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1.
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
4.
BMC Emerg Med ; 21(1): 95, 2021 08 14.
Article in English | MEDLINE | ID: covidwho-1440901

ABSTRACT

BACKGROUND: As the first link in the chain of providing healthcare services in the frontline of the battle against COVID-19, emergency medical services (EMS) personnel are faced with various challenges, which affect their professional performance. The present study aimed to identify some strategies to manage the COVID-19-related challenges faced by the pre-hospital emergency care personnel in the south of Iran. METHODS: In this qualitative descriptive study, 27 pre-hospital emergency care personnel who were selected through the purposeful sampling method. Data were collected through 27 semi-structured, in-depth, individual interviews. The collected data were then analyzed based on the Granheim and Lundman's method. RESULTS: Analysis of the data resulted in the identification of 3 main themes and eight sub-themes. These three main themes were as follows: comprehensive and systematic planning, provision of medical equipment, and reduction of professional challenges. CONCLUSION: The findings of the present study showed that, during the COVID-19 crisis, emergency medical services personnel should be provided with a comprehensive and systematic protocol to provide pre-hospital care and their performance should be assessed in terms of a set of scientific standards. Due to lack of equipment and work overload in the current crisis, emergency medical services personnel are faced with many psychological challenges, which adversely affect their quality of pre-hospital emergency care. Furthermore, emergency care senior managers should develop comprehensive protocols, provide more equipment, and eliminate professional challenges to pave the ground for improving the quality and safety of the healthcare services in pre-hospital emergency care during the current COVID-19 crisis.


Subject(s)
COVID-19/psychology , Emergency Medical Services/organization & administration , Emergency Responders/psychology , Health Personnel/psychology , COVID-19/epidemiology , Emergencies , Humans , Iran , Occupational Health , Pandemics , Qualitative Research , SARS-CoV-2
5.
PLoS One ; 16(7): e0253978, 2021.
Article in English | MEDLINE | ID: covidwho-1325434

ABSTRACT

Coronavirus disease 2019(COVID-19) has brought great disasters to humanity, and its influence continues to intensify. In response to the public health emergencies, prompt relief supplies are key to reduce the damage. This paper presents a method of emergency medical logistics to quick response to emergency epidemics. The methodology includes two recursive mechanisms: (1) the time-varying forecasting of medical relief demand according to a modified susceptible-exposed-infected- Asymptomatic- recovered (SEIAR) epidemic diffusion model, (2) the relief supplies distribution based on a multi-objective dynamic stochastic programming model. Specially, the distribution model addresses a hypothetical network of emergency medical logistics with considering emergency medical reserve centers (EMRCs), epidemic areas and e-commerce warehousing centers as the rescue points. Numerical studies are conducted. The results show that with the cooperation of different epidemic areas and e-commerce warehousing centers, the total cost is 6% lower than without considering cooperation of different epidemic areas, and 9.7% lower than without considering cooperation of e-commerce warehousing centers. Particularly, the total cost is 20% lower than without considering any cooperation. This study demonstrates the importance of cooperation in epidemic prevention, and provides the government with a new idea of emergency relief supplies dispatching, that the rescue efficiency can be improved by mutual rescue between epidemic areas in public health emergency.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Civil Defense/organization & administration , Emergency Medical Services/organization & administration , Pandemics , Public Health/methods , COVID-19/transmission , COVID-19/virology , China/epidemiology , Civil Defense/economics , Emergencies/epidemiology , Emergency Medical Services/economics , Humans , Intersectoral Collaboration , Models, Statistical , SARS-CoV-2/pathogenicity , SARS-CoV-2/physiology
6.
Ann Emerg Med ; 78(5): 577-586, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1281385

ABSTRACT

The COVID-19 pandemic has shed light on the ongoing pandemic of racial injustice. In the context of these twin pandemics, emergency medicine organizations are declaring that "Racism is a Public Health Crisis." Accordingly, we are challenging emergency clinicians to respond to this emergency and commit to being antiracist. This courageous journey begins with naming racism and continues with actions addressing the intersection of racism and social determinants of health that result in health inequities. Therefore, we present a social-ecological framework that structures the intentional actions that emergency medicine must implement at the individual, organizational, community, and policy levels to actively respond to this emergency and be antiracist.


Subject(s)
Emergency Medical Services , Emergency Medicine , Health Status Disparities , Racism , Social Determinants of Health , COVID-19/epidemiology , Cultural Competency , Cultural Diversity , Emergency Medical Services/organization & administration , Emergency Medicine/education , Emergency Medicine/organization & administration , Health Policy , Humans , Pandemics , Prejudice , SARS-CoV-2 , United States/epidemiology
7.
West J Emerg Med ; 22(3): 608-613, 2021 Mar 25.
Article in English | MEDLINE | ID: covidwho-1266880

ABSTRACT

Imperial County is in southern California, one of the state's two counties at the international United States-Mexico border. The county is one of the most resource-limited in the state, with only two hospitals serving its 180,000 citizens, and no tertiary care centers. A significant portion of the population cared for at the local hospitals commutes from Mexicali, a large city of 1.2 million persons, just south of Imperial County's ports of entry. Since May 2020, following an outbreak in Mexicali, Imperial County has seen a significant increase in the number of COVID-19 patients, quickly outpacing its local resources. In response to this surge an alternate care site (ACS) was created as part of a collaboration between the California State Emergency Medical Service Authority (EMSA) and the county. In the first month of operations (May 26-June 26, 2020) the ACS received 106 patients with an average length of stay of 3.6 days. The average patient age was 55.5 years old with a range of 19-95 years. Disposition of patients included 25.5% sent to the emergency department for acute care needs, 1.8% who left against medical advice, and 72.7% who were discharged home or to a skilled nursing facility. There were no deaths on site. This study shares early experiences, challenges, and innovations created with the implementation of this ACS. Improving communication with local partners was the single most significant step in overcoming initial barriers.


Subject(s)
COVID-19/epidemiology , Emergency Medical Services/organization & administration , Adult , Aged , Aged, 80 and over , California , Female , Humans , Male , Medically Underserved Area , Middle Aged , SARS-CoV-2 , Young Adult
8.
Pediatr Emerg Care ; 37(7): 389-396, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1258823

ABSTRACT

OBJECTIVES: The Pediatric Emergency Research Network (PERN) was launched in 2009 with the intent for existing national and regional research networks in pediatric emergency care to organize globally for the conduct of collaborative research across networks. METHODS: The Pediatric Emergency Research Network has grown from 5- to 8-member networks over the past decade. With an executive committee comprising representatives from all member networks, PERN plays a supportive and collaborative rather than governing role. The full impact of PERN's facilitation of international collaborative research, although somewhat difficult to quantify empirically, can be measured indirectly by the observed growth of the field, the nature of the increasingly challenging research questions now being addressed, and the collective capacity to generate and implement new knowledge in treating acutely ill and injured children. RESULTS: Beginning as a pandemic response with a high-quality retrospective case-controlled study of H1N1 influenza risk factors, PERN research has progressed to multiple observational studies and ongoing global randomized controlled trials. As a recent example, PERN has developed sufficient network infrastructure to enable the rapid initiation of a prospective observational study in response to the current coronavirus disease 2019 pandemic. In light of the ongoing need for translation of research knowledge into equitable clinical practice and to promote health equity, PERN is committed to a coordinated international effort to increase the uptake of evidence-based management of common and treatable acute conditions in all emergency department settings. CONCLUSIONS: The Pediatric Emergency Research Network's successes with global research, measured by prospective observational and interventional studies, mean that the network can now move to improve its ability to promote the implementation of scientific advances into everyday clinical practice. Achieving this goal will involve focus in 4 areas: (1) expanding the capacity for global randomized controlled trials; (2) deepening the focus on implementation science; (3) increasing attention to healthcare disparities and their origins, with growing momentum toward equity; and (4) expanding PERN's global reach through addition of sites and networks from resource-restricted regions. Through these actions, PERN will be able to build on successes to face the challenges ahead and meet the needs of acutely ill and injured children throughout the world.


Subject(s)
Emergency Medical Services/organization & administration , Emergency Medicine/methods , Health Services Research/organization & administration , Pediatrics/organization & administration , Child , Health Promotion , Humans , International Cooperation
9.
Semin Vasc Surg ; 34(2): 51-59, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1243326

ABSTRACT

Mass casualty incidents can be devastating events associated with a large number of fatalities, morbidities, and long-lasting sequelae. The negative outcomes can be further amplified if the incident occurred during a pandemic surge, such as what occurred in Beirut, Lebanon with the August 4, 2020 Beirut Port explosion. To decrease the mortality and morbidity and avoid inefficiency, management depends on having an established coordinated multidisciplinary approach from transport and triage to emergency department care and in-hospital management. In this article, the mass casualty management and the impact of the coronavirus disease 2019 pandemic will be discussed based on the American University of Beirut Medical Center experience.


Subject(s)
COVID-19/epidemiology , Emergency Medical Services/organization & administration , Infection Control/organization & administration , Mass Casualty Incidents , Academic Medical Centers , COVID-19/prevention & control , COVID-19/transmission , Humans , Lebanon/epidemiology , Retrospective Studies
10.
Emerg Med J ; 38(5): 371-372, 2021 May.
Article in English | MEDLINE | ID: covidwho-1197268

ABSTRACT

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people's services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.


Subject(s)
COVID-19/epidemiology , Community Health Services/organization & administration , Emergency Medical Services/organization & administration , Emergency Service, Hospital/organization & administration , Health Services for the Aged/organization & administration , Humans , Neoplasms/therapy , Palliative Care/organization & administration , Pandemics , Patient Discharge , SARS-CoV-2
13.
Indian J Ophthalmol ; 69(3): 701-705, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1089038

ABSTRACT

Purpose: The aim of this study was to evaluate the changing trends in terms of patient load, presenting complaints, surgical procedures and resource utilization in a multispeciality tertiary care hospital after lockdown due to COVID-19. Methods: Retrospective.data were collected from Ophthalmology in-patient and emergency services of a government medical college and multispecialty tertiary care hospital in North India. Data pertaining to patient census, presenting complaints, surgical procedures and resource consumption were compared in the 6-month period (March 25 to September 30, 2020) following national lockdown and subsequent gradual unlock to data of same time period last year. Results: A total of 1152 new patients visited Ophthalmology emergency service, whereas 324 sought tele-ophthalmology consultation.Majority were males (61.8%, n = 712), whereas average age of presentation was 34 ± 7.2 years. The number.of patients seeking emergency ophthalmic care reduced by 23.9% in the current year, in-patient record reduced by 96.53% and number of surgeries reduced by 98.13%. Tele-ophthalmology services comprised 21.95% of the total patient load. Use of triple layered surgical masks increased by 85.7%, use of disposable gloves increased by 89.5% but interestingly the availability of chlorhexidine hand rub fell by 15.9%, in the current year compared to last year. Conclusion: COVID-19 pandemic and lockdown have reduced the number of patients visiting tertiary health care facility for ophthalmic care. As manpower and resource consumption has increased, smart management is needed to tackle the current scenario efficiently. Tele-ophthalmology must be promoted and we must understand the changing trends to plan for the future accordingly.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/organization & administration , Emergency Medical Services/organization & administration , Eye Diseases/epidemiology , Ophthalmology/trends , Quarantine , SARS-CoV-2 , Comorbidity , Emergencies , Female , Humans , India/epidemiology , Male , Pandemics , Retrospective Studies
14.
Emerg Med J ; 38(4): 308-314, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1081663

ABSTRACT

Emilia-Romagna was one of the most affected Italian regions during the COVID-19 outbreak in February 2020. We describe here the profound regional, provincial and municipal changes in response to the COVID-19 pandemic, to cope with the numbers of patients presenting with COVID-19 illness, as well as coping with the ongoing need to care for patients presenting with non-COVID-19 emergencies. We focus on the structural and functional changes in one particular hospital within the city of Bologna, the regional capital, which acted as the central emergency hub for time-sensitive pathologies for the province of Bologna. Finally, we present the admissions profile to our emergency department in relation to the massive increase of infected patients observed in our region as well as the organisational response to prepare for the second wave of the pandemic.


Subject(s)
COVID-19/epidemiology , Disease Outbreaks , Emergency Medical Services/organization & administration , Emergency Service, Hospital/organization & administration , Air Ambulances , COVID-19/therapy , Critical Care/organization & administration , Hospital Restructuring , Hospitals, Urban/organization & administration , Humans , Intensive Care Units/organization & administration , Italy/epidemiology , Operating Rooms/organization & administration , Personal Protective Equipment
15.
J Fr Ophtalmol ; 44(3): 307-312, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1078008

ABSTRACT

PURPOSE: This study aimed to evaluate the ability of a freely accessible internet algorithm to correctly identify the need for emergency ophthalmologic consultation for correct diagnosis and management. METHOD: This retrospective observational cohort study was based on the first 100 patients who requested recommendations on the necessity of breaking the lockdown for emergency ophthalmology consultation during the period from March to May 2020. RESULTS: Ninety-one patients completed questionnaires. Forty-nine were directed to emergency consultation and 42 to differed scheduled visits or telemedicine visits. One patient sent for emergency consultation had an overestimated severity and could have been seen later, while two patients initially recommended for a scheduled visit were considered appropriate for emergency consultation. However, these patients' management did not suffer as a consequence of the delay. The sensitivity of the algorithm, defined as the number of emergency consultations suggested by the algorithm divided by the total number of emergency consultations deemed appropriate by the practitioner's final evaluation, was 96.0%. The specificity of the algorithm, defined as the number of patients recommended for delayed consultation by the algorithm divided by the number of patients deemed clinically appropriate for this approach, was 97.5%. The positive predictive value, defined as the number of appropriate emergency consultations divided by the total number of emergency consultations suggested by the algorithm, was 97.9%. Finally, the negative predictive value, defined as the number of appropriately deferred patients divided by the number of deferred patients recommended by the algorithm, was 95.2%. CONCLUSION: This study demonstrates the reliability of an algorithm based on patients' past medical history and symptoms to classify patients and direct them to either emergency consultation or to a more appropriate deferred, scheduled appointment. This algorithm might allow reduction of walk-in visits by half and thus help control patient flow into ophthalmologic emergency departments.


Subject(s)
Algorithms , Appointments and Schedules , COVID-19/epidemiology , Emergencies , Eye Diseases/therapy , Ophthalmology/organization & administration , Quarantine , Adult , Aged , Aged, 80 and over , Cohort Studies , Communicable Disease Control/standards , Emergencies/epidemiology , Emergency Medical Services/organization & administration , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/standards , Eye Diseases/epidemiology , Female , Humans , Male , Middle Aged , Paris/epidemiology , Referral and Consultation/organization & administration , Referral and Consultation/standards , Reproducibility of Results , Retrospective Studies , Surveys and Questionnaires , Telemedicine/organization & administration , Telemedicine/standards , Young Adult
16.
Ann Ig ; 33(5): 410-425, 2021.
Article in English | MEDLINE | ID: covidwho-1076850

ABSTRACT

Methods: We hereby provide a systematic description of the response actions in which the public health residents' workforce was pivotal, in a large tertiary hospital. Background: The Coronavirus Disease 2019 pandemic has posed incredible challenges to healthcare workers worldwide. The residents have been affected by an almost complete upheaval of the previous setting of activities, with a near total focus on service during the peak of the emergency. In our Institution, residents in public health were extensively involved in leading activities in the management of Coronavirus Disease 2019 pandemic. Results: The key role played by residents in the response to Coronavirus Disease 2019 pandemic is highlighted by the diversity of contributions provided, from cooperation in the rearrangement of hospital paths for continuity of care, to establishing and running new services to support healthcare professionals. Overall, they constituted a workforce that turned essential in governing efficiently such a complex scenario. Conclusions: Despite the difficulties posed by the contingency and the sacrifice of many training activities, Coronavirus Disease 2019 pandemic turned out to be a unique opportunity of learning and measuring one's capabilities and limits in a context of absolute novelty and uncertainty.


Subject(s)
COVID-19/epidemiology , Internship and Residency , Pandemics , Public Health Administration , Public Health/education , SARS-CoV-2 , Asymptomatic Infections , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/therapy , COVID-19 Testing , Case Management/organization & administration , Emergency Medical Services/organization & administration , Emergency Medical Services/supply & distribution , Health Personnel , Health Services Needs and Demand , Humans , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Italy , Mass Screening , Outpatient Clinics, Hospital/organization & administration , Population Surveillance , Preoperative Care , Quarantine , Role , Self-Assessment , Software Design , Tertiary Care Centers/organization & administration , Workforce
19.
Prehosp Disaster Med ; 35(6): 693-697, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1065737

ABSTRACT

This report describes the main adaptive and transformative changes adopted by the brand-new National Emergency Medical Service (NEMS) to face the novel coronavirus disease 2019 (COVID-19) in Sierra Leone, including ambulance re-distribution, improvements in communication flow, implementation of ad-hoc procedures and trainings, and budget re-allocation. In a time-span of four months, 1,170 COVID-19 cases have been handled by the NEMS through a parallel referral system, while efforts have been made to manage the routine emergencies of the country, causing a substantial intensification of daily activities.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/organization & administration , Emergency Medical Services/organization & administration , Government Programs , Humans , Pandemics , SARS-CoV-2 , Sierra Leone/epidemiology
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