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1.
Scand J Trauma Resusc Emerg Med ; 30(1): 6, 2022 Jan 15.
Article in English | MEDLINE | ID: covidwho-1622251

ABSTRACT

BACKGROUND: The COVID-19 pandemic has placed exceptional demand on Intensive Care Units, necessitating the critical care transfer of patients on a regional and national scale. Performing these transfers required specialist expertise and involved moving patients over significant distances. Air Ambulance Kent Surrey Sussex created a designated critical care transfer team and was one of the first civilian air ambulances in the United Kingdom to move ventilated COVID-19 patients by air. We describe the practical set up of such a service and the key lessons learned from the first 50 transfers. METHODS: Retrospective review of air critical care transfer service set up and case review of first 50 transfers. RESULTS: We describe key elements of the critical care transfer service, including coordination and activation; case interrogation; workforce; training; equipment; aircraft modifications; human factors and clinical governance. A total of 50 missions are described between 18 December 2020 and 1 February 2021. 94% of the transfer missions were conducted by road. The mean age of these patients was 58 years (29-83). 30 (60%) were male and 20 (40%) were female. The mean total mission cycle (time of referral until the time team declared free at receiving hospital) was 264 min (range 149-440 min). The mean time spent at the referring hospital prior to leaving for the receiving unit was 72 min (31-158). The mean transfer transit time between referring and receiving units was 72 min (9-182). CONCLUSION: Critically ill COVID-19 patients have highly complex medical needs during transport. Critical care transfer of COVID-19-positive patients by civilian HEMS services, including air transfer, can be achieved safely with specific planning, protocols and precautions. Regional planning of COVID-19 critical care transfers is required to optimise the time available of critical care transfer teams.


Subject(s)
Air Ambulances , COVID-19 , Emergency Medical Services , Adult , Aged , Aged, 80 and over , Aircraft , Critical Care , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
2.
Recenti Prog Med ; 112(12): 821-823, 2021 12.
Article in Italian | MEDLINE | ID: covidwho-1599874

ABSTRACT

Portable blood gas analyzers are intended for blood Point-of-care testing (POCT); they make it possible to perform the examination directly at the patient's bed. During the SARS-CoV-2 pandemic, this device proved useful in emergency medical service for the early assessment of respiratory distress, allowing the appropriate care level to be determined for each patient. 25 cases of covid-19 positive patients in the province of Arezzo were analyzed; POCT blood gas analysis made it possible to evaluate and treat at home about half of the patients (52%) and to admit the others directly to the most appropriate ward. However, some critical issues were found; the limited sample size suggest further research to assess the actual impact of this technology.


Subject(s)
COVID-19 , Emergency Medical Services , Blood Gas Analysis , Humans , Point-of-Care Systems , SARS-CoV-2
3.
Chirurgia (Bucur) ; 116(6): 643-644, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1598469

ABSTRACT

According to the UEMS (Union Europeene des Medicins Specialises) Section of surgery Board of Surgery, "Emergency Surgery" can be defined "as surgery that is required to deal with an acute threat to life, organ, limb or tissue caused by external trauma, acute disease process, acute exacerbation of a chronic disease process, or complication of a surgical or other interventional procedure". Performance of emergency surgery require complex and varied skills and abilities to achieve procedures from different fields of surgery: abdominal, urologic, thoracic, vascular, soft tissue, skeletal) within an interval of 24 hours (1). In U.S., since 2008, Acute Care Surgery concept was introduced, and nowadays is an evolving specialty with three essential components- trauma, critical care and emergency surgery (2). In UK there is an increasing subspecialisation within general surgery over the last ten years. More recently, there has been an increase in focus on emergency general surgery (3,4). This may not come as a surprise given the fact that trafic crashes kill 1.2 million people annually around the world (3242 people/day) and 90% are in middle and low income countries. In US trauma is the leading cause of death in persons up to 40 years. Optimal care for emergency surgical patients is one of the major challenges for every healthcare system worldwide. An emergency surgery mai intervene during the daily schedule of elective interventions and create pressure on both the organisation and costs (5). Since it's birth, in 2007, the Romanian Society for Emergency Surgery and Trauma was involved in supporting the development of practice in emergency surgery in Romania by many actions: each year, during biannual National Congres and National Conference of the Romanian Society of Surgery 2 sessions were dedicated to emergency surgery, with invited foreign speakers; oragnisation of European Congres of Emergency and Trauma Surgery in 2017 in Bucharest, 1 tematic issue of Chirurgia Journal dedicated to surgery of the cirrhotic patients. This tematic isssue includes varia subjects from emergency surgery in valuable articles. The management of open abdomen management are depicted by Anastasiu et al, in a review summarizing definition, classification, indications, methods of temporary abdominal closure and fascial closure, and enterocutanous fistula. Turculet et al, perfomed a review of the litterature to describe the main advantages and disadvantages of the trauma systems in Europe and to present the last concepts regarding the management of the polytrauma patients and the newest sets of measures to prevent car crashes in European Union. A rare case of small bowel hemangioma with hemoperitoneum mimicking trauma is described by Iordache et al, with a review of the litterature. The series of reviews ends with an interesting article for daily practice in emergency hospitals about the diagnostic and therapeutic peculiarities in abdominal trauma associated with spinal cord injurie by Grigorean et al. Abdominal trauma is addressed in 7 original papers. The definitive surgery for liver trauma in tertiary HPB center, the nonoperative treatment of abdominal trauma involving liver and spleen, the timing of splenic interventional radiology, the management of colon trauma at a level II trauma, challenges raised by the retroperitoneal hematoma in abdominal trauma, predicition of evolution of patients with abdominal trauma using the usual biological parameters, and clinico-pathological correlations in the acute surgical abdomen in the pre and post COVID-19 pandemic period are presented, analysed and discussed in papers coming from specialized surgical units from Fundeni Clinical Institute, Emergency Clinical Hospital Bucharest, Emergency University Hospital of Bucharest, "Bagdasar-Arseni" Clinical Emergency Hospital, "St. Pantelimon" Clinical Emergency Hospital, Clinical County Emergency Hospitals of Craiova and Tg-Mures. The surgical technique of intraomental splenic implant and an attempt of reassessement is presented in a paper by Beuran et al. We hope that this tematic issue will be an interesting and very useful lecture for our readers and bring useful informations for those involved in emergency surgery.


Subject(s)
Emergency Medical Services , Wounds and Injuries , COVID-19 , Humans , Pandemics , Wounds and Injuries/surgery
4.
PLoS One ; 16(12): e0260208, 2021.
Article in English | MEDLINE | ID: covidwho-1575897

ABSTRACT

Medical personnel working in emergency rooms (ER) are at increased risk of mental health problems and suicidality. There is increasing evidence that mindfulness-based interventions can improve burnout and other mental health outcomes in health care providers. In contrast, few longitudinal prospective studies have examined protective functions of dispositional mindfulness in this population. The objective of this study was to examine whether mindfulness prospectively predicts anxiety, depression, and social impairment in a sample of emergency care professionals. The authors administered online surveys to ER personnel prior to work in ER, and at 3 and 6 months follow up. Participants were 190 ER personnel (73% residents, 16% medical students, 11% nurses). Linear mixed effects regression was used to model longitudinal 3-month and 6-month follow up of depression, anxiety, and social impairment. Predictors included time-varying contemporaneous work stressors, perceived social support at work and life events, and baseline dispositional mindfulness, demographics, and workplace characteristics. Mindfulness indexed when starting ER work predicted less depression, anxiety, and social impairment 6 months later. Mindfulness remained a strong predictor of mental health outcomes after controlling for time-varying stressful events in emergency care, negative life events, and social support at work. Mindfulness moderated the adverse impact of poor social support at work on depression. To our knowledge, this is the first longitudinal study to show that mindfulness prospectively and robustly predicts anxiety, depression, and social impairment. Results support the role of mindfulness as a potential resilience factor in at-risk health care providers.


Subject(s)
Anxiety/pathology , Depression/pathology , Health Personnel/psychology , Mindfulness/methods , Adult , Emergency Medical Services , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Occupational Stress , Social Support , Surveys and Questionnaires , Workplace
6.
Medicina (Kaunas) ; 57(12)2021 Dec 14.
Article in English | MEDLINE | ID: covidwho-1572561

ABSTRACT

Background and Objectives: The aim of this study was to assess the association between prehospital peripheral oxygen saturation (SpO2) and intensive care unit (ICU) admission in confirmed or suspected coronavirus disease 19 (COVID-19) patients. Materials and Methods: We carried out a retrospective cohort study on patients requiring prehospital intervention between 11 March 2020 and 4 May 2020. All adult patients in whom a diagnosis of COVID-19 pneumonia was suspected by the prehospital physician were included. Patients who presented a prehospital confounding respiratory diagnosis and those who were not eligible for ICU admission were excluded. The main exposure was "Low SpO2" defined as a value < 90%. The primary outcome was 48-h ICU admission. Secondary outcomes were 48-h mortality and 30-day mortality. We analyzed the association between low SpO2 and ICU admission or mortality with univariable and multivariable regression models. Results: A total of 145 patients were included. A total of 41 (28.3%) patients had a low prehospital SpO2 and 21 (14.5%) patients were admitted to the ICU during the first 48 h. Low SpO2 was associated with an increase in ICU admission (OR = 3.4, 95% CI = 1.2-10.0), which remained significant after adjusting for sex and age (aOR = 5.2, 95% CI = 1.8-15.4). Mortality was higher in low SpO2 patients at 48 h (OR = 7.1 95% CI 1.3-38.3) and at 30 days (OR = 3.9, 95% CI 1.4-10.7). Conclusions: In our physician-staffed prehospital system, first low prehospital SpO2 values were associated with a higher risk of ICU admission during the COVID-19 pandemic.


Subject(s)
COVID-19 , Emergency Medical Services , Adult , Humans , Hypoxia/epidemiology , Intensive Care Units , Pandemics , Retrospective Studies , SARS-CoV-2
8.
Epidemiol Infect ; 148: e161, 2020 07 27.
Article in English | MEDLINE | ID: covidwho-1531968

ABSTRACT

After the 2003 SARS epidemic, China started constructing a primary-level emergency response system and focused on strengthening and implementation of policies, resource allocation. After 17 years of restructuring, China's primary-level response capabilities towards public health emergencies have greatly improved. During the coronavirus disease 2019 epidemic, primary-level administrative and medical personnel, social organisations, volunteers, etc. have played a significant role in providing professional services utilising the primary-level emergency response system of 17 years. However, China's organisations did not learn their lesson from the SARS epidemic, and certain problems are exposed in the system. By analysing the experience and shortcomings of China's disease prevention and control system at the primary level, we can focus on the development of disease control systems for major epidemics in the future.


Subject(s)
Coronavirus Infections/prevention & control , Emergency Medical Services/standards , Epidemics/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Public Health/standards , COVID-19 , China , Emergency Medical Services/organization & administration , Emergency Medical Services/trends , Health Policy/trends , Humans , Information Dissemination/methods , Information Technology/trends , Vulnerable Populations
9.
Medicina (Kaunas) ; 57(11)2021 Nov 19.
Article in English | MEDLINE | ID: covidwho-1534177

ABSTRACT

Background and Objectives: Due to the unexpected spread of coronavirus disease 2019 (COVID-19), there was a serious crisis of emergency medical system collapse. Healthcare workers working in the emergency department were faced with psychosocial stress and workload changes. Materials and Methods: This was a cross-sectional survey of healthcare workers in the emergency department in Daegu and Gyeongbuk, Korea, from November 16 to 25, 2020. In the survey, we assessed the general characteristics of the respondents; changes in the working conditions before and after the COVID-19 pandemic; and resulting post-traumatic stress disorder, depression and anxiety statuses using 49 questions. Results: A total of 529 responses were collected, and 520 responses were included for the final analyses. Changes in working conditions and other factors due to COVID-19 varied by emergency department level, region and disease group. Working hours, intensity, role changes, depression and anxiety scores were higher in the higher level emergency department. Isolation ward insufficiency and the risk of infection felt by healthcare workers tended to increase in the lower level emergency department. Treatment and transfer delay were higher in the fever and respiratory disease groups (M = 3.58, SD = 1.18; M = 4.08, SD = 0.95), respectively. In all the disease groups, both treatment and transfer were delayed more in Gyeongbuk than in Daegu. Conclusions: Different goals should be pursued by the levels and region of the emergency department to overcome the effects of the COVID-19 pandemic and promote optimal care.


Subject(s)
COVID-19 , Emergency Medical Services , Anxiety , Cross-Sectional Studies , Depression/epidemiology , Disease Outbreaks , Emergency Service, Hospital , Health Personnel , Humans , Pandemics , SARS-CoV-2 , Stress, Psychological/epidemiology , Workload
10.
BMC Emerg Med ; 21(1): 102, 2021 09 09.
Article in English | MEDLINE | ID: covidwho-1533244

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had profound effects on the utilization of health care services, including Emergency Medical Services (EMS). Social distancing measures taken to prevent the spread of the disease have greatly affected the functioning of societies and reduced or halted many activities with a risk of injury. The aim of this study was to report the effects of lockdown measures on trauma-related EMS calls in the Finnish capital area. METHODS: We conducted a retrospective cohort study of all EMS calls in the Helsinki University Hospital (HUH) catchment area between 1 January and 31 July 2020. Calls were identified from the HUH EMS database. Calls were grouped into pre-lockdown, lockdown, and post-lockdown periods according to the restrictions set by the Finnish government and compared to the mean number of calls for the corresponding periods in 2018 and 2019. Statistical comparisons were performed using Mann-Whitney U-test for weekly numbers and percentages. RESULTS: During the study period there was a total of 70,705 EMS calls, of which 14,998 (21.2%) were related to trauma; 67,973 patients (median age 61.6 years; IQR 35.3-78.6) were met by EMS. There was no significant change in the weekly number of total or trauma-related EMS calls during the pre-lockdown period. During the lockdown period, the number of weekly total EMS calls was reduced by 12.2% (p = 0.001) and the number of trauma-related calls was reduced by 23.3% (p = 0.004). The weekly number of injured patients met by EMS while intoxicated with alcohol was reduced by 41.8% (p = 0.002). During the post-lockdown period, the number of total and trauma-related calls and the number of injured patients intoxicated by alcohol returned to previous years' levels. CONCLUSIONS: The COVID-19 pandemic and social distancing measures reduced the number of trauma-related EMS calls. Lockdown measures had an especially significant effect on the number of injured patients intoxicated by alcohol met by the EMS. TRIAL REGISTRATION: Not applicable.


Subject(s)
COVID-19 , Emergency Medical Services , Wounds and Injuries/epidemiology , Communicable Disease Control , Emergency Medical Services/statistics & numerical data , Finland/epidemiology , Humans , Middle Aged , Pandemics , Retrospective Studies
11.
Prehosp Disaster Med ; 36(6): 676-683, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1526027

ABSTRACT

BACKGROUND: Some studies in countries affected by the coronavirus disease of 2019 (COVID-19) pandemic have shown that the missions of Emergency Medical Service (EMS) have changed during the COVID-19 pandemic, and the rate of death and out-of-hospital cardiac arrest (OHCA) has been increased due to the direct and indirect effects of COVID-19. OBJECTIVE: The aim of this study was to determine the effect of the COVID-19 pandemic on the process of EMS missions, death, and OHCA. METHODS: This cross-sectional study was performed in Tehran, Iran. All conducted missions in the first six months of the three consecutive solar years of March 21 until September 22 of 2018-2020, which were registered in the registry bank of the Tehran EMS center, were assessed and compared. Based on the opinion of experts, the technician's on-scene diagnoses were categorized into 14 groups, and then death and OHCA cases were compared. RESULTS: In this study, the data of 1,050,376 missions performed in three study periods were analyzed. In general, the number of missions in 2020 was 17.83% fewer than that of 2019 (P < .001); however, the number of missions in 2019 was 30.33% more than that of 2018. On the other hand, the missions of respiratory problems, cardiopulmonary arrest, infectious diseases, and poisoning were increased in 2020 compared to that of 2019. The raw number of OHCA and death cases respectively in 2018, 2019, and 2020 were 25.0, 22.7, and 28.6 cases per 1,000 missions. Of all patients who died in 2020, 4.9% were probable/confirmed COVID-19 cases. The history of heart disease, hypertension, diabetes, and respiratory disease in patients in 2020 was more frequent than that of the other two years. CONCLUSION: This study showed that the number of missions in the Tehran EMS in 2020 were decreased compared to that of 2019, however the number of missions in 2019 was more than that of 2018. Respiratory problems, infectious diseases, poisoning, death, and OHCA were increased compared to the previous two years and cardiovascular complaints, neurological problems, and motor vehicle collisions (MVCs) in 2020 were fewer than that of the other two years.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Cross-Sectional Studies , Humans , Iran/epidemiology , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Pandemics , SARS-CoV-2
13.
J Allergy Clin Immunol Pract ; 9(6): 2334-2335, 2021 06.
Article in English | MEDLINE | ID: covidwho-1525835
14.
Air Med J ; 40(6): 395-398, 2021.
Article in English | MEDLINE | ID: covidwho-1525663

ABSTRACT

OBJECTIVE: Prehospital emergency anesthesia in the form of rapid sequence intubation (RSI) is a critical intervention delivered by advanced prehospital critical care teams. Our previous simulation study determined the feasibility of in-aircraft RSI. We now examine whether this feasibility is preserved in a simulated setting when clinicians wear personal protective equipment (PPE) for aerosol-generating procedures (AGPs) for in-aircraft, on-the-ground RSI. METHODS: Air Ambulance Kent Surrey Sussex is a helicopter emergency medical service that uses an AW169 cabin simulator. Wearing full AGP PPE (eye protection, FFP3 mask, gown, and gloves), 10 doctor-paramedic teams performed RSI in a standard "can intubate, can ventilate" scenario and a "can't intubate, can't oxygenate" (CICO) scenario. Prespecified timings were reported, and participant feedback was sought by questionnaire. RESULTS: RSI was most commonly performed by direct laryngoscopy and was successfully achieved in all scenarios. The time to completed endotracheal intubation (ETI) was fastest (287 seconds) in the standard scenario and slower (370 seconds, P = .01) in the CICO scenario. The time to ETI was not significantly delayed by wearing PPE in the standard (P = .19) or CICO variant (P = .97). Communication challenges, equipment complications, and PPE difficulties were reported, but ways to mitigate these were also reported. CONCLUSION: In-aircraft RSI (aircraft on the ground) while wearing PPE for AGPs had no significant impact on the time to successful completion of ETI in a simulated setting. Patient safety is paramount in civilian helicopter emergency medical services, but the adoption of in-aircraft RSI could confer significant patient benefit in terms of prehospital time savings, and further research is warranted.


Subject(s)
Anesthesia , COVID-19 , Emergency Medical Services , Aircraft , Feasibility Studies , Humans , Intubation, Intratracheal , Personal Protective Equipment , SARS-CoV-2
15.
Surg Clin North Am ; 102(1): 169-180, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1517479

ABSTRACT

Mass casualty incidents are increasingly common. They are defined by large numbers of patients arriving nearly simultaneously, overwhelming available resources needed for optimal care. They require rapid mobilization of resources to provide optimal outcomes and limit disability and death. Because the mechanism of injury in a mass casualty incident is often traumatic in nature, surgeons should be aware of the critical role they play in planning and response. The coronavirus disease 2019 pandemic is a notable, resulting in a sustained surge of critically ill patients. Initial response requires local mobilization of resources; large-scale events potentially require a national response.


Subject(s)
Civil Defense , Emergency Medical Services , Health Resources , Mass Casualty Incidents , COVID-19/epidemiology , COVID-19/prevention & control , Decision Trees , Humans , Triage
16.
Int J Environ Res Public Health ; 18(21)2021 11 03.
Article in English | MEDLINE | ID: covidwho-1512296

ABSTRACT

BACKGROUND: There are more and more foreigners in Poland who become clients of the Polish healthcare system. They use, among others, emergency medical services provided by healthcare professionals: doctors, nurses, and paramedics. Skillful care for culturally different patients requires cultural competencies and cultural intelligence to ensure good quality of care and cultural safety. The study aimed to measure and assess the cultural competencies and cultural intelligence of medical professionals working in hospital emergency departments (HEDs) and hospital emergency rooms (HERs) in Malopolska, a region in southern Poland. METHODS: The following questionnaires were used in the study: the Cross-Cultural Competence Inventory (CCCI), the Cultural Intelligence Scale (CQS), and Questionnaire on Attitudes Towards Culturally Divergent People. In total, 709 medical professionals participated in the study, including 363 nurses, 223 paramedics, and 123 doctors. RESULTS: Cultural intelligence-the overall score and the scores on the metacognitive, cognitive, motivational, and behavioral subscales were significantly higher among HED and HER doctors. Cultural competencies-the overall score and the score on the cultural adaptation subscale were also significantly higher among HED and HER doctors. The CCCI and CQS scores were influenced by selected variables: taking care of and close interactions with representatives of other cultural circles; staying outside Poland for more than a month. Doctors were the group of medical professionals that were most tolerant and most positive towards people from other cultures. CONCLUSIONS: The research results confirm the positive impact of contact of medical professionals with people from other cultures on their cultural competencies and cultural intelligence. They indicate the need for training in acquiring cultural competencies and developing cultural intelligence, especially among nurses. They demonstrate the need to raise awareness among HED and HER medical professionals about issues in intercultural care and to increase diversity efforts, especially among nurses.


Subject(s)
Cultural Competency , Emergency Medical Services , Delivery of Health Care , Health Personnel , Humans , Intelligence , Surveys and Questionnaires
18.
PLoS One ; 16(11): e0259703, 2021.
Article in English | MEDLINE | ID: covidwho-1506037

ABSTRACT

Two mRNA vaccines (BNT162b2 and mRNA-1273) against severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) are globally authorized as a two-dose regimen. Understanding the magnitude and duration of protective immune responses is vital to curbing the pandemic. We enrolled 461 high-risk health services workers at the University of California, Los Angeles (UCLA) and first responders in the Los Angeles County Fire Department (LACoFD) to assess the humoral responses in previously infected (PI) and infection naïve (NPI) individuals to mRNA-based vaccines (BNT162b2/Pfizer- BioNTech or mRNA-1273/Moderna). A chemiluminescent microparticle immunoassay was used to detect antibodies against SARS-CoV-2 Spike in vaccinees prior to (n = 21) and following each vaccine dose (n = 246 following dose 1 and n = 315 following dose 2), and at days 31-60 (n = 110) and 61-90 (n = 190) following completion of the 2-dose series. Both vaccines induced robust antibody responses in all immunocompetent individuals. Previously infected individuals achieved higher median peak titers (p = 0.002) and had a slower rate of decay (p = 0.047) than infection-naïve individuals. mRNA-1273 vaccinated infection-naïve individuals demonstrated modestly higher titers following each dose (p = 0.005 and p = 0.029, respectively) and slower rates of antibody decay (p = 0.003) than those who received BNT162b2. A subset of previously infected individuals (25%) required both doses in order to reach peak antibody titers. The biologic significance of the differences between previously infected individuals and between the mRNA-1273 and BNT162b2 vaccines remains uncertain, but may have important implications for booster strategies.


Subject(s)
COVID-19 Vaccines , COVID-19/immunology , COVID-19/prevention & control , Immunity, Humoral , SARS-CoV-2 , Academic Medical Centers , Antibodies, Viral/immunology , Antibody Formation , California/epidemiology , Emergency Medical Services , Emergency Responders , Health Personnel , Humans , Immunoassay , RNA, Messenger/metabolism , Universities
19.
Acta Biomed ; 92(5): e2021486, 2021 11 03.
Article in English | MEDLINE | ID: covidwho-1503540

ABSTRACT

BACKGROUND AND AIM: The incidence of Out of Hospital Cardiac Arrest (OHCA) is estimated at 1/1000 persons/year. In the pre-Covid-19 era world, OHCA survival rate in Europe was 7-6%. The main objective is to analyze OHCA survival in the Lombardy region by highlighting the factors related to both the victims' characteristics and the chain of survival. METHODS: All OHCAs were grouped into four pre-established periods in 2019 (14-23 January; 15-24 April; 15-24 July; 14-23 October). Following the Utstein method, we selected witnessed OHCAs with presumed cardiac etiology. The outcome of each case was collected in four moments in time: Return of spontaneous circulation (ROSC), Emergency Department (ED), 24 hours and 30 days. The neurological outcome 30 days after OHCA was also investigated and stratified with the Cerebral Performance Category Score (CPC). RESULTS: We selected 456 cases of OHCA with witnessed cardiac etiology. ROSC was achieved in 121 cases (26.5%), survival in the Emergency Departments in 110 patients (24.1%), after 24 hours in 86 (18.86%) and after 30 days in 72 (15.8%). Male sex was shown to improve OHCA survival. A shockable presentation rhythm, Cardiopulmonary Resuscitation (CPR) performed by bystanders and the activation of Public Access Defibrillation (PAD) positively influenced OHCA outcome. CONCLUSIONS: Males are more predisposed to incur an OHCA event than females, but they have greater chances of survival. Factors most related to survival are: shockable rhythm, bystanders CPR and the activation of a PAD. (www.actabiomedica.it).


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Female , Humans , Male , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/etiology , Out-of-Hospital Cardiac Arrest/therapy , SARS-CoV-2
20.
Clin Infect Dis ; 73(9): e2853-e2860, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1501011

ABSTRACT

BACKGROUND: The objective of this study was to perform a seroprevalence survey on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among Danish healthcare workers to identify high-risk groups. METHODS: All healthcare workers and administrative personnel at the 7 hospitals, prehospital services, and specialist practitioner clinics in the Central Denmark Region were invited to be tested by a commercial SARS-CoV-2 total antibody enzyme-linked immunosorbent assay (Wantai Biological Pharmacy Enterprise Co, Ltd, Beijing, China). RESULTS: A total of 25 950 participants were invited. Of these, 17 971 had samples available for SARS-CoV-2 antibody testing. After adjustment for assay sensitivity and specificity, the overall seroprevalence was 3.4% (95% confidence interval [CI], 2.5%-3.8%). The seroprevalence was higher in the western part of the region than in the eastern part (11.9% vs 1.2%; difference: 10.7 percentage points [95% CI, 9.5-12.2]). In the high-prevalence area, the emergency departments had the highest seroprevalence (29.7%), whereas departments without patients or with limited patient contact had the lowest seroprevalence (2.2%). Among the total 668 seropositive participants, 433 (64.8%) had previously been tested for SARS-CoV-2 RNA, and 50.0% had a positive reverse-transcription polymerase chain reaction (PCR) result. CONCLUSIONS: We found large differences in the prevalence of SARS-CoV-2 antibodies in staff working in the healthcare sector within a small geographical area of Denmark. Half of all seropositive staff had been tested positive by PCR prior to this survey. This study raises awareness of precautions that should be taken to avoid in-hospital transmission. Regular testing of healthcare workers for SARS-CoV-2 should be considered to identify areas with increased transmission.


Subject(s)
COVID-19 , Emergency Medical Services , Administrative Personnel , Antibodies, Viral , Delivery of Health Care , Denmark/epidemiology , Health Personnel , Hospitals , Humans , RNA, Viral , SARS-CoV-2 , Seroepidemiologic Studies
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