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Douillet D, Plard D, Morin F, Courjault Y, Gaultier G, Lerolle N, Templier F, Roy PM, Savary D. Overcrowding in the Dispatching Centre During the COVID-19 Crisis: Are Medical Students a Resource? Disaster Med Public Health Prep 2024; 18:e38. [PMID: 38415406 DOI: 10.1017/dmp.2024.15] [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: 02/29/2024]
Abstract
INTRODUCTION In February, the emergence of COronaVIrus Disease 2019 (COVID - 19) in France made it necessary to rapidly adapt emergency and SAMU services in order to take care of many infected patients. To respond to the increase in the number of calls in the dispatch centers, reinforcements were necessary on the fronts of the Medical Regulation Assistants (ARM). The aim of this study was to assess the relevance of medical students' responses to first calls exclusively concerning COVID-19. METHODS This prospective, observational cohort study was carried out at the University Hospital Centre (CHU) in Angers. Twenty medical students mostly in the 5th year were voluntarily enrolled in the first line COVID-19 call taker team. Calls on the 1st, 3rd, and 5th starting day for each medical student, and randomly selected calls from the experienced first-line call taker were listened to by a medical expert to assess the adequate level of prioritization and orientation (emergency physician or general practitioner). The percentage of agreement between the expert, students, and experienced first-line call handlers were assessed. All participants gave their free consent to participate. The study was approved by the Ethics Committee of Angers (N° 2020-48). RESULTS From March 18 to April 23, 2020, 302 calls from medical students (n = 20 students) and 40 calls from experienced first-line call handlers were analyzed. The average prioritization agreement rate between the expert and students was 76.16% (95% Confidence Interval: 71.04 to 80.62%) (n = 230/302) compared to 87.50% (95% CI: 73.9 to 94.5%) (n = 45/50) for the experienced first-line call handlers (P = 0.15). Medical students took more time per call with an absolute difference of 2 minutes 16 seconds (P < 0.001). CONCLUSION The lessons to be observed from this COVID-19 crisis are that in the early days of increasing calls heralding a strain on the healthcare system, support by medical students must be considered.
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Affiliation(s)
- Delphine Douillet
- Emergency Department, Angers University Hospital, University of Angers, Angers, France
- UMR MitoVasc, Health Faculty, University of Angers, Angers, France
| | - Delphine Plard
- Emergency Department, Angers University Hospital, University of Angers, Angers, France
| | - François Morin
- Emergency Department, Angers University Hospital, University of Angers, Angers, France
| | - Yannick Courjault
- Emergency Department, Angers University Hospital, University of Angers, Angers, France
| | - Gwladys Gaultier
- Emergency Department, Angers University Hospital, University of Angers, Angers, France
| | - Nicolas Lerolle
- Medical Intensive Care Unit, CHU Angers, Angers University Hospital, Angers, France
| | - François Templier
- Emergency Department, Angers University Hospital, University of Angers, Angers, France
| | - Pierre-Marie Roy
- Emergency Department, Angers University Hospital, University of Angers, Angers, France
- UMR MitoVasc, Health Faculty, University of Angers, Angers, France
| | - Dominique Savary
- Emergency Department, Angers University Hospital, University of Angers, Angers, France
- EHESP, Irset, Inserm, University of Rennes, Rennes, France
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Hansen PM, Nielsen MS, Rehn M, Lassen AT, Mikkelsen S, Perner A, Brøchner AC. Ambulance and helicopter response time. Association with patient outcome and illness severity: Protocol of a systematic literature review and meta-analysis. Acta Anaesthesiol Scand 2024; 68:287-296. [PMID: 37870745 DOI: 10.1111/aas.14339] [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] [Received: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Response time for emergency medical service units is a key performance indicator. Studies have shown reduced response time association with improved outcome for specific critical conditions. To achieve short response time, emergency vehicles utilize lights and sirens, and crews are allowed to be non-compliant with traffic rules, posing a risk for accident. The purpose of the systematic review and meta-analysis is to provide an overview of the current body of evidence regarding the association, if any, between ambulance and helicopter response time and major complications and mortality in patients conveyed by ambulance and/or helicopter. Our secondary aim will be to enhance knowledge in the field of criteria-based dispatch to provide decision makers with evidence to optimize dispatch of limited resources. RESEARCH QUESTIONS What is the association between overall emergency medical services unit response time and patient outcomes, major complications, and time-critical conditions? What is the internal and external validity of the included literature? METHODS We plan the systematic review and meta-analysis to be in accordance with the Cochrane Handbook and Joanna Briggs Institute Manual for Systematic Reviews. The methodology will include formulating the review questions using a Population, Exposure, and Outcome framework. Every study design is eligible, including qualitative, quantitative, and mixed-methods designs. We will include all articles in English, Scandinavian, German, French and Portuguese in this systematic review. RESULTS We will publish results from the systematic review and meta-analysis in a peer-reviewed journal and we will present the results at scientific conferences and meetings. Results will also be available at www.ahrtemis.dk. CONCLUSION We will base our conclusions on the findings of the review and meta-analysis.
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Affiliation(s)
- Peter Martin Hansen
- Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital Svendborg, Odense C, Denmark
- Prehospital Research Unit, Region of South Denmark, Odense C, Denmark
| | - Martine Siw Nielsen
- Department of Anesthesiology and Intensive Care Medicine, Sygehus Lillebaelt, Kolding, Denmark
| | - Marius Rehn
- Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | | | - Søren Mikkelsen
- Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense C, Denmark
| | - Anders Perner
- Department of Anesthesiology and Intensive Care Medicine, Rigshospitalet, København Ø, Denmark
| | - Anne Craveiro Brøchner
- Prehospital Research Unit, Region of South Denmark, Odense C, Denmark
- Department of Anesthesiology and Intensive Care Medicine, Sygehus Lillebaelt, Kolding, Denmark
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Lewis MM, Pache K, Guan S, Shin J, Parayil M, Counts CR, Drucker C, Sayre MR, Kudenchuk PJ, Eisenberg M, Rea TD. Pediatric Out-of-Hospital Cardiac Arrest: The Role of the Telecommunicator in Recognition of Cardiac Arrest and Delivery of Bystander Cardiopulmonary Resuscitation. J Am Heart Assoc 2024; 13:e031740. [PMID: 38214298 PMCID: PMC10926809 DOI: 10.1161/jaha.123.031740] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Telecommunicator CPR (T-CPR), whereby emergency dispatch facilitates cardiac arrest recognition and coaches CPR over the telephone, is an important strategy to increase early recognition and bystander CPR in adult out-of-hospital cardiac arrest (OHCA). Little is known about this treatment strategy in the pediatric population. We investigated the role of T-CPR and related performance among pediatric OHCA. METHODS AND RESULTS This study was a retrospective cohort investigation of OHCA among individuals <18 years in King County, Washington, from April 1, 2013, to December 31, 2019. We reviewed the 911 audio recordings to determine if and how bystander CPR was delivered (unassisted or T-CPR), key time intervals in recognition of arrest, and key components of T-CPR delivery. Of the 185 eligible pediatric OHCAs, 23% (n=43) had bystander CPR initiated unassisted, 59% (n=109) required T-CPR, and 18% (n=33) did not receive CPR before emergency medical services arrival. Among all cases, cardiac arrest was recognized by the telecommunicator in 89% (n=165). Among those receiving T-CPR, the median (interquartile range) interval from start of call to OHCA recognition was 59 seconds (38-87) and first CPR intervention was 115 seconds (94-162). When stratified by age (≤8 versus >8), the older age group was less likely to receive CPR before emergency medical services arrival (88% versus 69%, P=0.002). For those receiving T-CPR, bystanders spent a median of 207 seconds (133-270) performing CPR. The median compression rate was 93 per minute (82-107) among those receiving T-CPR. CONCLUSIONS T-CPR is an important strategy to increase early recognition and early CPR among pediatric OHCA.
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Affiliation(s)
- Miranda M. Lewis
- Department of Emergency MedicineUniversity of California San Francisco‐FresnoFresnoCA
| | - Killian Pache
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
| | - Sally Guan
- Division of Emergency Medical Services, Department of Public HealthSeattle and King CountySeattleWA
| | - Jenny Shin
- Division of Emergency Medical Services, Department of Public HealthSeattle and King CountySeattleWA
| | - Megin Parayil
- Division of Emergency Medical Services, Department of Public HealthSeattle and King CountySeattleWA
| | - Catherine R. Counts
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
- Seattle Fire DepartmentSeattleWA
| | - Chris Drucker
- Division of Emergency Medical Services, Department of Public HealthSeattle and King CountySeattleWA
| | - Michael R. Sayre
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
- Seattle Fire DepartmentSeattleWA
| | - Peter J. Kudenchuk
- Division of Emergency Medical Services, Department of Public HealthSeattle and King CountySeattleWA
- Department of Medicine, Division of CardiologyUniversity of WashingtonSeattleWA
| | - Mickey Eisenberg
- Department of Emergency MedicineUniversity of WashingtonSeattleWA
- Division of Emergency Medical Services, Department of Public HealthSeattle and King CountySeattleWA
| | - Thomas D. Rea
- Division of Emergency Medical Services, Department of Public HealthSeattle and King CountySeattleWA
- Department of MedicineUniversity of WashingtonSeattleWA
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Khalemsky M, Khalemsky A, Lankenau S, Ataiants J, Roth A, Marcu G, Schwartz DG. Predictive Dispatch of Volunteer First Responders: Algorithm Development and Validation. JMIR Mhealth Uhealth 2023; 11:e41551. [PMID: 38015602 PMCID: PMC10716760 DOI: 10.2196/41551] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 06/03/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Smartphone-based emergency response apps are increasingly being used to identify and dispatch volunteer first responders (VFRs) to medical emergencies to provide faster first aid, which is associated with better prognoses. Volunteers' availability and willingness to respond are uncertain, leading in recent studies to response rates of 17% to 47%. Dispatch algorithms that select volunteers based on their estimated time of arrival (ETA) without considering the likelihood of response may be suboptimal due to a large percentage of alerts wasted on VFRs with shorter ETA but a low likelihood of response, resulting in delays until a volunteer who will actually respond can be dispatched. OBJECTIVE This study aims to improve the decision-making process of human emergency medical services dispatchers and autonomous dispatch algorithms by presenting a novel approach for predicting whether a VFR will respond to or ignore a given alert. METHODS We developed and compared 4 analytical models to predict VFRs' response behaviors based on emergency event characteristics, volunteers' demographic data and previous experience, and condition-specific parameters. We tested these 4 models using 4 different algorithms applied on actual demographic and response data from a 12-month study of 112 VFRs who received 993 alerts to respond to 188 opioid overdose emergencies. Model 4 used an additional dynamically updated synthetic dichotomous variable, frequent responder, which reflects the responder's previous behavior. RESULTS The highest accuracy (260/329, 79.1%) of prediction that a VFR will ignore an alert was achieved by 2 models that used events data, VFRs' demographic data, and their previous response experience, with slightly better overall accuracy (248/329, 75.4%) for model 4, which used the frequent responder indicator. Another model that used events data and VFRs' previous experience but did not use demographic data provided a high-accuracy prediction (277/329, 84.2%) of ignored alerts but a low-accuracy prediction (153/329, 46.5%) of responded alerts. The accuracy of the model that used events data only was unacceptably low. The J48 decision tree algorithm provided the best accuracy. CONCLUSIONS VFR dispatch has evolved in the last decades, thanks to technological advances and a better understanding of VFR management. The dispatch of substitute responders is a common approach in VFR systems. Predicting the response behavior of candidate responders in advance of dispatch can allow any VFR system to choose the best possible response candidates based not only on ETA but also on the probability of actual response. The integration of the probability to respond into the dispatch algorithm constitutes a new generation of individual dispatch, making this one of the first studies to harness the power of predictive analytics for VFR dispatch. Our findings can help VFR network administrators in their continual efforts to improve the response times of their networks and to save lives.
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Affiliation(s)
- Michael Khalemsky
- Department of Management, Hadassah Academic College, Jerusalem, Israel
| | - Anna Khalemsky
- Department of Management, Hadassah Academic College, Jerusalem, Israel
| | - Stephen Lankenau
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Janna Ataiants
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Alexis Roth
- School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - David G Schwartz
- The Graduate School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
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Larribau R, Healey B, Chappuis VN, Boussard D, Guiche F, Herren T, Gartner BA, Suppan L. Contribution of Live Video to Physicians' Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey. Int J Environ Res Public Health 2023; 20:3307. [PMID: 36834002 PMCID: PMC9959421 DOI: 10.3390/ijerph20043307] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID-19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID-19 number) with suspected COVID-19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. A total of 8957 patients were included, and 2157 (48.0%) of the 4493 patients assessed on the official emergency number had dyspnoea, 4045 (90.6%) of 4464 patients assessed on the COVID-19 number had flu-like symptoms and 1798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n = 81) of cases and caught 7 (7.7%) patients in a life-threatening emergency. Medical triage decisions for suspected COVID-19 patients are strongly influenced by the use of live video.
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Affiliation(s)
- Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211 Geneva, Switzerland
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Andelius L, Malta Hansen C, Jonsson M, Gerds TA, Rajan S, Torp-Pedersen C, Claesson A, Lippert F, Tofte Gregers MC, Berglund E, Gislason GH, Køber L, Hollenberg J, Ringh M, Folke F. Smartphone-activated volunteer responders and bystander defibrillation for out-of-hospital cardiac arrest in private homes and public locations. Eur Heart J Acute Cardiovasc Care 2022; 12:87-95. [PMID: 36574433 PMCID: PMC9910568 DOI: 10.1093/ehjacc/zuac165] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
AIMS To investigate the association between the arrival of smartphone-activated volunteer responders before the Emergency Medical Services (EMS) and bystander defibrillation in out-of-hospital cardiac arrest (OHCA) at home and public locations. METHODS AND RESULTS This is a retrospective study (1 September 2017-14 May 2019) from the Stockholm Region of Sweden and the Capital Region of Denmark. We included 1271 OHCAs, of which 1029 (81.0%) occurred in private homes and 242 (19.0%) in public locations. The main outcome was bystander defibrillation. At least one volunteer responder arrived before EMS in 381 (37.0%) of OHCAs at home and 84 (34.7%) in public. More patients received bystander defibrillation when a volunteer responder arrived before EMS at home (15.5 vs. 2.2%, P < 0.001) and in public locations (32.1 vs. 19.6%, P = 0.030). Similar results were found among the 361 patients with an initial shockable heart rhythm (52.7 vs. 11.5%, P < 0.001 at home and 60.0 vs. 37.8%, P = 0.025 in public). The standardized probability of receiving bystander defibrillation increased with longer EMS response times in private homes. The 30-day survival was not significantly higher when volunteer responders arrived before EMS (9.2 vs. 7.7% in private homes, P = 0.41; and 40.5 vs. 35.4% in public locations, P = 0.44). CONCLUSION Bystander defibrillation was significantly more common in private homes and public locations when a volunteer responder arrived before the EMS. The standardized probability of bystander defibrillation increased with longer EMS response times in private homes. Our findings support the activation of volunteer responders and suggest that volunteer responders could increase bystander defibrillation, particularly in private homes.
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Affiliation(s)
| | - Carolina Malta Hansen
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Jonsson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Thomas A Gerds
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5,1014 Copenhagen, Denmark
| | - Shahzleen Rajan
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Copenhagen University Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Freddy Lippert
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark
| | - Mads Chr Tofte Gregers
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ellinor Berglund
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Gunnar H Gislason
- The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Jägargatan 20, 118 67 Stockholm, Sweden
| | - Fredrik Folke
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
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Lupton JR, Neth MR, Sahni R, Wittwer L, Le N, Jui J, Newgard CD, Daya MR. The Association Between the Number of Prehospital Providers On-Scene and Out-of-Hospital Cardiac Arrest Outcomes. PREHOSP EMERG CARE 2021; 26:782-791. [PMID: 34669565 DOI: 10.1080/10903127.2021.1995799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: The ideal number of emergency medical services (EMS) providers needed on-scene during an out-of-hospital cardiac arrest (OHCA) resuscitation is unknown. Our objective was to evaluate the association between the number of providers on-scene and OHCA outcomes. Methods: This was a secondary analysis of adults (≥18 years old) with non-traumatic OHCA from a 10-site North American prospective cardiac arrest registry (Resuscitation Outcomes Consortium) including a 2005-2011 cohort and a 2011-2015 cohort. The primary outcome was survival to hospital discharge. We calculated the median number of EMS providers on-scene during the first 10 minutes of the resuscitation and used multivariable logistic regression adjusting for age, sex, witness status, bystander CPR, arrest location, initial rhythm, and dispatch to EMS arrival time. Results: There were 30,613 and 41,946 patients with necessary variables in the 2005-2011 and 2011-2015 cohorts, respectively. Survival to hospital discharge (95% CI) was higher with 9 or more providers on-scene (17.2% [15.8-18.5] and 14.0% [12.6-15.4]) compared to 7-8 (14.1% [13.4-14.8] and 10.5% [9.9-11.1]), 5-6 (10.0% [9.5-10.5] and 8.5% [8.1-8.9]), 3-4 (10.5% [9.3-11.6] and 9.3% [8.5-10.1]), and 1-2 (8.6% [7.2-10.0] and 8.0% [7.1-9.0]) providers for the 2005-2011 and 2011-2015 cohorts, respectively. In multivariable logistic regressions, compared to 5-6 providers, there were no significant differences in survival to hospital discharge for 1-2 or 3-4 providers, while having 7-8 (adjusted odds ratios (aORs) 1.53 [1.39-1.67] and 1.31 [1.20-1.44]) and 9 or more (aORs 1.76 [1.56-1.98] and 1.63 [1.41-1.89]) providers were associated with improved survival in both the 2005-2011 and 2011-2015 cohorts, respectively. Conclusions: The presence of seven or more prehospital providers on-scene was associated with significantly greater adjusted odds of survival to hospital discharge after OHCA compared to fewer on-scene providers.
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Howell D, Li T, De Bono J, Berkowitz J. Reduction in Interfacility Transfer Response Time after Implementation of an AutoLaunch Protocol. PREHOSP EMERG CARE 2021; 26:739-745. [PMID: 34251976 DOI: 10.1080/10903127.2021.1954271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Interfacility transfers (IFTs) are an essential component of healthcare systems to allow movement of patients between facilities. It is essential to limit any delays in patients receiving the care they require at the receiving facility. The primary objective of this study was to assess whether IFT response time was reduced after implementation of an AutoLaunch protocol, in which an ambulance is dispatched to the sending facility prior to acceptance of the patient by the receiving facility. The secondary objective was to describe the frequency and amount of time ambulances had to stage outside the sending facility in situations where the ambulance arrived prior to the patient being accepted by the receiving facility. Methods: This was a retrospective pre-post analysis of patients undergoing IFT for services not available at the sending facility between October 1, 2018 and September 30, 2019, with the AutoLaunch protocol being implemented on March 25, 2019. IFT response time was defined as the time the transfer request was initially made to the time the ambulance arrived at the sending facility. Dispatch call logs and transport records were analyzed before and after implementation of the AutoLaunch protocol to assess for a difference in IFT response time as well as frequency and amount of time ambulances had to stage. Results: Of 1,881 IFTs analyzed, 885 (47.0%) were completed under the traditional protocol and 996 (53.0%) were completed under the AutoLaunch protocol. The median IFT response time under the traditional protocol was 27.5 minutes (interquartile range (IQR): 17.9, 43.3), compared with 19.9 minutes (IQR: 12.8, 28.2) under the AutoLaunch protocol (p < 0.01), representing a 27.6% reduction in response time, or 7.6 minutes saved. Of the 996 AutoLaunch transfers, there were 215 incidents (21.6%) in which the IFT ambulance had to stage, and the median staging time was 10.1 minutes (IQR: 4.9, 24.2). Conclusions: Implementation of our AutoLaunch protocol resulted in a significant reduction in ambulance response time for interfacility transfers. Further studies are needed to assess whether the reduction in response time is associated with improved patient outcomes for certain conditions.
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Inoue J, Hirano Y, Fukumoto Y, Kudo T, Usami R, Kondo Y, Matsuda S, Okamoto K, Tanaka H. Risk factors for cancellation after dispatch of rapid response cars for prehospital emergency care: a single-center, case-control study. Acute Med Surg 2021; 8:e684. [PMID: 34336230 PMCID: PMC8312742 DOI: 10.1002/ams2.684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022] Open
Abstract
Aim The objective of this study is to identify the risk factors for cancellation after dispatch of rapid response cars (RRC) for prehospital emergency care. Methods We retrospectively extracted data from all RRC cases dispatched from our hospital between April 2017 and March 2019. A total of 1,440 cases were included in our study and divided into either the “cancelled” group (n = 723) or the “treated” group (n = 717), based on the occurrence of cancellation. The variables obtained from the request calls for RRC included patient characteristics, distance from the hospital to the scene, and reasons for RRC request. The variables were compared between the two groups and logistic regression analysis was carried out to identify the risk factors for RRC cancellation. Results Multivariable analysis showed that distance from the hospital to the scene (odds ratio [OR] 1.25; 95% confidence interval (CI), 1.21–1.28), suspicion of cardiopulmonary arrest with no witness information (OR 7.61; 95% CI, 4.13–14.00), dyspnea (OR 2.22; 95% CI, 1.19–4.11), and suicide by hanging (OR 3.49; 95% CI, 1.37–8.89) were independent risk factors for cancellation. Conclusions In our study, a greater distance from the hospital to the scene, suspicion of cardiopulmonary arrest with no witness information, dyspnea, and suicide by hanging were identified as independent risk factors for cancellation after dispatch of RRC. Evaluating the risk factors for cancellation at individual facilities could help hospitals adjust their dispatch criteria to allocate limited medical resources more effectively.
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Affiliation(s)
- Juri Inoue
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Yohei Hirano
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Yuichi Fukumoto
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Tomohiro Kudo
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Ryo Usami
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Shigeru Matsuda
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Ken Okamoto
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Hiroshi Tanaka
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
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Zhang L, Luo M, Myklebust H, Pan C, Wang L, Zhou Z, Yang Q, Lin Q, Zheng ZJ. When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China. Emerg Med J 2021; 38:252-257. [PMID: 32998954 PMCID: PMC7982934 DOI: 10.1136/emermed-2019-209291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several Chinese cities have implemented dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), although out-of-hospital cardiac arrest (OHCA) survival rates remain low. We aimed to assess the process compliance, barriers and outcomes of OHCA in one of the earliest implemented (DA-CPR) programmes in China. METHODS We retrospectively reviewed OHCA emergency dispatch records of Suzhou emergency medical service from 2014 to 2015 and included adult OHCA victims (>18 years) with a bystander-witnessed atraumatic OHCA that was subsequently confirmed by on-site emergency physician. The circumstances and DA-CPR process related to the OHCA event were analysed. Dispatch audio records were reviewed to identify potential barriers to implementation during the DA-CPR process. RESULTS Of the 151 OHCA victims, none survived. The median time from patient collapse to call for emergency services and that from call to provision of cardiopulmonary resuscitation instructions was 30 (IQR 20-60) min and 115 (IQR 90-153) s, respectively. Only 110 (80.3%) bystanders/rescuers followed the dispatcher instructions; of these, 51 (46.3%) undertook persistent chest compressions. Major barriers to following the DA-CPR instructions were present in 104 (68.9%) cases, including caller disconnection of the call, distraught mood or refusal to carry out either compressions or ventilations. CONCLUSIONS The OHCA survival rate and the DA-CPR process were far from optimal. The zero survival rate is disproportionally low compared with survival statistics in high-income countries. The prolonged delay in calling the emergency services negated and rendered futile any DA-CPR efforts. Thus, efforts targeted at developing public awareness of OHCA, calling for help and competency in DA-CPR should be increased.
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Affiliation(s)
- Lin Zhang
- Department of Epidemiology and Biostatistics, Shanghai Jiao Tong University School of Public Health, Shanghai, China
| | | | | | - Chun Pan
- Suzhou Emergency Center, Suzhou, China
| | | | | | | | - Qi Lin
- Suzhou Emergency Center, Suzhou, China
| | - Zhi-Jie Zheng
- Department of Global Health, Peking University School of Public Health, Beijing, China
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Jensen T, Holgersen MG, Jespersen MS, Blomberg SN, Folke F, Lippert F, Christensen HC. Strategies to Handle Increased Demand in the COVID-19 Crisis: A Coronavirus EMS Support Track and a Web-Based Self-Triage System. PREHOSP EMERG CARE 2020; 25:28-38. [PMID: 32870754 DOI: 10.1080/10903127.2020.1817212] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In emergencies, such as the COVID-19 pandemic, there is an increased need for contact with emergency medical services (EMS), and call volume might surpass capacity. The Copenhagen EMS operates two telephone line the 1-1-2 emergency number and the 1813 medical helpline. A separate coronavirus support track was implemented on the 1813 medical helpline and a web-based self-triage (web triage) system was created to reduce non-emergency call volume. The aim of this paper is to present call volume and the two measures implemented to handle the increased call volume to the Copenhagen EMS. METHODS This is a cross sectional observational study. Call volume and queue time is presented in the first month of the COVID-19 pandemic (27th of February 2020 to 27th of march) and compared to the equivalent month from the year before (2019). Descriptive statistics are conducted on call volumes and queue times and spearman's rank correlation test are performed to test correlation between web triage and call volume. RESULTS Total EMS call volume increase by 23.3% between 2019 and 2020 (92.670 vs. 114,250). The 1-1-2 emergency line total call volume increase by 4.4% (8,4942 vs. 8,870) and the 1813 medical helpline increased by 25.1% (84.176 vs. 105.380). The coronavirus support track handled 21,063 calls. The 1813 medical helpline queue time was a mean of 02 minutes and 23 seconds (CI: 2.22-2.25) in 2019 and 12 minutes and 2 seconds (CI 11:55-12:09) in 2020 (P < 0.001). The web triage was used 10,894 times. No correlation between call volume and web triage usage was seen. CONCLUSIONS In the first month of the ongoing COVID-19 pandemic a significant increase in call volume was observed in the 1813 medical helpline compared to 2019. A large number of calls were handled by the additional coronavirus track and diverted away from the regular tracks of the 1813 medical helpline. This likely contributed to mitigating increased call volumes and queue times. The web triage was widely used but no significant correlation was seen with 1813 medical helpline call volume. Other EMS organizations can learn from this to enhance capacity in a future epidemics.
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Abstract
Objective: To determine the impact of a new dispatch system on the efficiency of first resource assignment for critical EMS patients. Methods: In December 2014, the Los Angeles Fire Department (LAFD) implemented a new, internally-developed dispatch system. An interrupted time series study compared 9-1-1 incidents processed by LAFD-telecommunicators using either the Medical Priority Dispatch System® (MPDS, January 1 - September 30, 2014), or Los Angeles Tiered Dispatch System (LA-TDS, January 1 - September 30, 2015). All incidents were assigned a Dispatch Level of Service (DLOS), based on whether a basic life support (BLS) or advanced life support (ALS) resource was dispatched, and a Field-Recommended Level of Service (RLOS), a metric based on medical necessity, required scope of practice, number and intensity of interventions, and patient severity. DLOS options included BLS or ALS, whereas RLOS options included BLS, ALS1 and ALS2, with ALS2 cases having the greatest medical need. The primary outcome was critical under-triage rate, and secondary outcomes included rates of over-triage, total resource utilization and test characteristics of each dispatch system. Results: 563,188 incidents met inclusion criteria, including 271,604 using MPDS and 291,584 using LA-TDS. During the MPDS period, 96,561 (35.6%) incidents were initially dispatched with BLS resources (including 194 (0.071% ultimately found in the field to be high-acuity RLOS ALS2), and 175,043 were dispatched with ALS resources. During the LA-TDS period, 127,827 (43.8%) were dispatched as BLS (including 154 RLOS ALS2) and 163,798 were dispatched as ALS. For the primary outcome, the critical under-triage rate was 0.20% using MPDS and 0.12% using LA-TDS (Z 4.7, p < 0.0001, RR 0.61 CI 95% 0.50-0.76), and this improvement was primarily driven by improved triage of cardiac arrest. The over-triage rate using MPDS was 44%, which decreased to 33% using LA-TDS. LA-TDS was associated with significant improvements in specificity, positive predictive value and accuracy of initial resource assignment, and is projected to have saved over 23,000 EMS resource dispatches over the 9-month study period. Conclusion: The new Los Angeles Tiered Dispatch System significantly improved the efficiency of initial 9-1-1 resource assignments by decreasing both over-triage and critical under-triage, thus sending more appropriate resources to each 9-1-1 call.
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Sanko S, Lane C, Eckstein M. Impact of a New 9-1-1 Dispatch System on Call-Processing Times for Time-Critical Emergencies in the City of Los Angeles. PREHOSP EMERG CARE 2020; 24:537-543. [PMID: 31524547 DOI: 10.1080/10903127.2019.1668988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To determine the impact of a new emergency medical services (EMS) 9-1-1 dispatch system on call-processing times for field-confirmed time-critical emergencies. Methods: An interrupted time series study compared 9-1-1 calls for field-confirmed emergencies processed by Los Angeles Fire Department (LAFD)-telecommunicators using either the Medical Priority Dispatch System® (January 1 - September 30, 2014) or the new Los Angeles Tiered Dispatch System (January 1 - September 30, 2015). Prior to the study, authors identified seven categories of time-critical emergencies. Cases meeting inclusion criteria were systematically identified using LAFD electronic health records, and the elapsed time from call receipt to key events were obtained. The primary outcome was call-processing time (CPT), defined as time from 9-1-1 call receipt to when resources were dispatched. Results: During the study period, 12,439 incidents met inclusion criteria: 6,208 using MPDS and 6,231 using LA-TDS. Among all unique time-critical incidents, the mean CPT was 16 seconds faster using LA-TDS (M = 68.5) compared to MPDS (M = 84.4; p < 0.001). CPT was significantly (p < 0.01) lower using LA-TDS for: cardiac arrests with attempted resuscitation, patients requiring ventilation support, seizures requiring prehospital benzodiazepines, gunshot wounds with hypotension, automobile vs. pedestrian accidents, and long falls. There was no difference in CPT for drownings requiring resuscitation (p = 0.60). The elapsed time to arrival of first responders on scene improved from 370.1 seconds using MPDS to 354.8 seconds using LA-TDS (p < 0.001). Conclusion: The new Los Angeles Tiered Dispatch System significantly improved 9-1-1 call-processing times and total response times for nearly all identified time-critical emergencies under study.
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Yazaki H, Nishiura H. Ambulance Transport of Patients with Mild Conditions in Hokkaido, Japan. Int J Environ Res Public Health 2020; 17:ijerph17030919. [PMID: 32024234 PMCID: PMC7037900 DOI: 10.3390/ijerph17030919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/25/2020] [Accepted: 02/01/2020] [Indexed: 11/16/2022]
Abstract
Understanding the epidemiological distributions of ambulance transport for patients with mild conditions according to age, disease, and geographic region could help in achieving optimal use of ambulance services. In the present study, we explored the descriptive epidemiology of ambulance transports in Hokkaido, the northernmost prefecture of Japan, identifying potential factors that determine the frequency of transports for mild diseases. Of the total 153,667 ambulance transports in Hokkaido during 2016, we found that two-thirds were for older people, of which about 60% resulted in hospital admission. There were 74,485 transports for mild cases, which were most commonly for psychiatric disorders among working-age adults (n = 4805), heart diseases among older people (n = 4246), and sensory organ diseases among older people (n = 3589). Examining the ecological correlations over 58 geographic units of ambulance services, the total unemployment rate and distance to the nearest tertiary care hospital were, respectively, positively and negatively correlated with the standardized transport ratio for multiple mild diseases. The proportion of working-age adults was uniquely identified as a possible positive predictor in mild cases of psychiatric disorders. As the identified potential predictors could be helpful in considering countermeasures, the causal links should be examined in future studies.
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Affiliation(s)
- Hiroshi Yazaki
- Graduate School of Medicine, Hokkaido University, Kita 15-Jo Nishi 7-Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan
- Hosanna Family Clinic, Miyanosawa 3 Jo 3-6-1, Nishiku, Sapporo 0630053, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15-Jo Nishi 7-Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan
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Felice J, Coughlin RF, Burns K, Chmura C, Bogucki S, Cone DC, Joseph D, Parwani V, Li F, Saxa T, Ulrich A. Effects of Real-time EMS Direction on Optimizing EMS Turnaround and Load-balancing Between Neighboring Hospital Campuses. PREHOSP EMERG CARE 2019; 23:788-794. [PMID: 30798628 DOI: 10.1080/10903127.2019.1587123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Implemented in September 2017, the "nurse navigator program" identified the preferred emergency department (ED) destination within a single healthcare system using real-time assessment of hospital and ED capacity and crowding metrics. Objective: The primary objective of the navigator program was to improve load-balancing between two closely situated emergency departments, both of which feed into the same inpatient facilities of a single healthcare system. A registered nurse in the hospital command center made real-time recommendations to emergency medical services (EMS) providers via radio, identifying the preferred destination for each transported patient based on such factors as chief complaint, ED volume, and waiting room census. The destination decision was made via the utilization of various real-time measures of health system capacity in conjunction with existing protocols dictating campus-specific clinical service availability. The objective of this study was to evaluate the efficacy of this real-time ambulance destination direction program as reflected in changes to emergency medical services (EMS) turnaround time and the incidence of intercampus transports. Methods: A before-and-after time series was performed to determine if program implementation resulted in a change in EMS turnaround time or incidence of intercampus transfers. Results: Implementation of the nurse navigator program was associated with a statistically significant decrease in EMS turnaround times for all levels of dispatch and transport at both hospital campuses. Intercampus transfers also showed significant improvement following implementation of the intervention, although this effect lagged behind implementation by several months. Conclusion: A proactive approach to EMS destination control using a nurse navigator with access to real-time hospital and ED capacity metrics appears to be an effective method of decreasing EMS turnaround time.
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Abstract
Sporer KA . 911 patient redirection. Prehosp Disaster Med. 2017;32(6):589-592.
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Abstract
BACKGROUND Hurricanes Irene and Sandy heavily impacted New Jersey. Investigating EMS dispatch trends during these storms may allow us to prepare for future disasters. OBJECTIVES Our objectives to characterize the types of EMS dispatches immediately before, during, and after landfall compared to a control period. METHODS This retrospective study was conducted at a large EMS dispatch center that provides first responders, Basic Life Support (BLS), Advanced Life Support (ALS), and critical care transport services to an area with approximately 20 receiving hospitals including a Level I Trauma Center. At peak staffing, there are 8-10 ALS vehicles, 25 BLS vehicles, and 3 critical care transport vehicles deployed. We included of the day of landfall and seven days before and after. We compared dispatch data to a control period in 2010 that mirrored Hurricane Sandy the dates of. Descriptive statistics and two way ANOVA were used to assess dispatch, gender and age differences. RESULTS We found Hurricane Sandy dispatches peaked 2 days after landfall. Both ALS and BLS had an increase in age in the post-Sandy period compared to the pre-Sandy (ALS 58.5 to 64.2, p = 0.005, ANOVA p = 0.078; BLS 47.4 to 56.3, p < 0.001, ANOVA p = 0.001). There were 17 "hurricane related" (loss of power related issues, oxygen supply depleted, evacuation) and 15 carbon monoxide dispatches in the post-Sandy period and none in the others, including peri-Irene. The average age of cardiac arrest dispatches was lower in the post-Irene group compared to pre-Irene (74.3 to 47.8, p = 0.023). There were no critical care requests before or after Hurricane Sandy, but there were 14 around Hurricane Irene and 10 surrounding the control period. CONCLUSIONS Dispatch data can inform natural disaster planning. Education efforts can focus on geriatric patients, as well as resource distribution planning for an increase in geriatric populations. However, pattern variability between storms shows further study is needed to clarify exactly which resources should be utilized in order to maintain an ideal response to a natural disaster.
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Sanson G, Verduno J, Zambon M, Trevi R, Caggegi GD, Di Bartolomeo S, Antonaglia V. Emergency medical service treated out-of-hospital cardiac arrest: Identification of weak links in the chain-of-survival through an epidemiological study. Eur J Cardiovasc Nurs 2015; 15:328-36. [PMID: 25676670 DOI: 10.1177/1474515115573365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 09/03/2014] [Accepted: 01/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In-depth analysis of emergency medical services (EMSs) performances in out-of-hospital cardiac arrest (OHCA) promotes quality improvement. AIMS The purpose of this study was to identify the improvable factors of the EMS response to OHCA through the description and analysis of OHCA incidence, characteristics, management and outcome. METHODS This was a retrospective cohort study on all OHCA patients treated by the EMSs of the district of Trieste, Italy (236,556 inhabitants) in 2011. RESULTS A total of 678 OHCAs occurred and 142 (20.1%) underwent cardiopulmonary resuscitation (CPR), with a respective incidence of 287/100,000/year and 60/100,000/year. The incidence of shockable rhythms in the CPR group was 13/100,000. OHCAs occurred mainly during daytime, though the proportion of patients receiving CPR was significantly higher by night-time (p=0.01). Thirty-four CPR patients (23.9%) restored spontaneous circulation on scene; 12 (8.5%) survived to hospital discharge (11 with good neurological recovery). Survival was not correlated with age, while was significantly higher for patients with shockable rhythms (32.3%; p<0.001). Mean response time was 8 min. Direct intervention of physician-staffed units did not improve the outcome when compared with two-tiered activation. Patients immediately identified as OHCA by dispatch nurses and those undergoing therapeutic hypothermia showed a non-significant trend towards improved survival (p=0.09 and 0.07, respectively). CONCLUSIONS OHCA identification by dispatch nurses and reduction of response time were the factors most susceptible to improvement.
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Affiliation(s)
| | | | - Marco Zambon
- Emergency Medical Service System, Azienda per i Servizi Sanitari, Trieste, Italy
| | - Roberto Trevi
- Emergency Medical Service System, Azienda per i Servizi Sanitari, Trieste, Italy
| | - Giuseppe D Caggegi
- Emergency Medical Service System, Azienda per i Servizi Sanitari, Trieste, Italy
| | - Stefano Di Bartolomeo
- Department of Anesthesia, University Hospital, Udine, Italy Department of Clinical Governance, Agenzia Sanitaria e Sociale Regionale Emilia Romagna, Italy
| | - Vittorio Antonaglia
- Emergency Medical Service System, Azienda per i Servizi Sanitari, Trieste, Italy
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Abstract
Abstract Early, high-quality cardiopulmonary resuscitation (CPR) is the key to increasing the likelihood of successful resuscitation in cardiac arrest. The use of dispatch-assisted (DA) CPR can increase the likelihood of bystander CPR. We describe a case in which a metronome was introduced to guide DA-CPR. The wife of a 52-year-old male activated 9-1-1 after her husband suffered a cardiac arrest. During her 9-1-1 call she received CPR instructions and heard a metronome over the phone while following the instructions. Return of spontaneous circulation of the patient occurred during paramedic on scene care. The patient was transported to hospital and discharged 6 days later with no neurological deficit. This case supports the use of a metronome by emergency medical dispatchers during the provision of DA-CPR to improve bystander CPR.
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Maignan M, Richard A, Debaty G, Pommier P, Viglino D, Loizzo F, Timsit JF, Hanna J, Carpentier F, Danel V. Intentional drug poisoning care in a physician-manned emergency medical service. PREHOSP EMERG CARE 2014; 19:224-31. [PMID: 25350772 DOI: 10.3109/10903127.2014.964890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Severely poisoned patients can benefit from intensive and specific treatments. Emergency medical services (EMS) may therefore play a crucial role by matching prehospital care and hospital referral to the severity of poisoned patients. Our aim was to investigate EMS accuracy in this condition. METHODS A 3-year retrospective study was conducted in a university hospital. Emergency telephone calls about adult patients with intentional drug poisoning (IDP) were included. In daily practice, an emergency physician answers such telephone calls and dispatches either first responders or a mobile intensive care unit (MICU). According to on-scene evaluation, patients are referred to the emergency department (ED) or to an intensive care unit (ICU). We therefore calculated global EMS accuracy according to patients' actual medical needs. We further evaluated the performance of dispatch and hospital referral decision. We also performed a regression analysis to identify factors of inappropriate dispatch. RESULTS A total of 2,227 patients were studied. Median age was 41 years old (range 30-49) and 63% were women. Dispatch was appropriate for 1,937 (87%) patients. Sensitivity and specificity of dispatch decision were 0.43 and 0.93, respectively. Decision of patients' referral to an appropriate hospital facility had a sensitivity of 0.67 and a specificity of 0.98. Toxicological data, age, and Glasgow coma scale were significantly associated with inappropriate EMS decisions. CONCLUSIONS A physician-operated EMS is an accurate system to provide prehospital care to IDP patients. However, dispatch physicians should pay attention, especially to toxicological anamnesis, to anticipate proper patient care.
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Yokoyama Y, Hirano K, Sato M, Abe A, Uebayashi M, Kishi E, Sato M, Kuroda Y, Nakaita I, Fukushima F. Activities and health status of dispatched public health nurses after the great East Japan earthquake. Public Health Nurs 2014; 31:537-44. [PMID: 25080024 PMCID: PMC4282791 DOI: 10.1111/phn.12141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to elucidate the actual activities conducted by public health nurses during their dispatch and their health status during and after dispatch to the three prefectures most severely affected by the Great East Japan Earthquake. SAMPLE A survey request was sent to a total of 2,237 facilities. Of these, 778 facilities returned questionnaires from dispatched public health nurses. RESULTS The participants of this study were 1,570 dispatched health nurses who participated in activities mostly at evacuation centers, followed by evacuees' homes. After dispatch, an earlier postdisaster phase at the start of dispatch was independently associated with poor subjective well-being, low mood, worsened sleep state, and intense fatigue. Work hours per day were associated with poor subjective well-being and intense fatigue after dispatch. CONCLUSION Results suggest that the factor that most strongly affected the postdispatch health of the nurses was the phase that they began their dispatch.
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Affiliation(s)
- Yoshie Yokoyama
- Department of Public Health Nursing, Osaka City University, Osaka, Japan
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Kajita E, Araki P, Luarca M, Hwang B. Monitoring the Impact of Heat Waves with Emergency Service Utilization Data in Los Angeles County. Online J Public Health Inform 2013. [PMCID: PMC3692802] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective Introduction Methods Results Conclusions
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Dunkle SE, Mba-Jonas A, Loharikar A, Fouché B, Peck M, Ayers T, Archer WR, De Rochars VMB, Bender T, Moffett DB, Tappero JW, Dahourou G, Roels T, Quick R. Epidemic cholera in a crowded urban environment, Port-au-Prince, Haiti. Emerg Infect Dis 2011; 17:2143-6. [PMID: 22099120 PMCID: PMC3310575 DOI: 10.3201/eid1711.110772] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [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] [Indexed: 11/19/2022] Open
Abstract
We conducted a case-control study to investigate factors associated with epidemic cholera. Water treatment and handwashing may have been protective, highlighting the need for personal hygiene for cholera prevention in contaminated urban environments. We also found a diverse diet, a possible proxy for improved nutrition, was protective against cholera.
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Affiliation(s)
- Stacie E Dunkle
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Wu J, Liu S, Zhou S, Wang Z, Li K, Zhang Y, Yu J, Cong X, Chi X, Li J, Xu S, Du Y, Ren S, Wang J. Porcine reproductive and respiratory syndrome in hybrid wild boars, china. Emerg Infect Dis 2011; 17. [PMID: 21749773 PMCID: PMC3358207 DOI: 10.3201/eid1706.101518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We conducted a serologic investigation of porcine reproductive and respiratory syndrome virus (PRRSV) in hybrid wild boar herds in China during 2008-2009. PRRSV isolates with novel genetic markers were recovered. Experimental infection of pigs indicated that hybrid wild boars are involved in the epidemiology of PRRSV.
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Affiliation(s)
- Jiaqiang Wu
- Shandong Academy of Agricultural Sciences, Jinan, People's Republic of China
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Abstract
To determine if bovine caliciviruses circulate in France, we studied 456 fecal samples from diarrheic calves. We found a 20% prevalence of genogroup III noroviruses and a predominance of genotype III.2. Neboviruses, with a prevalence of 7%, were all related to the reference strain Bo/Nebraska/80/US, except for the strain Bo/DijonA216/06/FR, which could represent a novel genotype.
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Mitjà O, Hays R, Ipai A, Gubaila D, Lelngei F, Kirara M, Paru R, Bassat Q. Outcome predictors in treatment of yaws. Emerg Infect Dis 2011; 17. [PMID: 21749808 PMCID: PMC3363320 DOI: 10.3201/eid1706.101575] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To estimate failure rates after treatment with benzathine penicillin and to identify determinants of failure that affected outcomes for yaws, we conducted a cohort study of 138 patients; treatment failed in 24 (17.4%). Having low initial titers on Venereal Disease Research Laboratory test and living in a village where yaws baseline incidence was high were associated with increased likelihood of treatment failure.
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Affiliation(s)
- Oriol Mitjà
- Lihir Medical Centre, Lihir Island, Papua New Guinea.
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Abstract
Detecting spirochetes remains challenging in cases of African tick-borne relapsing fever. Using real-time PCR specific for the 16S rRNA Borrelia gene, we found 27 (13%) of 206 samples from febrile patients in rural Senegal to be positive, whereas thick blood smear examinations conducted at dispensaries identified only 4 (2%) as positive.
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Hasegawa M, Okada T, Sakata H, Nakayama E, Fuchigami T, Inamo Y, Mugishima H, Tajima T, Iwata S, Morozumi M, Ubukata K, Watanabe H, Takahashi T. Pandemic (H1N1) 2009-associated pneumonia in children, Japan. Emerg Infect Dis 2011; 17:279-82. [PMID: 21291606 PMCID: PMC3204745 DOI: 10.3201/eid1702.091904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 11/25/2022] Open
Abstract
To describe clinical aspects of pandemic (H1N1) 2009 virus-associated pneumonia in children, we studied 80 such children, including 17 (21%) with complications, who were admitted to 5 hospitals in Japan during August-November 2009 after a mean of 2.9 symptomatic days. All enrolled patients recovered (median hospitalization 6 days). Timely access to hospitals may have contributed to favorable outcomes.
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29
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Baliraine FN, Bwogi J, Bukenya H, Seguya R, Kabaliisa T, Kisakye A, Mbabazi WB, Smit SB. Possible interruption of measles virus transmission, Uganda, 2006-2009. Emerg Infect Dis 2011; 17:110-3. [PMID: 21192868 PMCID: PMC3204633 DOI: 10.3201/eid1701.100753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 11/19/2022] Open
Abstract
To determine what measles virus genotype(s) circulated in Uganda after strategic interventions aimed at controlling/eliminating measles, we examined samples obtained during 2006-2009 and found only genotype B3.1, which had not been previously detected. Kenya was the likely source, but other countries cannot be excluded.
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Affiliation(s)
- Frederick N Baliraine
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California 94143-0811, USA.
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30
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Sjölund-Karlsson M, Howie R, Krueger A, Rickert R, Pecic G, Lupoli K, Folster JP, Whichard JM. CTX-M-producing non-Typhi Salmonella spp. isolated from humans, United States. Emerg Infect Dis 2011; 17:97-9. [PMID: 21192864 PMCID: PMC3204627 DOI: 10.3201/eid1701.100511] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
CTX-M-type beta-lactamases are increasing among US Enterobacteriaceae isolates. Of 2,165 non-Typhi Salmonella isolates submitted in 2007 to the National Antimicrobial Resistance Monitoring System, 100 (4.6%) displayed elevated MICs (≥2 mg/L) of ceftriaxone or ceftiofur. Three isolates (serotypes Typhimurium, Concord, and I 4,5,12:i:-) contained bla(CTX-M-5), bla(CTX-M-15), and bla(CTX-M-55/57), respectively.
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Affiliation(s)
- Maria Sjölund-Karlsson
- National Antimicrobial Resistance Surveillance Team, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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31
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Abstract
Sequence analyses show that the outbreak of pandemic (H1N1) 2009 resulted from the spread of a recently derived hemagglutinin through a population of ancient and more diverse neuraminidase segments. This pattern implies reassortment and suggests that the novel form of hemagglutinin conferred a selective advantage.
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Affiliation(s)
- Priyasma Bhoumik
- University of South Carolina, Columbia, South Carolina 29208, USA
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32
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Liu H, Li MH, Zhai YG, Meng WS, Sun XH, Cao YX, Fu SH, Wang HY, Xu LH, Tang Q, Liang GD. Banna virus, China, 1987-2007. Emerg Infect Dis 2010; 16:514-7. [PMID: 20202434 PMCID: PMC3322026 DOI: 10.3201/eid1603.091160] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Banna viruses (BAVs) have been isolated from pigs, cattle, ticks, mosquitoes, and human encephalitis patients. We isolated and analyzed 20 BAVs newly isolated in China; this finding extends the distribution of BAVs from tropical zone to north temperate climates and demonstrate regional variations in BAV phylogeny and mosquito species possibly involved in BAV transmission.
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Affiliation(s)
- Hong Liu
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
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33
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Dapat C, Suzuki Y, Saito R, Kyaw Y, Myint YY, Lin N, Oo HN, Oo KY, Win N, Naito M, Hasegawa G, Dapat IC, Zaraket H, Baranovich T, Nishikawa M, Saito T, Suzuki H. Rare influenza A (H3N2) variants with reduced sensitivity to antiviral drugs. Emerg Infect Dis 2010; 16:493-6. [PMID: 20202427 PMCID: PMC3322031 DOI: 10.3201/eid1603.091321] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [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] [Indexed: 01/20/2023] Open
Abstract
In 2007 and 2008 in Myanmar, we detected influenza viruses A (H3N2) that exhibited reduced sensitivity to both zanamivir and amantadine. These rare and naturally occurring viruses harbored a novel Q136K mutation in neuraminidase and S31N mutation in M2.
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Affiliation(s)
- Clyde Dapat
- Department of Public Health, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
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34
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Szelei J, Liu K, Li Y, Fernandes S, Tijssen P. Parvovirus 4-like virus in blood products. Emerg Infect Dis 2010. [PMID: 20202447 PMCID: PMC3322013 DOI: 10.3210/eid1603.090746] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Porcine plasma and factor VIII preparations were screened for parvovirus 4 (PARV)-like viruses. Although the prevalence of PARV4-like viruses in plasma samples was relatively low, viruses appeared to be concentrated during manufacture of factor VIII. PARV4-like viruses from human and porcine origins coevolved likewise with their hosts.
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Affiliation(s)
- Jozsef Szelei
- Institut National de la Recherche Scientifique-Institut Armand-Frappier, Laval, Quebec, Canada
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35
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Ilyushina NA, Kim JK, Negovetich NJ, Choi YK, Lang V, Bovin NV, Forrest HL, Song MS, Pascua PNQ, Kim CJ, Webster RG, Webby RJ. Extensive mammalian ancestry of pandemic (H1N1) 2009 virus. Emerg Infect Dis 2010; 16:314-7. [PMID: 20113569 PMCID: PMC2958019 DOI: 10.3201/eid1602.091141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We demonstrate that the novel pandemic influenza (H1N1) viruses have human virus-like receptor specificity and can no longer replicate in aquatic waterfowl, their historic natural reservoir. The biological properties of these viruses are consistent with those of their phylogenetic progenitors, indicating longstanding adaptation to mammals.
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Affiliation(s)
- Natalia A Ilyushina
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA
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36
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Reed C, Angulo FJ, Swerdlow DL, Lipsitch M, Meltzer MI, Jernigan D, Finelli L. Estimates of the prevalence of pandemic (H1N1) 2009, United States, April-July 2009. Emerg Infect Dis 2009; 15:2004-7. [PMID: 19961687 PMCID: PMC3375879 DOI: 10.3201/eid1512.091413] [Citation(s) in RCA: 239] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Through July 2009, a total of 43,677 laboratory-confirmed cases of influenza A pandemic (H1N1) 2009 were reported in the United States, which is likely a substantial underestimate of the true number. Correcting for under-ascertainment using a multiplier model, we estimate that 1.8 million-5.7 million cases occurred, including 9,000-21,000 hospitalizations.
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Affiliation(s)
- Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A32, Atlanta, GA 30033, USA.
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37
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Abstract
We conducted a molecular analysis of Francisella tularensis strains isolated in Switzerland and identified a specific subpopulation belonging to a cluster of F. tularensis subsp. holarctica that is widely dispersed in central and western continental Europe. This subpopulation was present before the tularemia epidemics on the Iberian Peninsula.
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38
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Abstract
Recently discovered respiratory viruses were detected in 19 (9.2%) of 205 nasal swab specimens from children in Brazil with respiratory illnesses. Five each were positive for human metapneumovirus (HMPV) alone and human bocavirus (HBoV) alone, 3 for human coronaviruses (HCoV-HKU1 or -NL63) alone, and 6 for more than 1 recently discovered virus.
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39
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Abstract
Of 40 ready-to-eat salads, 3 (7.5%) were positive for Clostridium difficile by PCR. Two isolates were PCR ribotype 017 (toxin A-, B+), and 1 was PCR ribotype 001. Isolates were susceptible to vancomycin and metronidazole but variably resistant to other antimicrobial drugs. Ready-to-eat salads may be potential sources for virulent C. difficile.
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40
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Ninove L, Domart Y, Vervel C, Voinot C, Salez N, Raoult D, Meyer H, Capek I, Zandotti C, Charrel RN. Cowpox virus transmission from pet rats to humans, France. Emerg Infect Dis 2009; 15:781-4. [PMID: 19402968 PMCID: PMC2686997 DOI: 10.3201/eid1505.090235] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [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] [Indexed: 11/19/2022] Open
Abstract
In early 2009, four human cases of cowpox virus cutaneous infection in northern France, resulting from direct contact with infected pet rats (Rattus norvegicus), were studied. Pet rats, originating from the same pet store, were shown to be infected by a unique virus strain. Infection was then transmitted to humans who purchased or had contact with pet rats.
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41
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Abstract
We show high rates of extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage among the staff and children at an orphanage in Bamako, Mali. Enterobacteriaceae colonized in 100% and 63%, respectively, of the 38 children and 30 adults studied. Use of antimicrobial drugs appeared excessive and inappropriate; decontamination and hygiene protocols were also questioned.
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42
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Abstract
Brucellosis causes appreciable economic losses in livestock. Examination of milk and tissues from animals in Egypt for Brucella spp. showed increased prevalence rates of serologically reactive animals. All isolates were B. melitensis biovar 3. One Brucella sp. was isolated from milk of serologically nonreactive buffaloes.
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43
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Abstract
Adjustable rate mortgages and the downturn in the California housing market caused a 300% increase in notices of delinquency in Bakersfield, Kern County. This led to large numbers of neglected swimming pools, which were associated with a 276% increase in the number of human West Nile virus cases during the summer of 2007.
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Affiliation(s)
- William K Reisen
- Center for Vectorborne Diseases, Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Old Davis Rd, Davis, CA 95616, USA.
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44
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Kibadi K, Panda M, Tamfum JJM, Fraga AG, Longatto Filho A, Anyo G, Pedrosa J, Nakazawa Y, Suykerbuyk P, Meyers WM, Portaels F. New foci of Buruli ulcer, Angola and Democratic Republic of Congo. Emerg Infect Dis 2008; 14:1790-2. [PMID: 18976574 PMCID: PMC2630729 DOI: 10.3201/eid1411.071649] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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] [Indexed: 11/19/2022] Open
Abstract
We report 3 patients with laboratory-confirmed Buruli ulcer in Kafufu/Luremo, Angola, and Kasongo-Lunda, Democratic Republic of Congo. These villages are near the Kwango/Cuango River, which flows through both countries. Further investigation of artisanal alluvial mining as a risk factor for Buruli ulcer is recommended.
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Affiliation(s)
- Kapay Kibadi
- Institute of Tropical Medicine, Antwerp, Belgium
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45
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Abstract
We estimated the association between amount charged and probability that dog owners in N'Djaména, Chad, would have their dogs vaccinated against rabies. Owners would pay approximately 400-700 CFA francs (US $0.78-$1.36)/animal. To vaccinate >or=70% of dogs, and thus interrupt rabies transmission, health officials should substantially subsidize these vaccinations.
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Affiliation(s)
- Salome Dürr
- Swiss Tropical Institute, Basel, Switzerland
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46
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Gautret P, Soula G, Adamou H, Soavi MJ, Delmont J, Rotivel Y, Parola P, Brouqui P. Rabies postexposure prophylaxis, Marseille, France, 1994-2005. Emerg Infect Dis 2008; 14:1452-4. [PMID: 18760018 PMCID: PMC2603096 DOI: 10.3201/eid1409.071322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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] [Indexed: 12/03/2022] Open
Abstract
The administration of human rabies postexposure prophylaxis near Marseille (southern France) has changed since the eradication of terrestrial mammal rabies in 2001. Most injuries were associated with indigenous dogs; rabies vaccine was overprescribed. We suggest that the World Health Organization guidelines be adapted for countries free of terrestrial mammal rabies.
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Affiliation(s)
- Philippe Gautret
- Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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47
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Abstract
We evaluated a personal protective equipment removal protocol designed to minimize wearer contamination with pathogens. Following this protocol often resulted in virus transfer to hands and clothing. An altered protocol or other measures are needed to prevent healthcare worker contamination.
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Affiliation(s)
- Lisa Casanova
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - William A. Rutala
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - David J. Weber
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mark Sobsey
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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48
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Abstract
Four calves were experimentally inoculated with highly pathogenic avian influenza virus A/cat/Germany/R606/2006 (H5N1) isolated from a cat in 2006. All calves remained healthy, but several animals shed low amounts of virus, detected by inoculation of nasal swab fluid into embryonated chicken eggs and onto MDCK cells. All calves seroconverted.
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Affiliation(s)
- Donata Kalthoff
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Bernd Hoffmann
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Timm Harder
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Markus Durban
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Martin Beer
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
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49
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Abstract
Retrospective testing of 3,232 serum samples from the general population and 518 serum samples from a high-risk group showed no evidence of human exposure to Neospora caninum in England. Results were obtained by using immunofluorescence antibody testing and ELISA to analyze frequency distribution.
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Affiliation(s)
| | | | - Roland L Salmon
- National Public Health Service for Wales, Cardiff, Wales, UK
| | - Daniel Thomas
- National Public Health Service for Wales, Cardiff, Wales, UK
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50
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Abstract
We estimated the total number of human alveolar echinococcosis cases in Germany from 2003 through 2005 using the multiple source capture-recapture method. We found a 3-fold higher incidence of the disease than that shown by national surveillance data. We propose a revision of the reporting system to increase case ascertainment.
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