ABSTRACT
Background: Coronavirus disease 2019 (COVID-19] has become a global pandemic. Preventive policy during this outbreak possibly leads to a negative influence on the highly time-sensitive diseases such as acute ischemic stroke (AIS]. Objective(s): The present study was to determine the impact of the pandemic on rate of recombinant tissue plasminogen activator (rtPA] administration for AIS in Thailand. Material(s) and Method(s): A cross-sectional descriptive study. The magnitude of COVID-19 pandemic in each province of Thailand was reviewed from the website of the Ministry of Public Health. The number of patients with AIS who received rtPA was taken from the National Health Security Office, from 1st October 2019 to 21st August 2021. The authors demonstrate the correlation between the pandemic severity and the rate of rtPA administration for patients with AIS. Result(s): During the COVID-19 pandemic, there were 37 provinces (48%] in year 2020 and SO provinces (64.9%] in year 2021 had a reduction in rate of rtPA administration, 40 provinces (51.9%] in year 2020 and 27 provinces (35%] in year 2021 had increase in rate of rtPA administration. Over a period of two years, 25 provinces (32.5%] had only decreased rate (mean=1.12% and 1.63% in year 2020 and 2021 respectively], 15 provinces (19.5%) had only increased rate (mean=1.71% and 1.17% in year 2020 and 2021 respectively], and 37 provinces (48%] had diverse in rate of rtPA administration among both years. Conclusion(s): The present study demonstrated that the COVID-19 pandemic does not cause a significant impact on the rate of rtPA administration for AIS in Thailand.Copyright © 2023 Journal of the Medical Association of Thailand.
ABSTRACT
Background: Stroke is the leading cause of death and disability worldwide. In COVID-19 pandemic, stroke remains to be a medical emergency. To treat patients with acute ischemic stroke [AIS], early intravenous thrombolysis is highly time sensitive. This research investigated the impact of regionally imposed social and healthcare restrictions of COVID-19 on the time metrics in the management of AIS patients admitted at the stroke unit center in Srinagarind Hospital. Objective(s): Comparison of door to needle time for intravenous thrombolysis for AIS patients before and after the COVID-19 outbreak. Material(s) and Method(s): The present study is a retrospective analysis of patients with AIS who received intravenous tissue plasminogen activator [tPA] from 1 January 2019 to 31 December 2020 in Srinagarind Hospital, Khon Kaen. The patients admitted before and after the COVID-19 outbreak [January 13, 2020, as officially announced by the World Health Organization] were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and to compared door-to-needle time (DNT) for intravenous thrombolysis before and after the outbreak. Result(s): A total of 239 patients were included, of which 113 were enrolled before and 126 after the COVID-19 outbreak. According to the findings, DNT is 35.3 minutes before the pandemic and 35.8 minutes after the epidemic. Conclusion(s): COVID-19 has remarkable impacts on the management of AIS. However, DNT for before and after COVID-19 outbreak is nearly identical. It was established that administering intravenous thrombolysis to patients in the emergency room rather than the stroke unit allowed for speedier access. Therefore, a policy which provides quick AIS treatments in COVID-19 situations should be implemented.Copyright © 2023 Journal of the Medical Association of Thailand.
ABSTRACT
BACKGROUND: Mechanical chest compression devices play an important role in assisting patients undergoing cardiac arrest. However, this equipment induces an aerosol-generating procedure that could contaminate hospital staff. The development of a remote control system for mechanical chest compression devices may solve the problem;however, there are currently no studies regarding the efficacy of this system. AIM: This study aims to analyze efficacy of remote control systems for mechanical chest compression devices and compare it with non-remote control systems. METHODS: This was an analytical cross-sectional study at Srinagarind Hospital, Thailand. Data were collected in two periods of the study. The first period was between January and December 2021 using a non-remote control system to operate the mechanical chest compression device. The second period was from January to April 2022 and collected data on the use of a remote control system. RESULTS: Sixty-four participants were examined over the 16-month period of the study. A total of 53.1% (n = 34) of participants were male and the mean age of the patients was 52.4 ± 5.1 years old. The number of emergency medical service members (EMS) needed for resuscitation in the remote control group was less than the non-remote control group (3 vs. 5;p = 0.040). The number of emergency department (ED) members needed for resuscitation in the remote control group was four compared with eight in the non-remote control group. CONCLUSIONS: The remote controlled mechanical chest compression device can effectively reduce the number of staff working both in the EMS and in the ED of the hospital, thus reducing exposure and contamination from aerosol-generating procedure. It was also proven accurate in terms of rate and depth of chest compression according to resuscitation guidelines.
ABSTRACT
Background: The administration of an accurate and effective point-of-care ultrasound (POCUS) course is a crucial tool in improving health education and thus the healthcare system in low-to middle-income countries. The development of the ultrasound curriculum in these countries during the pandemic era is a major challenge for medical educators. Objective: This study aims to survey the learner experience after implementing the POCUS curriculum for first-year emergency medicine residents. Method: A cross-sectional 10-question survey study was conducted at Srinagarind Hospital, Department of Emergency Medicine, Thailand, from July 2019 to July 2021 to determine the experience of POCUS learning by using the 5-point Likert-type scale after first-year emergency residents finishing the ultrasound rotation. Results: All learners responded to the survey. Our results demonstrated that the ultrasound rotation and our ultrasound learning materials were useful tools that showed a positive impact on POCUS knowledge for our learners. However, some obstacles of POCUS learning were identified to assist in closing faculty development gaps: the availability of handheld devices as well as the remodeling of the ultrasound rotation course should be managed according to the feedback we received. This study demonstrated a clear need for constant updates in higher education, medical program development, the accuracy of local learning materials, and the explosion of virtual and online learning platforms during this decade. Conclusion: Our results demonstrated that all academic activities employed and the ultrasound learning materials were useful in improving POCUS knowledge. However, we found some obstacles of POCUS learning that needed to be improved, mainly the length of time of training.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 has caused a major worldwide disruption to nearly all aspects of the medical education process, which includes the teaching of point-of-care ultrasound (POCUS). However, the impacts of the pandemic on POCUS training during this time have not been well studied. AIM: This was a retrospective observational study of the 1st year of emergency medicine (EM) residents at the Department of EM who had received POCUS training at a tertiary university hospital in Thailand. METHODS: The study was conducted throughout the 2019–2020 Academic year. The primary aim of this study was to evaluate the new POCUS training methodology, which, due to health and safety protocols, was carried out through virtual learning. RESULTS: A total of 18 1st-year EM residents were evaluated. The average pre-training scores in the 2019–2020 academic years were 5.25 and 5, respectively. The average post-training scores in the 2019 and 2020 academic years were 8.5 and 8.67, respectively. In terms of the ultrasound (US) skills test, the total average scores in the 2019–2020 academic year were 17 out of 20 (85%) and 14.875 out of 20 (74.38%), respectively (p < 0.001). CONCLUSIONS: Virtual learning is effective for teaching theoretical US knowledge. However, it was not suitable for teaching practical skills, including US skills.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) outbreaks occurring in many countries around the world have had a significant impact on emergency medical services (EMSs) in terms of the number of operations and procedures performed, including those on ambulances. However, the number of EMS amid the rising number of COVID-19 cases in Khon Kaen, Thailand, has not been well studied. AIM: The aim of this study was to identify and analyze the relationship between the use of EMS and the outbreak of COVID-19. METHODS: A cross-sectional study was done in Srinagarind Hospital, Khon Kaen, Thailand, with a single EMS centered. Data were collected between March 27, 2021, and April 9, 2021, and designated as day-7 to day 7 of pandemic services as well as normal services which collected data between March 27, 2019, and April 9, 2019 (day-7 to day 7 of normal services). RESULTS: Three hundred and eight EMS operations were examined. A total of 77.9% (n = 95) of pandemic services were for males and the mean age of the patients was 32.1 ± 5.4 years. During the normal services in 2019, the average number of EMS operations was 13.3 ± 2.4 times/day over the 2 weeks of the study. In 2021, before the outbreak (day-7 to day 1), the average number of EMS operations was 13.2 ± 1.8 times/day. After day 1, there was a drop in the number of EMS operations which was associated with an increase in COVID-19 infections (p < 0.001). CONCLUSIONS: The number of EMS users during the COVID-19 outbreak decreased considerably compared to the pre-epidemic levels and normal service intervals, including the severity of the users, was more severe than normal.
ABSTRACT
BACKGROUND: The development of emergency medical services (EMSs) in Thailand is divided into two phases following the enactment of the Emergency Medical Act in 2007 aimed at making the work model more systematic. However, the amount of EMS operations has not been well studied. AIM: The aim of this study was to describe the pattern of EMS operations throughout a 5-year period. METHODS: A retrospective, single-centered study at a medical school hospital in Thailand. Data were gathered from the EMS database at Srinagarind Hospital throughout the years 2016–2020. RESULTS: A total of 10,384 EMS operations were examined over a 5-year period (2016–2020). The mean age of patients in 2016 was 40.2 ± 3.5 years, and 55.3% (n = 1178) were male. Operations were most commonly performed during the afternoon shift (4.00 p.m.–0.00 a.m.) 41.0%, 38.6%, 39.5%, 39.2%, and 50.8%, respectively. The amount of EMS members had a tendency to increase in number throughout the 5 years of study (p = 0.022). The average times from 1669 center call receipt to arrival on scene (response time) for 2016 and 2020 were 8.52 ± 2.20 min and 5.52 ± 3.02 min, respectively (p < 0.001). CONCLUSION: The development of EMS at Srinagarind Hospital took place with an increase in the age of patients, number of operations in the afternoon shift, and EMS members, yet with a decrease in response times.
ABSTRACT
BACKGROUND: Concerning the COVID-19 outbreak in Thailand, the number of patients has been increasing. Emergency medical services (EMS) operating duration differs from normal services due to equipment preparation, number of personnel, and on-board ambulance procedures. Notably, there have been no studies examining EMS duration regarding COVID-19 patients. AIM: The aim of this study was to compare the EMS time for COVID-19 patients and routine services. METHODS: This cross-sectional study was conducted in a tertiary university hospital in Khon Kaen, Thailand. Information gathering was carried out by employing the Srinagarind Hospital EMS database throughout January 1, 2020, and February 10, 2021. RESULTS: A total of 2420 EMS operations were examined, of which five tested positive for COVID-19 (0.21%). The mean age of the COVID-19 patients was 35.6 ± 7.2 years, with the activation interval for COVID-19 and routine services at 64.20 ± 10.14 and 1.42 ± 0.42 min, respectively (p < 0.001). The on-scene time for COVID-19 and routine services was 3.20 ± 0.44 and 5.20 ± 2.20 min, respectively. CONCLUSIONS: EMS operating time amid the activation interval for COVID-19 patients was significantly longer than in the normal group. However, on-scene time for COVID-19 patients was less time than in normal operations.
ABSTRACT
Due to the COVID-19 outbreak in Thailand, patients were unable to be examined, to receive follow-up treatments, or to receive medication in the normal ways that they previously had. As a result, Srinagarind Hospital of the Faculty of Medicine at Khon Kaen University established a home delivery system for those patients, who needed to be continuously treated. Two types of services were made available: 1) Patients were able to make a request on the Facebook page of 'Drug delivery' or on the Line application: @Dr. Somsak, and 2) the physicians phoned the patients in order to assess symptoms and to provide treatment based on the symptoms and severity of the disease. Regarding neurological patients in Thailand, most patients;such as people with epilepsy (PWE) are most often treated by general practitioners in community hospitals or by internist or pediatricians in provincial hospitals. Only a small percentage of PWE are actually treated by neurologists or pediatric neurologists. The Epilepsy Clinic of Srinagarind Hospital has, therefore, developed a service system for the out-patient department in which the physicians call the patients in order to assess their symptoms and to provide continued treatment to those individuals with PWE so that status epilepticus, which arises from drug deficiency, can be prevented. Consequently, the Integrated Epilepsy Research Group has developed a tele-medicine system for PWE, who are treated in the Epilepsy Clinic. Moreover, the newly developed service system will continue to be used to treat patients with neurological diseases in order to resolve the problem of gaining access to neurological doctors. © 2021 Medical Association of Thailand. All rights reserved.
ABSTRACT
BACKGROUND: Motorcycles (motorlance) are often deployed as ambulances to the scene of an emergency to reduce response time. The COVID-19 pandemic has affected emergency medical services (EMS) in Thailand in many respects, and this study was conducted to examine its effect on motorlance operation time. AIM: The aim of the study was to examine motorlance operation time during the COVID-19 pandemic in comparison to normal periods. METHODS: This cross-sectional study examined all EMS motorlance operations dispatched from Srinagarind Hospital (Thailand). Data were collected from the Srinagarind Hospital EMS operation database and hospital information database system. Data from June 1, 2018, to December 31, 2019 (normal period) were compared with those from January 13 to April 21, 2020 (COVID-19). RESULTS: Eight hundred seventy-one EMS operations were examined over two periods. Mean patient age during the COVID-19 pandemic was 41.5 ± 6.2 years, and 54.6% (n = 59) were male. Average response time was 6.20 ± 1.35 min during the normal period and 3.48 ± 1.01 min during the pandemic (p = 0.021). Transport time was also significantly shorter during the latter period (2.35 vs. 5.20 min). CONCLUSIONS: Motorlance response and transport time during the COVID-19 pandemic were significantly shorter than usual. © 2020 Korakot Apiratwarakul, Kamonwon Ienghong, Vajarabhongsa Bhudhisawasdi, Dhanu Gaysonsiri, Somsak Tiamkao.