Is Use Of An Interactive Voice Server In An Emergency Medical Dispatch Center An Efficient And Safe Measure?

Introduction: In the first wave of COVID-19 pandemic, Emergency Medical Dispatch Centers (EMDC) faced an influx of calls. During this time, with the scope of handling emergency calls more quickly, it was decided to use an Interactive Voice Server (IVS). The objective of this study was to identify whether the implementation of an IVS is efficient and safe. Method(s): From 20/03/19 until 20/04/26, an IVS was activated between 8 AM and midnight. IVS offered the caller to choose either 1-press the 'zero' key for Coronavirus Syndrome with no respiratory difficulties;or 2-stay on line for any other reason. If the caller typed 'zero', the call was directed to a 'crisis dispatcher' specially trained to handle COVID cases. If he stayed on line, his call was placed in the same queueing list as all emergency calls and handled by a "conventional dispatcher". All medical dispatch files picked up during IVS activation period were included and classified in 2 groups: "IVS Yes" if caller pressed 'zero' and "IVS No" if not. Patient's age, gender and profile of the caller (patient or third party) were collected. The level of severity of the patients was assessed upon the dispatcher' decision ranging from sending an Advanced Life Support ambulance (ALS), a Basic Life Support ambulance (BLS) or no transport. Data were compared between the 2 groups with Chi-square tests. Result(s): 2846 callers were in the group "IVS Yes" and 12111 in "IVS No". Main results are in table 1. Conclusion(s): IVS allowed almost 15% of calls to be directed to a specialized provider where they waited to be processed by staff trained within a few days to deal exclusively with COVID cases. This has led to decrease the number of calls handled by the conventional dispatch and allowed more time to respond to severe emergency calls. Moreover, because only 0.07% "IVS Yes" needed an ALS ambulance, we can assume that the use of IVS is safe. IVS is therefore an effective tool, which allows safe triage of less serious patients and frees up time to answer to severe calls.

Impact of the COVID-19 Pandemic on Acute Care Visits for Patients with Sickle Cell Disease

Introduction: The COVID-19 pandemic significantly impacted emergency department (ED) and overall hospital utilization, with a substantial decline in non-COVID-19-related medical presentations. In the weeks following the declaration of a national health emergency, ED visits declined by 42%. Patients with sickle cell disease (SCD) are at risk for needing ED-based care and hospitalization due to disease-specific complications. We examined the impact of the COVID-19 pandemic on acute care utilization by patients with SCD at our institution. Methods: We performed a retrospective cohort study at our institution comparing the period of the first “stay at home” order in Baltimore, MD (3/30/2020-6/8/2020) to the same date range in 2019. We included all adult patients with SCD who either presented to the ED or were directly admitted to the hospital. All SCD genotypes were included (HbSS, HbSC, HbSβ +/0 thalassemia). Data collected included presenting symptoms, disposition for ED visits, admission length of stay (LOS), re-admission within 7 days, as well as frequency of sickle cell-specific complications during hospitalization. We collected data regarding the acuity of patients' initial presentation using the emergency severity index (ESI), a five-tiered grading tool utilized by triage nurses to indicate the acuity and resource-intensiveness of a patient's presenting symptoms (1= highest urgency, 5= least urgency). We performed statistical analyses using Pearson's chi square test, Fisher's exact test and the Mann-Whitney U test. Results: During the initial stay at home order in 2020, 77 patients presented to acute care services at our institution, compared to 163 patients during the same dates in 2019, a decrease of > 50%. Statistically significant demographic differences between 2020 and 2019 included gender (53% vs 34% male gender, p = 0.004) and hemoglobinopathy type (2020: SS (66%), SC (27%), Sβ-thal (6.5%) vs 2019: SS (48%), SC (42%), Sβ-thal (10%), p = 0.03), whereas there was no difference in severity on presentation measured by ESI (median score of 3: 88% vs 90%, p = 0.13) or age (30 vs 30 years old, p = 0.925). More patients in 2020 presented with dyspnea (22% vs 11%, p = 0.02), and/or nausea or vomiting (22% vs 11%, p = 0.02), but more patients in 2019 presented with cough (7% vs 17%, p = 0.025). None of the patients tested positive for SARS-CoV-2. There was no statistically significant difference between the study periods in hospitalization rate (44% vs 37%, p = 0.32), LOS (60 vs 64 hrs, p = 0.73), admission to the ICU (3% vs 2.5%, p = 1.0) or step-down unit (0% vs 1%, p = 1.0), or death (0% vs 1%, p = 1.0). There was a difference in ED re-presentation within 7 days of the index visit (14% vs 47%, p < 0.001), but no difference in rate of readmission within 7 days (9% vs 15%, p = 0.225). Discussion: Although fewer patients with SCD presented for acute care in 2020, there was no significant difference in objective metrics, including admission rates, LOS, readmissions, and disease-specific complications. The decrease in ED return visits in 2020 may reflect patients' concerns regarding exposure to SARS-CoV-2 while in the ED. Our data demonstrate that although fewer patients with SCD presented for acute care utilization, they did not appear to be sicker. The data support more frequent management of uncomplicated pain crises outside of the ED, through optimization of outpatient services including infusion centers and telehealth. The advent of new care delivery models as a result of the Covid-19 pandemic may have a positive impact on frequency of ED utilization for patients with SCD. Disclosures: No relevant conflicts of interest to declare.

Urban gamification during lockdown and social isolation -from the teddy bear challenge to window expeditions

The first wave of the COVID-19 pandemic that affected many cities around the world during the spring and summer 2020 was often met with regulations requiring people to lockdown, to quarantine or to respect social distancing. Urban spaces often became off-limits and depopulated, filled with borders isolating people confined at home. Nevertheless, in these trying times new forms of urban gamification surfaced, allowing citizens to engage their surroundings playfully, to connect with others and to escape these dire situations. In this paper, we propose an overview of the many playful activities that emerged in the cities hit by the pandemic, organised according to the urban borders they engage (windows, balconies, rooftops). We then focus on how several borders can be engaged by the same play practice, through a gamified application called Window Expeditions, which aims at participatory data generation, while addressing some of the issues related to isolation and reduced mobility of its users. In the conclusions, we discuss the potential role of urban gamification during the pandemic and, in particular, its ability to comfort, connect, increase curiosity and encourage exploration. Copyright © 2021 for this paper by its authors.