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Khazaei A, Torabi M, Shayganihonar M, Bayat AR. Exploring the challenges of emergency medical service providers in the initial phase of the COVID-19 pandemic: a qualitative content analysis. BMC Emerg Med 2024; 24:159. [PMID: 39227772 PMCID: PMC11373188 DOI: 10.1186/s12873-024-01079-7] [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: 05/04/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND As the COVID-19 pandemic continues to unfold, there has been a substantial increase in the demand for prehospital services. Emergency medical service (EMS) providers have encountered a myriad of challenges that have had a discernible impact on their professional performance. This study was designed to explore the challenges faced by EMS providers during the initial phase of the COVID-19 pandemic. METHODS This qualitative research was conducted using a content analysis approach at emergency medical centers affiliated with Hamadan University of Medical Sciences in Iran between April and August 2021. This study included the participation of 21 EMS personnel, which was conducted using purposive sampling and semistructured interviews, and continued until data saturation was reached. The conventional content analysis method, as outlined by Graneheim and Lundman, was applied for data analysis. RESULTS The analysis of the interview data resulted in the identification of 219 primary codes, which were then organized into ten distinct categories. These categories were further consolidated into three overarching themes: personal safety challenges, professional-organizational challenges, and threatened mental health. CONCLUSIONS EMS personnel play a critical role in healthcare during disasters and pandemics, facing challenges that can have negative effects. Managing these challenges can impact mental health and professional well-being, but awareness, support, resources, and services can help mitigate adverse consequences.
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Affiliation(s)
- Afshin Khazaei
- Department of Prehospital Emergency Medicine, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Mohammad Torabi
- Department of Nursing, Malayer School of Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | | | - Ali Reza Bayat
- Emergency Medicine Expert, Hamadan University of Medical Sciences, Hamadan, Iran
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AbiNader MA, Rundle AG, Park Y, Lo AX. Population-Level Surveillance of Domestic Assaults in the Home Using the National Emergency Medical Services Information System (NEMSIS). PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:882-890. [PMID: 38814380 PMCID: PMC11390926 DOI: 10.1007/s11121-024-01683-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/31/2024]
Abstract
Violence in the home, including partner violence, child abuse, and elder abuse, is pervasive in the United States. An informatics approach allowing automated analysis of administrative data to identify domestic assaults and release timely and localized data would assist preventionists to identify geographic and demographic populations of need and design tailored interventions. This study examines the use of an established national dataset, the NEMSIS 2019, as a potential annual automated data source for domestic assault surveillance. An algorithm was used to identify individuals who utilized emergency medical services (EMS) for a physical assault in a private residence (N = 176,931). Descriptive analyses were conducted to define the identified population and disposition of patients. A logistic regression was performed to predict which characteristics were associated with consistent domestic assault identification by the on-scene EMS clinician and dispatcher. The sample was majority female (52.2%), White (44.7%), urban (85.5%), and 21-29 years old (24.4%). A disproportionate number of those found dead on scene were men (74.5%), and female patients more often refused treatment (57.8%) or were treated and then released against medical advice (58.4%). Domestic assaults against children and seniors had higher odds of being consistently identified by both the dispatcher and EMS clinician than those 21-49, and women had lower odds of consistent identification than men. While a more specific field to identify the type of domestic assault (e.g., intimate partner) would help inform specialized intervention planning, these data indicate an opportunity to systematically track domestic assaults in communities and describe population-specific needs.
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Affiliation(s)
| | - Andrew G Rundle
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yoosun Park
- The School of Social Policy and Practice, The University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander X Lo
- Dept. of Emergency Medicine, Center for Health Services Outcomes Research, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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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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Strum RP, McLeod B, Mondoux S, Miller P, Costa AP. Post-Pandemic Growth in 9-1-1 Paramedic Calls and Emergency Department Transports Surpasses Pre-Pandemic Rates in the COVID-19 Era: Implications for Paramedic Resource Planning. PREHOSP EMERG CARE 2024:1-8. [PMID: 38990606 DOI: 10.1080/10903127.2024.2372452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES The COVID-19 pandemic led to a decline in emergency department (ED) visits and a subsequent return to baseline pre-pandemic levels. It is unclear if this trend extended to paramedic services and if patient cohorts accessing paramedics changed. We examined trends and associations between paramedic utilization (9-1-1 calls and ED transports) and the COVID-19 timeframe. METHODS We conducted a retrospective cross-sectional study using paramedic call data from the Hamilton Paramedic Services from January 2016 to December 2023. We included all 9-1-1 calls where paramedics responded to an incident, excluding paramedic interfacility transfers. We calculated lines of best fit for the pre-pandemic period (January 2016 to January 2020) and compared their predictions to the actual volumes in the post-pandemic period (May 2021 to December 2023). We used an interrupted time series regression model to determine the association between pandemic timeframes (pre-, during-, post-COVID-19) and paramedic utilization (9-1-1 calls and ED transports), while testing for annual seasonality. RESULTS During the study timeframe, 577,278 calls for paramedics were received and 413,491 (71.6%) were transported to the ED. Post-pandemic, 9-1-1 calls exceeded predicted pre-pandemic levels by 1,298 per month, while ED transports exceeded by 543 per month. The pandemic significantly reduced monthly 9-1-1 calls (-588.2, 95% CI -928.8 to -247.5) and ED transports (-677.3, 95% CI -927.0 to -427.5). Post-pandemic, there was a significant and sustained resurgence in monthly 9-1-1 calls (1,208.0, 95% CI 822.1 to 1,593.9) and ED transports (868.8, 95% CI 585.8 to 1,151.7). Both models exhibited seasonal variations. CONCLUSIONS Post-pandemic, 9-1-1-initiated paramedic calls experienced a substantial increase, surpassing pre-pandemic growth rates. ED transports returned to pre-pandemic levels but with a steeper and continuous pattern of growth. The resurgence in paramedic 9-1-1 calls and ED transports post-COVID-19 emphasizes an urgent necessity to expedite development of new care models that address how paramedics respond to 9-1-1 calls and transport to overcrowded EDs.
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Affiliation(s)
- Ryan P Strum
- Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Brent McLeod
- Hamilton Paramedic Services, Hamilton, Ontario, Canada
| | - Shawn Mondoux
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Emergency Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Paul Miller
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Paramedic Education and Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Liu Z, Feng Y, Li J, Tao H, Liu Z, Li X. Improving urban emergency medical service systems through brownfield transformation in Huangshi, China. Sci Rep 2024; 14:14946. [PMID: 38942906 PMCID: PMC11213939 DOI: 10.1038/s41598-024-66080-3] [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: 03/23/2024] [Accepted: 06/26/2024] [Indexed: 06/30/2024] Open
Abstract
A comprehensive emergency medical service (EMS) system significantly enhances a city's capacity to prevent and mitigate disasters. Using Huangshi as a case study, this research evaluated the service radium coverage rate of the current EMS system by examining its transport capacity, population density, and prevalence rate, finding it to be only 61.49% with an inefficient spatial layout. To address this, we proposed transforming urban brownfields into EMS parks. By selecting the most suitable brownfields based on capacity and service radius, we increased the coverage rate to 90.21%. We introduced a new "consultation-referral" model, where existing EMS facilities serve as pre-diagnosis and triage centers, and the urban brownfield EMS parks function as isolation and centralized treatment centers. GIS network analysis confirmed the feasibility, showing all transit times to be under 30 min. The methodology outlined in this study-comprising "demand assessment, supply optimization, and feasibility verification"-not only strengthens the city's EMS system but also facilitates the renewal of urban brownfields. This approach can serve as a valuable reference for enhancing EMS systems in other cities.
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Affiliation(s)
- Zhiping Liu
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Yingxue Feng
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Jing Li
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Haoyu Tao
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Zhen Liu
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China
| | - Xiaodan Li
- State Key Laboratory for Tunnel Engineering, China University of Mining and Technology (Beijing), D11, Xueyuan Road, Haidian District, Beijing, China.
- School of Mechanics and Civil Engineering, China University of Mining and Technology (Beijing), Beijing, 100083, China.
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Yamada H, Aoki S, Nezu T, Neshige S, Motoda A, Yamazaki Y, Maruyama H. Emergency medical service response for cases of stroke-suspected seizure: A population-based study. J Stroke Cerebrovasc Dis 2024; 33:107681. [PMID: 38493957 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107681] [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: 12/21/2023] [Revised: 03/02/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES We evaluated the on-scene time of emergency medical services (EMS) for cases where discrimination between acute stroke and epileptic seizures at the initial examination was difficult and identified factors linked to delays in such scenarios. MATERIALS AND METHODS A retrospective review of cases with suspected seizure using the EMS database of fire departments across six Japanese cities between 2016 and 2021 was conducted. Patient classification was based on transport codes. We defined cases with stroke-suspected seizure as those in whom epileptic seizure was difficult to differentiate from stroke and evaluated their EMS on-scene time compared to those with epileptic seizures. RESULTS Among 30,439 cases with any seizures, 292 cases of stroke-suspected seizure and 8,737 cases of epileptic seizure were included. EMS on-scene time in cases of stroke-suspected seizure was shorter than in those with epileptic seizure after propensity score matching (15.1±7.2 min vs. 17.0±9.0 min; p = 0.007). Factors associated with delays included transport during nighttime (odds ratio [OR], 1.73, 95 % confidence interval [CI] 1.02-2.93, p = 0.041) and transport during the 2020-2021 pandemic (OR, 1.77, 95 % CI 1.08-2.90, p = 0.022). CONCLUSION This study highlighted the difference between the characteristics in EMS for stroke and epileptic seizure by evaluating the response to cases with stroke-suspected seizure. Facilitating prompt and smooth transfers of such cases to an appropriate medical facility after admission could optimize the operation of specialized medical resources.
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Affiliation(s)
- Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan.
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Atsuko Motoda
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
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Ng QX, Ng JCH, Lim YL, Han MX, Liew TM. What is said about '#paramedicine': an analysis of Twitter posts over the past decade. Singapore Med J 2024:00077293-990000000-00113. [PMID: 38779931 DOI: 10.4103/singaporemedj.smj-2022-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/16/2022] [Indexed: 05/25/2024]
Affiliation(s)
- Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore
- MOH Holdings Pte Ltd, Singapore
- NUS Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Justin Choon Hwee Ng
- MOH Holdings Pte Ltd, Singapore
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Yu Liang Lim
- MOH Holdings Pte Ltd, Singapore
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Ming Xuan Han
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Tau Ming Liew
- NUS Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Psychiatry, Singapore General Hospital, Singapore
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Burton E, Quinn R, Crosbie-Staunton K, Deasy C, Masterson S, O'Donnell C, Merwick Á, Willis D, Kearney PM, Mc Carthy VJC, Buckley CM. Temporal trends of ambulance time intervals for suspected stroke/transient ischaemic attack (TIA) before and during the COVID-19 pandemic in Ireland: a quasi-experimental study. BMJ Open 2024; 14:e078168. [PMID: 38508613 PMCID: PMC10961584 DOI: 10.1136/bmjopen-2023-078168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES Time is a fundamental component of acute stroke and transient ischaemic attack (TIA) care, thus minimising prehospital delays is a crucial part of the stroke chain of survival. COVID-19 restrictions were introduced in Ireland in response to the pandemic, which resulted in major societal changes. However, current research on the effects of the COVID-19 pandemic on prehospital care for stroke/TIA is limited to early COVID-19 waves. Thus, we aimed to investigate the effect of the COVID-19 pandemic on ambulance time intervals and suspected stroke/TIA call volume for adults with suspected stroke and TIA in Ireland, from 2018 to 2021. DESIGN We conducted a secondary data analysis with a quasi-experimental design. SETTING We used data from the National Ambulance Service in Ireland. We defined the COVID-19 period as '1 March 2020-31 December 2021' and the pre-COVID-19 period '1 January 2018-29 February 2020'. PRIMARY AND SECONDARY OUTCOME MEASURES We compared five ambulance time intervals: 'allocation performance', 'mobilisation performance', 'response time', 'on scene time' and 'conveyance time' between the two periods using descriptive and regression analyses. We also compared call volume for suspected stroke/TIA between the pre-COVID-19 and COVID-19 periods using interrupted time series analysis. PARTICIPANTS We included all suspected stroke/TIA cases ≥18 years who called the National Ambulance Service from 2018 to 2021. RESULTS 40 004 cases were included: 19 826 in the pre-COVID-19 period and 19 731 in the COVID-19 period. All ambulance time intervals increased during the pandemic period compared with pre-COVID-19 (p<0.001). Call volume increased during the COVID-19-period compared with the pre-COVID-19 period (p<0.001). CONCLUSIONS A 'shock' like a pandemic has a negative impact on the prehospital phase of care for time-sensitive conditions like stroke/TIA. System evaluation and public awareness campaigns are required to ensure maintenance of prehospital stroke pathways amidst future healthcare crises. Thus, this research is relevant to routine and extraordinary prehospital service planning.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork, Ireland
| | - Rory Quinn
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | | | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Cathal O'Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Áine Merwick
- Neurology Department, Cork University Hospital, Cork, Ireland
| | - David Willis
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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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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11
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Kuddes C. Public Health Preparedness Practitioners: Fluent in Disaster. Am J Public Health 2024; 114:180-182. [PMID: 38207234 PMCID: PMC10862223 DOI: 10.2105/ajph.2023.307533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Caleb Kuddes
- Caleb Kuddes is an emergency response coordinator at Douglas County Health Department, Omaha, NE, and a student at the College of Public Health, University of Nebraska Medical Center, Omaha
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12
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Yamada H, Neshige S, Nonaka M, Takebayashi Y, Ishibashi H, Motoda A, Aoki S, Yamazaki Y, Maruyama H. On-scene time delays for epileptic seizures in developed community-based integrated care system regions. Epilepsy Behav 2024; 151:109612. [PMID: 38157824 DOI: 10.1016/j.yebeh.2023.109612] [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: 09/25/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Delayed on-scene time by emergency medical services (EMS) can have detrimental effects on critical cases for people with epilepsy (PWE). In preparation for a super-aged society, a Community-based Integrated Care System is crucial to manage healthcare costs. However, sufficient coordination irrespective of sociomedical changes among medical providers is challenging. AIM This study aimed to evaluate on-scene time delays in the treatment of PWE, identify factors associated with such delays, and clarify regional differences. The focus was on the volume of acute care beds in regions with a developed Community-based Integrated Care System. METHODS This population-based observational study evaluated on-scene time delays in the treatment of PWE across six major cities in western Japan between 2017 and 2021. In addition, we also evaluated the association between regional differences focusing on volume of acute care beds ("Reduced region" and "Preserved region", as cities with numbers of acute care beds per 1,000 people below and above the national average, respectively) along with sociomedical factors associated with on-scene time delays. RESULTS This study included 8,737 PWE transported by EMS, with a mean on-scene time for EMS ranging from 12.9 ± 6.8 min to 21.7 ± 10.6 min. On-scene time delays were evident in Reduced regions, with an increase of 1.45 min (95 % confidence interval 0.86-2.03 min, p < 0.001). A high total EMS call volume independently influenced on-scene time delays during the middle period of the pandemic in Reduced regions. CONCLUSION Optimal coordination must be facilitated to ensure the effective functioning of the Community-based Integrated Care System, particularly during unusual circumstances.
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Affiliation(s)
- Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan.
| | - Megumi Nonaka
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yoshiko Takebayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Haruka Ishibashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Atsuko Motoda
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
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13
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Rundle AG, Crowe RP, Wang HE, Beard JR, Lo AX. A National Study on the Comparative Burden of Pedestrian Injuries from Falls Relative to Pedestrian Injuries from Motor Vehicle Collisions. J Urban Health 2024; 101:181-192. [PMID: 38236430 PMCID: PMC10897068 DOI: 10.1007/s11524-023-00815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 01/19/2024]
Abstract
Pedestrian injuries from falls are an understudied cause of morbidity. Here, we compare the burden of pedestrian injuries from falls occurring on streets and sidewalks with that from motor vehicle collisions. Data on injurious falls on streets and sidewalks, and pedestrian-motor vehicle collisions, to which Emergency Medical Services responded, along with pedestrian and incident characteristics, were identified in the 2019 National Emergency Medical Services Information System database. In total, 118,520 injurious pedestrian falls and 33,915 pedestrians-motor vehicle collisions were identified, with 89% of the incidents occurring in urban areas. Thirty-two percent of pedestrians struck by motor vehicles were coded as Emergent or Critical by Emergency Medical Services, while 19% of pedestrians injured by falls were similarly coded. However, the number of pedestrians whose acuity was coded as Emergent or Critical was 2.1 times as high for injurious falls as compared with pedestrians-motor vehicle collisions. This ratio was 3.9 for individuals 50 years and older and 6.1 for those 65 years and older. In conclusion, there has been substantial and appropriate policy attention given to preventing pedestrian injuries from motor vehicles, but disproportionately little to pedestrian falls. However, the population burden of injurious pedestrian falls is significantly greater and justifies an increased focus on outdoor falls prevention, in addition to urban design, policy, and built environment interventions to reduce injurious falls on streets and sidewalks, than currently exists across the USA.
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Affiliation(s)
- Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Henry E Wang
- Department of Emergency Medicine, Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - John R Beard
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alexander X Lo
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
- Center for Health Services & Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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14
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Kienbacher CL, Wei G, Rhodes JM, Herkner H, Roth D, Williams KA. Risk factors for pediatric intoxications in the prehospital setting. A geospatial survey. Front Public Health 2024; 12:1296250. [PMID: 38333741 PMCID: PMC10851149 DOI: 10.3389/fpubh.2024.1296250] [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: 09/18/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Background Socioeconomic factors and the COVID-19 pandemic influence children's physical and mental health. We aimed to investigate the association between a census tract's median household income [MHI in United States Dollars ($)] and pediatric intoxications in Rhode Island, the smallest state in the United States of America. Geographical hotspots, as well as interactions with the COVID-19 pandemic, should be identified. Methods This study is a retrospective analysis of ambulance calls for pediatric (<18 years) intoxication in Rhode Island between March 1st, 2018, and February 28th, 2022. March 1st, 2020 was considered the beginning of the COVID-19 pandemic. Prehospital data were joined with information from the United States Census Bureau. The census tracts' case counts and MHI were examined using Poisson regression. Geographical clusters were identified with the Global Moran's I and local indicators of spatial association tests in ArcGIS Pro (Esri Corporation, Redlands, CA). Results Inclusion criteria were met by 208 incidents (48% female, median age 16 (IQR 15 to 17) years). The regression model showed a 0.6% increase (IRR 1.006, 95% CI [1.002, 1.01], p = 0.003) in pediatric intoxications for every $ 1,000 increase in MHI. Interaction analysis showed that the effect of MHI was less pronounced during the pandemic (IRR 0.98, 95% CI [0.964, 0.997], p = 0.02). Thirty-four (14%) of the 244 census tracts contributed to geographical clusters, which changed after the onset of the pandemic. Conclusion Higher median household income could be a risk factor for pediatric intoxications. Geographical hotspots changed with the pandemic.
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Affiliation(s)
- Calvin Lukas Kienbacher
- Division of Emergency Medical Services, Department of Emergency Medicine, Brown University, Providence, RI, United States
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Guixing Wei
- Spatial Structures in the Social Sciences (S4), Population Studies and Training Center (PSTC), Brown University, Providence, RI, United States
| | - Jason M. Rhodes
- Rhode Island Department of Health, Center for Emergency Medical Services, Providence, RI, United States
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Kenneth A. Williams
- Division of Emergency Medical Services, Department of Emergency Medicine, Brown University, Providence, RI, United States
- Rhode Island Department of Health, Center for Emergency Medical Services, Providence, RI, United States
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15
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Baldi E, Klersy C, Chan P, Elmer J, Ball J, Counts CR, Rosell Ortiz F, Fothergill R, Auricchio A, Paoli A, Karam N, McNally B, Martin-Gill C, Nehme Z, Drucker CJ, Ruiz Azpiazu JI, Mellett-Smith A, Cresta R, Scquizzato T, Jouven X, Primi R, Al-Araji R, Guyette FX, Sayre MR, Daponte Codina A, Benvenuti C, Marijon E, Savastano S. The impact of COVID-19 pandemic on out-of-hospital cardiac arrest: An individual patient data meta-analysis. Resuscitation 2024; 194:110043. [PMID: 37952575 DOI: 10.1016/j.resuscitation.2023.110043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
AIM Prior studies have reported increased out-of-hospital cardiac arrests (OHCA) incidence and lower survival during the COVID-19 pandemic. We evaluated how the COVID-19 pandemic affected OHCA incidence, bystander CPR rate and patients' outcomes, accounting for regional COVID-19 incidence and OHCA characteristics. METHODS Individual patient data meta-analysis of studies which provided a comparison of OHCA incidence during the first pandemic wave (COVID-period) with a reference period of the previous year(s) (pre-COVID period). We computed COVID-19 incidence per 100,000 inhabitants in each of 97 regions per each week and divided it into its quartiles. RESULTS We considered a total of 49,882 patients in 10 studies. OHCA incidence increased significantly compared to previous years in regions where weekly COVID-19 incidence was in the fourth quartile (>136/100,000/week), and patients in these regions had a lower odds of bystander CPR (OR 0.49, 95%CI 0.29-0.81, p = 0.005). Overall, the COVID-period was associated with an increase in medical etiology (89.2% vs 87.5%, p < 0.001) and OHCAs at home (74.7% vs 67.4%, p < 0.001), and a decrease in shockable initial rhythm (16.5% vs 20.3%, p < 0.001). The COVID-period was independently associated with pre-hospital death (OR 1.73, 95%CI 1.55-1.93, p < 0.001) and negatively associated with survival to hospital admission (OR 0.68, 95%CI 0.64-0.72, p < 0.001) and survival to discharge (OR 0.50, 95%CI 0.46-0.54, p < 0.001). CONCLUSIONS During the first COVID-19 pandemic wave, there was higher OHCA incidence and lower bystander CPR rate in regions with a high-burden of COVID-19. COVID-19 was also associated with a change in patient characteristics and lower survival independently of COVID-19 incidence in the region where OHCA occurred.
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Affiliation(s)
- Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Catherine Klersy
- Biostatistics & Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paul Chan
- Department of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, USA
| | - Jonathan Elmer
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Jocasta Ball
- Centre of Cardiovascular Research & Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Catherine R Counts
- University of Washington School of Medicine, Seattle, USA; Seattle Fire Department, Seattle, USA
| | - Fernando Rosell Ortiz
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Rachael Fothergill
- Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Angelo Auricchio
- Fondazione Ticino Cuore, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Andrea Paoli
- Centrale Operativa Provinciale SUEM 118, Azienda ULSS 5 Polesana, Rovigo, Italy
| | - Nicole Karam
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Bryan McNally
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, USA
| | - Christian Martin-Gill
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Ziad Nehme
- Centre of Cardiovascular Research & Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | | | - José Ignacio Ruiz Azpiazu
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Adam Mellett-Smith
- Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Lugano, Switzerland; Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Xavier Jouven
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rabab Al-Araji
- Emory University, Woodruff Health Sciences Center, Atlanta, USA
| | - Francis X Guyette
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Michael R Sayre
- University of Washington School of Medicine, Seattle, USA; Seattle Fire Department, Seattle, USA
| | - Antonio Daponte Codina
- Andalusian School of Public Health, CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain
| | | | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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16
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Ouyang H, Jiang H, Huang J, Liu Z. COVID-19 Pandemic Brings Challenges to the Management of Stroke-The Differences Between Stroke Cases Admitted to a Tertiary Hospital Before and During COVID-19 Pandemic in China. Risk Manag Healthc Policy 2023; 16:2893-2905. [PMID: 38155847 PMCID: PMC10752818 DOI: 10.2147/rmhp.s435094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
Background An international public health emergency has resulted from the emergence of the new coronavirus-2. Both direct and indirect influences have been felt on the treatment of acute stroke. However, no conclusive link between COVID-19 and the alleged decline in admissions for stroke-related reasons has been established, and the findings of recent studies are contentious. Most of those researches are not made use of authentic data. Therefore, the goal of this study is to examine how the COVID-19 pandemic has affected hospital admissions for stroke patients, to provide a basis for managing stroke patients in hospitals during COVID-19 pandemic. Methods This retrospective study took place at the People's Hospital of Peking University in Beijing, China. For each patient, interventions such as the application of tissue plasminogen activator (tPA) were examined. We recorded each patient's outcomes. The stroke patients' hospital admissions were compared to the average of the prior year. As the time span of interest, we selected the epidemic period (January 2020 to December 2020). Results When compared to the previous year in the pre-COVID period, mean monthly stroke hospitalizations decreased during the pandemic by 54.42% (P<0.001); average lengths of stay (ALOS) increased; and non-emergency admissions decreased by 78.8% (P<0.001). The monthly volume of stroke patients exceeding the intravenous thrombolysis (IVT) window decreased by 25% and 59.73%, respectively (P <0.001). There was a 5.3% increase in the percentage of IVT or within IVT time window in male stroke patients (p=0.019; p=0.049). During COVID-19, the proportion of non-local patients among male stroke patients decreased by 10% compared with the previous year (p=0.006). Conclusion The COVID-19 epidemic has had a negative impact on stroke management in China, healthcare systems must work to assess and adapt to the new reality.
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Affiliation(s)
- Hui Ouyang
- Department of Neuromedicine, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Hong Jiang
- Department of Neuromedicine, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Jin Huang
- Department of Emergency, Yiyang Central Hospital, Yiyang, Hunan, People’s Republic of China
| | - Zunjing Liu
- Department of Neuromedicine, Peking University People’s Hospital, Beijing, People’s Republic of China
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Ghafil C, Yu J, Abramson TM, Inaba K, Matsushima K. Prehospital Care of Trauma Patients in Los Angeles County During the Early COVID-19 Pandemic. Am Surg 2023; 89:6342-6344. [PMID: 37145974 PMCID: PMC10164088 DOI: 10.1177/00031348231173982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Cameron Ghafil
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jeremy Yu
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tiffany M. Abramson
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
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18
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Maguire BJ, Al Amiry A, O’Neill BJ. Occupational Injuries and Illnesses among Paramedicine Clinicians: Analyses of US Department of Labor Data (2010 - 2020). Prehosp Disaster Med 2023; 38:581-588. [PMID: 37559197 PMCID: PMC10548021 DOI: 10.1017/s1049023x23006118] [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: 04/09/2023] [Revised: 05/06/2023] [Accepted: 05/14/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups. METHODS This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers. RESULTS The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022. CONCLUSIONS Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.
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Affiliation(s)
- Brian J. Maguire
- Leidos Inc., Reston, VirginiaUSA
- Central Queensland University - School of Medical and Applied Sciences, Queensland, Australia
| | - Ala’a Al Amiry
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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19
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Nakayama R, Uemura S, Koyama M, Hara M, Bunya N, Sawamoto K, Ohnishi H, Narimatsu E. Extension of Selection Time for the Emergency Destination of Patients with a Fever Due to the Coronavirus Disease 2019 Pandemic: A Difference-in-differences Analysis. Intern Med 2023; 62:2635-2641. [PMID: 37380458 PMCID: PMC10569917 DOI: 10.2169/internalmedicine.1852-23] [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: 02/24/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Objective During the coronavirus disease 2019 (COVID-19) pandemic period, an extended total activity time (TAT) in emergency cases has been reported, especially in febrile patients. A brief selection time (ST) regarding the transport of patients to designated hospitals is vital to achieving a good outcome. However, to our knowledge, no studies have reported the impact of the COVID-19 pandemic on the ST. We therefore examined the impact of a fever on the ST for the transportation of emergency patients during the COVID-19 pandemic. Methods We analyzed emergency medical services (EMS) data in Sapporo between January 2015 and December 2020. The primary outcome was the ST for the emergency destination of patients. The secondary outcomes were the number of inquiries, time from emergency call to arrival at the scene [call-to-scene time (CST)], time from arrival at the hospital to return base [arrival-to-return time (ART)], and TAT. We used a multivariable linear regression model to estimate the difference-in-differences effect. Results A total of 383,917 patients who were transported to the hospital were enrolled within the study period. The mean ST was 5.8 minutes in 2019 and 7.1 minutes in 2020. The difference-in-differences analyses showed that the mean ST increased by 2.52 minutes (p<0.001), the mean ART by 3.10 minutes (p<0.001), and the mean TAT by 7.27 minutes (p<0.001) for patients with a fever during the COVID-19 period. Conclusion This study showed that febrile patients had a longer ST, ART, and TAT during the 2020 COVID-19 period. Considering the COVID-19 pandemic and the threat of future pandemics, regional infection control and information-sharing should be conducted to reduce the EMS activity time.
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Affiliation(s)
- Ryuichi Nakayama
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Japan
| | - Masayuki Koyama
- Department of Public Health, Sapporo Medical University School of Medicine, Japan
| | | | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Japan
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Japan
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20
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Rundle AG, Crowe RP, Wang HE, Beard JR, Lo AX. A National Study on the Comparative Burden of Pedestrian Injuries from Falls Relative to Pedestrian Injuries from Motor Vehicle Collisions. RESEARCH SQUARE 2023:rs.3.rs-3218781. [PMID: 37609339 PMCID: PMC10441469 DOI: 10.21203/rs.3.rs-3218781/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Pedestrian injuries from falls are an understudied cause of morbidity. Here we compare the burden of pedestrian injuries from falls occurring on streets and sidewalks with that from motor vehicle collisions. Data on injurious falls on streets and sidewalks, and pedestrian-motor vehicle collisions, to which Emergency Medical Services responded, along with pedestrian and incident characteristics, were identified in the 2019 National Emergency Medical Services Information System database. In total, 129,343 injurious falls and 33,910 pedestrians-motor vehicle collisions were identified, with 89% of the incidents occurring in urban areas. Thirty two percent of pedestrians struck by motor vehicles were coded as Emergent or Critical by Emergency Medical Services, while 20% of pedestrians injured by falls were similarly coded. However, the number of pedestrians whose acuity was coded as Emergent or Critical was 2.33 times as high for injurious falls as compared with pedestrians-motor vehicle collisions. This ratio was nearly double at 4.3 for individuals 50 years and older, and almost triple at 6.5 for those 65 years and older. In conclusion, there has been substantial and appropriate policy attention given to preventing pedestrian injuries from motor vehicles, but disproportionately little to pedestrian falls. However, the population burden of injurious pedestrian falls is significantly greater and justifies an increased focus on outdoor falls prevention, in addition to urban design, policy and built environment interventions to reduce injurious falls on streets and sidewalks, than currently exists across the U.S.
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Affiliation(s)
| | | | | | - John R Beard
- Columbia University Mailman School of Public Health
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Bosson N, Toy J, Chang A, Haase D, Kipust A, Korotzer L, Warren J, Kim YS, Kazan C, Gausche-Hill M. Short-Term Outcomes and Patient Perceptions after Paramedic Non-Transport during the COVID-19 Pandemic. PREHOSP EMERG CARE 2023; 28:418-424. [PMID: 37078829 DOI: 10.1080/10903127.2023.2205512] [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: 01/30/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND EMS frequently encounter patients who decline transport, yet there are little data to inform the safety of patient and/or paramedic-initiated assess, treat, and refer (ATR) protocols. We determined patient decision-making and short-term outcomes after non-transport by EMS during the COVID-19 pandemic. METHODS This was a prospective, observational study of a random sample of patients evaluated and not transported by EMS from August 2020 to March 2021. From the EMS database, we randomly selected a daily sample of adult patients with disposition of ATR. We excluded patients dispositioned against medical advice (AMA) and those in police custody. Investigators contacted patients by phone to administer a standardized survey regarding decision-making, symptom progression, follow-up care, and satisfaction with non-transport decision. We also determined the proportion of patients who re-contacted 9-1-1 within 72 h, and unexpected deaths within 72 h using coroner data. Descriptive statistics were calculated. RESULTS Of 4613 non-transported patients, 3330 (72%) patients for whom the disposition was ATR were included. Patients were 46% male with a median age of 49 (inter-quartile range (IQR) 31-67). Median vital signs measurements fell within the normal range. Investigators successfully contacted 584/3330 patients (18%). The most common reason for failure was lack of accurate phone number. The most common reasons patients reported for not going to the ED on initial encounter were: felt reassured after the paramedic assessment (151/584, 26%), medical complaint resolved (113/584, 19%), paramedic suggested transport was not required (73/584, 13%), concern for COVID-19 exposure (57/584, 10%), and initial concern was not medical (46/584, 8%). Ninety-five percent (552/584) were satisfied with the non-transport decision and 49% (284/584) had sought follow-up care. The majority (501/584, 86%) reported equal, improved, or resolved symptoms, while 80 patients (13%) reported worse symptoms, of whom (64/80, 80%) remained satisfied with the non-transport decision. Overall, there were 154 of 3330 (4.6%) 9-1-1 recontacts within 72 h. Based on coroner data, three unexpected deaths (0.09%) occurred within 72 h of the initial EMS calls. CONCLUSION Paramedic disposition by ATR protocols resulted in a low rate of 9-1-1 recontact. Unexpected deaths were extremely rare. Patient satisfaction with the non-transport decision was high.
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Affiliation(s)
- Nichole Bosson
- Los Angeles County EMS Agency, Santa Fe Springs, California
- Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist Institute for Research, Torrance, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jake Toy
- Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist Institute for Research, Torrance, California
| | - Allen Chang
- Los Angeles County EMS Agency, Santa Fe Springs, California
- Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist Institute for Research, Torrance, California
| | - David Haase
- Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Adam Kipust
- University of California Los Angeles, Los Angeles, California
| | | | - Jonathan Warren
- Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist Institute for Research, Torrance, California
| | - Yun Son Kim
- Los Angeles County Fire Department, Los Angeles, California
| | - Clayton Kazan
- Los Angeles County Fire Department, Los Angeles, California
| | - Marianne Gausche-Hill
- Los Angeles County EMS Agency, Santa Fe Springs, California
- Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist Institute for Research, Torrance, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
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22
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Yamada H, Neshige S, Nonaka M, Takebayashi Y, Ishibashi H, Motoda A, Aoki S, Yamazaki Y, Maruyama H. On-scene time delays for epileptic seizures in emergencies during a social pandemic: A population-based study. Epilepsy Behav 2023; 142:109211. [PMID: 37088065 PMCID: PMC10122515 DOI: 10.1016/j.yebeh.2023.109211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES The on-scene time of Emergency Medical Services (EMS), including time for hospital selection, is critical for people in an emergency. However, the outbreak of the novel coronavirus disease 2019 (COVID-19) led to longer delays in providing immediate care for individuals with non-COVID-19-related emergencies, such as epileptic seizures. This study aimed to examine factors associated with on-scene time delays for people with epilepsy (PWE) with seizures needing immediate amelioration. MATERIALS & METHODS We conducted a population-based retrospective cohort study for PWE transported by EMS between 2016 and 2021. We used data from the Hiroshima City Fire Service Bureau database, divided into three study periods: "Pre period", the period before the COVID pandemic (2016-2019); "Early period", the early period of the COVID pandemic (2020); and "Middle period", the middle period of the COVID pandemic (2021). We performed linear regression modeling to identify factors associated with changes in EMS on-scene time for PWE during each period. In addition, we estimated the rate of total EMS call volume required to maintain the same on-scene time for PWE transported by EMS during the pandemic expansion. RESULTS Among 2,205 PWE transported by EMS, significant differences in mean age and prevalence of impaired consciousness were found between pandemic periods. Total EMS call volume per month for all causes during the same month <5,000 (-0.55 min, 95% confidence interval [CI] -1.02 - -0.08, p = 0.022) and transport during the Early period (-1.88 min, 95%CI -2.75 - -1.00, p < 0.001) decreased on-scene time, whereas transport during the Middle period (1.58 min, 95%CI 0.70 - 2.46, p < 0.001) increased on-scene time for PWE transported by EMS. The rate of total EMS call volume was estimated as 0.81 (95%CI -0.04 - 1.07) during the expansion phase of the pandemic to maintain the same degree of on-scene time for PWE transported by EMS before the pandemic. CONCLUSIONS On-scene time delays on PWE in critical care settings were observed during the Middle period. When the pandemic expanded, the EMS system required resource allocation to maintain EMS for time-sensitive illnesses such as epileptic seizures. Timely system changes are critical to meet dramatic social changes.
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Affiliation(s)
- Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan.
| | - Megumi Nonaka
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yoshiko Takebayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Haruka Ishibashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Atsuko Motoda
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, Hiroshima 734-8551, Japan
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23
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Mooney CM, Banks K, Borthwell R, Victorino K, Coutu S, Browder TD, Victorino GP. Shift in Pre-Hospital Mode of Transportation for Trauma Patients during the COVID-19 Pandemic. J Surg Res 2023; 289:16-21. [PMID: 37075606 PMCID: PMC9943740 DOI: 10.1016/j.jss.2023.02.002] [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: 03/08/2022] [Revised: 01/10/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Background Since the start of the COVID-19 pandemic, we experienced alterations to modes of transportation amongst trauma patients suffering penetrating injuries. Historically, a small percentage of our penetrating trauma patients use private means of pre-hospital transportation. Our hypothesis was that the use of private transportation among trauma patients increased during the COVID-19 pandemic and was associated with better outcomes. Methods We retrospectively reviewed all adult trauma patients (Jan. 1, 2017 to Mar. 19, 2021), using the date of the shelter-in-place ordinance (Mar. 19, 2020) to separate trauma patients into pre-pandemic and pandemic patient groups. Patient demographics, mechanism of injury, mode of pre-hospital transportation, and variables such as initial ISS, Intensive Care Unit (ICU) admission, ICU length of stay (LOS), mechanical ventilator days, and mortality were recorded. Results We identified 11,919 adult trauma patients, 9,017 (75.7%) in the pre-pandemic group and 2,902 (24.3%) in the pandemic group. The number of patients using private pre-hospital transportation also increased (from 2.4% to 6.7%, p<0.001). Between the pre-pandemic and pandemic private transportation cohorts, there were reductions in mean ISS (from 8.1 ±10.4 to 5.3 ±6.6: p=0.02), ICU admission rates (from 15% to 2.4%: p<0.001) and hospital LOS (from 4.0 ±5.3 to 2.3 ±1.9: p=0.02). However, there was no difference in mortality (4.1% and 2.0%, p=0.221). Conclusion We found that there was a significant shift in pre-hospital transportation among trauma patients toward private transportation after the shelter-in-place order. However, this did not coincide with a change in mortality despite a downward trend. This phenomenon could help direct future policy and protocols in trauma systems when battling major public health emergencies.
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Affiliation(s)
- Colin M Mooney
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA, 94602, USA,Corresponding Author: Colin Mooney, MD, Department of Surgery, UCSF- East Bay, 1411 E 31st St Oakland, CA 94602 USA C +1 (510) 266 2053, W +1 (510) 437 4267
| | - Kian Banks
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA, 94602, USA
| | - Rachel Borthwell
- Department of Surgery, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Kealia Victorino
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA, 94602, USA
| | - Sophia Coutu
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA, 94602, USA
| | - Timothy D Browder
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA, 94602, USA
| | - Gregory P Victorino
- Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA, 94602, USA
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Liu CH, Tsai MJ, Hsu CF, Tsai CH, Su YS, Cai DC. The Influence of the COVID-19 Pandemic on Emergency Medical Services to Out-of-Hospital Cardiac Arrests in a Low-Incidence Urban City: An Observational Epidemiological Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2713. [PMID: 36768079 PMCID: PMC9915115 DOI: 10.3390/ijerph20032713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
The Emergency Medical Services (EMS) system faced overwhelming challenges during the coronavirus disease 2019 (COVID-19) pandemic. However, further information is required to determine how the pandemic affected the EMS response and the clinical outcomes of out-of-hospital cardiac arrest (OHCA) patients in COVID-19 low-incidence cities. A retrospective study was conducted in Chiayi, Taiwan, a COVID-19 low-incidence urban city. We compared the outcomes and rescue records before (2018-2019) and during (2020-2021) the COVID-19 pandemic. A total of 567 patients before and 497 during the pandemic were enrolled. Multivariate analysis revealed that the COVID-19 pandemic had no significant influence on the achievement of return of spontaneous circulation (ROSC) and sustained ROSC but was associated with lower probabilities of survival to discharge (aOR = 0.43, 95% CI: 0.21-0.89, p = 0.002) and discharge with favorable neurologic outcome among OHCA patients (aOR = 0.35, 95% CI: 0.16-0.77, p = 0.009). Patients' ages and OHCA locations were also discovered to be independently related to survival results. The overall impact of longer EMS rescue times on survival outcomes during the pandemic was not significant, with an exception of the specific group that experienced prolonged rescue times (total EMS time > 21 min).
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Affiliation(s)
- Chung-Hsien Liu
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
- Graduate School of Design, National Yunlin University of Science and Technology, Yunlin 640, Taiwan
| | - Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
| | - Chi-Feng Hsu
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
| | - Cheng-Han Tsai
- Department of Emergency Medicine, Taichung Veteran’s General Hospital, Chia-Yi Branch, Chiayi City 600, Taiwan
| | - Yao-Sing Su
- Fire Bureau, Chiayi City Government, Chiayi City 600, Taiwan
| | - Deng-Chuan Cai
- Graduate School of Design, National Yunlin University of Science and Technology, Yunlin 640, Taiwan
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25
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Mental Health Risk Factors Related to COVID-19 among Canadian Public Safety Professionals. PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint4010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, an environment that has been complicated by the COVID-19 pandemic. Firefighters, paramedics, and public safety communicators were among the front-line workers that continued to serve the public throughout the course of the pandemic. The present study considered the potential impacts of the COVID-19 pandemic on self-reported symptoms of mental health challenges in Canadian firefighters, paramedics, and public safety communicators. Participants were firefighters (n = 123), paramedics (n = 246), and public safety communicators (n = 48), who completed an online survey, including demographics, questions related to COVID-19 exposure and worry, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Social Interaction Phobia Scale, and the Posttraumatic Stress Disorder Checklist-5. Results revealed that risk factors for increased mental health symptom reporting were paramedic occupation, self-identified female, younger in age, COVID-19 personal contact, requirement to self-isolate, and self-perception of COVID-19 contraction (without confirmation through testing). The COVID-19 pandemic should be considered a risk factor for increased mental health symptom reporting in PSP.
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26
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Kienbacher CL, Tanzer JR, Wei G, Rhodes JM, Roth D, Williams KA. Increases in Ambulance Call Volume Are an Early Warning Sign of Major COVID-19 Surges in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16152. [PMID: 36498225 PMCID: PMC9736099 DOI: 10.3390/ijerph192316152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Background: Infectious diseases, including COVID-19, have a severe impact on child health globally. We investigated whether emergency medical service (EMS) calls are a bellwether for future COVID-19 caseloads. We elaborated on geographical hotspots and socioeconomic risk factors. Methods: All EMS calls for suspected infectious disease in the pediatric population (under 18 years of age) in Rhode Island between 1 March 2018 and 28 February 2022 were included in this quasi-experimental ecological study. The first of March 2020 was the beginning of the COVID-19 pandemic. We used the 2020 census tract and the most recent COVID-19 data. We investigated associations between pediatric EMS calls and positive COVID-19 tests with time series analysis and identified geographical clusters using local indicators of spatial association. Economic risk factors were examined using Poisson regression. Results: We included 980 pediatric ambulance calls. Calls during the omicron wave were significantly associated with increases in positive COVID-19 tests one week later (p < 0.001). Lower median household income (IRR 0.99, 95% CI [0.99, 0.99]; p < 0.001) and a higher child poverty rate (IRR 1.02, 95% CI [1.02, 1.02]; p < 0.001) were associated with increased EMS calls. Neighborhood hotspots changed over time. Conclusion: Ambulance calls might be a predictor for major surges of COVID-19 in children.
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Affiliation(s)
- Calvin Lukas Kienbacher
- Division of Emergency Medical Services, Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, 55 Claverick Street, Providence, RI 02903, USA
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Joshua Ray Tanzer
- Lifespan Biostatistics, Epidemiology, and Research Design (BERD) Core, 130 Plain Street, Providence, RI 02903, USA
| | - Guixing Wei
- Spatial Structures in the Social Sciences (S4), Population Studies and Training Center (PSTC), Brown University, 68 Waterman Street, Providence, RI 02912, USA
| | - Jason M. Rhodes
- Center for Emergency Medical Services, Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, USA
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Kenneth Alan Williams
- Division of Emergency Medical Services, Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, 55 Claverick Street, Providence, RI 02903, USA
- Center for Emergency Medical Services, Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, USA
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27
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Bíró K, Deák MS, Pápai G, Nagy A, Dombrádi V, Szabó GT, Boruzs K, Bányai G, Csató G. The Emergency Performance of the Hungarian Ambulance Service during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10112331. [PMID: 36421656 PMCID: PMC9690681 DOI: 10.3390/healthcare10112331] [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: 09/20/2022] [Revised: 10/20/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
The COVID-19 pandemic had a considerable impact on the whole health sector, particularly on emergency services. Our aim was to examine the performance of the Hungarian National Ambulance Service during the first four waves of the pandemic. We defined the 2019 performance of the service as the baseline and compared it with the activity during the pandemic years of 2020 and 2021. The data contained deliveries related to acute myocardial infarction, hemorrhagic stroke, ischemic stroke, overall non-COVID-related ambulance deliveries, COVID screenings performed by the ambulance service, and COVID-related ambulance deliveries. The data were aggregated for each week of the investigated time period and stratified by gender and age. Compared with the pre-pandemic era, we found a significant increase in all three medical conditions and overall deliveries (p < 0.001 in all cases). As a result of the increased burden, it is important for emergency services to prepare for the next global epidemic and to improve organizational performance and rescue activities. The Hungarian example highlights that in a pandemic, it can be beneficial to organize the emergency care of a country or a larger region under a single provider with a single decision maker supported by business intelligence.
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Affiliation(s)
- Klára Bíró
- Institute of Health Economics and Management, Faculty of Economics and Business, University of Debrecen, 4032 Debrecen, Hungary
| | - Máté Sándor Deák
- Institute of Health Economics and Management, Faculty of Economics and Business, University of Debrecen, 4032 Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary
- Correspondence:
| | - György Pápai
- Hungarian National Ambulance Service, 1055 Budapest, Hungary
| | - Attila Nagy
- Department of Health Informatics, Institute of Health Sciences, Faculty of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary
| | - Viktor Dombrádi
- Health Services Management Training Centre, Faculty of Health and Public Administration, Semmelweis University, 1125 Budapest, Hungary
| | - Gábor Tamás Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Klára Boruzs
- Institute of Health Economics and Management, Faculty of Economics and Business, University of Debrecen, 4032 Debrecen, Hungary
| | - Gábor Bányai
- Institute of Health Economics and Management, Faculty of Economics and Business, University of Debrecen, 4032 Debrecen, Hungary
| | - Gábor Csató
- Hungarian National Ambulance Service, 1055 Budapest, Hungary
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28
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Pitt IL. The system-wide effects of dispatch, response and operational performance on emergency medical services during Covid-19. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2022; 9:412. [PMID: 36415345 PMCID: PMC9672593 DOI: 10.1057/s41599-022-01405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
In this paper, we analyze the Fire Department of New York City's pre-hospital emergency medical services dispatch data for the period of March 20, 2019-June 13, 2019, and the corresponding Covid lockdown period of March 20, 2020-June 13, 2020. A fixed effects negative binomial model is used to estimate the heterogeneity effects of average ambulance travel or response times on the daily volume of emergency calls, year, day of the week, dispatcher-assigned medical emergency call type, priority rank, ambulance crew response, borough and an offset for missing calls. We also address the limitations of other non-parametric Covid studies or parametric studies that did not properly account for over-dispersion. When our model is estimated and corrected for clustered standard errors, fixed effects, and over-dispersion, we found that Wednesday was the only day of the week that was most likely to increase travel response time with an odd ratio of 6.91%. All grouped call types that were categorized showed significant declines in average travel time, except for call types designated as allergy and an odds ratio of 21.81%. When compared to Manhattan, Staten Island ambulance response times increased with an odds ratio of 19.05% while the Bronx showed a significant decline with an odds ratio of 31.92% advanced life support (ALS) and BLS ambulances showed the biggest declines in travel time with the exception of BLS assigned ambulance types and emergency priority rank of 6. Surprisingly, in terms of capacity utilization, the dispatch system was not as overwhelmed as previously predicted as emergency call volume declined by 8.83% year over year.
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29
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Olani A, Beza Demisse L, Alemayehu M, Sultan M. Factors Associated with Willingness to Call Emergency Medical Services for Worsening Symptoms of COVID-19 in Addis Ababa, Ethiopia. Open Access Emerg Med 2022; 14:563-572. [PMID: 36285006 PMCID: PMC9588289 DOI: 10.2147/oaem.s380566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background In response to the COVID-19 pandemic, the Ethiopian Ministry of Health has established ambulances and dispatch centers specifically designed to transport COVID-19 patients to city medical centers. Due to a lack of evidence in this area, it is critical to assess the factors that influence the willingness to call for emergency medical services. Methods A community-based cross-sectional study was conducted from June to July 2021 in Addis Ababa. The data were gathered through use of a pretested questionnaire and analyzed using SPSS 25. Logistic regression was used to calculate odds ratios with and without confounding variable controls, and significant associations were declared at (0.05). For the variables that show significant associations in bivariate and multivariate analyses, a 95% confidence interval is provided. Results Three-quarters of those surveyed said they would call ambulance if they experienced worsening COVID-19 symptoms. The individual’s language was associated with the willingness to call EMS for worsening COVID-19 symptoms [AOR 0.51(95% CI: 0.28–0.92)].; awareness of the availability of toll-free ambulance services [AOR 3.4(95% CI: 1.92–5.95)]; recalling an EMS number [AOR 4.3(95% CI: 1.71–10.67)]; ambulance crew quality of care perception [AOR 3.6(95% CI: 2.09–6.10)]; ambulance service adequacy and accessibility perception [AOR 0.25(95% CI: 0.11–0.55)]. Conclusion The study showed significant portion of the Addis Ababa community recognized the need to call EMS due to worsening COVID-19 symptoms. The individual’s language, awareness of toll-free ambulance; ability to recall an ambulance number, perception of the ambulance crew’s quality of care and adequacy and accessibility of service in the city influence the decision to call an ambulance. The finding highlights the significance of addressing problems through various media outlet, for advocacy and public awareness. More research, including qualitative studies, is needed to investigate the factors that encourage people to seek EMS.
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Affiliation(s)
- Ararso Olani
- College of Medicine and Health Science, Arba Minch University, Arbaminch, Ethiopia
| | - Lemlem Beza Demisse
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,Correspondence: Lemlem Beza Demisse, Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Po Box 2021, Bole Road, Addis Ababa, Ethiopia, Tel +251 923-092533, Email
| | | | - Menbeu Sultan
- Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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30
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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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Ha JY, Sung WY. Impact of COVID-19 pandemic on emergency department length of stay and clinical outcomes of patients with severe pneumonia: A single-center observational study. Medicine (Baltimore) 2022; 101:e30633. [PMID: 36197269 PMCID: PMC9508957 DOI: 10.1097/md.0000000000030633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We examined the impact of COVID-19 pandemic on the emergency department length of stay (EDLOS) and clinical outcomes of patients with severe pneumonia admitted to the intensive care unit (ICU) through the emergency department (ED). This single-center retrospective observational study included adult patients with pneumonia admitted to the ICU through the ED between January and December 2019 (pre-pandemic) and between March 2020 and February 2021 (during-pandemic). We compared and analyzed the EDLOS by dividing it into pre-, mid-, and post-EDLOS and in-hospital mortality of patients with pneumonia admitted to the ICU according to the time of ED visits before and during the COVID-19 pandemic. Risk factors for in-hospital mortality according to the time of ED visits were analyzed using multiple logistic regression analysis. In total, 227 patients (73 patients pre-pandemic and 154 patients during the pandemic) with pneumonia admitted to the ICU through the ED were analyzed. During the COVID-19 pandemic, pre-, mid-, and post-EDLOS increased (P < .05), and the in-hospital mortality rate increased by 10.4%; however, this was not significant (P = .155). Multivariate logistic regression analysis revealed post-EDLOS (ED waiting time after making ICU admission decision) as an independent risk factor for in-hospital mortality of patients with pneumonia admitted to the ICU, pre-pandemic (odds ratio [OR] = 2.282, 95% confidence interval [CI]: 1.367-3.807, P = .002) and during the pandemic (OR = 1.126, 95% CI: 1.002-1.266, P = .047). Mid-EDLOS (ED time to assess, care, and ICU admission decision) was an independent risk factor for in-hospital mortality of patients with pneumonia admitted to the ICU during the COVID-19 pandemic (OR = 1.835, 95% CI: 1.089-3.092, P = .023). During the pandemic of emerging respiratory infectious diseases, to reduce in-hospital mortality of severe pneumonia patients, it is necessary to shorten the ED waiting time for admission by increasing the number of isolation ICU beds. It is also necessary to accelerate the assessment and care process in the ED, and make prompt decisions regarding admission to the ICU.
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Affiliation(s)
- Jun Young Ha
- Department of Emergency Medicine, Daejeon Eulji University Hospital, Daejeon, Republic of Korea
| | - Won Young Sung
- Department of Emergency Medicine, Daejeon Eulji University Hospital, Daejeon, Republic of Korea
- *Correspondence: Won Young Sung, Department of Emergency Medicine, Daejeon Eulji University Hospital, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea (e-mail: )
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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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Liveris A, Stone ME, Markel H, Agriantonis G, Bukur M, Melton S, Roudnitsky V, Chao E, Reddy SH, Teperman SH, Meltzer JA. When New York City was the COVID-19 pandemic epicenter: The impact on trauma care. J Trauma Acute Care Surg 2022; 93:247-255. [PMID: 35881035 PMCID: PMC9322893 DOI: 10.1097/ta.0000000000003460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND During early spring 2020, New York City (NYC) rapidly became the first US epicenter of the COVID-19 pandemic. With an unparalleled strain on health care resources, we sought to investigate the impact of the pandemic on trauma visits and mortality in the United States' largest municipal hospital system. METHODS We conducted a retrospective multicenter cohort study of the five level 1 trauma centers in NYC's public health care system, New York City's Health and Hospitals Corporation. Clinical characteristics, mechanism of injury, and mortality of trauma patients presenting during the early pandemic (March 1, 2020, to May 31, 2020) were compared with a similar period in the previous 2 years. To account for important patient and hospital-level confounding variables, we created a propensity score for treatment and applied inverse probability weighting. RESULTS In March to May 2020, there was a 25% decrease in median number of monthly trauma visits (693 vs. 528; p = 0.02) but a 50% increase (15% vs. 22%; p = <0.001) in patients presenting for penetrating injuries, compared with the same period for 2018 and 2019. Injured patients with COVID were significantly more likely to die compared with those without COVID-19 (10.5% vs. 3.6%; p < 0.001). Overall, there was no significant difference in mortality for non-COVID-injured New Yorkers cared for in 2020 compared with 2018 and 2019. Less severely injured non-COVID patients (Injury Severity Score, <15), however, were significantly more likely to die compared with this same subgroup in 2018 and 2019 (adjusted relative risk, 2.7 [95% confidence interval, 1.5-4.7]). CONCLUSION Despite a decline in overall trauma visits during the early part of the COVID pandemic in NYC, there was a significant increase in the proportion of penetrating mechanisms. Less-injured non-COVID patients experienced an increase in mortality in the early pandemic, possibly from a depletion of human and hospital resources from the large influx of COVID patients. These data lend support to the safeguarding of trauma system resources in the event of a future pandemic. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level III.
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Affiliation(s)
- Anna Liveris
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - Melvin E. Stone
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - Harley Markel
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - George Agriantonis
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - Marko Bukur
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - Sherry Melton
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - Valery Roudnitsky
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - Edward Chao
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - Srinivas H. Reddy
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - Sheldon H. Teperman
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
| | - James A. Meltzer
- From the Jacobi Medical Center (A.L., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Albert Einstein College of Medicine, (A.L., M.E.S., H.M., E.C., S.H.R., S.H.T., J.A.M.) Bronx, New York; Kings County Hospital Center (M.E.S., V.R.), Brooklyn, New York; Elmhurst Hospital Center (G.A.), Queens, New York; Icahn School of Medicine at Mount Sinai (G.A.), New York, New York; Bellevue Hospital Center (M.B.), New York, New York; NYU Langone Medical Center (M.B.), New York, New York; NYU Grossman School of Medicine (M.B.), New York, New York; Lincoln Hospital (S.M.), Bronx, New York; Weill-Cornell Medical College (S.M.), New York, New York; and SUNY Downstate Medical College (V.R.), Brooklyn, New York
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Gianquintieri L, Brovelli MA, Pagliosa A, Dassi G, Brambilla PM, Bonora R, Sechi GM, Caiani EG. Generating High-Granularity COVID-19 Territorial Early Alerts Using Emergency Medical Services and Machine Learning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9012. [PMID: 35897382 PMCID: PMC9330211 DOI: 10.3390/ijerph19159012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022]
Abstract
The pandemic of COVID-19 has posed unprecedented threats to healthcare systems worldwide. Great efforts were spent to fight the emergency, with the widespread use of cutting-edge technologies, especially big data analytics and AI. In this context, the present study proposes a novel combination of geographical filtering and machine learning (ML) for the development and optimization of a COVID-19 early alert system based on Emergency Medical Services (EMS) data, for the anticipated identification of outbreaks with very high granularity, up to single municipalities. The model, implemented for the region of Lombardy, Italy, showed robust performance, with an overall 80% accuracy in identifying the active spread of the disease. The further post-processing of the output was implemented to classify the territory into five risk classes, resulting in effectively anticipating the demand for interventions by EMS. This model shows state-of-art potentiality for future applications in the early detection of the burden of the impact of COVID-19, or other similar epidemics, on the healthcare system.
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Affiliation(s)
- Lorenzo Gianquintieri
- Electronics, Information and Biomedical Engineering Department, Politecnico di Milano, 20133 Milan, Italy;
| | - Maria Antonia Brovelli
- Civil and Environmental Engineering Department, Politecnico di Milano, 20133 Milan, Italy;
- Istituto per il Rilevamento Elettromagnetico dell’Ambiente, Consiglio Nazionale delle Ricerche, 20133 Milan, Italy
| | - Andrea Pagliosa
- Azienda Regionale Emergenza Urgenza (AREU), 20124 Milan, Italy; (A.P.); (G.D.); (P.M.B.); (R.B.); (G.M.S.)
| | - Gabriele Dassi
- Azienda Regionale Emergenza Urgenza (AREU), 20124 Milan, Italy; (A.P.); (G.D.); (P.M.B.); (R.B.); (G.M.S.)
| | - Piero Maria Brambilla
- Azienda Regionale Emergenza Urgenza (AREU), 20124 Milan, Italy; (A.P.); (G.D.); (P.M.B.); (R.B.); (G.M.S.)
| | - Rodolfo Bonora
- Azienda Regionale Emergenza Urgenza (AREU), 20124 Milan, Italy; (A.P.); (G.D.); (P.M.B.); (R.B.); (G.M.S.)
| | - Giuseppe Maria Sechi
- Azienda Regionale Emergenza Urgenza (AREU), 20124 Milan, Italy; (A.P.); (G.D.); (P.M.B.); (R.B.); (G.M.S.)
| | - Enrico Gianluca Caiani
- Electronics, Information and Biomedical Engineering Department, Politecnico di Milano, 20133 Milan, Italy;
- Istituto di Elettronica e di Ingegneria dell’Informazione e delle Telecomunicazioni, Consiglio Nazionale delle Ricerche, 20133 Milan, Italy
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Banfield WH, Elghawy O, Dewanjee A, Brady WJ. Impact of COVID-19 on emergency department management of stroke and STEMI. A narrative review. Am J Emerg Med 2022; 57:91-97. [PMID: 35526406 PMCID: PMC9057561 DOI: 10.1016/j.ajem.2022.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/20/2022] [Accepted: 04/11/2022] [Indexed: 10/28/2022] Open
Abstract
The novel coronavirus of 2019 (COVID-19) has resulted in a global pandemic; COVID-19 has resulted in significant challenges in the delivery of healthcare, including emergency management of multiple diagnoses, such as stroke and ST-segment myocardial infarction (STEMI). The aim of this study was to identify the impacts of the COVID-19 pandemic on emergency department care of stroke and STEMI patients. In this study a review of the available literature was performed using pre-defined search terms, inclusion criteria, and exclusion criteria. Our analysis, using a narrative review format, indicates that there was not a significant change in time required for key interventions for stroke and STEMI emergent management, including imaging (door-to-CT), tPA administration (door-to-needle), angiographic reperfusion (door-to-puncture), and percutaneous coronary intervention (door-to-balloon). Potential future areas of investigation include how emergency department (ED) stroke and STEMI care has adapted in response to different COVID-19 variants and stages of the pandemic, as well as identifying strategies used by EDs that were successful in providing effective emergency care in the face of the pandemic.
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Affiliation(s)
- W H Banfield
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - O Elghawy
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - A Dewanjee
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - W J Brady
- Department of Emergency Medicine University of Virginia Health Systems, Charlottesville, VA, United States.
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Burton E, Aladkhen J, O’Donnell C, Masterson S, Merwick A, McCarthy VJC, Kearney PM, Buckley CM. Effects of the COVID-19 pandemic on prehospital emergency care for adults with stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis. HRB Open Res 2022; 5:24. [PMID: 35859688 PMCID: PMC9266003 DOI: 10.12688/hrbopenres.13534.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results: Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions: This review will identify existing evidence reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Johnny Aladkhen
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Cathal O’Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhán Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Aine Merwick
- Department of Neurology, Cork University Hospital, Cork City, Cork, Ireland
| | - Vera JC McCarthy
- School of Nursing and Midwifery, University College Cork, Cork City, Cork, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Claire M Buckley
- School of Public Health, University College Cork, Cork City, Cork, Ireland
- Office of the NCAGL for Chronic Disease, Health Service Executive South East, Lacken, Dublin Road, Kilkenny, R95 NV08, Ireland
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Glober N, Hamilton J, Montelauro N, Ulintz A, Arkins T, Supples M, Liao M, O'Donnell D, Faris G. Safety of an Alternative Care Protocol for EMS non-transport in the COVID-19 Pandemic. PREHOSP EMERG CARE 2022; 27:315-320. [PMID: 35666266 DOI: 10.1080/10903127.2022.2086652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Our primary goal was to evaluate safety of a new emergency medical services (EMS) protocol directing non-transport of low-acuity patients during the COVID-19 pandemic. METHODS We performed a retrospective cohort analysis of all patients in Marion County, Indiana, from March 23, 2020 to May 25, 2020 for whom a novel non-transport protocol was used by EMS for patients with low-acuity COVID-19 symptoms. We assessed paramedic compliance with the protocol to determine numbers and types of deviations. We further reviewed a statewide health information exchange database to identify any patients with emergency department (ED) visits, hospital admissions, or death within 30 days of the EMS non-transport. For ED and hospital visits, we collected ED or admission diagnoses to determine if the etiologies were COVID-related. RESULTS Between March 24, 2020 and May 25, 2020, 222 patients were documented as "Treated, Released (per protocol)." The protocol was correctly applied 144 times (64.8%). The other 78 times, although the EMS clinicians documented use of the protocol, it was not actually used (e.g., another protocol such as "no medical emergency" was used). Of the 144 patients for whom the protocol was used, in 55 cases (38.2%), the clinicians documented patient factors that should have contraindicated use of the protocol (e.g., chest pain, past medical history of asthma). The protocol was applied 5 times (3.5%) in pediatric patients. Two patients were admitted to the hospital within 72 hours of incorrect application of the protocol; both were for COVID-related complaints. Two patients were admitted to the hospital within 72 hours of correct protocol use; one was for a COVID-related complaint. CONCLUSION In this case series, paramedics demonstrated large deviations from the novel non-transport protocol. Several patients were admitted to the hospital within 72 hours of non-transport both when the protocol was used correctly, and when it was used incorrectly.
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Affiliation(s)
- Nancy Glober
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | | | | | - Alex Ulintz
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Thomas Arkins
- Indianapolis Emergency Medical Services, Indianapolis, USA
| | - Michael Supples
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Mark Liao
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Daniel O'Donnell
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
| | - Greg Faris
- Department of Emergency Medicine, Indiana University, Indianapolis, USA
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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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Isakov A, Carr M, Munjal KG, Kumar L, Gausche-Hill M. EMS Agenda 2050 Meets the COVID-19 Pandemic. Health Secur 2022; 20:S97-S106. [PMID: 35475661 DOI: 10.1089/hs.2021.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alexander Isakov
- Alexander Isakov, MD, MPH, FACEP, FAEMS, is a Professor of Emergency Medicine, Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael Carr
- Michael Carr, MD, FACEP, is an Assistant Professor of Emergency Medicine, Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kevin G Munjal
- Kevin G. Munjal, MD, MPH, MSCR, is an Associate Professor of Emergency Medicine and Population Health Science and Policy, Departments of Emergency Medicine, Population Health Science and Policy, and Prehospital Care, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lekshmi Kumar
- Lekshmi Kumar, MD, MPH, FACEP, FAEMS, is an Associate Professor of Emergency Medicine, Section of Prehospital and Disaster Medicine, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Marianne Gausche-Hill
- Marianne Gausche-Hill MD, FACEP, FAAP, FAEMS, is a Professor of Clinical Emergency Medicine and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Burton E, McCarthy VJC, Merwick A, Kearney PM, Buckley CM. Effects of the COVID-19 pandemic on prehospital emergency care for stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis. HRB Open Res 2022; 5:24. [DOI: 10.12688/hrbopenres.13534.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance response times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance response times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions This review will identify existing literature reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.
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Comparison of Death Anxiety, Death Obsession, and Humor in Nurses and Medical Emergency Personnel in COVID-19 Pandemic. J Emerg Nurs 2022; 48:559-570. [PMID: 35690485 PMCID: PMC8894800 DOI: 10.1016/j.jen.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/24/2021] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
Introduction COVID-19 has created numerous challenges for the health system. Nurses and medical emergency personnel are at the forefront of fighting COVID-19 and exposed to psychological disorders such as death anxiety and death obsession. Humor is a defense and coping mechanism against the anxiety and obsession associated with death. This study aimed to compare death anxiety, death obsession, and humor among nurses and medical emergency personnel during the COVID-19 pandemic. Methods This descriptive cross-sectional study was conducted with 230 nurses and medical emergency personnel. To collect data, the Templer death anxiety scale, death obsession scale, and humor styles questionnaire were used. SPSS 19 was used for data analysis. The significance level was considered at P < .05. Results Mean and standard deviation of death anxiety in the nurses and medical emergency personnel were 6.86 (4.04) and 5.68 (3.57), respectively; these values for death obsession were 29.82 (12.30) and 25.30 (12.66) and for humor 116.75 (30.87) and 118.48 (24.66), respectively. The nurses had significantly higher death anxiety (t = 2.33, P = .02) and death obsession (t = −2.68, P = .008) than the medical emergency personnel; moreover, there was no significant relationship among humor, death anxiety (r = .11, P = .10), and death obsession (r = .07, P = .31) in nurses and emergency personnel. Discussion The results of this study showed that the levels of death anxiety and death obsession were higher in the nurses than the medical emergency personnel. There was no significant difference between the hospital nurses and medical emergency personnel in terms of humor.
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Birkun A. Laypeople's activity for seeking telephone number of EMS before and during the COVID-19 outbreak: An analysis of web search data. Am J Emerg Med 2021; 53:1-5. [PMID: 34968968 PMCID: PMC8710954 DOI: 10.1016/j.ajem.2021.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To explore trends and patterns of laypeople's activity for seeking telephone number of emergency medical services (EMS) based on analysis of online search traffic, including changes of the search activity with onset of the coronavirus disease 2019 (COVID-19) outbreak, in five countries – the United States of America (USA), India, Brazil, the United Kingdom (UK) and Russia. Methods Google Trends (GT) country-level data on weekly relative search volumes (RSV) for top queries to seek EMS number were examined for January 2018–October 2021, including a comparison of RSVs between pre-COVID-19 period (January 2018–October 2019) and COVID-19 period (January 2020–October 2021), and evaluation of temporal associations of RSVs with weekly numbers of new COVID-19 cases. Results The countries demonstrated diverse patterns of the search activity with significantly different mean RSVs (the USA 1.76, India 10.20, Brazil 2.51, the UK 6.42, Russia 56.79; p < 0.001). For all countries excepting the USA mean RSVs of the COVID-19 period were significantly higher compared with the pre-COVID-19 ones (India +74%, Brazil +148%, the UK +22%, Russia +9%; p ≤ 0.034), and exhibited positive correlations with numbers of new COVID-19 cases, more pronounced for 2021 (India rS = 0.538, Brazil 0.307, the UK 0.434, Russia 0.639; p ≤ 0.045). Conclusion Laypeople's activity for seeking EMS telephone number greatly varies between countries. It clearly responds to the spread of COVID-19 and could be reflective of public need for obtaining emergency help. Further studies are required to establish the role of GT for conducting real-time surveillance of population demand for EMS.
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Affiliation(s)
- Alexei Birkun
- Department of General Surgery, Anesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University; Lenin Blvd, 5/7, Simferopol 295051, Russian Federation.
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Association between Prehospital Hypoxemia and Admission to Intensive Care Unit during the COVID-19 Pandemic: A Retrospective Cohort Study. Medicina (B Aires) 2021; 57:medicina57121362. [PMID: 34946307 PMCID: PMC8707267 DOI: 10.3390/medicina57121362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/25/2022] Open
Abstract
Background and Objectives: The aim of this study was to assess the association between prehospital peripheral oxygen saturation (SpO2) and intensive care unit (ICU) admission in confirmed or suspected coronavirus disease 19 (COVID-19) patients. Materials and Methods: We carried out a retrospective cohort study on patients requiring prehospital intervention between 11 March 2020 and 4 May 2020. All adult patients in whom a diagnosis of COVID-19 pneumonia was suspected by the prehospital physician were included. Patients who presented a prehospital confounding respiratory diagnosis and those who were not eligible for ICU admission were excluded. The main exposure was “Low SpO2” defined as a value < 90%. The primary outcome was 48-h ICU admission. Secondary outcomes were 48-h mortality and 30-day mortality. We analyzed the association between low SpO2 and ICU admission or mortality with univariable and multivariable regression models. Results: A total of 145 patients were included. A total of 41 (28.3%) patients had a low prehospital SpO2 and 21 (14.5%) patients were admitted to the ICU during the first 48 h. Low SpO2 was associated with an increase in ICU admission (OR = 3.4, 95% CI = 1.2–10.0), which remained significant after adjusting for sex and age (aOR = 5.2, 95% CI = 1.8–15.4). Mortality was higher in low SpO2 patients at 48 h (OR = 7.1 95% CI 1.3–38.3) and at 30 days (OR = 3.9, 95% CI 1.4–10.7). Conclusions: In our physician-staffed prehospital system, first low prehospital SpO2 values were associated with a higher risk of ICU admission during the COVID-19 pandemic.
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