Effects of universal masking on Massachusetts healthcare workers' COVID-19 incidence.

BACKGROUND: Healthcare workers (HCWs) and other essential workers are at risk of occupational infection during the COVID-19 pandemic. Several infection control strategies have been implemented. Evidence shows that universal masking can mitigate COVID-19 infection, though existing research is limited by secular trend bias. AIMS: To investigate the effect of hospital universal masking on COVID-19 incidence among HCWs compared to the general population. METHODS: We compared the 7-day average incidence rates between a Massachusetts (USA) healthcare system and Massachusetts residents statewide. The study period was from 17 March (the date of first incident case in the healthcare system) to 6 May (the date Massachusetts implemented public masking). The healthcare system implemented universal masking on 26 March, we allotted a 5-day lag for effect onset and peak COVID-19 incidence in Massachusetts was 20 April. Thus, we categorized 17-31 March as the pre-intervention phase, 1-20 April the intervention phase and 21 April to 6 May the epidemic decline phase. Temporal incidence trends (i.e. 7-day average slopes) were compared using standardized coefficients from linear regression models. RESULTS: The standardized coefficients were similar between the healthcare system and the state in both the pre-intervention and epidemic decline phases. During the intervention phase, the healthcare system's epidemic slope became negative (standardized ß: -0.68, 95% CI: -1.06 to -0.31), while Massachusetts' slope remained positive (standardized ß: 0.99, 95% CI: 0.94 to 1.05). CONCLUSIONS: Universal masking was associated with a decreasing COVID-19 incidence trend among HCWs, while the infection rate continued to rise in the surrounding community.

Emergency medical services providers and weapons in the prehospital setting.

OBJECTIVES: To investigate emergency medical services (EMS) providers' experience with weapons encountered while working, and evaluate the training they have received regarding searching for and confiscating weapons in the field. METHODS: This was a descriptive, cross-sectional survey anonymously completed by a convenience sample of EMS providers in the metropolitan Boston and Los Angeles (LA) areas. RESULTS: Of 2,672 surveys distributed, 2,224 (83%) were returned. Forty-two percent of the respondents (39% of Boston and 46% of LA) reported searching patients for weapons, and 62% (51% of Boston and 76% of LA) reported finding weapons. The LA respondents were more likely than the Boston respondents to have found a firearm. Twenty-seven percent of the respondents reported they had found more than five weapons in their careers. One thousand seven hundred seventy-two (80%) providers replied that they would report discovered weapons, most frequently to law enforcement personnel. Providers with higher EMS education and ones who received weapons-related training were more likely to search for, find, and report weapons. Four hundred fifty-one (20%) respondents reported receiving formal weapons-related training, 291 (13%) considered their initial EMS training on weapons-related topics to be adequate, and 292 (13%) considered their continuing education in these areas adequate. CONCLUSIONS: These data suggest that weapons encountered in the field are a widespread problem for EMS providers. Although many EMS providers search for and find weapons on their patients, most of them feel they have been inadequately trained in this area. Prospective studies are needed to document the actual incidence of weapon encounters in the prehospital setting. Multidisciplinary discussions are needed to address the above issues.

Prehospital thrombolysis: an idea whose time has come.

Aggressive reperfusion therapy for myocardial infarction (MI) characterized by acute ST-segment elevation leads to improved patient outcome. Furthermore, use of thrombolytic therapy is highly time-dependent: reperfusion therapy is beneficial within 12 h, but the earlier it is administered, the more beneficial it is. Thus, the focus of both prehospital and emergency department management of patients with acute MI is on rapid identification and treatment. There are many components to the time delays between the onset of symptoms of acute MI and the achievement of reperfusion in the occluded infarct-related artery. Time delays occur with both the patient and the prehospital emergency medical system, although patient delays are more significant. This article focuses on the prehospital management of acute MI, including (1) the rationale for rapid reperfusion in patients with acute MI, (2) the factors related to time delays in patient presentation to the hospital, and (3) strategies for reducing time delays, both patient- and medical system-based.

End-tidal CO2 measurement in the detection of esophageal intubation during cardiac arrest.

Measurement of end-tidal carbon dioxide (ETCO2) has been used to detect accidental esophageal tube placement in noncardiac arrest situations. The purpose of our study was to determine whether ETCO2 measurement could distinguish tracheal from esophageal tube placement during closed-chest massage (CCM). Twelve large dogs were anesthetized, and endotracheal tubes were placed in both the trachea and the esophagus. Placement was verified by fiberoptic endoscopy. Ventricular fibrillation was induced by a 60-Hz discharge through a right ventricular pacemaker. After four minutes of cardiac arrest, CCM was initiated and continued for 20 minutes. The dogs were divided into two groups: Group A was ventilated through the tracheal tube, and group B was ventilated through the esophageal tube. Unused tubes were removed. ETCO2 was recorded continuously beginning two minutes before arrest until the end of the experiment. There were no significant between-group differences in mean arterial pressure, weight, blood loss, IV fluid volume administered, or prearrest arterial blood gases. ETCO2 differed significantly between the two groups throughout CCM (P = .001). In group A, ETCO2 ranged from 13 to 34 mm Hg (median, 20 mm Hg). In group B, ETCO2 ranged from 2 to 11 mm Hg (median, 3 mm Hg). In this experimental model, measurement of ETCO2 reliably distinguished esophageal from tracheal intubation during cardiac arrest and CCM. If confirmed in human beings, this may prove to be a quick, reliable method of detecting esophageal intubation during cardiac arrest.