The status of prehospital care delivery for COVID-19 patients in Addis Ababa, Ethiopia: The study emphasizing adverse events occurring in prehospital transport and associated factors

Lived experience of Iranian pre-hospital medical staff during the COVID-19 pandemic: a descriptive phenomenological study

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.

The Relationship between COVID-19 Exposure Risk and Burnout in Prehospital Emergency Medical Technicians

Introduction

Exposure to coronavirus disease 2019 (COVID-19) has caused many physical and psychological effects on front-line healthcare workers (HCWs). This study aimed to assess the relationship between the exposure risk to COVID-19 disease and burnout in prehospital emergency medical technicians (EMTs).

Methods

In this correlational study, 335 prehospital EMTs were selected by random sampling method from the 49 stations of emergency medical services in the northwest of Iran. Data were collected using a questionnaire developed by the world health organization for the risk assessment and management of exposure of health care workers to COVID-19. Moreover, Pines burnout measure was used for the assessment of participants' burnout. Data were analyzed using SPSS version 13.

Results

Results showed that 30.7 % of prehospital EMTs had a high burnout score against COVID-19 disease. The prehospital EMTs who had a high occupational exposure risk experienced a high risk of burnout (P=0.03). The results of the linear regression analysis showed that prehospital EMTs who had a low exposure risk of COVID-19 had a low burnout score (β=-9.30; P<0.001), and those who had less than 10 years of work experience showed less burnout (β=-10.54; P<0.001).

Conclusion

According to the results, the exposure risk to COVID-19 increases the prehospital EMT's burnout. As a result, reducing the exposure risk to COVID-19 by providing adequate access to personal protective equipment (PPE), development of training and following standards and protocols can be effective in controlling burnout in HCWs.

Methodology for designing intrahospital transportation of patients with suspected infectious disease that limits infection spread risk in China

Aims

The transport of patients suspected of having COVID-19 requires careful consideration. Using paths selected at random and not accounting for person flow along the path are risk factors for infection spread. Intrahospital transportation (IHT) protocols and guidelines should be used to help reduce the risk of secondary virus transmission during transport. This study aimed to propose optimal IHT for patients with an infectious disease presenting in an out-patient area.

Design

The map of a West China Hospital was used. We also used field investigation findings and simulated person flow to establish pathway length and transportation time. We identified three optimum pathways and estimated safety boundary marks, including a patient transportation border (PTB) and safety transportation border (STB). Finally, IHT, PTB, and STP formed a virtual transport pipeline (VTP) and a traceable IHT management system, which can generate a virtual isolation space.

Results

The three pathways met efficiency, accessibility, and by-stander flow criteria. No facility characteristic modification was required.

Conclusions

Using virtual models to identify pathways through out-patient hospital areas may help reduce the risk of infection spread.

Prehospital characteristics of COVID-19 patients transported by emergency medical service and the predictors of a prehospital sudden deterioration in Addis Ababa, Ethiopia

Background

Severally ill COVID-19 patients may require urgent transport to a specialized facility for advanced care. Prehospital transport is inherently risky; the patient’s health may deteriorate, and potentially fatal situations may arise. Hence, early detection of clinically worsening patients in a prehospital setting may enable selecting the best receiving facility, arranging for swift transportation, and providing the most accurate and timely therapies. The incidence and predictors of abrupt prehospital clinical deterioration among critically ill patients in Ethiopia are relatively limited.

Study objectives

This study was conducted to determine the incidence of sudden clinical deterioration during prehospital transportation and its predictors.

Methods

A prospective cohort study of 591 COVID-19 patients transported by a public EMS in Addis Ababa. For data entry, Epi data V4.2 and SPSS V 25 were used for analysis. To control the effect of confounders, the candidate variables for multivariable analysis were chosen using a p 0.25 inclusion threshold from the bivariate analysis. A statistically significant association was declared at adjusted relative risk (ARR) ≠ 1 with a 95 % confidence interval (CI) and a p value < 0.05 after adjusting for potential confounders.

Results

The incidence of prehospital sudden clinical deterioration in this study was 10.8%. The independent predictors of prehospital sudden clinical deterioration were total prehospital time [ARR 1.03 (95%; CI 1.00–1.06)], queuing delays [ARR 1.03 (95%; CI 1.00–1.06)], initial prehospital respiratory rate [ARR 1.07 (95% CI 1.01–1.13)], and diabetic mellitus [ARR 1.06 (95%; CI 1.01–1.11)].

Conclusion

In the current study, one in every ten COVID-19 patients experienced a clinical deterioration while an EMS provider was present. The factors that determined rapid deterioration were total prehospital time, queueing delays, the initial respiratory rate, and diabetes mellitus. Queueing delays should be managed in order to find a way to decrease overall prehospital time. According to this finding, more research on prehospital intervention and indicators of prehospital clinical deterioration in Ethiopia is warranted.