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1.
JMIR Public Health Surveill ; 7(6): e24312, 2021 06 09.
Article in English | MEDLINE | ID: covidwho-2197877

ABSTRACT

BACKGROUND: The COVID-19 outbreak has imposed physical and psychological pressure on health care professionals, including frontline physicians. Hence, evaluating the mental health status of physicians during the current pandemic is important to define future preventive guidelines among health care stakeholders. OBJECTIVE: In this study, we intended to study alterations in the mental health status of Portuguese physicians working at the frontline during the COVID-19 pandemic and potential sociodemographic factors influencing their mental health status. METHODS: A nationwide survey was conducted during May 4-25, 2020, to infer differences in mental health status (depression, anxiety, stress, and obsessive compulsive symptoms) between Portuguese physicians working at the frontline during the COVID-19 pandemic and other nonfrontline physicians. A representative sample of 420 participants stratified by age, sex, and the geographic region was analyzed (200 frontline and 220 nonfrontline participants). Moreover, we explored the influence of several sociodemographic factors on mental health variables including age, sex, living conditions, and household composition. RESULTS: Our results show that being female (ß=1.1; t=2.5; P=.01) and working at the frontline (ß=1.4; t=2.9; P=.004) are potential risk factors for stress. In contrast, having a house with green space was a potentially beneficial factor for stress (ß=-1.5; t=-2.5; P=.01) and anxiety (ß=-1.1; t=-2.4; P=.02). CONCLUSIONS: It is important to apply protective mental health measures for physicians to avoid the long-term effects of stress, such as burnout.


Subject(s)
Burnout, Professional , COVID-19 , Mental Health , Pandemics , Physicians/psychology , Adult , Aged , Anxiety , Depression , Emergency Medical Services , Female , Health Personnel , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder , Portugal , Professional Role , SARS-CoV-2 , Stress, Psychological , Surveys and Questionnaires
4.
Sao Paulo Med J ; 138(4): 305-309, 2020.
Article in English | MEDLINE | ID: covidwho-2140943

ABSTRACT

BACKGROUND: The COVID-19 pandemic is threatening healthcare systems and hospital operations on a global scale. Treatment algorithms have changed in general surgery clinics, as in other medical disciplines providing emergency services, with greater changes seen especially in pandemic hospitals. OBJECTIVES: To evaluate the follow-up of patients undergoing emergency surgery in our hospital during the COVID-19 pandemic. DESIGN AND SETTING: Cross-sectional study conducted in a tertiary-level public hospital. METHODS: The emergency surgeries carried out between March 11 and April 2, 2020, in the general surgery clinic of a tertiary-care hospital that has also taken on the functions of a pandemic hospital, were retrospectively examined. RESULTS: A total of 25 patients were included, among whom 20 were discharged without event, one remained in the surgical intensive care unit, two are under follow-up by the surgery service and two died. Upon developing postoperative fever and shortness of breath, two patients underwent thoracic computed tomography (CT), although no characteristics indicating COVID-19 were found. The discharged patients had no COVID-19 positivity at follow-up. CONCLUSION: The data that we obtained were not surgical results from patients with COVID-19 infection. They were the results from emergency surgeries on patients who were not infected with COVID-19 but were in a hospital largely dealing with the pandemic. Analysis on the cases in this study showed that both the patients with emergency surgery and the patients with COVID infection were successfully treated, without influencing each other, through appropriate isolation measures, although managed in the same hospital. In addition, these successful results were supported by 14-day follow-up after discharge.


Subject(s)
Coronavirus Infections , Emergency Medical Services , Pandemics , Pneumonia, Viral , Surgical Procedures, Operative , Betacoronavirus , COVID-19 , Cross-Sectional Studies , Hospitals, Public , Humans , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers , Turkey
5.
J Glob Health ; 12: 05039, 2022 Nov 08.
Article in English | MEDLINE | ID: covidwho-2110746

ABSTRACT

Background: Severe acute respiratory infections (SARIs) remain a leading cause of death globally, particularly in low- and middle-income countries (LMICs). Early intervention is critical, considering the potential for rapid decompensation in patients with SARIs. We aimed to evaluate the impact of acute and emergency care interventions on improving clinical outcomes in patients >10 years old with SARIs in LMICs. Methods: A systematic literature search was performed in PubMed, Global Health, and Global Index Medicus databases to identify peer-reviewed studies containing SARI, LMICs, and emergency care interventions. Studies published prior to November 2020 focusing on patients >10 years old were included. A narrative synthesis was performed due to the heterogeneity of identified articles. Risk of bias was assessed using the Risk of Bias 2 and Risk of Bias In Non-Randomized Studies of Interventions tools. Results: 20 223 studies were screened and 58 met the inclusion criteria. Thirty-four studies focused on coronavirus-2019 (COVID-19), 15 on pneumonia, seven on influenza, one study on severe acute respiratory syndrome, and one on undifferentiated SARI. Few COVID-19 studies found a benefit of the tested intervention on clinical status, mortality, or hospital length-of-stay. Little to no benefit was found for azithromycin, convalescent plasma, or zinc, and potential harm was found for hydroxychloroquine/chloroquine. There was mixed evidence for immunomodulators, traditional Chinese medicine, and corticosteroids among COVID-19 studies, with notable confounding due to a lack of consistency of control group treatments. Neuraminidase inhibitor antivirals for influenza had the highest quality of evidence for shortening symptom duration and decreasing disease severity. Conclusions: We found few interventions for SARIs in LMICs with have high-quality evidence for improving clinical outcomes. None of the included studies evaluated non-pharmacologic interventions or were conducted in low-income countries. Further studies evaluating the impact of antivirals, immunomodulators, corticosteroids, and non-pharmacologic interventions for SARIs in LMICs are urgently needed. Registration: PROSPERO registration number: CRD42020216117.


Subject(s)
COVID-19 , Emergency Medical Services , Influenza, Human , Humans , Adolescent , Child , Developing Countries , Antiviral Agents
6.
Psychiatr Danub ; 32(3-4): 563-569, 2020.
Article in English | MEDLINE | ID: covidwho-2100779

ABSTRACT

INTRODUCTION: Healthcare professionals are one of the groups most affected by a pandemic that affects the whole world. This study aimed to determine the anxiety level of emergency medical services professionals in Ankara, Turkey after the emergence of the COVID-19 pandemic. SUBJECTS AND METHODS: In the first part of the survey, the participants of the study were asked about their socio-demographic characteristics and their contact with the COVID-19 patients. In the second part, a survey with 20 questions that determined the state anxiety level derived from the State Anxiety Inventory was performed after obtaining verbal consent. RESULTS: The mean age of the participants was 33.1±6.9, while 52.7% of all participants were males. In this study, the mean STAI Anxiety Score was 50.7±11.6. Anxiety scores were higher in females and those who had family members at risk of COVID-19 infection (p<0.05). The majority of those who had family members at risk of the infection started to stay in guesthouses instead of going home. Participants were worried about transmitting the infection to their family members (p<0.05). They felt more anxious when treating COVID-19 diagnosed or other patients (p<0.05). In addition, they thought that their anxiety level increased in general (p<0.05). CONCLUSION: The COVID-19 pandemic caused an anxiety increase in EMS workers in Turkey. Protecting the physical and mental health of the EMS employees who work at the front line against the COVID-19 pandemic and who have a high risk of infection, and ensuring their efficient work should be the main priority.


Subject(s)
COVID-19 , Emergency Medical Services , Anxiety/epidemiology , Female , Humans , Male , Pandemics , SARS-CoV-2 , Turkey/epidemiology
7.
Scand J Trauma Resusc Emerg Med ; 28(1): 80, 2020 Aug 14.
Article in English | MEDLINE | ID: covidwho-2098373

ABSTRACT

BACKGROUND: Rapid access to emergency medical communication centers (EMCCs) is pivotal to address potentially life-threatening conditions. Maintaining public access to EMCCs without delay is crucial in case of disease outbreak despite the significant increased activity and the difficulties to mobilize extra staff resources. The aim of our study was to assess the impact of two-level filtering on EMCC performance during the COVID-19 outbreak. METHODS: A before-after monocentric prospective study was conducted at the EMCC at the Nantes University Hospital. Using telephone activity data, we compared EMCC performance during 2 periods. In period one (February 27th to March 11th 2020), call takers managed calls as usual, gathering basic information from the caller and giving first aid instructions to a bystander on scene if needed. During period two (March 12th to March 25th 2020), calls were answered by a first-line call taker to identify potentially serious conditions that required immediate dispatch. When a serious condition was excluded, the call was immediately transferred to a second-line call taker who managed the call as usual so the first-line call taker could be rapidly available for other incoming calls. The primary outcome was the quality of service at 20 s (QS20), corresponding to the rate of calls answered within 20 s. We described activity and outcome measures by hourly range. We compared EMCC performance during periods one and two using an interrupted time series analysis. RESULTS: We analyzed 45,451 incoming calls during the two study periods: 21,435 during period 1 and 24,016 during period 2. Between the two study periods, we observed a significant increase in the number of incoming calls per hour, the number of connected call takers and average call duration. A linear regression model, adjusted for these confounding variables, showed a significant increase in the QS20 slope (from - 0.4 to 1.4%, p = 0.01), highlighting the significant impact of two-level filtering on the quality of service. CONCLUSIONS: We found that rapid access to our EMCC was maintained during the COVID-19 pandemic via two-level filtering. This system helped reduce the time gap between call placement and first-line call-taker evaluation of a potentially life-threatening situation. We suggest implementing this system when an EMCC faces significantly increased activity with limited staff resources.


Subject(s)
Betacoronavirus , Communication , Coronavirus Infections/epidemiology , Emergencies , Emergency Medical Service Communication Systems/organization & administration , Emergency Medical Services/methods , Pneumonia, Viral/epidemiology , Triage/methods , COVID-19 , Controlled Before-After Studies , Humans , Pandemics , Prospective Studies , SARS-CoV-2 , Telephone
9.
Crit Care ; 26(1): 335, 2022 10 31.
Article in English | MEDLINE | ID: covidwho-2098416

ABSTRACT

BACKGROUND: Early public-access defibrillation (PAD) effectively improves the outcomes of out-of-hospital cardiac arrests (OHCA), but several strategies implemented to prevent the spread of coronavirus disease 2019 (COVID-19) could decrease the availability of PAD and worsen outcomes after OHCA. Previous studies have reported conflicting findings, and there is a paucity of nationwide observations. This study aims to investigate the impact of COVID-19 on PAD and OHCA outcomes using a nationwide OHCA registry in Japan, where PAD is well-documented. METHODS: This secondary analysis of the All-Japan Utstein Registry, a prospective population-based nationwide registry of OHCA patients, included patients aged ≥ 18 years with bystander-witnessed OHCA and an initial shockable rhythm who were transported to medical facilities between January 1, 2005, and December 31, 2020. The analytical parameters of this study were the proportion of patients who underwent PAD and patients with one-month survival with favorable neurological outcomes, defined as a cerebral performance category score of 1 or 2. We compared the data between 2019 and 2020 using a multivariable logistic regression analysis. RESULTS: During the study period, 1,930,273 OHCA patients were registered; of these, 78,302 were eligible for the analysis. Before the COVID-19 pandemic, the proportion of OHCA patients who underwent PAD and demonstrated favorable neurological outcomes increased gradually from 2005 to 2019 (P for trend < 0.001). The proportion of patient who had PAD were 17.7% (876/4959) in 2019 and 15.1% (735/4869) in 2020, respectively. The proportion of patient who displayed favorable neurological outcomes were 25.1% (1245/4959) in 2019 and 22.8% (1109/4869) in 2020, respectively. After adjusting for potential confounders, a significant reduction in the proportion of PAD was observed compared to that in 2019 (adjusted odds ratio [AOR], 0.86; 95% confidence interval [CI], 0.76-0.97), while no significant reduction was observed in favorable neurological outcomes (AOR, 0.97; 95% CI 0.87-1.07). CONCLUSION: The proportion of PAD clearly decreased in 2020, probably due to the COVID-19 pandemic in Japan. In contrast, no significant reduction was observed in favorable neurological outcomes.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Humans , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Out-of-Hospital Cardiac Arrest/complications , Defibrillators , COVID-19/epidemiology , COVID-19/therapy , Prospective Studies , Pandemics , Japan/epidemiology , Electric Countershock , Registries
10.
BMJ Open ; 12(11): e064038, 2022 11 03.
Article in English | MEDLINE | ID: covidwho-2097994

ABSTRACT

OBJECTIVES: This body of work aimed to elicit ambulance service staff's perceptions on the barriers and facilitators to adoption, and clinical utility of incorporating rapid SARS-CoV-2 testing during ambulance assessments. DESIGN: A mixed-methods survey-based project using a framework analysis method to organise qualitative data. SETTING: Emergency and non-emergency care ambulatory services in the UK were approached to take part. PARTICIPANTS: Current, practising members of the UK ambulance service (paramedics, technicians, assistants and other staff) were included in this body of work. RESULTS: Survey 1: 226 responses were collected between 3 December 2020 and 11 January 2021, 179 (79.2%) of which were completed in full. While the majority of respondents indicated that an ambulance-based testing strategy was feasible in concept (143/190, 75.3%), major barriers to adoption were noted. Many open-ended responses cited concerns regarding misuse of the service by the general public and other healthcare services, timing and conveyance issues, and increased workloads, alongside training and safety concerns. Survey 2: 26 responses were received between 8 February 2021 and 22 February 2021 to this follow-up survey. Survey 2 revealed conveyance decision-making, and risk stratification to be the most frequently prioritised use cases among ambulance service staff. Optimal test characteristics for clinical adoption according to respondents were; accuracy (above 90% sensitivity and specificity), rapidity (<30 min time to results) and ease of sample acquisition. CONCLUSIONS: The majority of commercially available lateral flow devices are unlikely to be supported by paramedics as their duty of care requires both rapid and accurate results that can inform clinical decision making in an emergency situation. Further investigation is needed to define acceptable test characteristics and criteria required for ambulance service staff to be confident and supportive of deployment of a SARS-CoV-2 test in an emergency care setting.


Subject(s)
COVID-19 , Emergency Medical Services , Humans , Ambulances , SARS-CoV-2 , COVID-19 Testing , Feasibility Studies , COVID-19/diagnosis , Surveys and Questionnaires , Point-of-Care Testing
11.
Int J Environ Res Public Health ; 19(18)2022 Sep 07.
Article in English | MEDLINE | ID: covidwho-2093838

ABSTRACT

At the early stage of a major public health emergency outbreak, there exists an imbalance between supply and demand in the distribution of emergency supplies. To improve the efficiency of emergency medical service equipment and relieve the treatment pressure of each medical treatment point, one of the most important factors is the emergency medical equipment logistics distribution. Based on the actual data of medical equipment demand during the epidemic and the characteristics of emergencies, this study proposed an evaluation index system for emergency medical equipment demand point urgency, based on the number of patients, the number of available inpatient beds, and other influencing factors as the index. An urban emergency medical equipment distribution model considering the urgency of demand, the distribution time window, and vehicle load was constructed with the constraints. Wuhan, Hubei Province, China, at the beginning of the outbreak was selected as a validation example, and the Criteria Importance Though Intercriteria Correlation (CRITIC) method and the genetic algorithm were used to simulate and validate the model with and without considering the demand urgency. The results show that under the public health emergencies, the distribution path designed to respond to different levels of urgency demand for medical equipment is the most efficient path and reduces the total distribution cost by 5%.


Subject(s)
Emergency Medical Services , Epidemics , China/epidemiology , Emergencies , Humans , Public Health
12.
Ann Cardiol Angeiol (Paris) ; 71(6): 345-349, 2022 Dec.
Article in French | MEDLINE | ID: covidwho-2085907

ABSTRACT

Technological advances over the past two decades have paved the way for the prehospital use of ultrasound. This practice was first developed in traumatology and then in a multitude of other indications, including cardiology. The development of pulmonary ultrasound is certainly the most visible illustration of this. Firstly, because it is an extra-cardiac examination that provides the answer to a cardiac question. Secondly because from a theoretical point of view this ultrasound indication was a bad indication for the use of ultrasound due to the air contained in the thorax. Thirdly, because this indication has become a 'standard of care' when caring for a patient with dyspnea - a practice that has become widespread during the COVID epidemic. In patients with heart failure, ultrasound has a high diagnostic power (including for alternative diagnoses) which is all the more precise since the technique is non-invasive, the response is obtained quickly, the examination can be repeated at desire to follow the evolution of the patient. The main other indications for prehospital ultrasound are cardiac arrest to search for a curable cause, identification of residual mechanical cardiac activity, monitoring of cerebral perfusion; chest pain, for both positive and negative diagnoses; shock for the search for an etiology and therapeutic follow-up or even pulmonary embolism or ultrasound for the search for dilation of the right ventricle which is now at the forefront of the recommendation algorithm.


Subject(s)
COVID-19 , Cardiology , Emergency Medical Services , Humans , Emergencies , COVID-19/diagnostic imaging , Ultrasonography/methods , Emergency Medical Services/methods
13.
Front Public Health ; 10: 937202, 2022.
Article in English | MEDLINE | ID: covidwho-2080285

ABSTRACT

Background: Emergency medical services (EMSs) are an important element of the healthcare system as it provides an opportunity to respond to critical medical conditions and save people's lives. In Saudi Arabia, EMS is offered via the EMS phone number "997" and mobile application "Asefny". Methods: This was an observational cross-sectional survey study exploring public awareness and use of the EMS phone number during the COVID-19 pandemic in Saudi Arabia. A bivariate analysis was performed to investigate factors affecting awareness and use of the EMS phone number and to compare the EMS acceptance to transport and timelines of ambulance arrival between requests made via the "997" EMS phone number and the "Asefny" mobile application during the country's emergency lockdown. Results: A total of 805 participants were included in the analysis, where 66% reported awareness of the EMS phone number and 75% of them accurately identified the nature of the service provided by dialing the number. The men who participated, those with a bachelor's degree, with children, and with chronic conditions were more aware of the EMS phone number compared to the other participants. Of the total sample, 46.7% used EMS phone numbers at least one time (ever users). During the COVID-19 lockdown, the EMS accepted to transport 87% of the calls made by 997 phone number and 56.2% of the mobile application requests (P < 0.00). The ambulance arrived in ≤ 8 min in 53.6% of the 997 phone calls and 35.5% of the Asefny mobile requests (P < 0.00). Conclusions: Findings showed commendable levels of awareness and the use of EMS phone numbers. However, the results suggest room for improvement by developing promotional and educational campaigns inspired by the factors identified as influential on both awareness and use. Mobile applications in EMS are promising to improve prehospital emergency service accessibility, which needs to be further investigated to assess its impact on the public health informatics experience.


Subject(s)
COVID-19 , Emergency Medical Services , Male , Child , Humans , COVID-19/epidemiology , Cross-Sectional Studies , Pandemics , Communicable Disease Control , Emergency Medical Services/methods
14.
Travel Med Infect Dis ; 50: 102472, 2022.
Article in English | MEDLINE | ID: covidwho-2069733

ABSTRACT

BACKGROUND: To explore the association between the use of prehospital medications and the development of fatal outcomes in patients who required hospitalization due to coronavirus disease-2019 (COVID-19). METHODS: This retrospective cohort study included adult patients who were hospitalized due to COVID-19. Demographic, clinical, and laboratory data, prehospital medication history, and fatal outcome development (use of high-flow oxygen therapy, intensive care unit [ICU] admission, or mortality) were extracted from the medical records of patients who were admitted due to COVID-19 to the Carlos Seguín Escobedo National Hospital of Arequipa, Peru during July to September 2021, the period after the second wave of COVID-19 cases in Peru. Survival was analyzed using the Cox proportional hazards model, and crude hazard ratios and adjusted hazard ratios (aHR) with their respective 95% confidence intervals (95% CI) were calculated. RESULTS: A total of 192 patients were evaluated, of whom 62% were males and 46.9% did not require oxygen support at admission. Additionally, 64.6% used nonsteroidal anti-inflammatory drugs, 35.4% used corticosteroids, 28.1% used macrolides or ceftriaxone, 24.5% used ivermectin, and 21.9% used warfarin before hospitalization. Of the patients, 30.2% developed a fatal outcome during follow-up. The multivariate analysis revealed that prehospital corticosteroid use was independently associated with the fatal outcome due to COVID-19 with an aHR = 5.29 (95%CI: 1.63-17.2). CONCLUSION: Prehospital corticosteroid use was associated with a 5-fold increased risk of fatal outcome development.


Subject(s)
COVID-19 , Emergency Medical Services , Adult , Male , Humans , Female , COVID-19/drug therapy , SARS-CoV-2 , Retrospective Studies , Peru/epidemiology , Hospitalization , Cohort Studies , Hospitals , Adrenal Cortex Hormones , Referral and Consultation , Oxygen
15.
Front Public Health ; 10: 895506, 2022.
Article in English | MEDLINE | ID: covidwho-2065641

ABSTRACT

Introduction: A good working climate increases the chances of adequate care. The employees of Emergency in Hospitals are particularly exposed to work-related stress. Support from management is very important in order to avoid stressful situations and conflicts that are not conducive to good work organization. The aim of the study was to assess the work climate of Emergency Health Services during COVID-19 Pandemic using the Abridged Version of the Work Climate Scale in Emergency Health Services. Design: A prospective descriptive international study was conducted. Methods: The 24-item Abridged Version of the Work Climate Scale in Emergency Health Services was used for the study. The questionnaire was posted on the internet portal of scientific societies. In the study participated 217 women (74.5%) and 74 men (25.4%). The age of the respondents ranged from 23 to 60 years (SD = 8.62). Among the re-spondents, the largest group were Emergency technicians (85.57%), followed by nurses (9.62%), doctors (2.75%) and Service assistants (2.06%). The study was conducted in 14 countries. Results: The study of the climate at work shows that countries have different priorities at work, but not all of them. By answering the research questions one by one, we can say that the average climate score at work was 33.41 min 27.0 and max 36.0 (SD = 1.52). Conclusion: The working climate depends on many factors such as interpersonal relationships, remuneration or the will to achieve the same selector. In the absence of any of the elements, a proper working climate is not possible.


Subject(s)
COVID-19 , Emergency Medical Services , Occupational Stress , Adult , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Organizational Culture , Pandemics , Young Adult
16.
PLoS One ; 17(10): e0275831, 2022.
Article in English | MEDLINE | ID: covidwho-2065149

ABSTRACT

BACKGROUND: Only very few studies have investigated the effect of the COVID-19 pandemic on the pre-hospital stroke code protocol. During the first wave, Spain was one of the most affected countries by the SARS-CoV-2 coronavirus disease pandemic. This health catastrophe overshadowed other pathologies, such as acute stroke, the leading cause of death among women and the leading cause of disability among adults. Any interference in the stroke code protocol can delay the administration of reperfusion treatment for acute ischemic strokes, leading to a worse patient prognosis. We aimed to compare the performance of the stroke code during the first wave of the pandemic with the same period of the previous year. METHODS: This was a multicentre interrupted time-series observational study of the cohort of stroke codes of SUMMA 112 and of the ten hospitals with a stroke unit in the Community of Madrid. We established two groups according to the date on which they were attended: the first during the dates with the highest daily cumulative incidence of the first wave of the COVID-19 (from February 27 to June 15, 2020), and the second, the same period of the previous year (from February 27 to June 15, 2019). To assess the performance of the stroke code, we compared each of the pre-hospital emergency service time periods, the diagnostic accuracy (proportion of stroke codes with a final diagnosis of acute stroke out of the total), the proportion of patients treated with reperfusion therapies, and the in-hospital mortality. RESULTS: SUMMA 112 activated the stroke code in 966 patients (514 in the pre-pandemic group and 452 pandemic). The call management time increased by 9% (95% CI: -0.11; 0.91; p value = 0.02), and the time on scene increased by 12% (95% CI: 2.49; 5.93; p value = <0.01). Diagnostic accuracy, and the proportion of patients treated with reperfusion therapies remained stable. In-hospital mortality decreased by 4% (p = 0.05). CONCLUSIONS: During the first wave, a prolongation of the time "on the scene" of the management of the 112 calls, and of the hospital admission was observed. Prehospital diagnostic accuracy and the proportion of patients treated at the hospital level with intravenous thrombolysis or mechanical thrombectomy were not altered with respect to the previous year, showing the resilience of the stroke network and the emergency medical service.


Subject(s)
COVID-19 , Emergency Medical Services , Stroke , Adult , COVID-19/epidemiology , COVID-19 Testing , Female , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapy , Thrombolytic Therapy
17.
Medicine (Baltimore) ; 101(40): e30902, 2022 Oct 07.
Article in English | MEDLINE | ID: covidwho-2063075

ABSTRACT

During the novel coronavirus disease (COVID-19) pandemic, emergency medical services (EMS) has borne a huge burden in transporting emergency patients. However, the protocol's effect on identifying emergency patients who are likely to have COVID-19 is unknown. We aimed to evaluate the diagnostic accuracy of a prehospital COVID-19 screening protocol for EMS. We conducted this population-based retrospective study in Nara Prefecture, Japan. The Nara Prefectural Government implemented a screening protocol for COVID-19 comprising the following symptom criteria (fever, cough, sore throat, headache, malaise, dysgeusia, or anosmia) and epidemiological criteria (contact history with confirmed COVID-19 cases or people with upper respiratory symptoms, or travel to areas with high infection rate). A patient meeting at least one criterion of each class was considered positive. We evaluated all 51,351 patients from the regional EMS database of the Nara Prefecture (emergency Medical Alliance for Total Coordination of Healthcare) who were registered from June 15, 2020 to May 31, 2021 and had results of COVID-19 reverse transcription polymerase chain reaction (RT-PCR) tests. We assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this protocol. We also assessed how these outcomes changed by adding vital signs and conducted a 10-fold and 100-fold prevalence simulation. The screening protocol was used for 246/51351 patients (0.5%). Among them, 31 tested positive after EMS transportation. This protocol's sensitivity, specificity, PPV, and NPV were 40.8%, 99.6%, 12.6%, and 99.9%, respectively. With the addition of ≥2 vital signs (body temperature ≥37.5 °C, respiratory rate ≥20 breaths/minute, and oxygen saturation <90%), sensitivity and PPV changed to 61.8% and 1.0%, respectively, while NPV remained 99.9%. With a 10-fold and 100-fold increase in disease, the protocol PPV would be 59.0% and 94.3%, and NPV would be 99.1% and 90.7%, respectively, and with additional vital signs, PPV would be 8.9% and 53.1%, and NPV would be 99.4% and 93.2%, respectively. This COVID-19 screening protocol helped enable EMS transport for patients with COVID-19 with a PPV of 12.6%. Adding other vital sign variables may improve its diagnostic value if the prevalence rate increases.


Subject(s)
COVID-19 , Emergency Medical Services , COVID-19/diagnosis , COVID-19/epidemiology , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Sensitivity and Specificity
19.
JAMA Netw Open ; 5(10): e2235401, 2022 10 03.
Article in English | MEDLINE | ID: covidwho-2047382

ABSTRACT

This cohort study investigates the association of the COVID-19 pandemic with prehospital characteristics and outcomes of pediatric patients with out-of-hospital-cardiac arrest in Japan.


Subject(s)
COVID-19 , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , COVID-19/epidemiology , Child , Humans , Japan/epidemiology , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Pandemics
20.
Circ J ; 86(10): 1579-1585, 2022 09 22.
Article in English | MEDLINE | ID: covidwho-2039167

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic may have influenced the prehospital emergency care and deaths of individuals experiencing an out-of-hospital cardiac arrest (OHCA).Methods and Results: We analyzed the registry data of 2,420 and 2,371 OHCA patients in Osaka City, Japan in 2019 and 2020, respectively, according to the 3 waves of the COVID-19 pandemic. Patient outcomes were compared using multivariable logistic regression analyses with the 2019 data as the reference. Bystander cardiopulmonary resuscitation (CPR) was initiated significantly less frequently in 2020 than in 2019 (2019: 48.0%, 2020: 42.7%, P<0.001), particularly during the first wave (2019: 47.2%, 2020: 42.9%, P=0.046) and second wave (2019: 48.1%, 2020: 41.2%, P=0.010), but not during the third wave (2019: 49.2%, 2020: 44.1%, P=0.066). The public-access automated external defibrillator was less frequently applied during the first wave (2019: 12.6%, 2020: 9.9%, P=0.043), with no significant difference during the second wave (2019: 12.5%, 2020: 12.8%, P=0.863) and third wave (2019: 13.7%, 2020: 13.0%, P=0.722). There was a significant difference in 1-month survival with favorable neurological outcomes (2019: 4.6%, 2020: 3.3%, P=0.018), with a 28% reduction in the adjusted odds ratio in 2020 (0.72; 95% confidence interval: 0.52-0.99, P=0.044). CONCLUSIONS: Bystander CPR and neurologically favorable outcomes after OHCA decreased significantly during the COVID-19 pandemic in Japan.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , COVID-19/epidemiology , Cardiopulmonary Resuscitation/methods , Emergency Medical Services/methods , Humans , Japan/epidemiology , Pandemics , Registries
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