Impact of repeated military conflicts on civilian patterns of emergency medical services utilization: A retrospective cohort study.

OBJECTIVE: To assess the impact of repeated rocket attacks on a civilian population during successive military conflicts on the patterns of emergency medical services (EMS) utilization. DESIGN: This retrospective cohort study (2008-2021) analyzed EMS data from one region of Israel characterized by intensive rocket attacks on a civilian population during four successive military conflicts. EMS activity for the periods prior to, during, and after the conflicts was compared. Data included call volume, type of calls ("medical illness," "motor vehicle collision (MVC)," and "other-injuries"), and level of response (advanced life support (ALS) or basic life support (BLS)). RESULTS: Compared to the Pre-Conflict period, there were statistically significant decreased volumes of calls during the 2008 (-20 percent), 2012 (-13 percent), and 2021 (-11 percent) military conflicts for "medical illness" and during the 2008 (-23 percent), 2012 (-30 percent), and 2021 (-31 percent) for "MVC." Decreases in calls for "medical illness" were accompanied by decreased ALS dispatches (-28, -33, and -18 percent for 2008, 2012, and 2021, respectively). The number of calls returned to preconflict values during the Post-Conflict periods. No change was evidenced in numbers of calls during the 2014 military conflict. CONCLUSION: Military conflicts involving a civilian population were usually found to be associated with lower numbers of calls for the categories of "medical illness" and "MVC." Less calls for "medical illness" were associated with fewer ALS dispatches. There was a rapid return of call volumes to preconflict levels shortly after a ceasefire was reached. The absence of change in calls during the 2014 conflict suggests involvement of habituation processes.

Responses of a Pre-hospital Emergency Medical Service During Military Conflict Versus COVID-19: A Retrospective Comparative Cohort Study.

BACKGROUND: Decreases in routine healthcare practices have been shown to occur during disasters. However, research regarding the impacts of natural disasters, pandemics, or military conflicts on emergency medical services (EMS) is scarce. OBJECTIVES: This study assessed the impact of a military conflict versus the coronavirus disease 2019 (COVID-19) pandemic on a national EMS organization in terms of responses to overall daily emergencies, medical illnesses, motor vehicle collisions, and other injuries. METHODS: This retrospective comparative cohort study assessed daily routine emergency ambulance calls to Magen David Adom (MDA), Israel's national EMS organization. This included overall emergency calls as well as those related to medical illnesses, motor vehicle collisions (MVCs), and other injuries. All data were obtained from the MDA command and control database. During the military conflict Operation Protective Edge (2014), the civilian population was subjected to intensive rocket attacks for 24 days, followed by 26 days of a progressive withdrawal of operations and then to a post-conflict period. During the first wave of the COVID-19 pandemic (March-April 2020), the population was subjected to 32 days of total lockdown, followed by 27 days of progressive relief of confinement, and then to a post-lockdown period. RESULTS: The total number of emergency calls in this study was 330,430. During the conflict, the mean number of daily calls decreased, followed by an increase during Relief and Post-Conflict with higher values in Post-Conflict than in Pre-Conflict. During the COVID-19 pandemic, there was a decrease in the mean daily number of calls during Lockdown. It remained low during Relief and increased during Post-Lockdown. However, it remained lower in Post-Lockdown than during Pre-Lockdown. Calls related to medical illnesses decreased during the conflict and during the lockdown. The post-conflict period was characterized by a similar baseline call magnitude but not during the post-lockdown period. Decreases in calls for MVC and other injuries were significant during the lockdown but not during the military conflict. Post-lockdown was accompanied by return to baseline call volumes for MVC, whereas calls for other injuries increased above baseline both after the lockdown and military conflict. CONCLUSION: This study shows decreasing trends in routine daily calls for EMS during both Operation Protective Edge and COVID-19. However, different patterns of needs for EMS were evidenced for medical illnesses, MVC, or calls concerning other injuries. These results are instrumental for managing the operational demands of EMS during military conflicts and pandemics.

Evolution of emergency medical calls during a pandemic - An emergency medical service during the COVID-19 outbreak.

INTRODUCTION: Emergency Medical Services (EMS) are expected to be affected by a pandemic outbreak. However, the available data about trends and extents of these effects is limited. METHODS: We analyzed numbers of ambulance calls for all 136 diagnosis codes used by Magen David Adom (MDA), Israel's national EMS during 121 days between January 01 and April 30, 2020. RESULTS: There was an increase in calls for COVID-19 symptoms (cough, fever, throat pain). This trend followed the same shape as the curve for confirmed COVID-19 patients. Trends were found to increase for calls not followed by transport to the hospital as well as in calls for mental or psychiatric causes. Simultaneously, there was a decrease in calls for cardiovascular issues, pneumonia, and all injuries. CONCLUSION: Understanding these correlations may allow better preparedness of the EMS and a better response towards the public needs in the period of an epidemic or a pandemic.

Effects of high-phosphorus and/or low-calcium diets on bone tissue in trained male rats.

PURPOSE: The aim of the present study was to investigate if wheel running exercise could offset the detrimental influences of independent or combined high-phosphorus and low-calcium diets on bone tissue in rats. METHODS: Forty male dark Agouti rats were randomly assigned to eight groups of five animals. Four sedentary groups (SED) and four voluntary trained groups (TR) were fed over 6 wk of either a standard food or a modified diet, namely, high phosphorus (HP), low calcium (LCa), or high phosphorus combined with low calcium (HP/LCa). After sacrifice, blood samples were collected to determine parathyroid hormone, Ca(2+), and Pi levels. Both tibiae were removed for bone mass determination and extended histomorphometric analyses. RESULTS: In SED rats, all unbalanced diets induced a sizeable bone volume decrease, up to 56%. Interestingly, steady training partially compensates for this bone volume loss, regardless of the considered modified diets. At the cellular level, only independent LCa diet induced a 38% decrease in osteoblastic surface in both SED and TR rat groups, generating thereby a reduction in bone neosynthesis. In terms of osteoclastic surface, an increase in this parameter was evidenced only in HP diets (both HP and HP-LCa), implying heightened bone resorption. The major effects of unbalanced diets are mainly observed on bone tissue because serum parameters (parathyroid hormone, Ca(2+), and Pi levels) remained only slightly modified. CONCLUSIONS: Training induced a positive effect on unbalanced diet-altered bone tissue formation but remained inadequate to reach standard bone mass measured in SED rats fed with balanced food. Further, we suggest that the nature of the diet influences the balance between bone formation and resorption: LCa diet decreases bone formation, whereas HP and HP-LCa increase bone resorption.

Spaceflight affects bone formation in rhesus monkeys: a histological and cell culture study.

Using analyses of iliac crest cell and tissue, back-scattered electron imaging, and biochemical techniques, we characterized the effects of a 14-day spaceflight (Bion 11) on bone structure and bone formation in two 3- to 4-yr-old male rhesus monkeys compared with eight age-matched Earth-control monkeys. We found that postflight bone volume was 35% lower than preflight values in flight monkeys. This was associated with reduced osteoid (-40%) and mineralizing (-32%) surfaces and decreased bone formation rate (-53%). Moreover, flight monkeys exhibited trends to lower values of mineralization profile in iliac bone (back-scattered electron imaging) and to decreased osteocalcin serum levels (P = 0.08). The initial number of trabecular bone cells yielded in cultures did not differ in flight and control animals before or after the flight. However, osteoblastic cell proliferation was markedly lower in postflight vs. preflight at 9 and 14 days of culture in one flight monkey. This study suggests that a 14-day spaceflight reduces iliac bone formation, osteoblastic activity, and/or recruitment in young rhesus monkeys, resulting in decreased trabecular bone volume.

Transforming growth factor beta2 inhibits adipocyte differentiation induced by skeletal unloading in rat bone marrow stroma.

Skeletal unloading induced by hindlimb suspension in rats reduces bone formation and induces osteopenia, but its effect on adipogenesis is unknown. We assessed the effects of unloading and transforming growth factor (TGF) beta2 on bone marrow stromal cell adipocyte differentiation in relation with osteoblast differentiation. Skeletal unloading rapidly (4-7 days) decreased osteoblast transcription factor Runx2, osteocalcin (OC), and type I collagen messenger RNA (mRNA) levels and reduced bone formation in the long bone metaphysis. Conversely, unloading increased expression of the adipocyte transcription factor peroxisome proliferator-activated receptor gamma2 (PPARgamma2) at 4 days and increased expression of the adipocyte differentiation genes lipoprotein lipase (LPL) and aP2 in the bone marrow stroma at 7 days. Consistently, unloading increased the number and volume of adipocytes in the bone marrow stroma. Continuous (0-7 days) and late (4-7 days) treatments with TGF-beta2 corrected the abnormal expression of Cbfa1/Runx2, OC, and type I collagen mRNAs and normalized bone formation in unloaded metaphyseal bone. Moreover, both TGF-beta2 treatments decreased PPARy2 and C/EBPalpha mRNA levels at 4 days and normalized aP2 and LPL expression and adipocyte number and volume at 7 days. These results show that skeletal unloading increases adipocyte differentiation concomitantly with inhibition of osteoblast differentiation. These abnormalities are prevented and reversed by TGF-beta2, suggesting a role for TGF-beta in the control of adipogenic differentiation in the bone marrow stroma.

Effects of space food bar feeding on bone mass and metabolism in normal and unloaded rats.

During spaceflights in the shuttle, rats are provided specific food bars. To determine whether this diet allows normal body and skeletal growth, we used four groups of rats fed either standard pellet food or space food bars during a 2-wk unloading experiment. We recorded food intake, body weight, tibial bone mass, and mineral content by ash analyses, cancellous bone volume, and cell activities by histomorphometry. We found that food intake was not different when comparing the two types of food, but that suspended animals had a lower food intake than normal loaded animals. Body weight and bone mass were found lower in suspended animals than in normal loaded animals. Finally, longitudinal growth rate, cancellous bone volume, and bone formation rate were lower in suspended animals, irrespective of the type of food. These results show that space food bar feeding did not affect normal body and skeletal growth, and that body and bone changes due to unloading were not significantly different in animals fed space food bars and standard food.