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Gianni A, Botteri M, Stirparo G, Mattesi G, Zorzi A, Villa GF. The impact of the Italian law mandating an automatic external defibrillator in all sports venues on sudden cardiac arrest resuscitation rates. Eur J Prev Cardiol 2024; 31:e16-e18. [PMID: 37758503 DOI: 10.1093/eurjpc/zwad313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Alessandro Gianni
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Via Giustiniani, 2, Padova 35128, Italy
| | | | | | - Giulia Mattesi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Via Giustiniani, 2, Padova 35128, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Via Giustiniani, 2, Padova 35128, Italy
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Stucchi R, Ripoll-Gallardo A, Sechi GM, Weinstein ES, Villa GF, Frigerio C, Federighi F, Grasselli G, Zoli A, Bonora R, Fumagalli R. Severe Acute Respiratory Syndrome Coronavirus 2 and Medical Evacuation in Lombardy: Lessons Learned from an Unprecedented Pandemic. Disaster Med Public Health Prep 2023; 17:e480. [PMID: 37667885 DOI: 10.1017/dmp.2023.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerging infectious disease pandemic developed in Lombardy (northern Italy) during the last week of February 2020 with a progressive increase of patients presenting with serious clinical findings. Despite the efforts of the Central Italian Government, regional resources were rapidly at capacity. The solution was to plan the medical evacuation (MEDEVAC) of 119 critically ill patients (median age 61 years) to in-patient intensive care units in other Italian regions (77) and Germany (42). Once surviving patients were deemed suitable, the repatriation process concluded the assignment. The aim of this report is to underline the importance of a rapid organization and coordination process between different nodes of an effective national and international network during an emerging infectious disease outbreak and draw lessons learned from similar published reports.
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Affiliation(s)
- Riccardo Stucchi
- SSD AAT Milano, Agenzia Regionale Emergenza Urgenza (AREU), Dipartimento di Emergenza e Accettazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alba Ripoll-Gallardo
- SSD AAT Milano, Agenzia Regionale Emergenza Urgenza (AREU), Dipartimento di Emergenza e Accettazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
| | | | - Eric S Weinstein
- CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
| | | | - Cristina Frigerio
- Dipartimento di Anestesia e Rianimazione, ASST Melegnano Martesana, Cernusco sul Naviglio, Italy
| | | | - Giacomo Grasselli
- Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
| | - Alberto Zoli
- Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
| | - Rodolfo Bonora
- Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Stirparo G, Fagoni N, Bellini L, Oradini‐Alacreu A, Migliari M, Villa GF, Botteri M, Signorelli C, Sechi GM, Zoli A. Cardiopulmonary resuscitation missed by bystanders: Collateral damage of coronavirus disease 2019. Acta Anaesthesiol Scand 2022; 66:1124-1129. [PMID: 35894939 PMCID: PMC9349817 DOI: 10.1111/aas.14117] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/17/2022] [Accepted: 06/26/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic changed the time-dependent cardiac arrest network. This study aims to understand whether the rescue standards of cardiopulmonary resuscitation (CPR) and out-of-hospital cardiac arrest (OHCA) were handled differently during pandemic compared to the previous year. METHODS Data for the years 2019 and 2020 were provided by the records of the Lombardy office of the Regional Agency for Emergency and Urgency. We analysed where the cardiac arrest occurred, when CPR started and whether the bystanders used public access to defibrillation (PAD). RESULTS During 2020, there was a reduction in CPRs performed by bystanders (odds ratio [OR] = 0.936 [95% confidence interval (CI95% ) 0.882-0.993], p = .029) and in the return of spontaneous circulation (ROSC) (OR = 0.621 [CI95% 0.563-0.685], p < .0001), while there was no significant reduction in the use of PAD. Analysing only March, the period of the first wave in Lombardy, the comparison shows a reduction in bystanders CPRs (OR = 0.727 [CI95% 0.602-0.877], p = .0008), use of PAD (OR = 0.441 [CI95% 0.272-0.716], p = .0009) and in ROSC (OR = 0.179 [CI95% 0.124-0.257], p < .0001). These phenomena could be influenced by the different settings in which the OHCAs occurred; in fact, those that occurred in public places with a mandatory PAD were strongly reduced (OR = 0.49 [CI95% , 0.44-0.55], p < .0001). CONCLUSIONS COVID-19 had a profound impact on the time-dependant OHCA network. During the first pandemic wave, CPR and PAD used by bystanders decreased. The different contexts in which OHCAs occurred may partially explain these differences.
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Affiliation(s)
- Giuseppe Stirparo
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly,Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Nazzareno Fagoni
- AAT Brescia, Azienda Regionale Emergenza Urgenza (AREU), Department of Anaesthesia, Intensive Care and Emergency, ASST Spedali Civili University HospitalBresciaItaly,Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Lorenzo Bellini
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly
| | - Aurea Oradini‐Alacreu
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly
| | - Maurizio Migliari
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Guido Francesco Villa
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Marco Botteri
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly,AAT Brescia, Azienda Regionale Emergenza Urgenza (AREU), Department of Anaesthesia, Intensive Care and Emergency, ASST Spedali Civili University HospitalBresciaItaly
| | - Carlo Signorelli
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly
| | - Giuseppe Maria Sechi
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Alberto Zoli
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
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Botteri M, Celi S, Perone G, Prati E, Bera P, Villa GF, Mare C, Sechi GM, Zoli A, Fagoni N. Effectiveness of massive transfusion protocol activation in pre-hospital setting for major trauma. Injury 2022; 53:1581-1586. [PMID: 35000744 DOI: 10.1016/j.injury.2021.12.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/16/2021] [Accepted: 12/29/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hemorrhage in major trauma is life-threatening and the activation of the Massive Transfusion Protocol (MTP) was found to reduce the time to transfusion and mortality. The purpose was (i) to verify whether MTP activation identifies patients that require massive transfusions once admitted to the Emergency Department (ED), (ii) to establish whether pre-hospital MTP activation reduces the time to transfusion on arrival at the ED, (iii) to identify the variable that best predicts MTP activation. MATERIALS AND METHODS This is a retrospective, single-center study. The MTP was implemented at the end of 2012; it was activated for major trauma in pre-hospital setting on the basis on established criteria. Pre-hospital MTP activation aimed to make blood products available prior to the patients' arrival at the ED. The blood products are transfused when the patient arrives at the hospital. RESULTS The MTP was activated in pre-hospital setting in 219 patients. On arrival at the hospital, the Trauma Team Leader confirmed MTP activation in 146 (66.7%) patients. Patients with MTP criteria received a higher amount of blood products than the patients without MTP criteria, median 7 (IQR 2-13) units versus 2 (0-6) units, respectively (P < 0.001). At the same time, patients with a Shock Index ≥ 0.9 received more transfusions (5.5 [2-13] units) compared with patients characterized by a lower SI (2 [0-7.25] units, P = 0.009). 146 patients were transfused in the first hour of ED admission. Poisson's multiple regression shows that the SI is the variable that better predicted MTP activation compared to age, gender and the number of injured sites. CONCLUSIONS Pre-hospital MTP activation is useful to identify patients that require an urgent blood transfusion on arrival at the ED. Further analysis should be considered to evaluate the implementation of the Shock Index as a criterion to activate MTP.
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Affiliation(s)
- Marco Botteri
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy; Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy
| | - Simone Celi
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy
| | - Giovanna Perone
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy
| | - Enrica Prati
- Immuno-Haematology and Transfusional Medicine Service (SIMT), ASST Spedali Civili University Hospital, Brescia, Italy
| | - Paola Bera
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy
| | | | - Claudio Mare
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy
| | | | - Alberto Zoli
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy
| | - Nazzareno Fagoni
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy; Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy; Department of Molecular and Translational Medicine, University of Brescia, Italy.
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Stirparo G, Bellini L, Fagoni N, Compatti S, Botteri M, Villa GF, Sironi S, Signorelli C, Sechi GM, Zoli A. Missed training, collateral damage from COVID 19? Disaster Med Public Health Prep 2022; 16:1-8. [PMID: 35000651 PMCID: PMC8961062 DOI: 10.1017/dmp.2022.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/12/2021] [Accepted: 12/26/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND during the COVID-19 pandemic a total lockdown was enforced all over Italy starting on March 9th. This resulted in the shrinking of economic activities. In addition, all formal occupational security-training courses were halted, among them the 81/08 law lectures and Basic Life Support-Defibrillation (BLS-D) laymen training courses. The aim of the study was to evaluate the impact of the pandemic on BLS-D laymen training courses in the Lombardy region. METHODS BLS-D training courses records for the Lombardy region were analysed. The analysis was conducted from 2016 to 2020 as part of the Hippo project. RESULTS between 2017 and 2019 BLS-D trained laymen kept increasing, moving from 53,500 trained individuals up to 74,700. In 2020 a stark reduction was observed with only 22,160 individuals trained. Formal courses were not halted completely during 2020. Still, in the months available for training, the number of individuals enrolled showed a sharp 50% reduction. CONCLUSIONS laymen training courses for emergency management are a fundamental component of primary prevention practice. The 81/08 and 158/12 Italian laws have decreed this practice mandatory on the workplace. Following the enforcement of the lockdown and the subsequent interruption of emergency management courses, efforts will be necessary to re-establish and guarantee the high quality training of the pre-pandemic period.
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Affiliation(s)
- Giuseppe Stirparo
- School of Public Health, University of Vita-Salute San Raffaele, Milano, Italy
| | - Lorenzo Bellini
- School of Public Health, University of Vita-Salute San Raffaele, Milano, Italy
| | - Nazzareno Fagoni
- AAT Brescia, Azienda Regionale Emergenza Urgenza (AREU), ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | | | - Marco Botteri
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy
| | | | - Stefano Sironi
- IR TeC- AREU (International Research & Teaching Centre), Milano, Italy
| | - Carlo Signorelli
- School of Public Health, University of Vita-Salute San Raffaele, Milano, Italy
| | | | - Albero Zoli
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy
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Andreoletti M, Bonora R, Botteri M, Villa CL, Sechi GM, Zoli A, Villa GF. OHCA survey in Lombardy: comparison between years 2014 and 2019 (pre COVID-19). Acta Biomed 2021; 92:e2021486. [PMID: 34738566 PMCID: PMC8689316 DOI: 10.23750/abm.v92i5.11804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
Background and aim: The incidence of Out of Hospital Cardiac Arrest (OHCA) is estimated at 1/1000 persons/year. In the pre-Covid-19 era world, OHCA survival rate in Europe was 7-6%. The main objective is to analyze OHCA survival in the Lombardy region by highlighting the factors related to both the victims’ characteristics and the chain of survival. Methods: All OHCAs were grouped into four pre-established periods in 2019 (14-23 January; 15-24 April; 15-24 July; 14-23 October). Following the Utstein method, we selected witnessed OHCAs with presumed cardiac etiology. The outcome of each case was collected in four moments in time: Return of spontaneous circulation (ROSC), Emergency Department (ED), 24 hours and 30 days. The neurological outcome 30 days after OHCA was also investigated and stratified with the Cerebral Performance Category Score (CPC). Results: We selected 456 cases of OHCA with witnessed cardiac etiology. ROSC was achieved in 121 cases (26.5%), survival in the Emergency Departments in 110 patients (24.1%), after 24 hours in 86 (18.86%) and after 30 days in 72 (15.8%). Male sex was shown to improve OHCA survival. A shockable presentation rhythm, Cardiopulmonary Resuscitation (CPR) performed by bystanders and the activation of Public Access Defibrillation (PAD) positively influenced OHCA outcome. Conclusions: Males are more predisposed to incur an OHCA event than females, but they have greater chances of survival. Factors most related to survival are: shockable rhythm, bystanders CPR and the activation of a PAD. (www.actabiomedica.it)
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Affiliation(s)
| | | | - Marco Botteri
- AREU - EMS Lombardy Agency SIEMS - EMS Italian Society, Brescia, Italy.
| | | | | | - Alberto Zoli
- AREU - EMS Lombardy Agency SIEMS - EMS Italian Society, Milano, Italy.
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Stirparo G, Oradini-Alacreu A, Migliori M, Villa GF, Botteri M, Fagoni N, Signorelli C, Sechi GM, Zoli A. Public health impact of COVID-19 pandemic on the emergency healthcare system: a region-wide analysis. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Lombardy region has been one of the Italian regions most affected by the COVID-19 pandemic in 2020, with 22.7% of total Italian cases and 33.9% of total deaths. The emergency healthcare system was under deep stress throughout the period under consideration due to the admission of COVID-19 patients to the Emergency Department (ED) and had to be thoroughly reorganized.
Methods
We performed a retrospective descriptive analysis of patients admitted into the ED recorded in the Lombardy online regional portal called EUOL. We compared the data registered in the EUOL with the patients admitted to the EDs from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020.
Results
The number of admissions to the ED decreased by 32.5% in 2020 compared to 2019, reaching the lowest number in March and April. However, the percentage of patients hospitalised after ED significantly increased in 2020 compared to 2019 (OR 1.47, p < 0.0001), reflecting the management of patients with a more severe clinical condition. Indeed, the number of patients classified as red or yellow codes at hospital admission was significantly higher in 2020 than in 2019 (p < 0.0001). Moreover, more patients arrived at the ED by ambulance in 2020 (21.7% in 2020 versus 15.1% in 2019. OR 1.56, p < 0.0001), with more than 35% of patients transported by ambulance in March and April 2020.
Conclusions
Our results showed, on the one hand, inappropriate visits to the EDs by non-emergency and low complex cases in 2019 before the pandemic and, on the other hand, they also highlighted that patients in critical condition were reluctant to visit the ED due to the fear of getting infected. This analysis showed that EMS played a crucial role in the overall public health impact of the COVID-19 pandemic, increasing the percentage of patients transported to the hospital with a severe clinical condition, reorganizing and allocating resources to the areas that were most affected during the pandemic.
Key messages
This is a descriptive analysis of the public health impact of the COVID-19 pandemic on the admission to Emergency Departments in 2020. Our results underline the need to monitor the pandemic’s evolution in order to reorganize the hospitals that admitted the COVID-19 patients.
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Affiliation(s)
- G Stirparo
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
- Agenzia Regionale Emergenza Urgenzau, Headquarters, Milan, Italy
| | - A Oradini-Alacreu
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - M Migliori
- Agenzia Regionale Emergenza Urgenzau, Headquarters, Milan, Italy
| | - GF Villa
- Agenzia Regionale Emergenza Urgenzau, Headquarters, Milan, Italy
| | - M Botteri
- Agenzia Regionale Emergenza Urgenzau, Headquarters, Milan, Italy
- AAT Brescia, Azienda Regionale Emergenza Urgenza, ASST Spedali Civili di Brescia, Brescia, Italy
| | - N Fagoni
- AAT Brescia, Azienda Regionale Emergenza Urgenza, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - C Signorelli
- School of Public Health, University Vita-Salute San Raffaele, Milan, Italy
| | - GM Sechi
- Agenzia Regionale Emergenza Urgenzau, Headquarters, Milan, Italy
| | - A Zoli
- Agenzia Regionale Emergenza Urgenzau, Headquarters, Milan, Italy
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Stirparo G, Oradini-Alacreu A, Migliori M, Villa GF, Botteri M, Fagoni N, Signorelli C, Sechi GM, Zoli A. Public health impact of the COVID-19 pandemic on the emergency healthcare system. J Public Health (Oxf) 2021; 44:e149-e152. [PMID: 34156071 PMCID: PMC8344573 DOI: 10.1093/pubmed/fdab212] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/17/2021] [Accepted: 06/04/2021] [Indexed: 12/26/2022] Open
Abstract
Background The Lombardy region has been the Italian region most affected by the coronavirus disease 2019 (COVID-19) pandemic in 2020. The emergency healthcare system was under deep stress throughout the past year due to the admission of COVID-19 patients to the emergency department (ED) and had to be thoroughly reorganized. Methods We performed a retrospective descriptive analysis of patients admitted into the ED recorded in the Lombardy online regional portal called EUOL (Emergenza e Urgenza OnLine). We compared the data registered in the EUOL with the patients admitted to the EDs from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Results The number of admissions to the ED decreased by 32.5% in 2020 compared with 2019, reaching the lowest number in March and April. However, the percentage of patients hospitalized after ED significantly increased in 2020 compared with 2019 (P < 0.0001), reflecting the management of patients with a more severe clinical condition. More patients arrived at the ED by ambulance in 2020 (21.7% in 2020 versus 15.1% in 2019; P < 0.0001), particularly during March and April. Conclusions This analysis showed the importance of monitoring the pandemic’s evolution in order to treat more critically ill patients, despite a lower number of patients.
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Affiliation(s)
- G Stirparo
- Faculty of Medicine, School of Public Health - University of Vita-Salute San Raffaele, Milano 20132, Italy.,Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - A Oradini-Alacreu
- Faculty of Medicine, School of Public Health - University of Vita-Salute San Raffaele, Milano 20132, Italy
| | - M Migliori
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - G F Villa
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - M Botteri
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy.,AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili di Brescia, Brescia 25123, Italy
| | - N Fagoni
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU), ASST Spedali Civili di Brescia, Brescia 25123, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia 25123, Italy
| | - C Signorelli
- Faculty of Medicine, School of Public Health - University of Vita-Salute San Raffaele, Milano 20132, Italy
| | - G M Sechi
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
| | - A Zoli
- Department of Research and Development, Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano 20124, Italy
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Del Romano M, Ciapessoni L, Di Mola F, Romanò G, Gavezzotti M, Rigamonti M, Carnelli M, Cappelletti R, Peup ES, Orlandi E, Villa GF, Manuel G, Ponzoni W. Rapid response air medical evacuation by civilian HEMS crew of critical patients during COVID-19 outbreak – First Fixed Points. Emerg Care J 2020. [DOI: 10.4081/ecj.2020.9373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Covid-19 emergency requires a shared plan for the longrange helicopter transfer of patients affected by the virus in order to reduce the overload of intensive care units. To date, there is limited peer reviewed literature on aeromedical transport of patients with highly hazardous communicable diseases, most of it is military, and none deals specifically with patients affected by Covid- 19. To meet this need, we propose reference criteria regarding preflight, in-flight and post-flight patient management and helicopter sanitization.
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Fagoni N, Perone G, Villa GF, Celi S, Bera P, Sechi GM, Mare C, Zoli A, Botteri M. The Lombardy Emergency Medical System Faced with COVID-19: The Impact of Out-of-Hospital Outbreak. PREHOSP EMERG CARE 2020; 25:1-7. [PMID: 32940538 DOI: 10.1080/10903127.2020.1824051] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Lombardy region was among the areas most affected by COVID-19 infection worldwide; the Lombardy Emergency Medical System (EMS) responded immediately to this emergency. We analyzed several critical aspects to understand what occurred in that region. METHODS This retrospective study compares the events managed by the dispatch center and the characteristics of the patients transported to the hospital -age, sex, SpO2, deaths- managed by the EMS in Brescia and Bergamo provinces between March-April 2020 and March-April 2019. Ambulances' waiting time at the hospitals before discharging patients and the patients' severity at emergency department admission were also analyzed. RESULTS EMS managed 37,340 events in March-April 2020, +51.5% versus 2019. "Breathing" or "Infective" events reported to the dispatch center increased more than ten-fold (OR 25.1, p < 0.0001) in March 2020 and two-fold in April 2020 compared to 2019 (OR 3, p < 0.0001). Deaths increased +246% (OR 1.7, p < 0.0001), and patients not transported to hospital +481% (OR 2.9, p < 0.0001) in March 2020 compared to 2019. In some hospitals, ambulances waited more than one hour before discharging the patients, and the emergency departments doubled the admission of critically ill patients. Transported patients for "Breathing" or "Infective" events were primarily males (OR 1.5, p < 0.0001). The patients had lower SpO2 in 2020 than in 2019 and they were younger. CONCLUSIONS The Lombardy region experienced an unexpected outbreak in an extremely short timeframe and in a limited area. The EMS coped with this pandemic, covering an extremely higher number of requests, with a ten-fold increase in the number of events managed.
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Perego E, Balzarini F, Botteri M, Favetti S, Zoli A, Sechi GM, Odone A, Signorelli C, Villa GF. Emergency treatment in Lombardy: a new methodology for the pre-Hospital Drugs management on Advanced Rescue Vehicles. Acta Biomed 2020; 91:111-118. [PMID: 32275275 PMCID: PMC7975893 DOI: 10.23750/abm.v91i3-s.9421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/26/2022]
Abstract
Background and aim of the work: The main objectives of our work were the regional harmonization and standardization of pharmaceutical supplies on MSA in Lombardy. Methods: The retrospective investigation was articulated in 2 phases: the first was the collection of data in every area of the Region (2012), the second was the analysis and elaboration of the information retrieved. Results: Beginning with 24 common drugs used by 8 AATs out of 12 an evaluation of the chemical-therapeutic characteristics was performed. The temporary list, including over 80 drugs classified in more than 25 therapeutic groups, was finally reduced to provide bags that were easier to handle but at the same time complete. Between October and November 2014, the proposed supply, including 71 formulations and approved by the Technical Board of AREU, officially entered into force. At the same time, the working group followed the same procedure to define the standard equipment for the Region’s helicopters, with only 58 formulations for relatively reduced weight allowed on board. Conclusions: In conclusion, we can state that, thanks to the support of experts, of the literature review, and thanks to the practical experience of the members of the AREU working groups and thanks to the documents coming from AIFA and EMA, the first operative regional project of unified pharmacological supply for MSA was delivered.
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Affiliation(s)
| | - Federica Balzarini
- School of Hygiene and Preventive Medicine University Vita-Salute San Raffaele- Milan.
| | | | | | | | | | - Anna Odone
- School of Hygiene and Preventive Medicine University Vita-Salute San Raffaele- Milan.
| | - Carlo Signorelli
- School of Hygiene and Preventive Medicine University Vita-Salute San Raffaele- Milan.
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Villa GF, Kette F, Balzarini F, Riccò M, Manera M, Solaro N, Pagliosa A, Zoli A, Migliori M, Sechi GM, Odone A, Signorelli C. Out-of-hospital cardiac arrest (OHCA) Survey in Lombardy: data analysis through prospective short time period assessment. Acta Biomed 2019; 90:64-70. [PMID: 31517891 PMCID: PMC7233661 DOI: 10.23750/abm.v90i9-s.8710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022]
Abstract
Background and aim of the work: The results of out-of-hospital cardiac arrests (OHCA) are usually reported through data collected collected via “ad hoc” registries, but in large populations, samples of short time periods can be used to apply the results to the entire population. We would like to describe the situation of Lombardy to provide evidence on successful procedures, which may be carried out in a larger context. Methods: Observational, prospective, analytical, single cohort study in Lombardy population. Data of OHCA of cardiac aetiology, according to “Utstein Style”, with resuscitation attempts started by the Emergency Medical Service (EMS), were collected for 40 days subdivided in 10-day-periods in all seasons 2014-15 via Operating System “Emergency Management” (EmMa). Results: Of 1219 cases, 536 events of witnessed OHCA of presumed cardiac etiology were analyzed. Outcomes were: sustained Return Of Spontaneous Circulation ROSC (25.6%), Survival Event in Emergency Department (22.8%), Survival after 24 hours (21.2%) and Survival after hospital discharge at home 30 days after (11.2%). Statistically significant results were found in age, rhythm of presentation, and resuscitation by bystanders. Sex, seasonality and rescue timing did not differ statistically. Conclusions: Overall the thirty-day survival rate was similar to studies with larger databases. Our data are consistent with the concept that all emergency service should provide CPR instructions for every citizen who activate the EMS in the suspect of a SCA; further investigation should clarify how long interval could be useful for ROSC and sustained ROSC in patients resuscitated by lay people using CPR instructions. (www.actabiomedica.it)
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Gianquitieri L, Brovelli MA, Brambilla P, Pagliosa A, Villa GF, Caiani EG. P2548A health geomatics framework for the assessment of the spatial distribution of out-of-hospital cardiac arrests and effective use of automated external defibrillators: the case of the city of Milan. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Gianquitieri
- Politecnico di Milano, Electronics, Information and Biomedical Engineering, Milan, Italy
| | - M A Brovelli
- Politecnico di Milano, Civil and Environmental Engineering, Milan, Italy
| | - P Brambilla
- Azienda Regionale Emergenza Urgenza -AREU, Milan, Italy
| | - A Pagliosa
- Azienda Regionale Emergenza Urgenza -AREU, Milan, Italy
| | - G F Villa
- Azienda Regionale Emergenza Urgenza -AREU, Milan, Italy
| | - E G Caiani
- Politecnico di Milano, Electronics, Information and Biomedical Engineering, Milan, Italy
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De Luca A, Giorgi Rossi P, Villa GF. The use of Cincinnati Prehospital Stroke Scale during telephone dispatch interview increases the accuracy in identifying stroke and transient ischemic attack symptoms. BMC Health Serv Res 2013; 13:513. [PMID: 24330761 PMCID: PMC3867422 DOI: 10.1186/1472-6963-13-513] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 11/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely and appropriate hospital treatment of acute cerebrovascular diseases (stroke and Transient Ischemic Attacks - TIA) improves patient outcomes. Emergency Medical Service (EMS) dispatchers who can identify cerebrovascular disease symptoms during telephone requests for emergency service also contribute to these improved outcomes. The Italian Ministry of Health issued guidelines on the management of AC patients in pre-hospital emergency service, including Cincinnati Prehospital Stroke Scale (CPSS) use.We measured the sensitivity and Positive Predictive Value (PPV) of EMS dispatchers' ability to recognize stroke/TIA symptoms and evaluated whether the CPSS improves accuracy. METHODS A cross-sectional multicentre study was conducted to collect data from 38 Italian emergency operative centres on all cases identified with stroke/TIA symptoms at the time of dispatch and all cases with stroke/TIA symptoms identified on the scene by the ambulance personnel from November 2010 to May 2011. RESULTS The study included 21760 cases: 18231 with stroke/TIA symptoms at dispatch and 9791 with symptoms confirmed on the scene. The PPV of the dispatch stroke/TIA symptoms identification was 34.3% (95% CI 33.7-35.0; 6262/18231) and the sensitivity was 64.0% (95% CI 63.0-64.9; 6262/9791). Centres using CPSS more often (>10% of cases) had both higher PPV (56%; CI 95% 57-60 vs 18%; CI 95% 17-19) and higher sensitivity (71%; CI 95% 87-89 vs 52%; CI 95% 51-54).In the multivariate regression a centre's CPSS use was associated with PPV (beta 0.48 p = 0.014) and negatively associated with sensitivity (beta -0.36; p = 0.063); centre sensitivity was associated with CPSS (beta 0.32; p = 0.002), adjusting for PPV. CONCLUSIONS Centres that use CPSS more frequently during phone dispatch showed greater agreement with on-the-scene prehospital assessments, both in correctly identifying more cases with stroke/TIA symptoms and in giving fewer false positives for non-stroke/TIA cases. Our study shows an extreme variability in the performance among OCs, highlighting that form many centres there is room for improvement in both sensitivity and positive predictive value of the dispatch. Our results should be used for benchmarking proposals in the effort to identify best practices across the country.
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Affiliation(s)
- Assunta De Luca
- Health Direction of Regional Authority of Emergency Services (ARES 118) Lazio Region Italy. New affiliation, Health Direction of Sant’Andrea Hospital Sapienza Rome University, Via Tronto 32, Roma, CAP 00198 Italy
| | | | - Guido Francesco Villa
- Pre hospital emergency Operative Center of Lecco and coordinator of Italian Group Pre-hospital management of acute stroke – Italian Society of pre hospital emergency Services (SIS118). New affiliation: Azienda Regionale Emergenza Urgenza (AREU), Milan Lombardy, Italy
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Abstract
There is a dire need to have complementary form of disaster training which is cost effective, relatively easy to conduct, comprehensive, effective and acceptable. This will complement field drills training. A classroom-based training and simulation module was built by combining multiple tools: Powerpoint lectures, simulations utilising the Kuala Lumpur International Airport (KLIA) schematic module into 'floortop' model and video show of previous disaster drill. 76 participants made up of medical responders, categorised as Level 1 (specialists and doctors), Level 2 (paramedics), Level 3 (assistant paramedics) and Level 4 (health attendants and drivers) were trained using this module. A pre-test with validated questions on current airport disaster plans was carried out before the training. At the end of training, participants answered similar questions as post-test. Participants also answered questionnaire for assessment of training's acceptance. There was a mean rise from 47.3 (18.8%) to 84.0 (18.7%) in post-test (p<0.05). For Levels 1, 2, 3 and 4 the scores were 94.8 (6.3)%, 90.1 (11)%, 80.3 (20.1)% and 65 (23.4)% respectively. Nevertheless Level 4 group gained most increase in knowledge rise from baseline pre-test score (51.4%). Feedback from the questionnaire showed that the training module was highly acceptable. A classroom-based training can be enhanced with favourable results. The use of classroom training and simulation effectively improves the knowledge of disaster plan significantly on the back of its low cost, relatively-easy to conduct, fun and holistic nature. All Levels of participants (from specialists to drivers) can be grouped together for training. Classroom training and simulation can overcome the problem of "dead-document" phenomenon or "paper-plan syndrome".
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Affiliation(s)
- A M Idrose
- Emergency Department, Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia.
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Villa GF, Colombo S, Cabrini L, Scandroglio AM, Torri G. [Interposed abdominal compression in mechanical cardiopulmonary resuscitation. Description of a clinical case]. Minerva Anestesiol 1998; 64:415-8. [PMID: 9835731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Among the different techniques proposed to integrate the standard cardiopulmonary resuscitation (sCPR) protocol, mechanical CPR (mCPR) and interposed abdominal compression (IAC) were found to be particularly effective for the simplicity of the procedure and the significant results obtained. A case of a 54-year old male with cardiogenic shock following viral infection, in which prolonged mechanical cardiopulmonary resuscitation with interposed abdominal compression was performed, is presented. Five hours after admission in the ICU, the patient's condition worsened with subsequent cardiac arrest with pulseless electrical activity (PEA). Mechanical CPR was promptly started, subsequently associated with IAC and prolonged for 1 hour and 20 minutes. Although the patient survived for only eight hours following cardiac arrest, prolonged IAC-mCPR allowed to start extra corporeal circulation (CPP). The patient was then transferred to the cardiosurgical operating theatre for ventricular assistance by centrifugal pump (VAP). Cardiovascular data obtained from patients monitoring did not shown any cardiac lesions or adverse effects as observed by autoptic examination and suggest the reliability of this mechanical method, which allows a better performance when compared to standard CPR. In prolonged resuscitations a few contraindications to both mCPR and IAC suggest the application of the associated techniques at all times in cardiac arrest, combining the benefits of both procedures.
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Affiliation(s)
- G F Villa
- Cattedra di Anestesia e Rianimazione, Università degli Studi, Milano
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Villa A, De Cristofaro A, Villa GF. [Differential diagnostic aspect of sequelae of accidents with digital syncopal crisis: discussion of a case]. Med Lav 1982; 73:131-5. [PMID: 7110041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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