period. Increases were observed in poisonings, non-motorized vehicle collisions, lacerations, drownings, trampoline injuries; and, foreign body ingestions. Implications Findings from this review can inform interventions and policies to identify gaps in public education, promote safety within the home, and decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.
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Affiliation(s)
- Shazya Karmali
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | | | | | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Faculty of Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Scott D, McGrath M, Beard N, Chislett S, Baldwin R, Nehme Z, Lubman DI, Ogeil RP. Adolescent Suicidal Behaviors During the COVID-19 Pandemic in Australia: Analysis of Acute Harms Assessed via Ambulance Data. J Adolesc Health 2024; 74:908-915. [PMID: 38340123 DOI: 10.1016/j.jadohealth.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE This study investigated changes in suicidal ideation, attempts, and nonsuicidal self-injury (NSSI)-related ambulance attendances among adolescents during the COVID-19 pandemic. METHODS An interrupted time series analysis using data from the National Ambulance Surveillance System, a globally unique mental health and suicide surveillance system. Patients aged 12-17 years from the state of Victoria, Australia who were attended by ambulance for suicide attempts, suicide ideation, and NSSI between January 2016 and October 2021 were included. Monthly ambulance attendances during the pre-COVID period (January 2016-March 2020) were compared to those in the peak period of COVID-19 (April 2020-October 2021). RESULTS There were 20,125 ambulance attendances for suicide ideation, suicide attempt, and NSSI in adolescents over the study period. During the pre-COVID period, the number of suicide ideation, attempts, and NSSI attendances was increasing by 1.1% per month (incidence rate ratio [IRR]:1.011; 95% confidence interval [1.009-1.013], p < .001). There was no change in the rate of all suicide ideation, attempt, and NSSI for all adolescents during the period of COVID-19. However, when disaggregated by gender, there was a 0.7% increase in the monthly rate of attendances for females (IRR: 1.007 [1.001-1.013], p = .029), and a 3.0% decrease for males (IRR: 0.970 [0.964-0.975], p < .001). DISCUSSION Adolescent female suicide ideation, attempt, and NSSI attendances increased during the COVID-19 period, compared with males in the same time period. These findings suggest tailored intervention strategies may be needed to address the increasing trends of self-harm among young people.
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Affiliation(s)
- Debbie Scott
- Turning Point, Eastern Health, Richmond, Victoria, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Box Hill, Victoria, Australia
| | - Michael McGrath
- Turning Point, Eastern Health, Richmond, Victoria, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Box Hill, Victoria, Australia
| | - Naomi Beard
- Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Sarah Chislett
- Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Ryan Baldwin
- Turning Point, Eastern Health, Richmond, Victoria, Australia; School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Ziad Nehme
- Departments of Paramedicine, Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia; Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, Victoria, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Box Hill, Victoria, Australia
| | - Rowan P Ogeil
- Turning Point, Eastern Health, Richmond, Victoria, Australia; Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Box Hill, Victoria, Australia.
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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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Kirchner H, Bohn A, Hulsmans N, Brzoska P, Pajonk FGB. [Impact of the 2020 lockdown on prehospital psychiatric emergencies in a large city]. DIE ANAESTHESIOLOGIE 2024; 73:26-32. [PMID: 38214705 DOI: 10.1007/s00101-023-01370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low. OBJECTIVE The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in a large German city. MATERIAL AND METHODS A retrospective analysis was conducted on all prehospital psychiatric emergencies in a large German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as a reference. RESULTS During the first lockdown there was a significant increase in the number of emergency missions with respect to psychiatric cases. A substantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played a minor role during the lockdown. CONCLUSION The lockdown had a notable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both a deterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular.
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Affiliation(s)
- Heribert Kirchner
- Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58455, Witten, Deutschland.
| | - Andreas Bohn
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Deutschland
- Feuerwehr, Ärztliche Leitung Rettungsdienst, Stadt Münster, Münster, Deutschland
| | - Nik Hulsmans
- Fakultät V, Department für Psychologie, Universität Siegen, Siegen, Deutschland
| | - Patrick Brzoska
- Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58455, Witten, Deutschland
| | - Frank-Gerald B Pajonk
- Zentrum Isartal, Kloster Schäftlarn, Schäftlarn, Deutschland
- Klinik und Poliklinik für Psychiatrie am Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Chan AHY, Tomlin A, Chan E, Harrison J, Beyene KA. Effect of the COVID-19 pandemic on asthma exacerbations in New Zealand: An interrupted time series analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100157. [PMID: 37781646 PMCID: PMC10509955 DOI: 10.1016/j.jacig.2023.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/22/2023] [Accepted: 04/07/2023] [Indexed: 10/03/2023]
Abstract
Background New Zealand (NZ) implemented some of the strictest restrictions during the novel coronavirus pandemic (coronavirus disease 2019 [COVID-19]), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). How this impacted asthma exacerbation rates in NZ is unknown. Objective We sought to explore the effects of the COVID-19 restrictions on asthma exacerbations in NZ during 2020. Methods We used a population-based, interrupted time series to examine the impact of the first COVID-19 lockdown in NZ on asthma exacerbation rate. The primary outcome measure was change in the monthly exacerbation rate, defined as hospitalization and/or course of corticosteroids, before and after the first lockdown. In a secondary analysis, we quantified the number of patients with asthma, the actual asthma exacerbation rate from March to December 2019 versus March to December 2020, and the number of asthma hospitalizations. Results There was a significant drop in the exacerbation rate immediately after lockdown (-3.02; P < .0001) followed by a significant and sustained increasing trend; the rate postlockdown increased relative to that prelockdown (0.27; P < .0001). Similar patterns were observed in all sociodemographic groups. In our secondary analysis, we identified 507,622 people with asthma; this reduced to 458,023 in 2020 postlockdown. The overall asthma exacerbation rate was 33.3% less in 2020 than in 2019 (reduction from 48.6/1000 patients to 32.4/1000 patients). The rate of asthma hospitalizations decreased from 9.5 per 1000 patients in 2019 to 6.2 per 1000 patients in 2020; this decrease was observed across all demographic groups. Conclusions The first COVID-19 lockdown in 2020 in NZ significantly reduced asthma exacerbation rates across all sociodemographic groups. Whether these reductions are sustained requires further investigation.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrew Tomlin
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Eliza Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jeff Harrison
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kebede A. Beyene
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Pharmaceutical and Administrative Sciences, St Louis College of Pharmacy, University of Health Sciences and Pharmacy, St Louis, Mo
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Moskatel LS, Slusky DJG. The Impact of COVID-19 Incidence on Emergency Medical Services Utilization. J Emerg Med 2023; 65:e111-e118. [PMID: 37460386 PMCID: PMC10129907 DOI: 10.1016/j.jemermed.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/03/2023] [Accepted: 04/19/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Leon S Moskatel
- Division of Headache, Department of Neurology, Stanford Health Care, Palo Alto, California.
| | - David J G Slusky
- Department of Economics, University of Kansas, Lawrence, Kansas; National Bureau of Economics Research, Cambridge, Massachusetts; IZA Institute of Labor Economics, Bonn, Germany
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Hegenberg K, Althammer A, Gehring C, Prueckner S, Trentzsch H. Pre-Hospital Emergency Medical Services Utilization Amid COVID-19 in 2020: Descriptive Study Based on Routinely Collected Dispatch Data in Bavaria, Germany. Healthcare (Basel) 2023; 11:1983. [PMID: 37510425 PMCID: PMC10379196 DOI: 10.3390/healthcare11141983] [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: 05/25/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND AND IMPORTANCE The COVID-19 pandemic affected the utilization of health care services and posed organizational challenges. While many previous studies focused on the misuse of pre-hospital EMS for low-urgency health problems, the pandemic has put more emphasis on the avoidance of medically necessary calls. OBJECTIVE To compare the utilization of pre-hospital emergency medical services before and after specific pandemic periods. DESIGN, SETTING AND PARTICIPANTS This was a retrospective, descriptive analysis of routine data from 26 dispatch centers in Bavaria, Germany. OUTCOMES MEASURE AND ANALYSIS We investigated the number of emergencies per 100,000 population, as well as the relative change in the emergency rates and transport rates in 2020, compared to the two previous years. Boxplots showed the distributions across the Bavarian districts per calendar week. The mean rates and standard deviations as well as the relative changes were presented for the specific periods. A paired samples t-test was used to compare the rates. MAIN RESULTS Compared to the average of the two previous years, the emergency rates in 2020 were lower in 35 out of 52 calendar weeks. The strongest reductions were observed during the first wave, where the average emergency rate declined by 12.9% (SD 6.8, p < 0.001). There was no statistically significant difference in the overall emergency rate during the summer holidays. Lower transport rates were observed throughout the year, especially during the first wave. CONCLUSIONS Utilization of pre-hospital emergency medical services decreased in 2020, especially during the periods with strict measures. This could be due to the lower morbidity from the behavioral changes during the pandemic, but also to the avoidance of medical services for both less urgent and severe conditions. While a reduction in unnecessary care would be beneficial, patients must be encouraged to seek necessary urgent care, even during a pandemic.
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Affiliation(s)
- Kathrin Hegenberg
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Alexander Althammer
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Christian Gehring
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Stephan Prueckner
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
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Nishtala PS, Pickering JW, Bergler U, Mangin D, Hilmer SN, Jamieson H. Post Hoc Analyses of a Randomized Controlled Trial for the Effect of Pharmacist Deprescribing Intervention on the Anticholinergic Burden in Frail Community-Dwelling Older Adults. J Am Med Dir Assoc 2023:S1525-8610(23)00478-4. [PMID: 37339754 DOI: 10.1016/j.jamda.2023.05.014] [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: 02/24/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES Anticholinergic burden is detrimental to cognitive health. Multiple studies found that a high anticholinergic burden is associated with an increased risk for dementia, changes to the brain structure, function, and cognitive decline. We performed a post hoc analysis of a randomized controlled deprescribing trial. We compared the effect of the intervention on baseline anticholinergic burden across the treatment and control groups and the time of recruitment before and after a lockdown due to the COVID pandemic with subgroup analyses by baseline frailty index. DESIGN Randomized controlled trial. SETTINGS AND PARTICIPANTS We analyzed data from a de-prescribing trial of older adults (>65 years) previously conducted in New Zealand that was focused on reducing the Drug Burden Index (DBI). METHODS We used the anticholinergic cognitive burden (ACB) to quantify the impact of the intervention on reducing the anticholinergic burden. Participants not taking anticholinergics at the start of the trial were excluded. The primary outcome for this subgroup analysis was a change in ACB, measured with the ĝHedges statistic describing the difference in standard deviation units of this change between intervention and control. For this analysis, the trial participants were stratified into low, medium, and high frailty and timing into prior- and post-lockdown (public health measures for COVID-19). RESULTS Among the 295 participants in this analysis, the median (IQR) age was 79 (74, 85), and 67% were women. For the primary outcome ĝHedges = -0.04 (95% CI -0.26 to 0.19) with a -0.23 mean reduction in ACB in the intervention arm and -0.19 in the control arm. Before lockdown ĝHedges = -0.38 (95% CI -0.84 to 0.04) and post-lockdown ĝHedges = 0.07 (95% CI -0.19 to 0.33). The mean change in ACB for each of the frailty strata was as follows: low frailty (-0.02; 95% CI -0.65 to 0.18); medium frailty (0.05; 95% CI -0.28 to 0.38); high frailty (0.08; 95% CI -0.40 to 0.56). CONCLUSIONS AND IMPLICATIONS The study did not provide evidence for the effect of pharmacist deprescribing intervention on reducing the anticholinergic burden. However, this post hoc analysis examined the impact of COVID on the effectiveness of the intervention, and further research in this area may be warranted.
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Affiliation(s)
- Prasad S Nishtala
- Centre for Therapeutic Innovation, Department of Pharmacy and Pharmacology, University of Bath, United Kingdom.
| | - John W Pickering
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Ulrich Bergler
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Dee Mangin
- University of Otago, Christchurch, New Zealand; McMaster University, Hamilton, Ontario, Canada
| | - Sarah N Hilmer
- Faculty of Medicine and Health, Northern Clinical School, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Australia
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand; Burwood Hospital, Christchurch, New Zealand
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Roland D, Gardiner A, Razzaq D, Rose K, Bressan S, Honeyford K, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie IK, Bognar Z, Moll HA, Titomanlio L, Nijman RGG. Influence of epidemics and pandemics on paediatric ED use: a systematic review. Arch Dis Child 2023; 108:115-122. [PMID: 36162959 DOI: 10.1136/archdischild-2022-324108] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. SETTING Systematic review. DESIGN Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO). PATIENTS Children under 18 years. INTERVENTIONS National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used. MAIN OUTCOME MEASURES Changes in paediatric emergency care utilisation. RESULTS 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively. CONCLUSIONS The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed. TRIAL REGISTRATION NUMBER CRD42021242808.
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Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adam Gardiner
- School of Medicine, University of Leicester, Leicester, UK
| | - Darakhshan Razzaq
- Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
| | - Katy Rose
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Division of Emergency Medicine, University College London NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Kate Honeyford
- Health Informatics Team, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Danilo Buonsenso
- Department of Women, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Ian K Maconochie
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Luigi Titomanlio
- Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France
| | - Ruud Gerard Gerard Nijman
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
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11
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John J, Synn EP, Winata T, Eapen V, Lin PI. Increased ambulance attendances related to suicide and self-injury in response to the pandemic in Australia. Aust N Z J Psychiatry 2023; 57:140-142. [PMID: 36062782 PMCID: PMC10076165 DOI: 10.1177/00048674221121090] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- James John
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia.,Academic Unit of Child Psychiatry Services, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Ei Phyu Synn
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Teresa Winata
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia.,Academic Unit of Child Psychiatry Services, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia.,Academic Unit of Child Psychiatry Services, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Ping-I Lin
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia.,Academic Unit of Child Psychiatry Services, South Western Sydney Local Health District, Liverpool, NSW, Australia.,Department of Mental Health, School of Medicine, Western Sydney University, Penrith, NSW, Australia
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12
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Sokolović D, Drakul D, Joksimović B, Lalović N, Avram N, Milić M, Nogo-Živanović D, Mijović B. Consumption of Antibiotics in Primary Care Setting before and during COVID-19 Pandemic in Republic of Srpska, Bosnia and Herzegovina. Antibiotics (Basel) 2022; 11:antibiotics11101319. [PMID: 36289977 PMCID: PMC9598767 DOI: 10.3390/antibiotics11101319] [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: 08/31/2022] [Revised: 09/17/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
The pandemic of COVID-19 has brought many changes in health care systems at all levels of health care. The increase in the number of cases of COVID-19 has led to overuse and misuse of antibiotics.The aim of this study was to compare the consumption of antibiotics for systemic use in outpatients in the Republic of Srpska (RS), before and during the first year of the COVID-19 pandemic, as well as the association between antibiotic consumption and the rate of incidence and mortality of COVID-19. The total consumption of the antibiotics for systemic use (J01) in outpatients in the Republic of Srpska during 2019 was 19.40 DDD/TID, with an increase to 30.80 DDD/TID in 2020.Significantly higher use of penicillin (10.58 ± 11.01 DDD/TID in 2019 vs. 17.10 ± 13.63 DDD/TID in 2020), cephalosporins (2.68 ± 1.90 DDD/TID in 2019 vs. 5.93 ± 2.77 DDD/TID in 2020) and macrolides (2.14 ± 2.22 DDD/TID in 2019 vs. 3.40 ± 3.44 DDD/TID in 2020) was observed during the pandemic period. It is necessary to improve the prescribing practice of antibiotics at the primary health care level, public awareness about rational use of antibiotics, as well as the current antibiotic stewardship programs and control their implementation.
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Affiliation(s)
- Dragana Sokolović
- Faculty of Medicine Foča, University of East Sarajevo, Studentska 5, 73300 Foča, Bosnia and Herzegovina
- Correspondence: ; Tel.: +387-6599-4867
| | - Dragana Drakul
- Faculty of Medicine Foča, University of East Sarajevo, Studentska 5, 73300 Foča, Bosnia and Herzegovina
| | - Bojan Joksimović
- Faculty of Medicine Foča, University of East Sarajevo, Studentska 5, 73300 Foča, Bosnia and Herzegovina
| | - Nenad Lalović
- Faculty of Medicine Foča, University of East Sarajevo, Studentska 5, 73300 Foča, Bosnia and Herzegovina
- Department of Surgery, University Hospital Foča, Studentska 5, 73300 Foča, Bosnia and Herzegovina
| | - Nada Avram
- Faculty of Medicine Foča, University of East Sarajevo, Studentska 5, 73300 Foča, Bosnia and Herzegovina
- Department of Ophtalmology, University Hospital Foča, Studentska 5, 73300 Foča, Bosnia and Herzegovina
| | - Marija Milić
- Department of Epidemiology, Faculty of Medicine, University of Pristina Temporarily Seated in Kosovska Mitrovica, Henri Dunant, 38220 Kosovska Mitrovica, Serbia
| | - Dajana Nogo-Živanović
- Faculty of Medicine Foča, University of East Sarajevo, Studentska 5, 73300 Foča, Bosnia and Herzegovina
| | - Biljana Mijović
- Faculty of Medicine Foča, University of East Sarajevo, Studentska 5, 73300 Foča, Bosnia and Herzegovina
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13
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COVID-19 Pandemic Lockdown and Wellbeing: Experiences from Aotearoa New Zealand in 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042269. [PMID: 35206457 PMCID: PMC8871666 DOI: 10.3390/ijerph19042269] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 01/09/2023]
Abstract
In 2020, in the first COVID-19 pandemic lockdown, Aotearoa New Zealand consistently maintained stringent public health measures including stay-at-home lockdowns and distancing responses. Considering the widespread disruption to social functioning caused by the pandemic, this paper aimed to explore environmental and social factors that influenced the wellbeing of individuals during the first lockdown in Aotearoa New Zealand. Our mixed-methods study involved a survey (n = 1010) and semi-structured interviews of a subset of surveyed individuals undertaken at the tail end of the first 2020 lockdown. Survey participants were recruited through social media-driven snowball sampling, less than 50% were aged under 45 years and 85% identified as female. Of those interviewed, 63% identified as female. Qualitative interview findings and open-ended survey results were analysed thematically. Participants described a variety of factors influencing wellbeing, largely related to the community and household; physical, behavioural, and lifestyle factors; access to health services; and social and economic foundations. While much of the focus of COVID-19 recovery was on reversing the economic and physical toll of the pandemic, our findings emphasise the need to empower individuals, families, and communities to mitigate the pandemic’s negative implications on wellbeing.
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14
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Leszczyński PK, Sobolewska P, Muraczyńska B, Gryz P, Kwapisz A. Impact of COVID-19 Pandemic on Quality of Health Services Provided by Emergency Medical Services and Emergency Departments in the Opinion of Patients: Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1232. [PMID: 35162255 PMCID: PMC8835461 DOI: 10.3390/ijerph19031232] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to assess the quality of assistance provided by emergency medical service (EMS) and hospital emergency department (ED) staff in the opinion of patients. METHODS Simple random sampling was performed to select the responders. A group of 131 people who correctly completed the questionnaire form was included in the study. The questionnaire was directed only to patients receiving EMS and/or ED assistance during the time period when the pandemic was announced in Poland. RESULTS Problems in the ED were reported by 38 people (31.15%), and calling EMS was reported as generating problems by 7 people (16.67%). Dissatisfaction with the help provided in EDs was reported by 33 patients (27.05%), and dissatisfaction with the help by EMS was reported by eight people (19.05%). The assessment of the patient's satisfaction level significantly correlated with the waiting time in the ED (Spearman = 0.217; p = 0.016) as well as with the waiting for EMSs (Spearman = 0.403; p = 0.008). CONCLUSIONS Patients of the ambulance service and hospital emergency departments during the pandemic positively assessed the actions of medical services, despite significant delays in providing health services.
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Affiliation(s)
- Piotr Konrad Leszczyński
- Faculty of Medical Sciences and Health Sciences, University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; (B.M.); (P.G.)
| | - Paulina Sobolewska
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, 90-419 Łódź, Poland; (P.S.); (A.K.)
| | - Bożena Muraczyńska
- Faculty of Medical Sciences and Health Sciences, University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; (B.M.); (P.G.)
| | - Paulina Gryz
- Faculty of Medical Sciences and Health Sciences, University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; (B.M.); (P.G.)
| | - Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, 90-419 Łódź, Poland; (P.S.); (A.K.)
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15
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Ogeil RP, Scott D, Faulkner A, Wilson J, Beard N, Smith K, Manning V, Lubman DI. Changes in alcohol intoxication-related ambulance attendances during COVID-19: How have government announcements and policies affected ambulance call outs? LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 14:100222. [PMID: 34545354 PMCID: PMC8443417 DOI: 10.1016/j.lanwpc.2021.100222] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/26/2023]
Abstract
Background In response to COVID-19, government-mandated health directives including widespread lockdowns were implemented. Changes in alcohol purchasing were reported, with growing concern that alcohol may be consumed as a way to cope with pandemic-associated stressors. Hitherto, there have been limited studies examining alcohol-related harms, including acute harms requiring an ambulance, and their relationship to government announcements or policies related to COVID-19. Methods Analyses were conducted between January and September 2020, with matched months in 2019, using Victorian data from the National Ambulance Surveillance System in Australia. Interrupted time series (ITS) models with odds ratios (OR) were used to map alcohol-related harms as a function of government policies for both metropolitan and regional areas. Findings A total of 43,003 alcohol intoxication-related ambulance attendances occurred between January 2019 and September 2020. Attendances in the home increased in 2020 by 9% compared to matched 2019 months. The most socioeconomically advantaged cases showed the highest percentage change. ITS models showed decreased odds of alcohol-related attendances at the beginning of each COVID-19 wave in metropolitan (OR:0•77; 95%CI: 0•71-0•83; p<0•001) and regional Victoria (OR: 0•72; 95%CI: 0•67-0•79, p<0•001) separately, and increased odds following the introduction of harsher restrictions in metropolitan Melbourne (OR:1•07; 95%CI:1•01-1•11, p=0•005). A 19% increase in odds of alcohol-related harms was observed at the end of the second wave lockdown period in regional Victoria (OR:1•19; 95%CI: 1•01-1•41, p=0•004). Interpretation Alcohol-related attendances during COVID-19 restrictions showed a displacement to home settings. Changes in patterns of harms were evident in specific sociodemographic groups, and geographic regions when mapped to government health directives. This study is one of the first to investigate alcohol-related harms at the population level in response to a global pandemic. Funding Commonwealth Department of Health and Victorian Department of Health.
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Affiliation(s)
- Rowan P Ogeil
- Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Debbie Scott
- Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | | | - James Wilson
- Turning Point, Eastern Health, Richmond, Australia
| | - Naomi Beard
- Turning Point, Eastern Health, Richmond, Australia
| | - Karen Smith
- Department of Community Emergency Health and Paramedic Practice, Monash University, Clayton, Australia.,Research and Evaluation, Ambulance Victoria, Blackburn North, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
| | - Victoria Manning
- Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Dan I Lubman
- Eastern Health Clinical School and Monash Addiction Research Centre, Monash University, Box Hill, Australia.,Turning Point, Eastern Health, Richmond, Australia
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16
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Kuisma M, Harve-Rytsälä H, Pirneskoski J, Boyd J, Lääperi M, Salo A, Puolakka T. Prehospital characteristics of COVID-19 patients in Helsinki - experience of the first wave of the pandemic. Scand J Trauma Resusc Emerg Med 2021; 29:95. [PMID: 34281612 PMCID: PMC8287109 DOI: 10.1186/s13049-021-00915-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022] Open
Abstract
Background There is a lack of knowledge how patients with COVID-19 disease differ from patients with similar signs or symptoms (but who will have a diagnosis other than COVID-19) in the prehospital setting. The aim of this study was to compare the characteristics of these two patient groups met by the emergency medical services. Methods All prehospital patients after the World Health Organisation (WHO) pandemic declaration 11.3.2020 until 30.6.2020 were recruited for the study. The patients were screened using modified WHO criteria for suspected COVID-19. Data from the electronic prehospital patient reporting system were linked with hospital laboratory results to check the laboratory confirmation for COVID-19. For comparison, we divided the patients into two groups: screening- and laboratory-positive patients with a hospital diagnosis of COVID-19 and screening-positive but laboratory-negative patients who eventually received a different diagnosis in hospital. Results A total of 4157 prehospital patients fulfilled the criteria for suspected COVID-19 infection during the study period. Five-hundred-thirty-six (12.9%) of the suspected cases received a laboratory confirmation for COVID-19. The proportion of positive cases in relation to suspected ones peaked during the first 2 weeks after the declaration of the pandemic. In the comparison of laboratory-positive and laboratory-negative cases, there were clinically insignificant differences between the groups in age, tympanic temperature, systolic blood pressure, heart rate, on-scene time, urgency category of the call and mode of transportation. Foreign-language-speakers were overrepresented amongst the positive cases over native language speakers (26,6% vs. 7,4%, p < 0,001). The number of cases in which no signs or symptoms of COVID-19 disease were reported, but patients turned out to have a positive test result was 125 (0,3% of the whole EMS patient population and 11,9% of all verified COVID-19 patients encountered by the EMS). Conclusions In a sample of suspected COVID-19 patients, the laboratory-positive and laboratory-negative patients were clinically indistinguishable from each other during the prehospital assessment. Foreign-language-speakers had a high likelihood of having Covid-19. The modified WHO criteria still form the basis of screening of suspected COVID-19 patients in the prehospital setting.
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Affiliation(s)
- Markku Kuisma
- Departments of Emergency Medicine & Services, Anaesthesiology & Intensive Care Medicine, P.O. Box 112, 00099, Helsinki, Finland.
| | - Heini Harve-Rytsälä
- Departments of Emergency Medicine & Services, Anaesthesiology & Intensive Care Medicine, P.O. Box 112, 00099, Helsinki, Finland
| | - Jussi Pirneskoski
- Departments of Emergency Medicine & Services, Anaesthesiology & Intensive Care Medicine, P.O. Box 112, 00099, Helsinki, Finland
| | - James Boyd
- Departments of Emergency Medicine & Services, Anaesthesiology & Intensive Care Medicine, P.O. Box 112, 00099, Helsinki, Finland
| | - Mitja Lääperi
- Departments of Emergency Medicine & Services, Anaesthesiology & Intensive Care Medicine, P.O. Box 112, 00099, Helsinki, Finland
| | - Ari Salo
- Departments of Emergency Medicine & Services, Anaesthesiology & Intensive Care Medicine, P.O. Box 112, 00099, Helsinki, Finland
| | - Tuukka Puolakka
- Departments of Emergency Medicine & Services, Anaesthesiology & Intensive Care Medicine, P.O. Box 112, 00099, Helsinki, Finland.,Departments of Emergency Medicine & Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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