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Pireddu R, Bottega F, De la Rosa MJ, Ruberti S, Giupponi A, Mina A, Filetici L, Cipolotti G, Zoli A, Signorelli C. The Impact of the Coronavirus Disease 2019 Pandemic on Helicopter Emergency Medical Services. Air Med J 2024; 43:440-444. [PMID: 39293923 DOI: 10.1016/j.amj.2024.07.004] [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: 02/02/2024] [Revised: 06/24/2024] [Accepted: 07/18/2024] [Indexed: 09/20/2024]
Abstract
The coronavirus disease 2019 pandemic has profoundly affected the Lombardy healthcare system. Although air transport of critical patients played a crucial role, there are still gaps in understanding how the pandemic impacted helicopter emergency medical services (HEMS). A retrospective observational analysis was performed using data from the regional emergency-urgency online portal. The investigation focused on patients airlifted by helicopter to the Lombardy emergency departments from January 1, 2019, to December 31, 2021. A total of 12,953 admissions to the emergency departments have been recorded (5,733 in 2019, 3,550 in 2020, and 3,670 in 2021). The monthly average of events changed significantly over the 3 years (2019 [477.7], 2020 [295.8], and 2021 [305.8]) (P < .001). Additionally, there was a notable increase in the percentage of severe cases with red triage codes in 2020 (28.9%) and 2021 (33.5%) compared with 2019 (19.9%). Moreover, the number of hospitalized patients increased in 2020 (39.9%) and 2021 (37.2%) compared with 2019 (27.7%). The HEMS documented a noteworthy decrease in mission numbers and an increase in patient clinical severity during the pandemic. Consequently, the HEMS might be allocated for specific roles in national pandemic plans during the alert phase activation, such as secondary transport between hospital facilities.
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Affiliation(s)
- Roberta Pireddu
- School of Public Health, Faculty of Medicine, University of Vita-Salute San Raffaele, Milan, Italy
| | - Francesca Bottega
- School of Public Health, Faculty of Medicine, University of Vita-Salute San Raffaele, Milan, Italy.
| | - Maria José De la Rosa
- School of Public Health, Faculty of Medicine, University of Vita-Salute San Raffaele, Milan, Italy
| | | | - Angelo Giupponi
- Agenzia Regionale Emergenza Urgenza, Milan, Italy; HEMS - Mountain Helicopter Emergency Medical Services Association, Como, Italy
| | - Andrea Mina
- HEMS - Mountain Helicopter Emergency Medical Services Association, Como, Italy; Azienda Sanitaria Zero, Piemonte, Turin, Italy
| | - Luca Filetici
- HEMS - Mountain Helicopter Emergency Medical Services Association, Como, Italy; Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Giovanni Cipolotti
- HEMS - Mountain Helicopter Emergency Medical Services Association, Como, Italy
| | - Alberto Zoli
- Agenzia Regionale Emergenza Urgenza, Milan, Italy
| | - Carlo Signorelli
- School of Public Health, Faculty of Medicine, University of Vita-Salute San Raffaele, Milan, Italy
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Stirparo G, Bellini L, Solla D, Stirparo P, Fagoni N, Gambolò L. Should basic life support-defibrillator training be compulsory for newly licensed Italian physicians? An observational study. J Cardiovasc Med (Hagerstown) 2024; 25:632-636. [PMID: 38916227 PMCID: PMC11262733 DOI: 10.2459/jcm.0000000000001645] [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: 01/19/2024] [Revised: 05/07/2024] [Accepted: 05/12/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is a relevant event with a fatal outcome in most cases. Basic life support-defibrillator (BLSD) training is central to rescuing a patient in arrest and ensuring that the patient has a better chance of returning to spontaneous circulation. Despite this, BLSD training is not mandatory for newly licensed physicians. Our study aims to evaluate the preparedness of newly qualified doctors to manage an OHCA and the impact of BLSD training. MATERIALS AND METHODS We tested 120 newly qualified doctors, members of the 'Italian Society of Medicine and Scientific Divulgation' network, evaluating their practical and theoretical knowledge in managing an OHCA before and after a BLSD training course conducted according to the American Heart Association guidelines. RESULTS Fifty-nine physicians (49.2%) had an adequate background of the theoretical basis of cardiopulmonary resuscitation (CPR); 37 (30.8%) were able to perform effective CPR on a mannequin, but only 19 (15.8%) were able to perform effective CPR with adequate depth and frequency of compressions. After the BLSD training course, 111 physicians (92.5%) were able to perform effective and quality CPR on a mannequin with feedback. CONCLUSION In Italy, BLSD training for physicians is not mandatory, and newly licensed physicians showed good knowledge of the theoretical basis of CPR, but few of them performed compressions of adequate depth and frequency. These results should guide future educational policy decisions in Italian academies.
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Affiliation(s)
- Giuseppe Stirparo
- SIMED Società Italiana di Medicina e Divulgazione Scientifica, Parma
| | - Lorenzo Bellini
- SIMED Società Italiana di Medicina e Divulgazione Scientifica, Parma
| | - Daniele Solla
- SIMED Società Italiana di Medicina e Divulgazione Scientifica, Parma
| | | | - Nazzareno Fagoni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Luca Gambolò
- SIMED Società Italiana di Medicina e Divulgazione Scientifica, Parma
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Bottega F, Kacerik E, Perotti G, Signorelli C, Ristagno G. Reshaping Emergency Care: Dynamics of OHCA and STEMI in a Three-Year Analysis. EPIDEMIOLOGIA 2024; 5:362-370. [PMID: 39051206 PMCID: PMC11270370 DOI: 10.3390/epidemiologia5030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/02/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
The COVID-19 pandemic drastically reshaped healthcare in Lombardy, Italy, notably impacting EMS and emergency departments and altering the epidemiology of time-dependent pathologies such as STEMI and OHCA. While previous studies focused on modifications during the pandemic peak, with an increase in the number of OHCA diagnoses and a reduction in the number of STEMI, little evidence exists regarding the inter-pandemic phases. We analyzed OHCA and STEMI accesses to the ED in the regional emergency department access register (EUOL) for 2019-2021. The analysis revealed a significant difference in monthly diagnosis averages. For STEMI, the change was statistically significant (F(2, 33) = 4.45, p = 0.02), while it was not for OHCA (F(2, 33) = 0.18, p = 0.83). Despite the monthly decreases, the likelihood of receiving a STEMI diagnosis increased with total accesses, OR 1.40 [95% CI 1.25-1.58, p < 0.0001]. Additionally, there was a significant increase in March 2020 discharge diagnoses for OHCA compared to March 2019, OR 3.35 [95% CI 2.88-3.90, p < 0.0001], corresponding to the first pandemic wave. Therefore, our analysis indicates that the epidemiology of STEMI and OHCA was altered during the COVID-19 pandemic.
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Affiliation(s)
- Francesca Bottega
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Erika Kacerik
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Gabriele Perotti
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Via Campanini 6, 20124 Milano, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Giuseppe Ristagno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Via Festa del Perdono 7, 20122 Milano, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20090 Milano, Italy
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Pireddu R, Ristagno G, Gianquintieri L, Bonora R, Pagliosa A, Andreassi A, Sechi GM, Signorelli C, Stirparo G. Out-of-Hospital Cardiac Arrest in the Paediatric Patient: An Observational Study in the Context of National Regulations. J Clin Med 2024; 13:3133. [PMID: 38892845 PMCID: PMC11172461 DOI: 10.3390/jcm13113133] [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: 04/11/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: Cardiac arrest results in a high death rate if cardiopulmonary resuscitation and early defibrillation are not performed. Mortality is strongly linked to regulations, in terms of prevention and emergency-urgency system organization. In Italy, training of lay rescuers and the presence of defibrillators were recently made mandatory in schools. Our analysis aims to analyze Out-of-Hospital Cardiac Arrest (OHCA) events in pediatric patients (under 18 years old), to understand the epidemiology of this phenomenon and provide helpful evidence for policy-making. Methods: A retrospective observational analysis was conducted on the emergency databases of Lombardy Region, considering all pediatric OHCAs managed between 1 January 2016, and 31 December 2019. The demographics of the patients and the logistics of the events were statistically analyzed. Results: The incidence in pediatric subjects is 4.5 (95% CI 3.6-5.6) per 100,000 of the population. School buildings and sports facilities have relatively few events (1.9% and 4.4%, respectively), while 39.4% of OHCAs are preventable, being due to violent accidents or trauma, mainly occurring on the streets (23.2%). Conclusions: Limiting violent events is necessary to reduce OHCA mortality in children. Raising awareness and giving practical training to citizens is a priority in general but specifically in schools.
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Affiliation(s)
- Roberta Pireddu
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Giuseppe Ristagno
- Department of Medical and Surgical Pathophysiology and Transplantation, University of Milano, 20133 Milano, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20090 Milano, Italy
| | - Lorenzo Gianquintieri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milano, Italy
| | - Rodolfo Bonora
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
| | - Andrea Pagliosa
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
| | - Aida Andreassi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
| | | | - Carlo Signorelli
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Giuseppe Stirparo
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milano, Italy
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
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Fagoni N, Bellini L, Bonora R, Botteri M, Migliari M, Pagliosa A, Sechi GM, Signorelli C, Zoli A, Stirparo G. Changing the stroke network during pandemic scenarios does not affect the management of patients with a positive Cincinnati prehospital stroke scale. Neurol Sci 2024; 45:655-662. [PMID: 37672177 PMCID: PMC10791942 DOI: 10.1007/s10072-023-07046-7] [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] [Received: 04/22/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Time plays a crucial role in the management of stroke, and changing the prehospital emergency network, altering the HUB and spoke relationship in pandemic scenarios, might have an impact on time to fibrinolysis or thrombectomy. The aim of this study was to evaluate the time-dependent stroke emergency network in Lombardy region (Italy) by comparing 2019 with 2020 and early 2021. Three parameters were investigated: (i) time of arrival of the first vehicle at the scene, (ii) overall duration of missions, and (iii) number of patients transported by emergency vehicles. METHODS Data analysis process conducted using the SAS-AREU portal (SAS Institute, USA). RESULTS The number of patients with a positive CPSS was similar among the different pandemic waves. Mission duration increased from a mean time (SD) of 52.9 (16.1) min in 2019 to 64.1 (19.7) in 2020 and 55.0 (16.8) in 2021. Time to first vehicle on scene increased to 15.7 (8.4) min in 2020 and 16.0 (7.0) in 2021 compared to 2019, 13.6 (7.2) (P < 0.05). The number of hospital with available stroke units decreased from 46 in 2019 to 10 during the first pandemic wave. CONCLUSIONS The pandemic forced changes in the clinical mission of many hospitals by reducing the number of stroke units. Despite this, the organization of the emergency system allowed to identify strategic hospitals and thus avoid excessive transport time. The result was an adequate time for fibrinolysis/thrombectomy, in agreement with the guidelines. Coordinated management in emergency situations makes it possible to maintain service quality standards, despite the unfavorable scenario.
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Affiliation(s)
- Nazzareno Fagoni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili Di Brescia, Brescia, Italy.
| | - Lorenzo Bellini
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
| | - Rodolfo Bonora
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Marco Botteri
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili Di Brescia, Brescia, Italy
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Maurizio Migliari
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Andrea Pagliosa
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Giuseppe Maria Sechi
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Zoli
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
| | - Giuseppe Stirparo
- Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, Italy
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan, Italy
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Stirparo G, Kacerik E, Ristagno G, Andreassi A, Coppo A, Migliari M, Albonico A, Sechi GM, Zoli A, Signorelli C. Management of possible stroke by laypeople in pre-hospital setting: who should we train? ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023203. [PMID: 37850778 PMCID: PMC10644920 DOI: 10.23750/abm.v94i5.14261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/20/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND AIM The pre-hospital management of a possible stroke is fundamental for the transport of patients to the correct HUB facility; thus, they must be transported to the Emergency Department (ED) by EMS vehicles. Our study aims to analyze the factors correlated with a higher probability of accessing the ED through the EMS in this event. METHODS This is a retrospective observational study. All accesses in the 120 EDs of the Lombardy region, with a diagnosis of discharge whose symptoms could resemble CPSS, were analyzed between 1 January 2019 and 31 December 2019. RESULTS We identified an increased probability of using the EMS vehicles of 0,05% (I.C. 95%: 0.04% - 0.06%; p<0.0001) for each additional year of age, considering patients aged 20 to 100 years and the percentage was significantly higher in the female population (58% vs 49%; p<0.001). Moreover, we calculated that the incidence of stroke was approximately 140 cases per 100,000 inhabitants. CONCLUSIONS Only half of the citizens in the Lombardy region use the EMS in case of suspicion of stroke; further information campaigns are essential to educate citizens. Information strategies should be directed especially at men between 30 and 59 years old.
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Affiliation(s)
- Giuseppe Stirparo
- Faculty of Medicine, School of Public Health - Università Vita-Salute San Raffaele, 20132 Milan, Italy.
| | - Erika Kacerik
- Faculty of Medicine, School of Public Health - Università Vita-Salute San Raffaele, 20132 Milan, Italy.
| | - Giuseppe Ristagno
- Department of Fisiopatologia Medico-Chirurgica e dei Trapianti - Università degli Studi di Milano, 20122 Milan.
| | - Aida Andreassi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ).
| | - Anna Coppo
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ).
| | | | | | | | - Alberto Zoli
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ).
| | - Carlo Signorelli
- Faculty of Medicine, School of Public Health - Università Vita-Salute San Raffaele, 20132 Milan, Italy.
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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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Bellini L, Fagoni N, Andreassi A, Sechi GM, Bonora R, Stirparo G. Effectiveness of Cardiopulmonary Resuscitation at the Workplace. LA MEDICINA DEL LAVORO 2023; 114:e2023010. [PMID: 37309884 PMCID: PMC10281073 DOI: 10.23749/mdl.v114i3.13995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/04/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Out-of-Hospital Cardiac Arrest (OHCA) is a medical emergency whose chances of survival can be increased by rapid Cardiopulmonary Resuscitation (CPR) and early use of Public Access Defibrillators (PAD). Basic Life Support (BLS) training became mandatory in Italy to spread knowledge of resuscitation maneuvers in the workplace. Basic Life Support (BLS) training became mandatory according to the DL 81/2008 law. To improve the level of cardioprotection in the workplace, the national law DL 116/2021 increased the number of places required to be provided with PADs. The study highlights the possibility of a Return to spontaneous circulation in OHCA in the workplace. METHODS A multivariate logistic regression model was fitted to the data to extrapolate associations between ROSC and the dependent variables. The associations' robustness was evaluated through sensitivity analysis. RESULTS The chance to receive CPR (OR 2.3; 95% CI:1.8-2.9), PAD (OR 7.2; 95% CI:4.9 - 10.7), and achieve Return to spontaneous circulation (ROSC) (crude OR 2.2; 95% CI:1.7-3.0, adjusted OR 1.6; 95% CI:1.2-2.2) is higher in the workplace compared to all other places. CONCLUSION The workplace could be considered cardioprotective, although further research is necessary to understand the causes of missed CPRs and identify the best places to increase BLS and defibrillation training to help policymakers implement correct programming on the activation of PAD projects.
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Affiliation(s)
- Lorenzo Bellini
- School of Public Health - University of Vita-Salute San Raffaele, Milano, Italy.
| | - Nazzareno Fagoni
- Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia.
| | | | | | | | - Giuseppe Stirparo
- School of Medicine, University Vita-Salute San Raffaele, Milan - Italy.
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Stirparo G, Pireddu R, Andreassi A, Sechi GM, Signorelli C. Social Illness Before and After the COVID-19 Pandemic: A Regional Study. Prehosp Disaster Med 2023; 38:243-246. [PMID: 36912108 DOI: 10.1017/s1049023x23000286] [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: 03/14/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has dramatically changed the epidemiology of several diseases. Much evidence on this has been published in the pandemic phase. In addition, many studies have shown that phenomena such as stress, substance abuse, and burnout increased in the general population during the lockdown. Unfortunately, few studies analyze the post-pandemic phase. STUDY OBJECTIVE The study aimed to evaluate the trend of broad social problems, such as a diagnosis by the emergency department (ED), in the post-pandemic phase in the Lombardy (Italy) region. METHODS The study is a retrospective observational cohort study. All admissions to emergency rooms in the Lombardy region registered in the Emergency Urgency OnLine (EUOL) portal made from January through June 2019 were analyzed, having as main causes: psychiatric disorders, self-harm, substance abuse, social disadvantage, and violence. All accesses in emergency rooms in the Lombardy region registered in the EUOL portal made from January 1, 2019 through June 30, 2019 were analyzed and compared with the same period in 2022. RESULTS The study recorded an increase in the likelihood of events of self-harm (OR = 2.1; 95% CI, 1.8-2.6; P <.0001), substance abuse (OR = 1.2; 95% CI, 1.1-1.3; P <.0001), violence by others (OR = 1.3; 95% CI, 1.2-1.4; P <.0001), and social disadvantage (OR = 1.2; 95% CI, 1.1-1.4; P = .0045). The events are more concentrated in suburban areas (OR = 1.3; 95% CI, 1.2-1.4; P <.001). CONCLUSION The increase in diagnoses of these social problems in the ED is only the culmination of a phenomenon that hides an underlying rise in social illness. In the post-COVID-19 phase, there is a need to invest in community care and social illness prevention policies.
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Affiliation(s)
- Giuseppe Stirparo
- School of Public Health, Faculty of Medicine, University of Vita-Salute San Raffaele, Milan20132, Italy
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan20124, Italy
| | - Roberta Pireddu
- School of Public Health, Faculty of Medicine, University of Vita-Salute San Raffaele, Milan20132, Italy
| | - Aida Andreassi
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan20124, Italy
| | - Giuseppe Maria Sechi
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milan20124, Italy
| | - Carlo Signorelli
- School of Public Health, Faculty of Medicine, University of Vita-Salute San Raffaele, Milan20132, Italy
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Stirparo G, Solla D, Gambolò L, Bellini L, Mantovanelli L, Trapani M, Pregliasco FE, Sarli L, Signorelli C. SIMED-New Doc course, a matter of reflection. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023035. [PMID: 36786254 PMCID: PMC9987498 DOI: 10.23750/abm.v94i1.13959] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM Obtaining a degree in medicine in Italy qualifies for the medical profession; this fact has entailed a newly qualified doctor's remarkable involvement on the medical activities of the National Health Service, especially during the Covid-19 pandemic. It is important to understand the knowledge of the newly qualified doctors and to create specific courses oriented to them. The aim of the study is to evaluate the impact of a peer learning course for the students who attend the last year of medicine school, with the purpose of defining the formal requests to integrate on the course. METHODS A pre and post qualitative research has been carried out on SIMED-NEWDOC course. The course consisted on peer teaching lectures, as lecturers were resident doctors part of SIMED board. At the end of the course it has been submitted a survey to the participants, and data has been analyzed. RESULTS The students enrolled were 139, the average of the participants was 27% of the registered. A qualitative evaluation questionnaire was submitted, the responses were 32 (86%). Average age was 25. Participants attending the last year of medicine school were 30 (95%). 40% of them declared to have attended at least 5 lessons. Among the course participants, 96% judged the course as very useful. CONCLUSIONS All questionnaire results are useful to reflect on future projects. It is necessary to implement further educational projects to better understand the phenomenon, considering the positive impact that participants declared.
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Affiliation(s)
- Giuseppe Stirparo
- SIMED (Società Italiana di Medicina e Divulgazione Scientifica), Parma (Italy); Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, (Italy)..
| | - Daniele Solla
- SIMED (Società Italiana di Medicina e Divulgazione Scientifica), Parma (Italy); Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, (Italy)..
| | - Luca Gambolò
- SIMED (Società Italiana di Medicina e Divulgazione Scientifica), Parma (Italy); University of Parma, Parma, (Italy)..
| | - Lorenzo Bellini
- SIMED (Società Italiana di Medicina e Divulgazione Scientifica), Parma (Italy); Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Milan, (Italy)..
| | - Luca Mantovanelli
- SIMED (Società Italiana di Medicina e Divulgazione Scientifica), Parma (Italy); University of Parma, Parma, (Italy)..
| | - Martino Trapani
- ASST Rhodense, Public Health Division, Garbagnate Hospital, Milan, (Italy)..
| | | | - Leopoldo Sarli
- University of Parma, Department of Medicine and Surgery, Parma, (Italy)..
| | - Carlo Signorelli
- School of Medicine, University Vita-Salute San Raffaele, Milan, (Italy)..
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Changes to the Major Trauma Pre-Hospital Emergency Medical System Network before and during the 2019 COVID-19 Pandemic. J Clin Med 2022; 11:jcm11226748. [PMID: 36431225 PMCID: PMC9692576 DOI: 10.3390/jcm11226748] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: During the coronavirus disease 2019 pandemic, emergency medical services (EMSs) were among the most affected; in fact, there were delays in rescue and changes in time-dependent disease networks. The aim of the study is to understand the impact of COVID-19 on the time-dependent trauma network in the Lombardy region. Methods: A retrospective analysis on major trauma was performed by analysing all records saved in the EmMa database from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Age, gender, time to first emergency vehicle on scene and mission duration were collected. Results: In 2020, compared to 2019, there was a reduction in major trauma diagnoses in March and April, during the first lockdown, OR 0.59 (95% CI 0.49−0.70; p < 0.0001), and a reduction in road accidents and accidents at work, while injuries related to falls from height and violent events increased. There was no significant increase in the number of deaths in the prehospital setting, OR 1.09 (95% CI 0.73−1.30; p = 0.325). Conclusions: The COVID-19 pandemic has changed the epidemiology of major trauma, but in the Lombardy region there was no significant change in mortality in the out-of-hospital setting.
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