The epidemiology of out-of-hospital cardiac arrest in Australia and New Zealand: A binational report from the Australasian Resuscitation Outcomes Consortium (Aus-ROC).

INTRODUCTION: The Australasian Resuscitation Outcomes Consortium (Aus-ROC) out-of-hospital cardiac arrest (OHCA) Epistry (Epidemiological Registry) now covers 100% of Australia and New Zealand (NZ). This study reports and compares the Utstein demographics, arrest characteristics and outcomes of OHCA patients across our region. METHODS: We included all OHCA cases throughout 2019 as submitted to the Epistry by the eight Australian and two NZ emergency medical services (EMS). We calculated crude and age-standardised incidence rates and performed a national and EMS regional comparison. RESULTS: We obtained data for 31,778 OHCA cases for 2019: 26,637 in Australia and 5,141 in NZ. Crude incidence was 107.9 per 100,000 person-years in Australia and 103.2/100,000 in NZ. Overall, the majority of OHCAs occurred in adults (96%), males (66%), private residences (76%), were unwitnessed (63%), of presumed medical aetiology (83%), and had an initial monitored rhythm of asystole (64%). In non-EMS-witnessed cases, 38% received bystander CPR and 2% received public defibrillation. Wide variation was seen between EMS regions for all OHCA demographics, arrest characteristics and outcomes. In patients who received an EMS-attempted resuscitation (13,664/31,778): 28% (range across EMS = 13.1% to 36.7%) had return of spontaneous circulation (ROSC) at hospital arrival and 13% (range across EMS = 9.9% to 20.7%) survived to hospital discharge/30-days. Survival in the Utstein comparator group (bystander-witnessed in shockable rhythm) varied across the EMS regions between 27.4% to 42.0%. CONCLUSION: OHCA across Australia and NZ has varied incidence, characteristics and survival. Understanding the variation in survival and modifiable predictors is key to informing strategies to improve outcomes.

Public Perceptions of Legislative Action to Reduce Plastic Pollution: A Case Study of Atlantic Canada

Government-led legislation is a key strategy to reduce plastic pollution;however, societal perception can heavily influence government intervention for environmental issues. To understand the public acceptability of government action to reduce plastic pollution, we examine the perception of existing and upcoming legislative action on single-use plastics (SUPs) by means of a structured survey with additional semi-structured interviews. Our focus is on the four Atlantic provinces of Canada, which was the first region in Canada to implement provincial-wide legislation for plastic reduction at the consumer level in 2019. Results show strong public support (77%, n = 838) for bans of SUP bags at the consumer level, and for further plastic pollution reduction legislation. However, the level of support differed between regions and by demographics. Semi-structured interviews show that decision makers should increase efforts in raising consumer awareness and standardizing regulations across jurisdictions for smoother transitions prior to legislative action.

Opportunities for single-use plastic reduction in the food service sector during COVID-19.

The COVID-19 pandemic caused a surge in consumption of single-use plastics (SUPs), particularly in the food service sector, due to concerns for public health and safety. To follow public health guidelines, food services have been limited to takeout service and have restricted use of personal reusable items. This study investigated opportunities to reduce increased use of SUPs in Nova Scotia food services sparked by the COVID-19 pandemic using semi-structured interviews and focus groups with stakeholders from the food service sector. Many participants had already implemented SUP reduction strategies prior to COVID-19. However, the COVID-19 pandemic forced businesses to rely on SUPs and to pause SUP reduction strategies. Obstacles to SUP reduction included operational challenges from COVID-19 restrictions, misunderstanding of local waste management systems, costs of transitioning to zero plastic waste, poorly manufactured alternatives, greenwashing, and ingrained societal convenience culture. Whilst not all SUP consumption patterns were attributed to COVID-19, these barriers prevented food retailers, waste managers and consumers from achieving zero-plastic waste goals. Food services should adopt SUP reduction strategies, including re-introducing reusables, implementing exchange programs for bulk items and takeout, providing education and awareness to staff and consumers, and sourcing sustainable SUP alternatives. SUP reduction strategies can be implemented immediately as public health officials and researchers agree reusable items can be used safely when using basic hygiene measures. Food services across Nova Scotia should adapt their operational procedures and create behaviour change to reduce SUPs.

Implementation study of SARS-CoV-2 antigen lateral flow tests in men's professional (Premiership) rugby union sports squads in England during the COVID-19 pandemic.

This study evaluated the validity and utility of antigen-detection rapid diagnostic tests (Ag-RDTs) for SARS-CoV-2 in elite sports. The data on utility, ease of use and application for Ag-RDTs as a new testing format were positive from players and staff. This evaluation was limited by the low prevalence of SARS-CoV-2 circulating within the three squads. This study highlights the need for continued service evaluations for SARS-CoV-2 Ag-RDTs in elite sport settings.

Citizen science: A way forward in tackling the plastic pollution crisis during and beyond the COVID-19 pandemic.

The COVID-19 pandemic has resulted in an unprecedented surge of production, consumption, and disposal of single-use plastics (SUPs) and personal protective equipment (PPE) by the public. This widespread use of mostly plastic items like face masks and disposable gloves has led to global reports of improper disposal of potentially infectious PPE both in our urban and natural environments. Due to international travel restrictions during the pandemic, many research programs targeted at measuring plastic pollution were halted. These disruptions to research programs have stunted the ability to assess the true quantities of SUPs and PPE being mismanaged from the waste stream into the environment. This article calls for increased citizen science participation in collecting plastic pollution data both during and post pandemic. By initiating this dialogue and raising attention to the importance and potential of citizen science data collection, data can be used to develop globally informed plastic pollution mitigation strategies.

The Impact of the COVID-19 Pandemic on Demand for Emergency Ambulances in Victoria, Australia.

Objective: Relatively little has been reported about the impact of COVID-19 restrictions on emergency ambulance services. We describe the influence of the COVID-19 pandemic on the emergency ambulance system in Victoria, Australia.Methods: We performed an interrupted time series analysis of consecutive calls for ambulance from January 2018 to February 2021, including two waves of COVID-19. The COVID-19 lockdown period included seven months of stay-at-home restrictions (16/03/2020-18/10/2020). Nineteen weeks of post-lockdown data were included (19/10/2020-28/02/2021).Results: In total, 2,356,326 consecutive calls were included. COVID-19 lockdown was associated with an absolute reduction of 64,991 calls (almost 2,100 calls/week). According to time series analysis, lockdown was associated with a 12.6% reduction in weekly calls (IRR = 0.874 [95% CI 0.811, 0.941]), however no change in long-term trend (IRR = 1.000 [95% CI 0.996, 1.003]). During lockdown, the long-term trend of attendances to patients with suspected acute coronary syndromes (ACS, IRR = 1.006 [95% CI 1.004, 1.009]) and mental health-related issues (IRR = 1.005 [95% CI 1.002, 1.008]) increased. After lockdown, the call volume was 5.6% below pre-COVID-19 predictions (IRR = 0.944 [95% CI 0.909, 0.980]), however attendances for suspected ACS were higher than predicted (IRR = 1.069 [95% CI 1.009, 1.132]). Ambulance response times deteriorated, and total case times were longer than prior to the pandemic, driven predominantly by extended hospital transfer times.Conclusion: The COVID-19 pandemic had a dramatic impact on the emergency ambulance system. Despite lower call volumes post-lockdown than predicted, we observed deteriorating ambulance response times, extended case times and hospital delays. The pattern of attendance to patients with suspected ACS potentially highlights the collateral burden of delaying treatment for urgent conditions.

Food packaging during the COVID-19 pandemic: Consumer perceptions.

While plastics play an important role in the safety, shelf-life, and affordability of many foods, their mismanagement as waste presents a serious environmental problem. In 2019, governments in Canada and globally were poised to take legislative action to curb the use of single-use plastics, with strong public support. However, the COVID-19 pandemic has since disrupted those initiatives as well as the public sentiment underlying them. The aim of our study is to measure changes in Canadian consumers' attitudes toward single-use plastic food packaging, from Summer 2019 to Summer 2020. The methodology relies on two, representative surveys of the Canadian population, carried out in May 2019 (n = 1,094) and in June 2020 (n = 977). Our measures explored potential impacts on consumer perceptions, driven both by new food safety concerns during the pandemic and also by increased price consciousness during a time of economic recession. We found that 55% of respondents were more concerned about food safety since COVID-19, and that 50% of respondents had become more price conscious when buying groceries. However, we found only a slight decline in motivation to reduce plastics - though with a sharper reduction among males. A stronger shift was seen in attitudes towards policy, where our results show a clear decline in support for tighter regulations or bans on single-use plastics, along with an increase in consumers' willingness to pay for biodegradable alternatives. These findings suggest a more difficult road ahead for legislative approaches, but also potential opportunities for market-based strategies and innovations in the food sector.

Emergency clinicians' knowledge, preparedness and experiences of managing COVID-19 during the 2020 global pandemic in Australian healthcare settings.

BACKGROUND: Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19. METHODS: A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020). RESULTS: Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3-78% from each group indicated that their current knowledge of COVID-19 was 'good to very good'. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6-86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload 'had lessened' while 36.4-40% of emergency nurses and physicians stated that their workload had 'considerably increased'. Common concerns raised included disease transmission to family, public complacency, and PPE availability. CONCLUSIONS: Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE.

Increased plastic pollution due to COVID-19 pandemic: Challenges and recommendations.

Plastics have become a severe transboundary threat to natural ecosystems and human health, with studies predicting a twofold increase in the number of plastic debris (including micro and nano-sized plastics) by 2030. However, such predictions will likely be aggravated by the excessive use and consumption of single-use plastics (including personal protective equipment such as masks and gloves) due to COVID-19 pandemic. This review aimed to provide a comprehensive overview on the effects of COVID-19 on macroplastic pollution and its potential implications on the environment and human health considering short- and long-term scenarios; addressing the main challenges and discussing potential strategies to overcome them. It emphasises that future measures, involved in an emergent health crisis or not, should reflect a balance between public health and environmental safety as they are both undoubtedly connected. Although the use and consumption of plastics significantly improved our quality of life, it is crucial to shift towards sustainable alternatives, such as bio-based plastics. Plastics should remain in the top of the political agenda in Europe and across the world, not only to minimise plastic leakage and pollution, but to promote sustainable growth and to stimulate both green and blue- economies. Discussions on this topic, particularly considering the excessive use of plastic, should start soon with the involvement of the scientific community, plastic producers and politicians in order to be prepared for the near future.

Rethinking and optimising plastic waste management under COVID-19 pandemic: Policy solutions based on redesign and reduction of single-use plastics and personal protective equipment.

Plastics have been on top of the political agenda in Europe and across the world to reduce plastic leakage and pollution. However, the COVID-19 pandemic has severely disrupted plastic reduction policies at the regional and national levels and induced significant changes in plastic waste management with potential for negative impacts in the environment and human health. This paper provides an overview of plastic policies and discusses the readjustments of these policies during the COVID-19 pandemic along with their potential environmental implications. The sudden increase in plastic waste and composition due to the COVID-19 pandemic underlines the crucial need to reinforce plastic reduction policies (and to implement them into action without delays), to scale up in innovation for sustainable and green plastics solutions, and to develop dynamic and responsive waste management systems immediately. Policy recommendations and future research directions are discussed.

COVID-19 Pandemic Repercussions on the Use and Management of Plastics.

Plastics are essential in society as a widely available and inexpensive material. Mismanagement of personal protective equipment (PPE) during the COVID-19 pandemic, with a monthly estimated use of 129 billion face masks and 65 billion gloves globally, is resulting in widespread environmental contamination. This poses a risk to public health as waste is a vector for SARS-CoV-2 virus, which survives up to 3 days on plastics, and there are also broad impacts to ecosystems and organisms. Concerns over the role of reusable plastics as vectors for SARS-CoV-2 virus contributed to the reversal of bans on single-use plastics, highly supported by the plastic industry. While not underestimating the importance of plastics in the prevention of COVID-19 transmission, it is imperative not to undermine recent progress made in the sustainable use of plastics. There is a need to assess alternatives that allow reductions of PPE and reinforce awareness on the proper public use and disposal. Finally, assessment of contamination and impacts of plastics driven by the pandemic will be required once the outbreak ends.