bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporal Trends of Ambulance Times for Suspected Stroke/Transient Ischemic Attack (TIA) Before and During the COVID-19 Pandemic in Ireland: A Retrospective Cohort Study
Authors: Burton Edel , Quinn Rory , Deasy Conor , Masterson Siobhán , O'Donnell Cathal , Merwick Áine , Willis David , Kearney Patricia , McCarthy Vera , Buckley Claire 
Published: June 2023

Introduction:International reports suggest there have been prehospital delays for time-sensitive emergencies like stroke and TIA during the COVID-19 pandemic. The aim was to investigate the impact of the COVID-19 pandemic on ambulance times and emergency call volume for adults with suspected stroke and TIA in Ireland.Method:We conducted a retrospective cohort study of patients ≥ 18 years with suspected stroke/TIA, based on data from the National Ambulance Service. We included all cases assigned code 28 (suspected stroke/TIA) by the emergency call-taker, from 2018-2021. We compared ambulance times and emergency call volume by week, the four COVID-19 waves (defined by the Health Protection Surveillance Centre) and annually. The COVID-19 period was from March 1, 2020 - December 19, 2021 and the pre-COVID-19 period January 1, 2018 - February 29, 2020. Continuous variables were compared with t-tests and categorical variables with Pearson’s χ2 tests.Results:40,012 cases were included: 20,281 in the pre-COVID-19 period and 19,731 in the COVID-19 period. Mean patient age significantly decreased between the two periods, from 71 years (±16.5) to 69.8 years (±17.1); p<0.001. Mean ambulance response time increased between the two periods from 17 minutes 31 seconds to 18 minutes 59 seconds (p<0.001). The number of cases with symptom onset to emergency call time of >4 hours significantly increased from 5,581 to 6,060 during the COVID-19 period (p<0.001). Mean calls/day increased from 25.1/day to 30.1/day during the COVID-19 period.Conclusion:Early findings from the study suggest an increase in call volume for stroke/TIA between the COVID-19 and pre-COVID-19 periods. An increase in response times during the same periods was also found. We concluded that longer symptom-to-call times indicate a change in healthcare-seeking behavior. Sustaining high levels of compliance with stroke code protocols is crucial during healthcare crises. Future research will involve further analysis including controlling for confounders.
Developing Prehospital Care in India–A Potential Model for Low- and Middle-income Countries
Authors: Bruce David , Ramakrishnan Trichur , Patel Pankaj (Peter) 
Published: June 2023

Introduction:Road traffic accidents and natural disasters cause significant numbers of deaths and life-changing injuries in low & middle-income countries. Most of these countries have limited resources for pre-hospital care and training. In 2021, there were 155,622 deaths due to road accidents and >18,000 railway-related deaths. Natural and manmade disasters also contribute to high numbers of serious injuries and deaths in the region. India is the pilot for developing an international training course for prehospital trauma care.Method:A review of pre-hospital care training and ambulance services in Tamil Nadu and Kerala states of India was carried out in 2019. An international workshop on developing pre-hospital care in India was held in Chennai in October 2022. The workshop included experts from UK and India and 52 practitioners from various parts of India.Results:India has developed a country-wide ambulance service sub-contracted to private providers under a public-private partnership initiative and in addition, there are private and charitable providers. In-transit care and resuscitation are limited and the vehicles are primarily a transport mechanism with a scoop-and-run policy. Infrastructure, traffic congestion, rural and hard-to-reach areas, poorly equipped ambulance services and variations in training and scope of practice contribute to the challenges of providing high quality pre-hospital care.Conclusion:There is a need for high-quality pre-hospital care training, regulation and continuing professional development within the pre-hospital care sector. Delivery of pre-hospital care could be reinforced by wider involvement of doctors such as General Practitioners and other allied health care professionals. It was agreed by all delegates and speakers that an international course on pre-hospital care based upon an existing UK course from the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh, edited to take account of India’s current resources, should be piloted in Chennai in 2023.
Immediate Medical Care Rendered by U.S. Law Enforcement Officers After Officer-Involved Shootings – An Open-Access Public Domain Video Analysis
Authors: Keim Audrey , McGuire Sarayna , Blakeney Craig , Brand Shari , Klassen Aaron , Luke Anuradha , Maher Steven , Wood Jeffrey , Sztajnkrycer Matthew 
Published: June 2023

Introduction:After officer-involved shootings, rapid delivery of emergency medical care is critical but may be delayed due to scene safety concerns. The purpose of this study was to describe medical care rendered by law enforcement officers (LEO) after lethal force incidents.Method:Retrospective analysis of open-source video footage of officer-involved shootings (OIS) occurring between 2/15/2013 and 12/31/2020. Frequency and nature of care provided, time until LEO and emergency medical services (EMS) care, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board.Results:342 videos were included in the final analysis. LEOs rendered care in 172 (50.3%) incidents. The average elapsed time from the time of injury to LEO-provided care was 155.8 + 198.8 seconds. Hemorrhage control was the most common intervention performed. An average of 214.2 seconds elapsed between LEO care and EMS arrival. No mortality difference was identified between LEO vs EMS care (p = 0.1631). Subjects with truncal wounds were more likely to die than those with extremity wounds (p < 0.00001).Conclusion:LEO rendered medical care in half of all OIS incidents, initiating care on average 3.5 minutes prior to EMS arrival. Although no significant mortality difference was noted for LEO versus EMS care, this finding must be interpreted cautiously, as specific interventions, such as extremity hemorrhage control, may have impacted select patients. Future studies are needed to determine optimal LEO care for these patients.
Developing Prepositioned Burn Care-Specific Disaster Resources for a BMCI
Authors: Kearns Randy , Flores Carl , Hargrove Paige , Arledge Frances , Prats Rosanne , Kanter Joseph , Hector Chris , Woods Jason , Sittig Kevin , Carter Jeffrey 
Published: June 2023

Introduction:Disaster planning and preparedness for a burn mass casualty incident (BMCI) must consider the needs of those who will be directly involved and support the response to such an event. An aspect of developing a more comprehensive statewide burn disaster program included meeting (regionally) with healthcare coalitions (HCC) to identify gaps in care and deficiencies.Method:Regularly scheduled (quarterly) HCC meetings are held around the state linking stakeholders representing local hospitals, health departments, emergency medical services (EMS) agencies, and other interested parties. We were able to use the HCCs regional meetings to serve as a platform for conducting focus group research to identify gaps specific to a BMCI and to inform strategy development for a statewide approach. Additionally, we held engagement meetings with state emergency response network (a state agency that coordinates the movement of ambulances to appropriate destinations) and the Burn Medical Directors findings were vetted from the focus groups.Results:One of the deficiencies identified, included a lack of burn-specific wound care dressings that could support the initial response. Relying on this same process, a consensus was attained for equipment types and quantities, including a kit for storage. Furthermore, a maintenance, supply replacement, and delivery to the scene processes were developed for these kits of supplies that could augment a BMCI response.Conclusion:Focus group feedback reminded us that outside of the world of burn care, many report an infrequent opportunity to provide care for patients with burn injuries. Several types of burn-specific dressings can be expensive, and with the occurrence being infrequent. EMS agencies and rural hospitals alike reported that it was unlikely their agency/hospital would have more than a minimal stock of burn injury supplies. Developing supply caches that can be quickly mobilized and deployed to the impacted area was one of the deficiencies we addressed.
Emergencies as Catalysts to Invest in the Health Workforce
Authors: Nitzan Dorit , Benin-Goren Odeda 
Published: June 2023

Introduction:Emergencies provide opportunities for deep systemic intra-action and after-action reviews, followed by changes and adaptations that are aimed at enhancing resilience against future health emergencies. One of the most prevalent lessons learned from the COVID-19 pandemic is the need to intensify the investment in the health workforce. Diverse groups of health workers have brought their expertise from the benches to patients’ beds, and the desks of the decision-makers.Method:Match skill mix of health staff with the needed level of care: those with mild diseases can be cared for by basic nursing staff. Critical patients require advanced skilled nursing that is familiarized with advanced technologies such as ECMO, and use “out-of-the-box” thinking.Developing the capabilities of the communities and civil society organizations to respond to emergencies. Cooperation agreements with partners that are not involved in medical care during “regular days” should be set before emergencies strike.Formulate civil-military-police cooperation as well as the Good Samaritan Law is an important legal instrument to allow for humanitarian aid from within and outside the country.Results:Matching the skill mix of the health staff with the needed level of care for basic nursing for minor patients as well as advanced nursing for critical patients, while using “out of the box “ thinking to develop a high level of knowledge is important to maintain quality care during emergencies.Conclusion:The COVID-19 pandemic and other emergencies provide us with the opportunity to switch from bouncing back to bouncing forward, and from just coping to anticipating and transforming. Investing in the health workforce would enhance preparedness and readiness so that emergencies will not turn into disasters and crises. The presentation will highlight some of the new approaches and methods applied during the COVID-19 outbreak, as well as those applied in countries that are faced with wars and military conflicts.
Use of Postmortem Computed Tomography in Disaster Victim Identification: Current Japanese Methods and Challenges
Authors: Yoshida Maiko , Motomura Ayumi , Makino Yohsuke , Saito Hisako , Iwase Hirotaro 
Published: June 2023

Introduction:In Japan, victims of large-scale disasters are usually identified by non-objective means. In the case of the 2011 Great East Japan Earthquake, ~90% of the bodies were identified based on nonobjective means such as facial features or belongings, which resulted in misidentification. At present, the situation remains the same. However, according to global standards, a method referred to as “disaster victim identification” (DVI; individual identification of disaster victims) is recommended by the International Criminal Police Organization; in this method, a multidisciplinary investigation team integrates objective information such as dental charts and DNA. Furthermore, recently, there has been a movement to employ postmortem computed tomography (CT) for personal identification, and radiologists are expected to be included in the DVI team.Method:In the Department of Legal Medicine of Chiba University in Japan, individual identification via CT or magnetic resonance imaging was conducted in forensic autopsy cases of unknown identities when there was an assumed person for the body and the antemortem image of the person could be acquired. Two certified radiologists interpreted and compared the antemortem CT with the postmortem CT taken prior to autopsy and assessed whether the two images were compatible to indicate the same person.Results:A total of 20 cases were judged. In all cases, two images were compatible, indicating the same person. Image-based identification was particularly useful when dental findings or fingerprints were unavailable for comparison and there were no family members available for DNA testing.Conclusion:In the future, this method will be applied to large-scale disasters.
Clinician Consensus on “Inappropriate” Presentations to the Emergency Department in the Better Data, Better Planning (BDBP) Census: A Cross-sectional Multi-center Study of Emergency Department Utilization in Ireland
Authors: Cummins Niamh , Barry Louise , Garavan Carrie , Devlin Collette , Corey Gillian , Cummins Fergal , Ryan Damien , Deasy Conor , McCarthy Gerald , Galvin Rose 
Published: June 2023

Introduction:Utilization of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing avoidable attendance is an important area for intervention in the prevention of ED crowding. This study aims to develop a consensus among clinicians across care settings about the “appropriateness” of attendance at the ED in Ireland.Method:The Better Data, Better Planning study was a multi-center, cross-sectional study investigating factors influencing ED utilization in Ireland. Following ethical approval, data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels.Results:The National Panel determined that 11% (GP) to 38% (EMC) of n=306 lower acuity presentations could be treated by a GP within 24-48h (k=0.259; p<0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered “inappropriate” (k=0.341; p<0.001). For attendances deemed “appropriate” the admission rate was 47% compared to 0% for “inappropriate” attendees. There was no consensus on 45% of charts (n=136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0-59% and for inappropriate attendances ranged from 0-29%. For the Local Panel review (n=306) consensus on appropriateness ranged from 40-76% across sites.Conclusion:Multidisciplinary clinicians agree that “inappropriate” use of Irish EDs is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogeneous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.
Critical Decision-making in Medical Command and Control During Early Covid-19: An Interview Study
Authors: Pettersson Jenny , Jonson Carl-Oscar , Friberg Marc , Björnqvist Anton , Berggren Peter , Frisk Jessica , Prytz Erik 
Published: June 2023

Introduction:A resilient health care system is expected to withstand disruptive events and consistently deliver high quality care by continually adapting, learning, and improving. To achieve these expectations, medical command and control teams are responsible for making relevant strategic decisions, reallocating resources, and initiating cooperation. Early during Covid-19, medical command and control teams were faced with an unforeseen increase in number of patients, as well as unknown disease mechanisms and treatment regimes. Timely and adequate decision-making to become a resilient healthcare system and maintain high quality care was necessary. The aim of the present study was to describe the challenges and strategies in a medical command and control team during the early phase of the Covid-19 pandemic.Method:A semi-structured retrospective in-depth interview study with phenomenological approach and inductive design was used. Thirteen experienced decision makers serving in a regional medical command and control team were interviewed using the Critical Decision Method. The interviews were analyzed using manifest conventional content analyses.Results:The respondents described twelve separate episodes during the Covid-19 management. The analysis resulted in five themes: organization, adaptation, common operational picture, assumptions, and analysis. Organization described how organizational challenges affected the decision-making process. Adaptation described the strategies to overcome the obstructive organizational factors. Common operational picture described how challenges in lack of available information affected decision-making and strategies used in creating situational awareness. Assumptions offered descriptions of strategies used to make decisions. Analysis emphasized descriptions and strategies affecting the decision-making process.Conclusion:This study enables a better understanding of how medical command and control teams can be organized and structured, while also highlighting challenges in maintaining high-quality care during unexpected events. The findings obtained in the present study provide further knowledge about disaster resilience and can be utilized in educational and training settings for medical command and control.
From Crisis to Challenges: The Use of ECMO During COVID-19 Outbreak in Israel
Authors: Goren Odeda Benin , Taub Sigal Liverant , Kassif Yigal 
Published: June 2023

Introduction:The use of ECMO devices began about 50 years ago. The purpose of the ECMO device is to enable gas exchange (oxygen and carbon dioxide) and/or hemodynamic support in situations of pulmonary or heart failure to recover or to serve as a bridge in a waiting period for heart pulmonary, heart, or artificial heart transplantation. The COVID-19 outbreak increased the need for the use of ECMO as a life-saving treatment. As a result, there was an increasing demand for qualified personnel in overloaded hospitals' ICUs to care for COVID-19 patients in general, specifically for those who required ECMO treatment. These required rapid team training and new methodology development collaboration between the Ministry of Health (MOH), multi-disciplinary teams, and a national professional committee that set the treatment protocols based on universal standards.Method:A professional national committee was appointed by the MoH. The committee included Physicians, Nurses, Cardiopulmonary Bypass Machine Operators/Perfusionists as well as MoH representatives. The role of the committee was to establish guidelines and standards for operating ECMO services. These guidelines were adopted by the MoH and are the basic recommendations for operating ECMO units in Israeli hospitals.Results:The whole process had a dual challenge. One challenge was establishing new ECMO units according to the guidelines and the universal standards created by the committee. The other challenge was to motivate the old and experienced ECMO units to adopt and work according to the official standards set by the committee.Conclusion:These days the committee started the evaluation of the old ECMO Units to bring all ECMO units in Israel to work by the same guidelines and standards.
Community-Based Response to Pandemic: Case Study of Home Isolation Center using Flexible Surge Capacity
Authors: Phattharapornjaroen Phatthranit , Carlström Eric , Sivarak Ornlatcha , Tansuwannarat Phantakan , Chalermdamrichai Phanorn , Sittichanbuncha Yuwares , Kongtoranin Lalana , Phattranonuthai Rabkwan , Marlow Phimonrat , Winyuchonjaroen Wiyada , Pongpasupa Nathikarn , Khorram-Manesh Amir 
Published: June 2023

Introduction:The SARS-CoV-2 virus 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the Flexible Surge Capacity concept in relieving hospitals by focusing on the community resources to develop “Home Isolation Centers” in Bangkok, Thailand.Method:This is a qualitative study consisting of observational and semi-structured interview data. The development and activities of Home Isolation Centers were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analyzed and categorized based on the practical elements necessary in disaster and emergency management.Results:The obtained data could be categorized into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: 1) coordination and collaboration, 2) staff engagement, 3) responsibility clarification, and 4) sustainability. Safety presented two subcategories: 1) patients’ information privacy and treatment, and 2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment, and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organization guidelines and hospital operations. Several supplies and patient-related challenges were identified and managed during center development.Conclusion:The use of community resources, based on the flexible surge capacity concept, was feasible under restricted circumstances and enabled the relief of hospitals during the pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of the emergencies’ etiology.
Towards the Next Pandemic–What Have We Learned? Insights of a Large Tertiary Care Hospital
Authors: Schwartz Dagan , Hayat Michal , Nagar Dorit 
Published: June 2023

Introduction:The first cases of COVID-19 arrived in Israel in March 2020. In Israel, the first known cases were Israeli patients diagnosed with COVID-19 aboard the Diamond Princess which were repatriated.Shortly later, additional cases were found in increasing numbers constituting the "first wave". The high number of patients put significant strain on Israeli hospitals. The initial wave was later followed by additional surges in the number of patients further straining the system. At the peak, hospitals with a total bed capacity of 800 had 135 covid-19 patients with 21 of them requiring ventilatory support.Method:Daily and weekly multidisciplinary meetings were held and daily reports were composed. Following each wave, lessons learned and recommendations for improved preparedness were formulated. The following results and conclusion sections summarize some of the main insights and recommendations.Results:The main challenges in Beilinson hospital during the "first wave" were a shortage of personal protective equipment (PPE) and how to best utilize the existing supplies, uncertainty regarding infectiveness, best management practices and uncertainty regarding the expected magnitude and duration of the pandemic. In retrospect, the major insights were the need for a flexible and divisible ED to safely care for changing loads of suspected and verified COVID-19 patients as well as COVID-19 negative patients. Increasing the in-hospital stockpile of PPE as well as the regional and national stockpile and creating local production capacities. The importance of the daily multidisciplinary managerial meeting was to improve situational awareness and allow improved decision making. Staff briefing occurred on a daily basis and during times of high uncertainty at the beginning of every shift.Conclusion:Performing structured and frequent debriefing and analysis to achieve clinical and operational insights is crucial for improved short-term performance as well as improving preparedness for future challenges.