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Bodur İ, Aydın O, Yaradılmış RM, Güneylioğlu MM, Güngör A, Akkaya B, Göktuğ A, Öztürk B, Karacan CD, Tuygun N. Emergency medical service use at a pediatric center in Turkey, during the COVID-19 pandemic period. J Trop Pediatr 2024; 70:fmae007. [PMID: 38627996 DOI: 10.1093/tropej/fmae007] [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] [Indexed: 04/19/2024]
Abstract
AIM This study aimed to evaluate aspects of pediatric patients presenting to a hospital in Turkey via emergency ambulance services, including incidence of visits to the hospital, acuity of illness and most common diagnoses, during the one-year period before and after the onset of the coronavrrus dsease 2019 (COVID-19) pandemic. METHODS This was a retrospective and single center analysis of children, transported by Emergency Medical Services to the Emergency Department (ED) of a children's hospital in Turkey, between 10 March 2019 and 11 March 2021. RESULTS Percentage of high acuity group (68.1% vs.76.9%) during pandemic period was significantly lower than prepandemic period (p < 0.001). On the contrary, the percentage of patients using emergency ambulance service with a low level of acuity increased during the pandemic period compared to the prepandemic period (31.9% vs. 23.1%) (p < 0.001). A significant decrease was observed in the cases of lower respiratory tract infections, febrile status epilepticus and excessive alcohol use during the pandemic period. No significant differences were found hospitalizations requiring PICU and mortality in ED during the pandemic period. CONCLUSION During the COVID-19 pandemic; also, a decrease in admissions was observed for those with high-risk conditions. On the contrary, an increase was detected in patients with low acuity levels. Efforts should be made to ensure access to safe and quality emergency care during the pandemic.
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Affiliation(s)
- İlknur Bodur
- Department of Pediatric Emergency Medicine, Dr Sami Ulus Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Orkun Aydın
- Department of Pediatric Emergency Medicine, Ankara Etlik City Hospital, Ankara, Turkey
| | | | | | - Ali Güngör
- Department of Pediatric Emergency Medicine, Ankara Etlik City Hospital, Ankara, Turkey
| | - Bilge Akkaya
- Department of Pediatric Emergency Medicine, Ankara Etlik City Hospital, Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency Medicine, Göztepe City Hospital, İstanbul, Turkey
| | - Betül Öztürk
- Department of Pediatric Emergency Medicine, Ankara Etlik City Hospital, Ankara, Turkey
| | - Can Demir Karacan
- Department of Pediatric Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency Medicine, Ankara Etlik City Hospital, Ankara, Turkey
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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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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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Katayama Y, Tanaka K, Domi H, Masui J, Nakao S, Tachino J, Hirose T, Kitamura T, Oda J, Matsuoka T. Outcome of emergency patients transported by ambulance during the COVID-19 pandemic in Osaka Prefecture, Japan: a population-based descriptive study. Front Public Health 2024; 11:1322236. [PMID: 38274542 PMCID: PMC10808805 DOI: 10.3389/fpubh.2023.1322236] [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: 10/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background The novel corona virus (COVID-19) pandemic occurred worldwide. Although an excessive burden was placed on emergency medical institutions treating urgent and severe patients, its impact on patient outcome remains unknown. This study aimed to assess the impact of the COVID-19 pandemic in 2021 on the emergency medical services (EMS) system and patient outcomes in Osaka Prefecture, Japan. Methods This was a retrospective descriptive study with a study period from January 1, 2019 to December 31, 2021. We included patients who were transported by ambulance and had cleaned data that was recorded in the ORION system. The study endpoints were the number of patients transported by ambulance and the number of deaths among these patients in each month. To assess the impact of the COVID-19 pandemic on the EMS system, the incidence rate ratio (IRR) and 95% confidence interval (CI) were calculated using 2019 as the reference year. Mortalities were evaluated based on deaths in the emergency department and deaths at 21 days after hospitalization. Results The numbers of patients transported by ambulance were 500,194 in 2019, 443,321 in 2020 (IRR: 0.88, 95% CI: 0.87-0.88), and 448,054 in 2021 (IRR: 0.90, 95% CI: 0.89-0.90). In 2019, the number of patients transported by ambulance and who died in the emergency departments was 4,980, compared to 5,485 in 2020 (IRR: 1.10, 95% CI; 1.06-1.44) and 5,925 in 2021 (IRR: 1.19, 95% CI: 1.15-1.24). In 2019, the number of patients who died within 21 days after hospitalization was 11,931, compared to 11,913 in 2020 (IRR; 1.00, 95% CI; 0.98-1.03) and 13,376 in 2021 (IRR; 1.12, 95% CI; 1.09-1.15). Conclusion The COVID-19 pandemic decreased the number of ambulance requests and worsened mortality of patients transported by ambulance in Osaka Prefecture during 2021.
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Affiliation(s)
- Yusuke Katayama
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenta Tanaka
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hisaya Domi
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Osaka Prefectural Government, Osaka, Japan
| | - Jun Masui
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuya Matsuoka
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture, Osaka, Japan
- Rinku General Medical Center, Izumisano, Japan
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Çirakli Ü, Orhan M, Sayar B, Demiray EKD. Impact of COVID-19 on emergency service usage in Turkey: interrupted time series analysis. Intern Emerg Med 2023; 18:2105-2112. [PMID: 37338714 DOI: 10.1007/s11739-023-03344-2] [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: 04/20/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
The aim of this study is to reveal the impact of the COVID-19 pandemic, which constitutes an extraordinary situation, on the habits of emergency health service use. The data of the study consist of emergency service applications of a public hospital in Turkey between the years 2018-2021. The number of applications to the emergency service was examined periodically. The interrupted time series analysis method was used to reveal the impact of the COVID-19 outbreak on emergency service admissions. When the main findings are analyzed in quarterly periods (3 months = 1 quarter); there has been a sharp decrease in emergency service applications since March 2019, when the first case was seen in Turkey. When an evaluation is made between consecutive quarters, it is seen that there are fluctuations up to 80% in the number of applications. When the statistical analysis findings are examined; while the effect of COVID-19 on the number of applications was found to be significant for the first four periods, it was found to be insignificant for the following periods. With the conducted study, it was revealed that COVID-19 has a significant impact on the use of emergency health services. Although there was a statistically significant decrease in the number of applications, especially in the months following the first case, there was an increase in the number of applications over time. Considering the necessity of using emergency health services when necessary, it can be thought that some of the decrease in the number of applications during the COVID-19 period will be related to the use of unnecessary emergency health services.
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Affiliation(s)
- Ümit Çirakli
- Faculty of Health Sciences, İzmir Bakırçay University, Izmir, Turkey
| | - Mustafa Orhan
- Faculty of Health Sciences, İzmir Bakırçay University, Izmir, Turkey.
| | - Burak Sayar
- Vocational School of Health Services, Bitlis Eren University, Bitlis, Turkey
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Hegenberg K, Althammer A, Gehring C, Prueckner S, Trentzsch H. Pre-Hospital Emergency Medical Services Utilization Amid COVID-19 in 2020: Descriptive Study Based on Routinely Collected Dispatch Data in Bavaria, Germany. Healthcare (Basel) 2023; 11:1983. [PMID: 37510425 PMCID: PMC10379196 DOI: 10.3390/healthcare11141983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND AND IMPORTANCE The COVID-19 pandemic affected the utilization of health care services and posed organizational challenges. While many previous studies focused on the misuse of pre-hospital EMS for low-urgency health problems, the pandemic has put more emphasis on the avoidance of medically necessary calls. OBJECTIVE To compare the utilization of pre-hospital emergency medical services before and after specific pandemic periods. DESIGN, SETTING AND PARTICIPANTS This was a retrospective, descriptive analysis of routine data from 26 dispatch centers in Bavaria, Germany. OUTCOMES MEASURE AND ANALYSIS We investigated the number of emergencies per 100,000 population, as well as the relative change in the emergency rates and transport rates in 2020, compared to the two previous years. Boxplots showed the distributions across the Bavarian districts per calendar week. The mean rates and standard deviations as well as the relative changes were presented for the specific periods. A paired samples t-test was used to compare the rates. MAIN RESULTS Compared to the average of the two previous years, the emergency rates in 2020 were lower in 35 out of 52 calendar weeks. The strongest reductions were observed during the first wave, where the average emergency rate declined by 12.9% (SD 6.8, p < 0.001). There was no statistically significant difference in the overall emergency rate during the summer holidays. Lower transport rates were observed throughout the year, especially during the first wave. CONCLUSIONS Utilization of pre-hospital emergency medical services decreased in 2020, especially during the periods with strict measures. This could be due to the lower morbidity from the behavioral changes during the pandemic, but also to the avoidance of medical services for both less urgent and severe conditions. While a reduction in unnecessary care would be beneficial, patients must be encouraged to seek necessary urgent care, even during a pandemic.
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Affiliation(s)
- Kathrin Hegenberg
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Alexander Althammer
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Christian Gehring
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Stephan Prueckner
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwigs-Maximilians-Universität München, Schillerstr. 53, 80336 Munich, Germany
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Quintal C, Moura Ramos L, Antunes M, Lourenço Ó. Unmet healthcare needs among the population aged 50+ and their association with health outcomes during the COVID-19 pandemic. Eur J Ageing 2023; 20:12. [PMID: 37119316 PMCID: PMC10148617 DOI: 10.1007/s10433-023-00758-x] [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] [Accepted: 04/17/2023] [Indexed: 05/01/2023] Open
Abstract
The COVID-19 pandemic led to unprecedented levels of subjective unmet healthcare needs (SUN). This study investigates the association between SUN in 2020 and three health outcomes in 2021-mortality, cancer, and self-assessed health (SAH), among adults aged 50 years and older, using data from the regular administration of the Survey of Health, Ageing and Retirement in Europe and from the two special waves administered in 2020 and 2021 regarding COVID-19. Three types of SUN were surveyed: care foregone due to fear of contracting COVID-19, pre-scheduled care postponed, and inability to get medical appointments or treatments demanded. We resort on the relative risk and the logistic specification to investigate the association between SUN and health outcomes. To avoid simultaneity, 1-year lagged SUN variables are used. We found a negative association between SUN and mortality. This result differs from the (scarce) previous evidence, suggesting that health systems prioritised life-threatening conditions, in the pandemic context. In line with previous studies, we obtained a positive association between SUN and worse health, in the case of cancer, though it is statistically significant only for the global measure of SUN (any reason). The higher chances of reporting cancer among those exposed to SUN might mean delayed cancer diagnosis, confirming that healthcare foregone was truly needed for a timely diagnosis. The association between SUN and poor or fair SAH is positive but not statistically significant, for the period analysed.
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Affiliation(s)
- Carlota Quintal
- CeBER, Faculty of Economics, Univ Coimbra, Avenida Dias da Silva, 165, 3004-512 Coimbra, Portugal
| | - Luis Moura Ramos
- CeBER, Faculty of Economics, Univ Coimbra, Avenida Dias da Silva, 165, 3004-512 Coimbra, Portugal
| | - Micaela Antunes
- CeBER, Faculty of Economics, Univ Coimbra, Avenida Dias da Silva, 165, 3004-512 Coimbra, Portugal
| | - Óscar Lourenço
- CeBER, Faculty of Economics, Univ Coimbra, Avenida Dias da Silva, 165, 3004-512 Coimbra, Portugal
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Ghazali DA, Choquet C, Bouzid D, Peyrony O, Fontaine JP, Sonja C, Javaud N, Plaisance P, Revue E, Chauvin A, Casalino E. The Response of Emergency Departments (EDs) to the COVID-19 Pandemic: The Experience of 5 EDs in a Paris-Based Academic Hospital Trust. Qual Manag Health Care 2023; 32:46-52. [PMID: 35383728 PMCID: PMC9797124 DOI: 10.1097/qmh.0000000000000351] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has imposed unforeseen and unprecedented constraints on emergency departments (EDs). In this study, we detail the organizational and managerial tools recently implemented among 5 academic EDs in a French region particularly affected by COVID-19 and analyze how EDs responded to the COVID-19-related disease burden during different phases of the epidemic. Initially, they focused on the early detection of suspected cases by identifying 3 predominant COVID-19 syndromes. During this diagnostic process, patients were placed in respiratory isolation (facial mask before triage) and droplet isolation (ED rooms). A 3-level strategy for triage, clinical pathways in the EDs, and the organization of hospital spaces was based on the real-time polymerase chain reaction (RT-PCR) COVID-19 positivity rate, with ED strategies adapted to the exigencies of each level. This crisis demonstrated hospitals' adaptability and capacity to mobilize in the face of new risks, with hospitals and EDs coordinating their management to reallocate resources, optimize interoperability, and rethink patient pathways. This report on their processes may assist hospitals and EDs in areas currently spared by the new variants.
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Affiliation(s)
- Daniel Aiham Ghazali
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Christophe Choquet
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Donia Bouzid
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Olivier Peyrony
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Jean-Paul Fontaine
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Curac Sonja
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Nicolas Javaud
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Patrick Plaisance
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Eric Revue
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Anthony Chauvin
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
| | - Enrique Casalino
- Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud)
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9
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Katayama Y, Tanaka K, Kitamura T, Dohmi H, Masui J, Hirose T, Nakao S, Tachino J, Oda J, Matsuoka T. Incidence and outcome of patients with difficulty in hospital acceptance during COVID-19 pandemic in Osaka Prefecture, Japan: A population-based descriptive study. Acute Med Surg 2023; 10:e880. [PMID: 37564634 PMCID: PMC10410119 DOI: 10.1002/ams2.880] [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: 04/20/2023] [Revised: 06/24/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
Aim The impact of the coronavirus disease (COVID-19) pandemic on the emergency medical service system in Japan has not been fully revealed. The purpose of this study was to determine the impact of the COVID-19 pandemic in 2021 on the difficulty in hospital acceptance of patients and patient outcome in Osaka Prefecture. Methods This study was a descriptive epidemiological study with a 3-year study period from January 2019 to December 2021. We included patients who were transported by ambulance and had registered in the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. The primary end-point of this study was the difficulty in hospital acceptance by month, and the secondary outcome was the mortality of patients who experience difficulty in hospital acceptance in each year. Results We included 1,302,646 cases in this study. The proportion of cases with difficulty in hospital acceptance was 2.74% (12,829/468,709) in 2019, 3.74% (15,527/414,987) in 2020, and 5.09% (21,311/418,950) in 2021. The crude odds ratio for 2020 was 1.38 (95% confidence interval, 1.35-1.41) and for 2021 was 1.90 (95% confidence interval, 1.86-1.95). In 2019, 218 patients with difficulty in hospital acceptance had died by 21 days after hospitalization, whereas the number increased to 405 in 2020 and 750 in 2021. Conclusion The number of patients experiencing difficulty in hospital acceptance during the COVID-19 pandemic in Osaka Prefecture increased, and patient outcomes were worse than before the pandemic.
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Affiliation(s)
- Yusuke Katayama
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Kenta Tanaka
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tetsuhisa Kitamura
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Hisaya Dohmi
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Osaka Prefectural GovernmentOsakaJapan
| | - Jun Masui
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
- Osaka Prefectural GovernmentOsakaJapan
- Department of Emergency MedicineTane General HospitalOsakaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jun Oda
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tetsuya Matsuoka
- The Working Group to Analyse the Emergency Medical Care System in Osaka PrefectureOsakaJapan
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10
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Kim YS, Lee SH, Lim HJ, Hong WP. Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea. J Korean Med Sci 2023; 38:e92. [PMID: 36974401 PMCID: PMC10042732 DOI: 10.3346/jkms.2023.38.e92] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/20/2022] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database. METHODS We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC. RESULTS The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96-1.09]). CONCLUSION This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.
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Affiliation(s)
- Young Su Kim
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
| | - Seung Hyo Lee
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
| | - Hyouk Jae Lim
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Won Pyo Hong
- 119 EMS Division, National Fire Agency 119, Sejong, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
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11
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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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12
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Scacchi A, Conti A, Politano G, Dalmasso M, Ostellino S, Gianino MM. Impact of COVID-19 on emergency department visits among palliative home care recipients: a retrospective population-based cohort study in the Piedmont region, Italy. Palliat Care Soc Pract 2022; 16:26323524221136880. [PMID: 36405349 PMCID: PMC9666412 DOI: 10.1177/26323524221136880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/14/2022] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Integrated palliative home care (IHPC) is delivered to patients with progressive end-stage diseases. During the COVID-19 pandemic, IHPC needed to provide high-quality home care services for patients who were treated at home, with the goal of avoiding unnecessary care, hospital admissions, and emergency department (ED) visits. This study aimed to compare the ED visits of IHPC recipients in a large Italian region before and during the first two waves of the COVID-19 pandemic and to find sociodemographic or clinical characteristics associated with changes in ED visits during the first two waves of COVID-19 pandemic, compared with the period before. METHODS Administrative databases were used to identify sociodemographic and clinical variables of IHPC recipients admitted before and during the pandemic. The obtained data were balanced by applying a propensity score. The average number of ED visits before and during the pandemic was calculated by using the Welch's t test and stratified by all the variables. RESULTS Before and during the pandemic, 5155 and 3177 recipients were admitted to IHPC, respectively. These individuals were primarily affected by neoplasms. ED visits of IHPC recipients reduced from 1346 to 467 before and during the pandemic, respectively. A reduced mortality among IHCP patients who had at least one ED visit during the pandemic (8% during the pandemic versus 15% before the pandemic) was found. The average number of ED visits decreased during the pandemic [0.143, confidence interval (CI) = (0.128-0.158) versus 0.264, CI = (0.242-0.286) before the pandemic; p < 0.001] for all ages and IHPC duration classes. The presence of a formal caregiver led to a significant decrease in ED use. Medium and high emergency ED admissions showed no difference, whereas a decrease in low-level emergency ED admissions during the pandemic [1.27, CI = (1.194-1.345) versus 1.439, CI = (1.3-1.579) before the pandemic; p = 0.036] was found. CONCLUSION ED visits among IHPC recipients were significantly decreased during the first two waves of the COVID-19 pandemic, especially in those individuals characterized by a low level of emergency. This did not result in an increase in mortality among IHPC recipients. These findings could inform the reorganization of home care services after the pandemic.
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Affiliation(s)
- Alessandro Scacchi
- Department of Public Health and Paediatric
Sciences, University of Turin, Turin, Italy
| | - Alessio Conti
- Department of Public Health and Paediatric
Sciences, University of Turin, Via Santena, 5 bis, Turin 10126, Italy
| | - Gianfranco Politano
- Department of Control and Computer Engineering,
Politecnico di Torino, Torino, Italy
| | - Marco Dalmasso
- Epidemiology Unit, Local Health Unit TO3,
Grugliasco, Italy
| | - Sofia Ostellino
- Department of Control and Computer Engineering,
Politecnico di Torino, Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health and Paediatric
Sciences, University of Turin, Turin, Italy
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13
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Youn HM, Quan J, Mak IL, Yu EYT, Lau CS, Ip MSM, Tang SCW, Wong ICK, Lau KK, Lee MSF, Ng CS, Grépin KA, Chao DVK, Ko WWK, Lam CLK, Wan EYF. Long-term spill-over impact of COVID-19 on health and healthcare of people with non-communicable diseases: a study protocol for a population-based cohort and health economic study. BMJ Open 2022; 12:e063150. [PMID: 35973704 PMCID: PMC9385580 DOI: 10.1136/bmjopen-2022-063150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has a significant spill-over effect on people with non-communicable diseases (NCDs) over the long term, beyond the direct effect of COVID-19 infection. Evaluating changes in health outcomes, health service use and costs can provide evidence to optimise care for people with NCDs during and after the pandemic, and to better prepare outbreak responses in the future. METHODS AND ANALYSIS This is a population-based cohort study using electronic health records of the Hong Kong Hospital Authority (HA) CMS, economic modelling and serial cross-sectional surveys on health service use. This study includes people aged ≥18 years who have a documented diagnosis of diabetes mellitus, hypertension, cardiovascular disease, cancer, chronic respiratory disease or chronic kidney disease with at least one attendance at the HA hospital or clinic between 1 January 2010 and 31 December 2019, and without COVID-19 infection. Changes in all-cause mortality, disease-specific outcomes, and health services use rates and costs will be assessed between pre-COVID-19 and-post-COVID-19 pandemic or during each wave using an interrupted time series analysis. The long-term health economic impact of healthcare disruptions during the COVID-19 pandemic will be studied using microsimulation modelling. Multivariable Cox proportional hazards regression and Poisson/negative binomial regression will be used to evaluate the effect of different modes of supplementary care on health outcomes. ETHICS AND DISSEMINATION The study was approved by the institutional review board of the University of Hong Kong, the HA Hong Kong West Cluster (reference number UW 21-297). The study findings will be disseminated through peer-reviewed publications and international conferences.
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Affiliation(s)
- Hin Moi Youn
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jianchao Quan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chak Sing Lau
- School of Clinical Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mary Sau Man Ip
- Division of Respiratory, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sydney Chi Wai Tang
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
- School of Pharmacy, University College London, London, UK
- Aston Pharmacy School, Aston University, Birmingham, UK
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Michael Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong SAR, China
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Carmen S Ng
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Karen Ann Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - David Vai Kiong Chao
- Department of Family Medicine and Primary Health Care, Hospital Authority Kowloon East Cluster, Hong Kong SAR, China
| | - Welchie Wai Kit Ko
- Department of Family Medicine and Primary Health Care, Hospital Authority Hong Kong West Cluster, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
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14
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Dale JN, Morken T, Eliassen KE, Blinkenberg J, Rørtveit G, Hunskaar S, Rebnord IK, Baste V. Preparedness and management during the first phase of the COVID-19 outbreak - a survey among emergency primary care services in Norway. BMC Health Serv Res 2022; 22:896. [PMID: 35820916 PMCID: PMC9275270 DOI: 10.1186/s12913-022-08284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background The emergency primary care (EPC) services in Norway have been at the frontline of the COVID-19 pandemic. Knowledge about the EPC services’ management of the COVID-19 outbreak can be used to prepare for future outbreaks and improve patient management. The objectives of this study were to identify pandemic preparedness and management strategies in EPC centres in Norway during the COVID-19 outbreak. Methods Questions regarding patient management of the COVID-19 outbreak were included in data collection for the National Out-Of-Hours Services Registry. The data collection was web-based, and an invitation was sent by email to the managers of all EPC services in Norway in June 2020. The EPC services were asked questions about pre-pandemic preparedness, access to personal protective equipment (PPE), organizational measures taken, and how staffing was organized during the onset of the pandemic. Results There were 169 municipal and inter-municipal EPC services in Norway in 2020, and all responded to the questionnaire. Among the EPC services, 66.7% (n = 112) had a pandemic plan, but only 4.2% had performed training for pandemic preparedness. Further, fewer than half of the EPC centres (47.5%) had access to supplies of PPE, and 92.8% answered that they needed extra supplies of PPE. 75.3% of the EPC services established one or more respiratory clinics. Staffing with other personnel than usual was done in 44.6% (n = 74) of the EPC services. All EPC services except one implemented new strategies for assessing patients, while about half of the wards implemented new strategies for responding to emergency calls. None of the largest EPC services experienced that their pandemic plan was adequate, while 13.3% of the medium-sized EPC services and 48.9% of the small EPC services reported having an adequate pandemic plan. Conclusions Even though the EPC services lacked well-tested plans and had insufficient supplies of PPE at the outbreak of the COVID-19 pandemic, most services adapted to the pandemic by altering the ways they worked and by hiring health care professionals from other disciplines. These observations may help decision makers plan for future pandemics. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08284-9.
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Affiliation(s)
- Jonas Nordvik Dale
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Tone Morken
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Knut Eirik Eliassen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jesper Blinkenberg
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guri Rørtveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingrid Keilegavlen Rebnord
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Durand C, Douriez E, Chappuis A, Poulain F, Yazdanpanah Y, Lariven S, Lescure FX, Peiffer-Smadja N. Contributions and challenges of community pharmacists during the COVID-19 pandemic: a qualitative study. J Pharm Policy Pract 2022; 15:43. [PMID: 35710392 PMCID: PMC9202330 DOI: 10.1186/s40545-022-00438-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare services across the world have been deeply impacted by the COVID-19 pandemic. In primary care, community pharmacists have had an important role in the frontline healthcare response to the pandemic. Objectives This study aimed to explore the experiences, contributions and perceived challenges of community pharmacists regarding the provision of healthcare services during the COVID-19 pandemic. Methods Semi-structured qualitative interviews were conducted with community pharmacists in France. Participants were recruited through a professional organization of pharmacists combined with a snowballing technique. Interviews were transcribed and then analyzed using thematic analysis. Results A total of 16 community pharmacists participated in the interviews. Study participants described providing a range of novel services in response to the pandemic on top of continuing their usual services. All participants described providing preventative services to reduce and mitigate the spread of SARS-CoV-2, such as education on hygiene and social distancing, delivery of face masks and hand sanitizer and adjusting pharmacy premises. Most respondents also described being involved in SARS-CoV-2 detection through screening and performing antigen testing in pharmacies. Participants reported being actively involved in COVID-19 vaccination by educating the general public about vaccines, facilitating their distribution to general practitioners as well as administering vaccines. Over half the respondents described rapidly changing guidelines and service users’ anxiety as challenges to the provision of healthcare services during the pandemic. Conclusions This study suggests that community pharmacists have significantly contributed to the response to the COVID-19 pandemic by ensuring continuity of pharmaceutical services and providing novel screening, testing and vaccination services. Their roles and responsibilities during the COVID-19 health crisis indicate that they can play an important role in the management of emerging infectious diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00438-8.
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Affiliation(s)
- Claire Durand
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University of Paris, French Institute for Medical Research (INSERM), Paris, France. .,Infectious Disease Department, University Hospital of Nice, Nice, France.
| | - Eric Douriez
- Union Régionale Des Professionnels de Santé Pharmaciens Ile-de-France, Paris, France
| | - Aude Chappuis
- Union Régionale Des Professionnels de Santé Pharmaciens Ile-de-France, Paris, France
| | - Frédérique Poulain
- Union Régionale Des Professionnels de Santé Pharmaciens Ile-de-France, Paris, France
| | - Yazdan Yazdanpanah
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University of Paris, French Institute for Medical Research (INSERM), Paris, France.,Infectious Disease Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Sylvie Lariven
- Infectious Disease Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - François-Xavier Lescure
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University of Paris, French Institute for Medical Research (INSERM), Paris, France.,Infectious Disease Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Nathan Peiffer-Smadja
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University of Paris, French Institute for Medical Research (INSERM), Paris, France.,Infectious Disease Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
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Effects of COVID-19 lockdown strategies on emergency medical services. Am J Emerg Med 2022; 60:40-44. [PMID: 35905600 PMCID: PMC9186951 DOI: 10.1016/j.ajem.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The aim of this study is to evaluate the change in the number of EMS cases by comparing the lockdown period, the non-lockdown period, and the pre-pandemic period. Methods In our study, 3 periods of EMS cases were compared to evaluate the effect of lockdown. The first period (Period A) included in the study was the lockdown period (01-12-2020 and 31–01–2021. The second period (period B) is the period between 01 and 10-2020 and 30–11–2020, where there was no lockdown despite the pandemic. The third period (period C) in the study is the period between 01 and 12-2019 and 31–01–2020 before the pandemic. Results A total of 120,989 cases in 3 periods were included in the study. It was determined that the highest number of patients were in period C (42,703, 35.3%), while the least was in period A (39,054, 32.2%). On the other hand, it was found that the number of calls was highest in period A (246,200, 35.1%), while the least was in period C (212,267, 30.2%). Response times were longer in the pandemic period than in the pre-pandemic period. Mean talk time were longer during the pandemic period. The most frequent diagnosis in period A (21.6%) and B (42.2%) was COVID-19. The second most frequent disease group in these two periods was cardiovascular diseases. Conclusion While the number of EMS cases decreased during the pandemic period, it decreased even more during the lockdown period. However, the number of calls increased significantly during the lockdown period, and the response times and talk times increased accordingly.
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Rezaee N, Mardani-Hamooleh M, Hamidi H. Barriers to teamwork in caring for patients with COVID-19: A qualitative analysis of nurses’ perceptions in a secondary care setting in Iran. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2073005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nasrin Rezaee
- Department of Nursing, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Marjan Mardani-Hamooleh
- Department of Nursing, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Hamidi
- Department of English Language, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Emergency Medical Services Calls Analysis for Trend Prediction during Epidemic Outbreaks: Interrupted Time Series Analysis on 2020-2021 COVID-19 Epidemic in Lazio, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105951. [PMID: 35627487 PMCID: PMC9140838 DOI: 10.3390/ijerph19105951] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/27/2022] [Accepted: 05/11/2022] [Indexed: 01/18/2023]
Abstract
(1) Background: During the COVID-19 outbreak in the Lazio region, a surge in emergency medical service (EMS) calls has been observed. The objective of present study is to investigate if there is any correlation between the variation in numbers of daily EMS calls, and the short-term evolution of the epidemic wave. (2) Methods: Data from the COVID-19 outbreak has been retrieved in order to draw the epidemic curve in the Lazio region. Data from EMS calls has been used in order to determine Excess of Calls (ExCa) in the 2020−2021 years, compared to the year 2019 (baseline). Multiple linear regression models have been run between ExCa and the first-order derivative (D’) of the epidemic wave in time, each regression model anticipating the epidemic progression (up to 14 days), in order to probe a correlation between the variables. (3) Results: EMS calls variation from baseline is correlated with the slope of the curve of ICU admissions, with the most fitting value found at 7 days (R2 0.33, p < 0.001). (4) Conclusions: EMS calls deviation from baseline allows public health services to predict short-term epidemic trends in COVID-19 outbreaks, and can be used as validation of current data, or as an independent estimator of future trends.
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Mak IL, Wan EYF, Wong TKT, Lee WWJ, Chan EWY, Choi EPH, Chui CSL, Ip MSM, Lau WCS, Lau KK, Lee SF, Wong ICK, Yu EYT, Lam CLK. The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review. Public Health Rev 2022; 43:1604121. [PMID: 35574567 PMCID: PMC9091177 DOI: 10.3389/phrs.2022.1604121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders.Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found.Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future.Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.
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Affiliation(s)
- Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- *Correspondence: Eric Yuk Fai Wan,
| | - Teenie Kwan Tung Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wendy Woo Jung Lee
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Esther Wai Yin Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Mary Sau Man Ip
- Division of Respiratory Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wallace Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shing Fung Lee
- Department of Clinical Oncology, Queen Mary Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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20
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A Region-Wide All-Hazard Training Program for Prehospital Mass Casualty Incident Management: A Real-World Case Study. Disaster Med Public Health Prep 2022; 17:e184. [PMID: 35361292 DOI: 10.1017/dmp.2022.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We report the development, implementation, and results of a sustainable region-wide mass-casualty management prehospital training program implemented by the Regione Lombardia emergency medical services (EMS) agency AREU in Italy. METHODS The educational program learning objectives are: (1) command and control, communications, and resource management; (2) mass casualty triage and the START triage protocol; (3) on-scene management; (4) Regione Lombardia and AREU Mass Casualty standard operating procedures; and (5) inter-agency communications and relations. For each course edition data on participants' summative assessment, participants' feedback and costs were collected. RESULTS Between June 26, 2013, and December 31, 2020, a total of 84 editions of the provider training event were delivered, training an overall 1329 prehospital providers; 1239 (93%) passed the summative assessment and were qualified as being operationally "ready." Regarding participant feedback, the overall program was rated 4.4 ± 0.7 out of 5. The overall cost of running the provider program during the study period was €321 510 (circa US $382 000). The average cost per edition was €3828 and €242 per participant. CONCLUSIONS We have described a simple yet interactive simulation and blended-learning approach, which has yielded good pass rates, good participant satisfaction, and contained costs to systematically train emergency medical service personnel.
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21
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Rizzi D, Asperges E, Rovati A, Bigoni F, Pistillo E, Corsico A, Mojoli F, Perlini S, Bruno R. Psychological Support in a COVID-19 Hospital: A Community Case Study. Front Psychol 2022; 12:820074. [PMID: 35250697 PMCID: PMC8893142 DOI: 10.3389/fpsyg.2021.820074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/31/2021] [Indexed: 01/08/2023] Open
Abstract
Burnout is a well-documented entity in Care Workers population, affecting up to 50% of physicians, just as it is equally well established that managing an infectious disease outbreaks, such as confirmed in the COVID-19 pandemic, increases Post-Traumatic Stress Disorder (PTSD) and the psychological burden. Mental health support, in the form of formal or remote sessions, has been shown to be helpful to health care staff, despite the organizational difficulties in an emergency. During the first emergence of COVID-19 in Italy, the Scientific Institute for Research, Hospitalization and Health Care Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation (Pavia, Lombardy), the Italian hospital that treated “patient 1,” has activated an agreement with the Soleterre Foundation, an international Non-Governmental Organization (NGO) that manages health emergency projects, to provide psychological support. A task force of psychologists was created with the aim of designing and administering a Therapeutic Mental Health Assessment for COVID-19 Care Workers (TMHA COVID-19 CWs) to evaluate and support health care workers’ mental health. The assessment battery was developed to evaluate symptoms and behaviors associated with trauma and the corresponding maladaptive behaviors (the National Stressful Events Survey for PTSD-Short Scale “NSESSS” and the Diagnostic and Statistical Manual of Mental Disorders “DSM-5” Self-Rated Level 1 transversal Symptom Measure—Adult). Once the TMHA COVID-19 CWs had been developed, the team of psychologists regularly visited healthcare staff in the ward to administer it. One hundred seven care workers (44 males, mean age 40 ± 15) across Intensive Care Units (ICUs), the emergency room and medical ward were administered the TMHA COVID-19 CWs. PTSD symptoms were reported as severe by 13% of the population. Depressive symptoms as severe for 7% and Anxiety symptoms as severe for 14%. Severe psychotic symptoms were experienced by 2% and severe suicidal thoughts by 1% of the population. The possibility of acting upon the results of the TMHA COVID-19 CWs allowed an early intervention through individual session beyond the cut-off level (moderate and severe symptoms) for PTSD in NSESSS. In fact, 280 individual support sessions were offered. Therefore, we considered our project a protective and support factor for healthcare workers’ mental well-being and we recommend implementing a mental health screening program in ward involved in COVID-19 patients’ care.
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Affiliation(s)
- Damiano Rizzi
- Fondazione Soleterre Strategie di Pace ONLUS, Milan, Italy.,Unit of Emergency Medicine, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Erika Asperges
- Unit of Infectious Disease, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Anna Rovati
- Fondazione Soleterre Strategie di Pace ONLUS, Milan, Italy.,Unit of Emergency Medicine, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Francesca Bigoni
- Fondazione Soleterre Strategie di Pace ONLUS, Milan, Italy.,Unit of Emergency Medicine, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Elena Pistillo
- Fondazione Soleterre Strategie di Pace ONLUS, Milan, Italy
| | - Angelo Corsico
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation, University of Pavia, Milan, Italy
| | - Francesco Mojoli
- Unit of Anaesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Stefano Perlini
- Unit of Emergency Medicine, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Unit of Infectious Disease, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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22
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Vallecillo G, Fonseca F, Oviedo L, Durán X, Martinez I, García-Guix A, Castillo C, Torrens M, Llana S, Roquer A, Martinez MDLC, Aguelo S, Canosa I. Similar COVID-19 incidence to the general population in people with opioid use disorder receiving integrated outpatient clinical care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100027. [PMID: 35156106 PMCID: PMC8760741 DOI: 10.1016/j.dadr.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022]
Abstract
Introduction During the COVID-19 pandemic, limited access to health care augmented COVID-19 risk in subjects with opioid use disorder (OUD). The aim of the study was to compare COVID-19 incidence in individuals with OUD receiving continuous clinical care with that of the general population. Methods A prospective cohort study was carried out from March 2020 to March 2021 comparing COVID-19 cumulative incidence of individuals presenting an OUD receiving integrated clinical care with that of an age-reference general population, in three public outpatient treatment centers for addiction in Barcelona, Spain. Results Over the study period, 366 individuals received clinical care. Mean age: 48.2±8.9 years, 280 (76.5%) were men and 283 (77.3%) native Spanish. All subjects were on opioid agonist therapy. Prevalence of communicable diseases were: HIV infection in 109 (29.8%) and hepatitis C in 46 (12.6%). Psychiatric comorbidity was present in 207 (56.6%), and 119 (32.5%) had >1 chronic medical disease. COVID-19 was diagnosed in 10 patients a cumulative incidence of 2,732 casesx100,000 people/year (C.I.95%: 1,318–4,967). There were no differences compared to the age-general population: 2,856 casesx100,000 people/year (C.I.95%: 2,830–2,880) (p=0.81). In the bivariate analysis, hypertension (5[50.0%] vs. 53[14.9%], p=0.01) and cardiovascular chronic diseases (2 [20.0%] vs. 8 [2.2%], p=0.03) were more prevalent in patients with OUD and COVID-19. Conclusions Individuals with OUD who received integrated clinical care had a COVID-19 incidence comparable to the general population. Ensuring comprehensive healthcare is essential to prevent the clinical impact of COVID-19 on individuals with OUD.
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Solbiati M, Russo L, Beverina A, Groff P, Strada A, Furlan L, Montano N, Costantino G, Casazza G. Examination of the relationship between emergency department presentations and population mortality: a multicenter analysis of emergency department presentations during the COVID-19 pandemic. Eur J Intern Med 2021; 94:34-38. [PMID: 34511339 PMCID: PMC8364807 DOI: 10.1016/j.ejim.2021.08.004] [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] [Received: 05/24/2021] [Revised: 07/16/2021] [Accepted: 08/09/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND In the spring of 2020, Italy experienced a significant reduction in the number of emergency department (ED) presentations during the first wave of the COVID-19 pandemic. If ED access has an impact on patients' prognosis, such a reduction in ED presentations would be expected to correlate with a parallel increase in the mortality rate of the corresponding population. The aim of the present study was to evaluate the impact of reduced ED presentations on the all-cause mortality of the general population. METHODS Absolute and relative variation in ED accesses from March 1 to April 30 of both 2019 and 2020 in three hub hospitals in areas with different COVID-19 prevalence and age-standardized mortality data from January 1 to June 30 in 2019 and 2020 of the same areas were evaluated. RESULTS During March and April 2020, ED consults were decreased of approximately 50% in all three hospitals, as compared with the same months in 2019. There was a marked increase in cumulative mortality in Milan (high SARS-CoV2 infection spread zone) compared with the same period in 2019. In the other two municipalities (Ferrara and Perugia), which had intermediate and low levels of infection spread, the mortality in 2020 was not substantially changed from that of 2019. CONCLUSIONS Taking into account the increase in mortality due to SARS-CoV-2, reductions in ED access did not seem to affect death rates. If this finding will be confirmed, ED organization and access would need to be reconsidered.
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Affiliation(s)
- Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Russo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Paolo Groff
- Pronto Soccorso e Osservazione Breve, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Andrea Strada
- Medicina d'Emergenza Urgenza, Azienda Ospedaliero Universitaria S. Anna, Ferrara, Italy
| | - Ludovico Furlan
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
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Effect of the First Wave of the Belgian COVID-19 Pandemic on Physician-Provided Prehospital Critical Care in the City of Antwerp (Belgium). Prehosp Disaster Med 2021; 37:12-18. [PMID: 34802479 PMCID: PMC8649355 DOI: 10.1017/s1049023x21001278] [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] [Indexed: 11/07/2022]
Abstract
INTRODUCTION There is evidence to suggest that patients delayed seeking urgent medical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A delay in health-seeking behavior could increase the disease severity of patients in the prehospital setting. The combination of COVID-19-related missions and augmented disease severity in the prehospital environment could result in an increase in the number and severity of physician-staffed prehospital interventions, potentially putting a strain on this highly specialized service. STUDY OBJECTIVE The aim was to investigate if the COVID-19 pandemic influences the frequency of physician-staffed prehospital interventions, prehospital mortality, illness severity during prehospital interventions, and the distribution in the prehospital diagnoses. METHODS A retrospective, multicenter cohort study was conducted on prehospital charts from March 14, 2020 through April 30, 2020, compared to the same period in 2019, in an urban area. Recorded data included demographics, prehospital diagnosis, physiological parameters, mortality, and COVID-status. A modified National Health Service (NHS) National Early Warning Score (NEWS) was calculated for each intervention to assess for disease severity. Data were analyzed with univariate and descriptive statistics. RESULTS There was a 31% decrease in physician-staffed prehospital interventions during the period under investigation in 2020 as compared to 2019 (2019: 644 missions and 2020: 446 missions), with an increase in prehospital mortality (OR = 0.646; 95% CI, 0.435 - 0.959). During the study period, there was a marked decrease in the low and medium NEWS groups, respectively, with an OR of 1.366 (95% CI, 1.036 - 1.802) and 1.376 (0.987 - 1.920). A small increase was seen in the high NEWS group, with an OR of 0.804 (95% CI, 0.566 - 1.140); 2019: 80 (13.67%) and 2020: 69 (16.46%). With an overall decrease in cases in all diagnostic categories, a significant increase was observed for respiratory illness (31%; P = .004) and cardiac arrest (54%; P < .001), combined with a significant decrease for intoxications (-58%; P = .007). Due to the national test strategy at that time, a COVID-19 polymerase chain reaction (PCR) result was available in only 125 (30%) patients, of which 20 (16%) were positive. CONCLUSION The frequency of physician-staffed prehospital interventions decreased significantly. There was a marked reduction in interventions for lower illness severity and an increase in higher illness severity and mortality. Further investigation is needed to fully understand the reasons for these changes.
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25
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Vissio E, Falco EC, Scozzari G, Scarmozzino A, Trinh DAA, Morino M, Papotti M, Bertero L, Cassoni P. The Adverse Impact of the COVID-19 Pandemic on Abdominal Emergencies: A Retrospective Clinico-Pathological Analysis. J Clin Med 2021; 10:jcm10225254. [PMID: 34830534 PMCID: PMC8618829 DOI: 10.3390/jcm10225254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023] Open
Abstract
The COVID-19 pandemic has caused a worldwide significant drop of admissions to the emergency department (ED). The aim of the study was to retrospectively investigate the pandemic impact on ED admissions, management, and severity of three abdominal emergencies (appendicitis, diverticulitis, and cholecystitis) during the COVID-19 pandemic using 2017–2019 data as a control. The difference in clinical and pathological disease severity was the primary outcome measure while differences in (i) ED admissions, (ii) triage urgency codes, and (iii) surgical rates were the second ones. Overall, ED admissions for the selected conditions decreased by 34.9% during the pandemic (control: 996, 2020: 648) and lower triage urgency codes were assigned for cholecystitis (control: 170/556, 2020: 66/356, p < 0.001) and appendicitis (control: 40/178, 2020: 21/157, p = 0.031). Less surgical procedures were performed in 2020 (control: 447, 2020: 309), but the surgical rate was stable (47.7% in 2020 vs. 44.8% in 2017–2019). Considering the clinical and pathological assessments, a higher percentage of severe cases was observed in the four pandemic peak months of 2020 (control: 98/192, 2020: 87/109; p < 0.001 and control: 105/192, 2020: 87/109; p < 0.001). For the first time in this study, pathological findings objectively demonstrated an increased disease severity of the analyzed conditions during the early COVID-19 pandemic.
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Affiliation(s)
- Elena Vissio
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
| | - Enrico Costantino Falco
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
| | - Gitana Scozzari
- Hospital Medical Direction, Molinette Hospital, “Città della Salute e della Scienza di Torino” University Hospital, 10126 Turin, Italy; (G.S.); (A.S.)
| | - Antonio Scarmozzino
- Hospital Medical Direction, Molinette Hospital, “Città della Salute e della Scienza di Torino” University Hospital, 10126 Turin, Italy; (G.S.); (A.S.)
| | - Do An Andrea Trinh
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
| | - Mario Morino
- General Surgery 1U, Department of Surgical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy;
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy;
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
- Correspondence: ; Tel.: +39-0116336181
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
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Characteristics of Emergency Medical Service Missions in Out-of-Hospital Cardiac Arrest and Death Cases in the Periods of Before and After the COVID-19 Pandemic. Prehosp Disaster Med 2021; 36:676-683. [PMID: 34622749 PMCID: PMC8529353 DOI: 10.1017/s1049023x21001138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Some studies in countries affected by the coronavirus disease of 2019 (COVID-19) pandemic have shown that the missions of Emergency Medical Service (EMS) have changed during the COVID-19 pandemic, and the rate of death and out-of-hospital cardiac arrest (OHCA) has been increased due to the direct and indirect effects of COVID-19. Objective: The aim of this study was to determine the effect of the COVID-19 pandemic on the process of EMS missions, death, and OHCA. Methods: This cross-sectional study was performed in Tehran, Iran. All conducted missions in the first six months of the three consecutive solar years of March 21 until September 22 of 2018-2020, which were registered in the registry bank of the Tehran EMS center, were assessed and compared. Based on the opinion of experts, the technician’s on-scene diagnoses were categorized into 14 groups, and then death and OHCA cases were compared. Results: In this study, the data of 1,050,376 missions performed in three study periods were analyzed. In general, the number of missions in 2020 was 17.83% fewer than that of 2019 (P < .001); however, the number of missions in 2019 was 30.33% more than that of 2018. On the other hand, the missions of respiratory problems, cardiopulmonary arrest, infectious diseases, and poisoning were increased in 2020 compared to that of 2019. The raw number of OHCA and death cases respectively in 2018, 2019, and 2020 were 25.0, 22.7, and 28.6 cases per 1,000 missions. Of all patients who died in 2020, 4.9% were probable/confirmed COVID-19 cases. The history of heart disease, hypertension, diabetes, and respiratory disease in patients in 2020 was more frequent than that of the other two years. Conclusion: This study showed that the number of missions in the Tehran EMS in 2020 were decreased compared to that of 2019, however the number of missions in 2019 was more than that of 2018. Respiratory problems, infectious diseases, poisoning, death, and OHCA were increased compared to the previous two years and cardiovascular complaints, neurological problems, and motor vehicle collisions (MVCs) in 2020 were fewer than that of the other two years
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Voza A, Desai A, Luzzi S, Giotta Lucifero A, Azzolini E, Kogan M, Goretti G, Piovani D, Bonovas S, Angelotti G, Savevski V, Aghemo A, Greco M, Costantini E, Lleo A, Angelini C, Giordano M, Badalamenti S, Cecconi M. Clinical Outcomes in the Second versus First Pandemic Wave in Italy: Impact of Hospital Changes and Reorganization. APPLIED SCIENCES 2021; 11:9342. [DOI: 10.3390/app11199342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
The region of Lombardy was the epicenter of the COVID-19 outbreak in Italy. Emergency Hospital 19 (EH19) was built in the Milan metropolitan area during the pandemic’s second wave as a facility of Humanitas Clinical and Research Center (HCRC). The present study aimed to assess whether the implementation of EH19 was effective in improving the quality of care of COVID-19 patients during the second wave compared with the first one. The demographics, mortality rate, and in-hospital length of stay (LOS) of two groups of patients were compared: the study group involved patients admitted at HCRC and managed in EH19 during the second pandemic wave, while the control group included patients managed exclusively at HCRC throughout the first wave. The study and control group included 903 (56.7%) and 690 (43.3%) patients, respectively. The study group was six years older on average and had more pre-existing comorbidities. EH19 was associated with a decrease in the intensive care unit admission rate (16.9% vs. 8.75%, p < 0.001), and an equal decrease in invasive oxygen therapy (3.8% vs. 0.23%, p < 0.001). Crude mortality was similar but overlap propensity score weighting revealed a trend toward a potential small decrease. The adjusted difference in LOS was not significant. The implementation of an additional COVID-19 hospital facility was effective in improving the overall quality of care of COVID-19 patients during the first wave of the pandemic when compared with the second. Further studies are necessary to validate the suggested approach.
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The Impact of the COVID-19 Pandemic on Nursing Care: A Cross-Sectional Survey-Based Study. J Pers Med 2021; 11:jpm11100945. [PMID: 34683086 PMCID: PMC8538569 DOI: 10.3390/jpm11100945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has had a severe impact on nursing care. This cross-sectional survey-based study compared aspects of nursing care and nurses’ satisfaction with care provided before and during the first wave of the COVID-19 pandemic. A total of 936 registered nurses (RNs) rated the frequency with which they performed fundamental care, nursing techniques, patient education, symptom management, and nurse–patient relationships before and during the pandemic. A recursive partitioning for ordered multivariate response in a conditional inference framework approach was applied. More frequent fundamental cares were associated with their frequency before the pandemic (p < 0.001), caring for COVID-19 patients (p < 0.001), and workplace reassignment (p = 0.004). Caring for COVID-19 patients (p < 0.001), workplace reassignment (p = 0.030), and caring for ≤7.4 COVID-19 patients (p = 0.014) increased nursing techniques. RNs in high-intensity COVID-19 units (p = 0.002) who educated patients before the pandemic, stopped this task. RNs caring for COVID-19 patients reported increased symptom management (p < 0.001), as did RNs caring for more non-COVID-19 patients (p = 0.037). Less frequent nurse–patient relationships before the pandemic and working in high-intensity COVID-19 units decreased nurse–patient relationships (p = 0.002). Despite enormous challenges, nurses continued to provide a high level of care. Ensuring the appropriate deployment and education of nurses is crucial to personalize care and to maintain nurses’ satisfaction with the care provided.
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Al Amiry A, Maguire BJ. Emergency Medical Services (EMS) Calls During COVID-19: Early Lessons Learned for Systems Planning (A Narrative Review). Open Access Emerg Med 2021; 13:407-414. [PMID: 34522146 PMCID: PMC8434918 DOI: 10.2147/oaem.s324568] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/05/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Over the course of the COVID-19 progress, reports from many locations around the world indicated major increases in EMS call volume, which imposed great pressure on EMS dispatch centers (EMSDC) globally. No studies yet have been done to examine this phenomenon. OBJECTIVE This paper examines the interrelated effects of the unprecedented global increase of EMS call, the effect of the COVID-19 crisis on responding to non-COVID-19 emergencies, and the concurrent effects of having overwhelmed dispatch centers. It tries to explain the current evidence of the bottleneck of EMS calls during the early phase of the worldwide pandemic. ELIGIBILITY CRITERIA We examine the numbers of EMS calls internationally between March and June 2020, derived from published literature and news media. Only articles in English were selected, with certain keywords related to EMS calls, ambulance delay, stroke and cardiac arrest. SOURCE OF EVIDENCE Google Scholar was the main searching source. RESULTS After applying the selection criteria, a total of 29 citations were chosen, and a pattern of knowledge resulted in the emergence of five themes: EMS calls during COVID-19, Reduced EMS operator response time, Ambulance response delays, Collateral mortality and morbidity among non-COVID-19 cases, and Total ambulance call time. CONCLUSION Over the course of COVID-19 progress, there was a global phenomenon of exponential increases in EMS calls, which is expected to impose a great pressure on EMS dispatch centers. Several factors contributing to the bottleneck of EMS calls are identified and explained.
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Affiliation(s)
- Alaa Al Amiry
- Department of Clinical Studies, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Brian J Maguire
- Leidos (Research Laboratory), Groton, CT, USA
- Central Queensland University in Australia, Rockhampton, Queensland, Australia
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Rezoagli E, Magliocca A, Bellani G, Pesenti A, Grasselli G. Development of a Critical Care Response - Experiences from Italy During the Coronavirus Disease 2019 Pandemic. Anesthesiol Clin 2021; 39:265-284. [PMID: 34024430 PMCID: PMC7879060 DOI: 10.1016/j.anclin.2021.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Italy was the first western country facing an outbreak of coronavirus disease 2019 (COVID-19). The first Italian patient diagnosed with COVID-19 was admitted, on Feb. 20, 2020, to the intensive care unit (ICU) in Codogno (Lodi, Lombardy, Italy), and the number of reported positive cases increased to 36 in the next 24 hours, and then exponentially for 18 days. This triggered a response that resulted in a massive surge in ICU bed capacity. The COVID19 Lombardy Network organized a structured logistic response and provided scientific evidence to highlight information on COVID-19 associated respiratory failure.
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Affiliation(s)
- Emanuele Rezoagli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, Monza 20900, Italy,Department of Emergency and Intensive Care, San Gerardo Hospital, Via G. B. Pergolesi, 33, Monza 20900, Italy,Corresponding author. Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza (MB) 20900, Italy
| | - Aurora Magliocca
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, Monza 20900, Italy
| | - Giacomo Bellani
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, Monza 20900, Italy,Department of Emergency and Intensive Care, San Gerardo Hospital, Via G. B. Pergolesi, 33, Monza 20900, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, Milano 20122, Italy,Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 10, Milano 20122, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, Milano 20122, Italy,Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 10, Milano 20122, Italy
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Vallecillo G, Perelló R, Güerri R, Fonseca F, Torrens M. Clinical impact of COVID-19 on people with substance use disorders. J Public Health (Oxf) 2021; 43:9-12. [PMID: 33103716 PMCID: PMC7665679 DOI: 10.1093/pubmed/fdaa181] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Background People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders. Methods an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020. Results Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died. Conclusion Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.
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Affiliation(s)
- G Vallecillo
- Drug Addiction Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona 08003, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona 08003, Spain
| | - R Perelló
- Emergency Department, Hospital Clínic, Barcelona 09036, Spain
| | - R Güerri
- Hospital del Mar Medical Research Institute (IMIM), Barcelona 08003, Spain.,Infectious Diseases Department, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona 08003, Spain
| | - F Fonseca
- Drug Addiction Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona 08003, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona 08003, Spain
| | - M Torrens
- Drug Addiction Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona 08003, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona 08003, Spain
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Laukkanen L, Lahtinen S, Liisanantti J, Kaakinen T, Ehrola A, Raatiniemi L. Early impact of the COVID-19 pandemic and social restrictions on ambulance missions. Eur J Public Health 2021; 31:1090-1095. [PMID: 33856015 PMCID: PMC8083286 DOI: 10.1093/eurpub/ckab065] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background The SARS-CoV-2 coronavirus disease 2019 (COVID-19) has had a major impact on health care services globally. Recent studies report that emergency departments have experienced a significant decline in the number of admitted patients in the early phase of the pandemic. To date, research regarding the influence of COVID-19 on emergency medical services (EMS) is limited. This study investigates a change in the number and characteristics of EMS missions in the early phase of the pandemic. Methods All EMS missions in the Northern Ostrobothnia region, Finland (population 295 500) between 1 March to 30 June 2020 were screened and analyzed as the study group. A control group was composed from the EMS calls between the corresponding months in the years 2016–19. Results A total of 74 576 EMS missions were screened for the study. Within the first 2 months after the first COVID-19 cases in the study area, the decline in the number of EMS missions was 5.7–13% compared with the control group average. EMS time intervals (emergency call to dispatch, dispatch, en-route, on-scene and hospital handover) prolonged in the COVID-19 period. Dispatches concerning mental health problems increased most in the study period (+1.2%, P < 0.001). Only eleven confirmed COVID-19 infections were encountered by EMS in the study period. Conclusion Our findings suggest that the present COVID-19 pandemic and social restrictions lead to changes in the EMS usage. These preliminary findings emphasize the importance of developing new strategies and protocols in response to the oncoming pandemic waves.
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Affiliation(s)
- Lauri Laukkanen
- Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland
| | - Sanna Lahtinen
- Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland.,Department of Anaesthesiology, Oulu University Hospital, Oulu, Finland
| | - Janne Liisanantti
- Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland.,Department of Anaesthesiology, Oulu University Hospital, Oulu, Finland
| | - Timo Kaakinen
- Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland.,Department of Anaesthesiology, Oulu University Hospital, Oulu, Finland
| | - Ari Ehrola
- Oulu-Koillismaa Rescue Department, Emergency Medical Services, Oulu, Finland
| | - Lasse Raatiniemi
- Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Medical Research Center of Oulu University, Oulu University Hospital, Oulu, Finland.,Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland
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Tascini C, Sermann G, Pagotto A, Sozio E, De Carlo C, Giacinta A, Sbrana F, Ripoli A, Castaldo N, Merelli M, Cadeo B, Macor C, De Monte A. Blood ozonization in patients with mild to moderate COVID-19 pneumonia: a single centre experience. Intern Emerg Med 2021; 16:669-675. [PMID: 33131033 PMCID: PMC7603641 DOI: 10.1007/s11739-020-02542-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023]
Abstract
The emerging outbreak of the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread worldwide. We prescribed some promising medication to our patients with mild to moderate pneumonia due to SARS-CoV-2, however such drugs as chloroquine, hydrossichloroquine, azithromycin, antivirals (lopinavir/ritonavir, darunavir/cobicistat) and immunomodulating agents (steroids, tocilizumab) were not confirmed as effective against SARS-CoV2. We, therefore, started to use auto-hemotherapy treated with an oxygen/ozone (O2/O3) gaseous mixture as adjuvant therapy. In Udine University Hospital (Italy) we performed a case-control study involving hospitalized adult patients with confirmed COVID-19 with mild to moderate pneumonia. Clinical presentations are based upon clinical phenotypes identified by the Italian Society of Emergency and Urgency Medicine (SIMEU-Società Italiana di Medicina di Emergenza-Urgenza) and patients that met criteria of phenotypes 2 to 4 were treated with best available therapy (BAT), with or without O3-autohemotherapy. 60 patients were enrolled in the study: 30 patients treated with BAT and O2/O3 mixture, as adjuvant therapy and 30 controls treated with BAT only. In the group treated with O3-autohemotherapy plus BAT, patients were younger but with more severe clinical phenotypes. A decrease of SIMEU clinical phenotypes was observed (2.70 ± 0.67 vs. 2.35 ± 0.88, p = 0.002) in all patients during hospitalization but this clinical improvement was statistically significant only in O3-treated patients (2.87 ± 0.78 vs. 2.27 ± 0.83, p < 0.001), differently to the control group (2.53 ± 0.51 vs. 2.43 ± 0.93, p = 0.522). No adverse events were observed associated with the application of O2/O3 gaseous mixture. O2/O3 therapy as adjuvant therapy could be useful in mild to moderate pneumonia due to SARS-CoV-2. Randomized prospective study is ongoing [Clinical Trials.gov ID: Z7C2CA5837].
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Affiliation(s)
- Carlo Tascini
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy.
| | - Giovanni Sermann
- SOC Anestesia e Rianimazione Uno, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
| | - Alberto Pagotto
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
| | - Emanuela Sozio
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
- Pronto Soccorso e Medicina d'urgenza / HDU Livorno, Azienda USL, Toscana Nord Ovest, 33100, Livorno, Italy
| | - Chiara De Carlo
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
| | - Alessandro Giacinta
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
| | - Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi, 1, 56124, Pisa, Italy.
| | - Andrea Ripoli
- Deep Health Unit, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi, 1, 56124, Pisa, Italy
| | - Nadia Castaldo
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
| | - Maria Merelli
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
| | - Barbara Cadeo
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
| | - Cristiana Macor
- SOC Anestesia e Rianimazione Uno, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
| | - Amato De Monte
- SOC Anestesia e Rianimazione Uno, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy
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Feldman O, Samuel N, Kvatinsky N, Idelman R, Diamand R, Shavit I. Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study. PLoS One 2021; 16:e0248383. [PMID: 33788837 PMCID: PMC8011788 DOI: 10.1371/journal.pone.0248383] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/25/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In the prehospital setting, endotracheal intubation (ETI) may be required to secure the coronavirus disease 2019 (COVID-19) patient airway. It has been suggested that the use of a protective barrier can reduce possible aerosol delivery from patients to clinicians during ETI. We sought to assess the performance of ETI by paramedics wearing personal protective equipment with and without the use of a box barrier. METHODS A randomized, crossover simulation study was performed in a simulation laboratory. Study participants were 18 paramedics actively working in the clinical environment. Participants' performance of ETI via direct laryngoscopy (DL) with and without the use of a box barrier was assessed. The sequence of intubation was randomized to either BoxDL-first or DL-first. The primary outcome was the success rate of ETI on first-attempt. The secondary and tertiary outcomes were ETI success rates on three attempts and total intubation time, respectively. RESULTS There were no differences between the DL group and the BoxDL group in one-attempt success rates (14/18 vs 12/18; P = 0.754), and in overall success rates (16/18 vs 14/18; P = 0.682). The mean (standard deviation) of the total intubation times for the DL group and the BoxDL group were 27.3 (19.7) seconds and 36.8 (26.2) seconds, respectively (P < 0.015). CONCLUSIONS The findings of this pilot study suggest that paramedics wearing personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID-19 patients remain to be investigated.
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Affiliation(s)
- Oren Feldman
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Nir Samuel
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Noa Kvatinsky
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Ravit Idelman
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Raz Diamand
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Itai Shavit
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
- * E-mail:
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Ferron R, Agarwal G, Cooper R, Munkley D. The effect of COVID-19 on emergency medical service call volumes and patient acuity: a cross-sectional study in Niagara, Ontario. BMC Emerg Med 2021; 21:39. [PMID: 33781229 PMCID: PMC8006102 DOI: 10.1186/s12873-021-00431-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background The COVID-19 pandemic is a major public health problem. Subsequently, emergency medical services (EMS) have anecdotally experienced fluctuations in demand, with reports across Canada of both increased and decreased demand. Our primary objective was to assess the effect of the COVID-19 pandemic on call volumes for several determinants in Niagara Region EMS. Our secondary objective was to assess changes in paramedic-assigned patient acuity scores as determined using the Canadian Triage and Acuity Scale (CTAS). Methods We analyzed data from a regional EMS database related to call type, volume, and patient acuity for January to May 2016–2020. We used statistical methods to assess differences in EMS calls between 2016 and 2019 and 2020. Results A total of 114,507 EMS calls were made for the period of January 1 to May 26 between 2016 and 2020, inclusive. Overall, the incidence rate of EMS calls significantly decreased in 2020 compared to the total EMS calls in 2016–2019. Motor vehicle collisions decreased in 2020 relative to 2016–2019 (17%), while overdoses relatively increased (70%) in 2020 compared to 2016–2019. Calls for patients assigned a higher acuity score increased (CTAS 1) (4.1% vs. 2.9%). Conclusion We confirmed that overall, EMS calls have decreased since the emergence of COVID-19. However, this effect on call volume was not consistent across all call determinants, as some call types rose while others decreased. These findings indicate that COVID-19 may have led to actual changes in emergency medical service demand and will be of interest to other services planning for future pandemics or further waves of COVID-19.
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Affiliation(s)
| | - Gina Agarwal
- Department of Family Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
| | - Rhiannon Cooper
- Department of Family Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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Secco G, Cappa G, Barcella B, Perlini S. The role of emergency medicine residents during the global SARS-Cov-2 pandemic: The Pavia experience. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In late January 2020, the first cases of Covid-19 were diagnosed in Italy. A month later the epidemic broke out in Lombardy bringing along dire consequences. Up to January 23rd 2021, the region counted 522,000 cases, and 26.518 deaths on a population of nearly 10 million. For many weeks thereafter tens of emergency COVID-19 patients were admitted every day through the ED requiring further adjustments in the organization of the Hospital, always in close cooperation with the out-of-hospital Emergency network. Among these, important and time-sensitive changes took place in the role of Residents in Emergency Medicine. As residents who worked through the first and second wave of the Sars-CoV-2 pandemic in the Emergency Department, we would like to discuss the consequences of our massive involvement on the front line of the healthcare effort to fight it.
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Moynihan R, Sanders S, Michaleff ZA, Scott AM, Clark J, To EJ, Jones M, Kitchener E, Fox M, Johansson M, Lang E, Duggan A, Scott I, Albarqouni L. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open 2021; 11:e045343. [PMID: 33727273 PMCID: PMC7969768 DOI: 10.1136/bmjopen-2020-045343] [Citation(s) in RCA: 553] [Impact Index Per Article: 184.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/21/2020] [Accepted: 02/02/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic. DESIGN Systematic review. ELIGIBILITY Eligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19. DATA SOURCES PubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact. DATA ANALYSIS Risk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis. OUTCOME MEASURES Primary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores). RESULTS 3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR -51% to -20%), comprising median reductions for visits of 42% (-53% to -32%), admissions 28% (-40% to -17%), diagnostics 31% (-53% to -24%) and for therapeutics 30% (-57% to -19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference. CONCLUSIONS Healthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery. PROSPERO REGISTRATION NUMBER CRD42020203729.
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Affiliation(s)
- Ray Moynihan
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Sharon Sanders
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Zoe A Michaleff
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Emma J To
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Eliza Kitchener
- Faculty of Medicine, Dentistry and Health, Griffith University, Brisbane, Queensland, Australia
| | - Melissa Fox
- Health Consumers Queensland, Adelaide, Queensland, Queensland
| | | | - Eddy Lang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anne Duggan
- Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia
| | - Ian Scott
- Internal Medicine and Clinical Epidemiology, Princess Alexander Hospital, Brisbane, Queensland, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
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Paglia S, Nattino G, Occhipinti F, Sala L, Targetti E, Cortellaro F, Cosentini R, Costantino G, Fichtner F, Mancarella M, Marinaro C, Sorlini C, Bertolini G, Acquistapace G, Agostinis M, Bonzi M, Brena N, Caruso S, Mascolo M, Massabò D, Scrignoli F. The Quick Walk Test: A Noninvasive Test to Assess the Risk of Mechanical Ventilation During COVID-19 Outbreaks. Acad Emerg Med 2021; 28:244-247. [PMID: 33249678 PMCID: PMC7753836 DOI: 10.1111/acem.14180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | - Giovanni Nattino
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | - Federica Occhipinti
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | - Luca Sala
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | - Elena Targetti
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | | | - Roberto Cosentini
- Emergency Department and Medicine ASST Papa Giovanni XXIII Bergamo (BG)Italy
| | - Giorgio Costantino
- Pronto Soccorso e Medicina d’Urgenza Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico MilanoItaly
- and the Università degli Studi di Milano Milano (MI) Italy
| | | | - Marta Mancarella
- Pronto Soccorso e Medicina d’Urgenza Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico MilanoItaly
| | - Claudia Marinaro
- Emergency Department and Medicine ASST Papa Giovanni XXIII Bergamo (BG)Italy
| | - Cristina Sorlini
- Accident and Emergency Services ASST Santi Paolo e Carlo Milano (MI)Italy
| | - Guido Bertolini
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
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Galassi L, Schena D. The Modified National Early Warning Score (m-NEWS) for COVID-19-Infected Patient Evaluation: a Proof-of-Concept. ACTA ACUST UNITED AC 2021; 3:9-10. [PMID: 33426469 PMCID: PMC7778686 DOI: 10.1007/s42399-020-00718-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
The second wave of Sars CoV 2 pandemic in Italy still represents an important concern for the Italian health system (IHS). Despite the experience gained during the first phase of the pandemic in January 2020, COVID-19 patients are still arising, putting on a strain resources of local authorities and emergency services. The aim of this research project is to analyze the feasibility of using the modified National Early Warning Score (m-NEWS) as a way to rapidly identify COVID-19-infected patient with high risk of clinical deterioration, helping the clinical pre-evaluation in a moment of overwhelming request for the Italian out-of-hospital emergency system (Perlini et al., Intern Emerg Med 15(5):825–833, 2020) as during the initial coronavirus outbreak.
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Affiliation(s)
- Luca Galassi
- Orthopedics and Traumatology Unit, A.O. ASST Bergamo Est, P.O. Pesenti Fenaroli, Alzano Lombardo, Bergamo, Italy
| | - Daniele Schena
- Orthopedics and Traumatology Unit, A.O. ASST Bergamo Est, P.O. Pesenti Fenaroli, Alzano Lombardo, Bergamo, Italy
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40
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Campagna S, Conti A, Dimonte V, Dalmasso M, Starnini M, Gianino MM, Borraccino A. Trends and Characteristics of Emergency Medical Services in Italy: A 5-Years Population-Based Registry Analysis. Healthcare (Basel) 2020; 8:healthcare8040551. [PMID: 33322302 PMCID: PMC7763006 DOI: 10.3390/healthcare8040551] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Emergency Medical Services (EMS) plays a fundamental role in providing good quality healthcare services to citizens, as they are the first responders in distressing situations. Few studies have used available EMS data to investigate EMS call characteristics and subsequent responses. Methods: Data were extracted from the emergency registry for the period 2013–2017. This included call and rescue vehicle dispatch information. All relationships in analyses and differences in events proportion between 2013 and 2017 were tested against the Pearson’s Chi-Square with a 99% level of confidence. Results: Among the 2,120,838 emergency calls, operators dispatched at least one rescue vehicle for 1,494,855. There was an estimated overall incidence of 96 emergency calls and 75 rescue vehicles dispatched per 1000 inhabitants per year. Most calls were made by private citizens, during the daytime, and were made from home (63.8%); 31% of rescue vehicle dispatches were advanced emergency medical vehicles. The highest number of rescue vehicle dispatches ended at the emergency department (74.7%). Conclusions: Our data showed that, with some exception due to environmental differences, the highest proportion of incoming emergency calls is not acute or urgent and could be more effectively managed in other settings than in an Emergency Departments (ED). Better management of dispatch can reduce crowding and save hospital emergency departments time, personnel, and health system costs.
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Affiliation(s)
- Sara Campagna
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
| | - Alessio Conti
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
| | - Valerio Dimonte
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
| | - Marco Dalmasso
- Epidemiology Unit, Local Health Unit TO3, Piedmont Region, 10195 Grugliasco, Italy;
| | - Michele Starnini
- Institute of Scientific Interchange (ISI) Foundation, 10126 Torino, Italy;
| | - Maria Michela Gianino
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
- Correspondence:
| | - Alberto Borraccino
- Department of Public Health and Paediatrics, University of Torino, 10126 Torino, Italy; (S.C.); (A.C.); (V.D.); (A.B.)
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Lasbleiz A, Cariou B, Darmon P, Soghomonian A, Ancel P, Boullu S, Houssays M, Romain F, Lagier JC, Boucekine M, Resseguier N, Gourdy P, Pichelin M, Wargny M, Dutour A, Gaborit B. Phenotypic Characteristics and Development of a Hospitalization Prediction Risk Score for Outpatients with Diabetes and COVID-19: The DIABCOVID Study. J Clin Med 2020; 9:jcm9113726. [PMID: 33233575 PMCID: PMC7699790 DOI: 10.3390/jcm9113726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 01/10/2023] Open
Abstract
Diabetes mellitus (DM) has been identified as a risk factor for severe COVID-19. DM is highly prevalent in the general population. Defining strategies to reduce the health care system burden and the late arrival of some patients thus seems crucial. The study aim was to compare phenotypic characteristics between in and outpatients with diabetes and infected by COVID-19, and to build an easy-to-use hospitalization prediction risk score. This was a retrospective observational study. Patients with DM and laboratory- or CT-confirmed COVID-19, who did (n = 185) and did not (n = 159) require hospitalization between 10 March and 10 April 2020, were compared. Data on diabetes duration, treatments, glycemic control, complications, anthropometrics and peripheral oxygen saturation (SpO2) were collected from medical records. Stepwise multivariate logistic regressions and ROC analyses were performed to build the DIAB score, a score using no more than five easy-to-collect clinical parameters predicting the risk of hospitalization. The DIAB score was then validated in two external cohorts (n = 132 and n = 2036). Hospitalized patients were older (68.0 ± 12.6 vs. 55.2 ± 12.6 years, p < 0.001), with more class III obesity (BMI ≥ 40 kg/m2, 9.7 vs. 3.5%, p = 0.03), hypertension (81.6 vs. 44.3%, p < 0.0001), insulin therapy (37% vs. 23.7%, p = 0.009), and lower SpO2 (91.6 vs. 97.3%, p < 0.0001) than outpatients. Type 2 DM (T2D) was found in 94% of all patients, with 10 times more type 1 DM in the outpatient group (11.3 vs. 1.1%, p < 0.0001). A DIAB score > 27 points predicted hospitalization (sensitivity 77.7%, specificity 89.2%, AUC = 0.895), and death within 28 days. Its performance was validated in the two external cohorts. Outpatients with diabetes were found to be younger, with fewer diabetic complications and less severe obesity than inpatients. DIAB score is an easy-to-use score integrating five variables to help clinicians better manage patients with DM and avert the saturation of emergency care units.
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Affiliation(s)
- Adèle Lasbleiz
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, 13005 Marseille, France; (A.L.); (P.D.); (A.S.); (S.B.); (A.D.)
- Aix Marseille University, INSERM, INRAE, C2VN, 13005 Marseille, France;
| | - Bertrand Cariou
- L’institut du Thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Département d’Endocrinologie, Diabétologie et Nutrition, Hôpital Guillaume et René Laennec, 44093 Nantes, France; (B.C.); (M.P.)
| | - Patrice Darmon
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, 13005 Marseille, France; (A.L.); (P.D.); (A.S.); (S.B.); (A.D.)
- Aix Marseille University, INSERM, INRAE, C2VN, 13005 Marseille, France;
| | - Astrid Soghomonian
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, 13005 Marseille, France; (A.L.); (P.D.); (A.S.); (S.B.); (A.D.)
| | - Patricia Ancel
- Aix Marseille University, INSERM, INRAE, C2VN, 13005 Marseille, France;
| | - Sandrine Boullu
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, 13005 Marseille, France; (A.L.); (P.D.); (A.S.); (S.B.); (A.D.)
- Aix Marseille University, INSERM, INRAE, C2VN, 13005 Marseille, France;
| | - Marie Houssays
- Assistance-Publique Hôpitaux de Marseille, Medical Evaluation Department, CIC-CPCET, 13005 Marseille, France;
| | - Fanny Romain
- Public Health and Medical Information Department, APHM, 13005 Marseille, France;
| | - Jean Christophe Lagier
- Aix Marseille University, IRD, AP-HM, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France;
| | - Mohamed Boucekine
- Aix-Marseille University, EA 3279 CEReSS—Health Service Research and Quality of Life Center, 13005 Marseille, France; (M.B.); (N.R.)
| | - Noémie Resseguier
- Aix-Marseille University, EA 3279 CEReSS—Health Service Research and Quality of Life Center, 13005 Marseille, France; (M.B.); (N.R.)
- Support Unit for Clinical Research and Economic Evaluation, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Pierre Gourdy
- Département d’Endocrinologie, Diabétologie et Nutrition, CHU Toulouse, Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 Inserm/UPS, Université de Toulouse, 31432 Toulouse, France;
| | - Matthieu Pichelin
- L’institut du Thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Département d’Endocrinologie, Diabétologie et Nutrition, Hôpital Guillaume et René Laennec, 44093 Nantes, France; (B.C.); (M.P.)
| | - Matthieu Wargny
- CIC-EC 1413, Clinique des Données, CHU de Nantes, 44000 Nantes, France;
| | - Anne Dutour
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, 13005 Marseille, France; (A.L.); (P.D.); (A.S.); (S.B.); (A.D.)
- Aix Marseille University, INSERM, INRAE, C2VN, 13005 Marseille, France;
| | - Bénédicte Gaborit
- Department of Endocrinology, Metabolic Diseases and Nutrition, Pôle ENDO, APHM, 13005 Marseille, France; (A.L.); (P.D.); (A.S.); (S.B.); (A.D.)
- Aix Marseille University, INSERM, INRAE, C2VN, 13005 Marseille, France;
- Correspondence: ; Tel.: +33-4919-6823
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Boriani G, Palmisano P, Guerra F, Bertini M, Zanotto G, Lavalle C, Notarstefano P, Accogli M, Bisignani G, Forleo GB, Landolina M, D'Onofrio A, Ricci R, De Ponti R. Impact of COVID-19 pandemic on the clinical activities related to arrhythmias and electrophysiology in Italy: results of a survey promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing). Intern Emerg Med 2020; 15:1445-1456. [PMID: 32889687 PMCID: PMC7474489 DOI: 10.1007/s11739-020-02487-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
COVID-19 outbreak had a major impact on the organization of care in Italy, and a survey to evaluate provision of for arrhythmia during COVID-19 outbreak (March-April 2020) was launched. A total of 104 physicians from 84 Italian arrhythmia centres took part in the survey. The vast majority of participating centres (95.2%) reported a significant reduction in the number of elective pacemaker implantations during the outbreak period compared to the corresponding two months of year 2019 (50.0% of centres reported a reduction of > 50%). Similarly, 92.9% of participating centres reported a significant reduction in the number of implantable cardioverter-defibrillator (ICD) implantations for primary prevention, and 72.6% a significant reduction of ICD implantations for secondary prevention (> 50% in 65.5 and 44.0% of the centres, respectively). The majority of participating centres (77.4%) reported a significant reduction in the number of elective ablations (> 50% in 65.5% of the centres). Also the interventional procedures performed in an emergency setting, as well as acute management of atrial fibrillation had a marked reduction, thus leading to the conclusion that the impact of COVID-19 was disrupting the entire organization of health care, with a massive impact on the activities and procedures related to arrhythmia management in Italy.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo 71, 41121, Modena, Italy.
| | | | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria Di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Verona, Italy
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Roma, Italy
| | | | | | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, Castrovillari, Italy
| | | | | | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale Di Circolo-University of Insubria, Varese, Italy
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Drogrey M, Pernet J, Hausfater P. Retour d’expérience sur la réorganisation d’un service d’urgence de centre hospitalo-universitaire en réponse à l’épidémie de Covid-19. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Depuis décembre 2019 le monde a dû faire face à une nouvelle maladie nommée : Covid-19. Sa dissémination rapide a imposé à l’Organisation mondiale de la santé de déclarer le statut de pandémie mondiale. La réponse des services d’urgence français à cette catastrophe sanitaire était cruciale. Elle a dû intégrer la notion d’urgence inhérente à la multiplication des nouveaux cas, mais également la nécessité d’une réponse organisée et d’une modulation continuelle de celle-ci sur une période jusqu’alors inconnue. Nous présentons dans cet article un schéma d’organisation et un retour d’expérience, d’un service d’urgence de centre hospitalier universitaire (CHU), établissement de santé de référence (ESR) pour le risque épidémique et biologique pour faire face à l’épidémie. Nous exposons les grandes lignes d’une réorganisation structurelle de notre service, la modification du circuit patient en amont de la filière des urgences et en aval, mais également la modification de nos pratiques de soins. Cette réorganisation a dû prendre en compte la notion de contagiosité avec la nécessité d’une séparation précoce en deux filières de soins, effectuée grâce à un processus de prétriage et de triage en amont de la filière. L’un des points clés de cette organisation a été l’évolutivité des définitions des cas suspects au cours du temps et au gré de l’évolution de la connaissance de ce virus et de sa dissémination. Cela a nécessité une adaptabilité de notre filière et une réévaluation quasi quotidienne de cette organisation associée à une information, une formation et un entraînement du personnel de cette structure.
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Risk of coronavirus disease 2019 (COVID-19) acquisition among emergency department patients: A retrospective case control study. Infect Control Hosp Epidemiol 2020; 42:105-107. [PMID: 32962781 PMCID: PMC7542312 DOI: 10.1017/ice.2020.1224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Plumereau C, Cho TH, Buisson M, Amaz C, Cappucci M, Derex L, Ong E, Fontaine J, Rascle L, Riva R, Schiavo D, Benhamed A, Douplat M, Bony T, Tazarourte K, Tuttle C, Eker OF, Berthezène Y, Ovize M, Nighoghossian N, Mechtouff L. Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network. J Neurol 2020; 268:2314-2319. [PMID: 32902732 PMCID: PMC7479751 DOI: 10.1007/s00415-020-10199-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 01/13/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. Methods We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. Results A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187–339] vs 210 [163–260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133–2238] vs 1023 [960–1410]; p < 0.01). Conclusions Our study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.
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Affiliation(s)
- Cécile Plumereau
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Matteo Cappucci
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Elodie Ong
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Julia Fontaine
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Lucie Rascle
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Roberto Riva
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - David Schiavo
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Axel Benhamed
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Thomas Bony
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Karim Tazarourte
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Célia Tuttle
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Michel Ovize
- CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France. .,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.
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Polosa R, Spinicci M, Prisco D. "COVID-19: diagnosis, management and prognosis": a new topical collection of Internal and Emergency Medicine. Intern Emerg Med 2020; 15:747-750. [PMID: 32734430 PMCID: PMC7391015 DOI: 10.1007/s11739-020-02461-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Riccardo Polosa
- Dipartimento Di Medicina Clinica E Sperimentale (MEDCLIN), University of Catania, Catania, Italy.
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy.
| | - Michele Spinicci
- Dipartimento Di Medicina Sperimentale E Clinica (DMSC), Università Di Firenze, Florence, Italy
- SOD Malattie Infettive E Tropicali, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Domenico Prisco
- Dipartimento Di Medicina Sperimentale E Clinica (DMSC), Università Di Firenze, Florence, Italy
- SOD Medicina Interna Interdisciplinare, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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