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Objective Simulation-based training has a significant effect in enhancing professionals’ skills in the helicopter emergency medical service (HEMS) setting and is reported to be more effective than other learning strategies. The main objective of this study was to assess the efficacy of a specific high-fidelity simulation (HFS) training course for HEMS nurses before entering into operational service. Methods This report describes the first Italian experience of a specifically designed HFS training program for HEMS nurses held in Bologna, Italy, in a dedicated scenario with a mock-up helicopter and an advanced mannequin. Results A total of 14 nurses participated in the SAFE2019 (Simulazione ad Alta Fedelta per l'Elisoccorso–High-Fidelity Simulation for HEMS) courses. The aspects considered most useful and effective were related to team working, communication issues, and nontechnical skills (NTS) development. Moreover, participants suggested implementing a series of scheduled HFS retraining sessions. Conclusion HFS in a dedicated HEMS scenario during the orientation period has contributed to enhanced technical competencies and NTS, increasing comfort and situational awareness for new entrant flight nurses. Simulation may represent a valuable resource to assess and maintain competencies through periodic retraining sessions for full HEMS teams or when new devices are adopted.

Introduction During the first wave of the COVID-19 pandemic in spring 2020, our stroke network shifted from a drip-and-ship strategy (transport of acute ischemic stroke patients to the nearest primary stroke centers) toward a mothership model (direct transportation to the Comprehensive Stroke Center). We retrospectively analyzed stroke network performances comparing the two models. Patients and methods All spoke-district patients treated with endovascular thrombectomy (EVT) between 15th March–15th June 2019 (drip-and-ship) and 2020 (mothership) were considered. We compared onset-to-groin time (OGT) and onset-to-needle time (ONT) between the two periods. Secondarily, we investigated other performances parameters (percentage of IV thrombolysis, timing of diagnostic and treatment) and clinical outcome (3-month modified Rankin Scale). Results Twenty-four spoke-district patients in 2019 (drip-and-ship) and 26 in 2020 (mothership) underwent EVT. The groups did not differ for age, sex, risk factors, pre-stroke mRS 0–1, NIHSS, and ASPECTS distribution. The MS model showed a significant decrease of the OGT (162.5 min vs 269 min, p = 0.001) without significantly affecting the ONT (140.5 min vs 136 min, p = 0.853), ensuring a higher number of IV thrombolysis in combination with EVT (p = 0.030). The mothership model showed longer call-to-door time (median + 23 min, p

Background During the coronavirus disease 2019 (COVID-19) outbreak, a decrease of stroke’s hospital admissions and reperfusion therapy has been reported worldwide. This retrospective observational study assessed the volume of stroke cases managed in the Emergency Department (ED) and reperfusion therapies in an Italian stroke network with a high incidence of COVID-19, particularly to evaluate if the in-hospital rerouting and the switch from a drip-and-ship to a mothership model could assure an adequate volume of acute treatments. Methods We compared data from March 2020 with those from previous years and formulated five PICO questions regarding (1) incidence of stroke cases in the ED; (2) relation between stroke cases and COVID-19; (3) differences in the number of reperfusion therapies, (4) in the call-to-needle and door-to-needle times for intravenous thrombolysis, and (5) in the call-to-groin and door-to-groin times for thrombectomy. Results We found (1) a 28% decreased of confirmed stroke cases managed in the ED, (2) a negative correlation between stroke cases in ED and COVID-19 progression (rs = − .390, p = .030), and (3) a similar number of treatments in March 2020 and March 2019. The adoption of the mothership model (4) did not delay alteplase infusion (median call-to-needle p = .126, median door-to-needle p = .142) but led to (5) a significant reduction in median call-to-groin (p = .018) and door-to-groin times (p = .010). Conclusion The “hospital avoidance” of stroke patients during the “stay-at-home” appeals needs to be considered for future public health campaigns. A prompt reorganization of the stroke network can guarantee optimal performances at times of crisis. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-020-04914-4.

Background and Aims: The choice between transport of acute ischemic stroke patients to the nearest Primary Stroke Centers (drip-and-ship model) versus direct transport to the Comprehensive Stroke Center (mothership model) is still a matter of debate. We shifted from a dripand-ship towards a mothership model during the first wave of COVID-19 pandemic in spring 2020. We retrospective analyzed stroke network performances comparing the two models. Methods: All spoke-district patients treated with endovascular thrombectomy (EVT) between 15th March -15th June 2019 (drip-and-ship) and 2020 (mothership) were included in the study.We compared call-to-door time (CDT), door-to-CT time (DCT), door-to-needle time (DNT), doorto-groin time (DGT), call-to-needle time (CNT) and call-to-groin time (CGT) between the two periods. We also compared functional independence (modified Rankin Scale, mRS) at 3 months. Results: 24 spoke-district patients in 2019 (drip-and-ship) and 26 in 2020 (mothership) underwent EVT. In 2020 a higher number of patients received IV thrombolysis in combination with EVT (p=.030). The groups did not differ for age, sex, risk factors, pre-stroke mRS 0-1, NIHSS and ASPECTS distribution. In 2020 we found longer CDT (+23 minutes, p

Background In blunt trauma, orthopedic injuries are often associated with cerebral and torso injuries. The optimal timing for definitive care is a concern. The aim of the study was to develop evidence-based guidelines for damage-control orthopedic (DCO) and early total care (ETC) of pelvic and long-bone fractures, closed or open, and mangled extremities in adult trauma patients with and without associated injuries. Methods The literature since 2000 to 2016 was systematically screened according to Preferred Reporting Items for Systematic Reviews and meta-analyses protocol. One hundred twenty-four articles were reviewed by a panel of experts to assign grade of recommendation and level of evidence using the Grading of recommendations Assessment, Development, and Evaluation system, and an International Consensus Conference, endorsed by several scientific societies was held. Results The choice between DCO and ETC depends on the patient's physiology, as well as associated injuries. In hemodynamically unstable pelvic fracture patient, extraperitoneal pelvic packing, angioembolization, external fixation, C-clamp, and resuscitative endovascular balloon occlusion of the aorta are not mutually exclusive. Definitive reconstruction should be deferred until recovery of physiological stability. In long bone fractures, DCO is performed by external fixation, while ETC should be preferred in fully resuscitated patients because of better outcomes. In open fractures early debridement within 24 hours should be recommended and early closure of most grade I, II, IIIa performed. In mangled extremities, limb salvage should be considered for non-life-threatening injuries, mostly of upper limb. Conclusion Orthopedic priorities may be: to save a life: control hemorrhage by stabilizing the pelvis and femur fractures; to save a limb: treat soft tissue and vascular injuries associated with fractures, stabilize fractures, recognize, and prevent compartmental syndrome; to save functionality: treat dislocations, articular fractures, distal fractures. While DCO is the best initial treatment to reduce surgical load, ETC should be applied in stable or stabilized patients to accelerate the recovery of normal functions. Level of evidence Systematic review of predominantly level II studies, level II.

Recently, however, various different works have been published which have cast doubt on the real efficacy of tracheal intubation, a maneuver which is considered to be the gold standard in airway management. In some cases the management of prehospital tracheal intubation has been attributed to potentially worsening the critical patient’s final outcome. Unfortunately, an analysis of prehospital airway management studies, especially the more recently published articles, has created more questions than answers.

Negli ultimi anni, anche in Italia si e prestata attenzione ai rischi connessi all’esercizio delle professioni sanitarie e alle conseguenze di interventi non idonei ed errati e questo ha portato allo sviluppo del settore del risk management e del risk assessement, il cui obiettivo e la riduzione delle conseguenze dannose per i pazienti [1]. Nel settore dell’emergenza, in relazione all’esigenza di operare in tempi ristretti e in condizioni non sempre ottimali, la percentuale di trattamenti inappropriati e particolarmente elevata. L’analisi della qualita del trattamento sanitario in campo traumatologico considera, tra l’altro, la mortalita evitabile. Piu in dettaglio si possono identificare tre categorie di mortalita da trauma [2]: a) morti non evitabili dovute a lesioni singole o multiple di gravita tale da non consentire la sopravvivenza della persona, indipendentemente dalla qualita del trattamento ricevuto; b) morti potenzialmente inevitabili causate da lesioni gravi, che potrebbero essere trattate con terapie aggressive in condizioni di assistenza e organizzazione ottimali; c) morti evitabili causate da lesioni di modesta entita e semplice trattamento la cui evoluzione sfavorevole e dovuta a una cattiva (errata) gestione sanitaria.