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Background: EMS providers are often the only emergency workers with medical knowledge at the scene of chemical hazards and are exposed to severe risks. They should always be prepared to face chemical hazards to be able to provide an effective response to them. Therefore, this study identified the dimensions and components of emergency medical services system preparedness in chemical hazards. Methods: We searched the relevant electronic databases, including ProQuest, Embase, PubMed, Web of Science, and Scopus. The search included articles in English published up to November 2, 2023. In addition, organizational websites, including WHO, CDC, OSHA, NIOSH, FEMA, IFRC, NFPA, OECD, and OPCW, were searched to find gray literature. Studies were selected using the PRISMA checklist, and thematic analysis was used to analyze the findings. Results: Finally, of 8193 selected records, 16 papers were included in the final analysis. Using thematic analysis, two main themes, 15 categories, and 57 subcategories were revealed. The categories for management measures included Plans and guidelines, Communication and coordination, Risk management, Management of physical spaces and Sources of funding, and for technical measures were recognition of chemical release, incident scene management, personal protection, casualty management, ambulance equipment and drugs, decontamination, psychological support, supporting units, Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) ambulances, and training. Conclusions: Due to the importance and extent of the effects of chemical hazards, EMS systems need to develop their preparedness using more specific approaches to provide medical services in chemical hazards. EMS systems should provide medical equipment and antidotes, chemical ambulances, chemical protective equipment, and necessary physical spaces with appropriate financing. Also, preparedness and response plans should be prepared and practiced regularly based on previous lessons learned and with the cooperation and participation of other organizations involved in chemical disasters. [ABSTRACT FROM AUTHOR]

Background: The outpatient palliative care system is a central component of the palliative care structure in Germany, with family caregivers playing a vital role in ensuring and maintaining its success. However, crisis situations can destabilise and harm outpatient care. Previous studies have analysed hospitalisations and emergency admissions during palliative care. However, little is known about the factors that contribute to the emergence of crises in palliative outpatient care. The aim of this study was to identify factors contributing to the emergence of crisis in palliative outpatient care including the identification of protective strategies. Methods: A qualitative study using semi-structured interviews with family caregivers recently involved in outpatient palliative care was performed. The analysis was conducted using thematic coding. Results: A total of 15 family caregivers (13 female and 2 male) were recruited for the study. Crisis situations emerged through a cumulation of factors. Four categories of factors were identified: (1) structural factors, including limited access to health care professionals and a lack of necessary information, (2) illness related factors such as sudden progression in the illness trajectory and symptoms, (3) the intensity of care involvement and (4) emotional and psychological burden of family caregivers. A diverse range of protective strategies were employed by family caregivers, encompassing the involvement of the social network, the pursuit of information and the identification of a sense of purpose. Conclusion: The findings of this study confirm the importance of providing continuous, competent, and empathetic care to both family caregivers and patients in palliative outpatient care. The study highlights the importance of expanding the palliative care infrastructure, as well as ensuring unrestricted access to palliative care professionals, developing tailored information tools for family caregivers, and reducing bureaucracy. Further studies are needed to identify additional influencing factors and evaluate effective measures. [ABSTRACT FROM AUTHOR]

AbstractBasic life support and advanced cardiovascular life support training are required every two years; however, these skills often deteriorate due to lack of routine practice which can increase anxiety in healthcare workers. The purpose of this project is to determine the effect of interdisciplinary simulation training on self-efficacy and anxiety levels of healthcare professionals in managing a medical emergency. Sessions simulating emergent situations were held every two weeks for eight weeks. Surveys (GAD-7) were completed two weeks pre- and postintervention, and an effectiveness questionnaire (SET) was completed immediately post-intervention. Participants agreed that the simulation sessions were an effective means of increasing confidence in responding to a medical emergency. Overall anxiety was decreased post-intervention. [ABSTRACT FROM AUTHOR]

Background: England's urgent care telephone triage system comprises non-clinician-led primary triage (NHS111) assessment followed, for approximately 50% patients, by clinician-led secondary triage. Digital decision support is utilised by both. We explore the system's safety and accuracy relative to patients' use of emergency departments (EDs) and in-patient care in the subsequent 24 h. Methods: Descriptive analyses were used to investigate outcomes of 98,946 calls that underwent primary and secondary triage. We investigated sensitivity (safety) and specificity (efficiency/accuracy) in relation to subsequent ED attendance and in-patient hospital admission. Mixed effects regression models were used to explore potential under-estimation of clinical risk (under-triage). Results: Sensitivity was greater in primary triage, whilst specificity was greater in secondary triage. The positive predictive value for attending ED after being assigned a triage urgency level of within 2 h was 46.0% for secondary triage compared to 20.7% for primary triage; for inpatient admission it was 18.0% and 9.2% respectively. 1.5% (n = 1468) patients triaged to same-day or less urgent care at secondary triage were subsequently admitted for in-patient care. In relation to in-patient admission within 24 h, there were greater odds of potential under-triage for calls made between midnight and 6am, and for shorter duration calls, respectively OR = 1.71; CI:1.32–2.21 and OR: 1.66, CI: 1.30–2.11. The service provider (e.g., service provider 2, OR = 5.61; CI:3.36–9.36) and individual clinician (OR covering the 95% midrange = 16.15) conducting triage were the characteristics most greatly associated with this potential under-triage; p < 0.001 for all. Conclusions: Clinician-led urgent care triage is more accurate in identifying the likelihood of a need for ED or in-patient care than non-clinician triage. Non-clinician primary triage is risk averse, reflected in its high sensitivity but low specificity. Service and clinician characteristics associated with potential under-triage need further investigation to inform ways of improving the safety and effectiveness of urgent care telephone triage. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

The aggressive work involved in proposing new distance measures between two neutrosophic sets has been obvious for the past ten years. These continuous efforts are commonly motivated by the need to provide a variety of alternatives in the study of decision-making. This study starts by providing complete proof of the satisfaction of single-valued neutrosophic set properties for a new distance measure. The novel distance measure averages out two different distance measures to reduce the possibility of information loss. Secondary data gathered from a questionnaire survey on the medical emergency knowledge of twenty dental students is used here to become the numerical example for the application of the new distance measure. The single-valued neutrosophic data are then aggregated using a sine trigonometric single-valued neutrosophic aggregator to gain the benefit of preserving the periodicity and symmetry in nature about the origin and eventually satisfying the decision-maker preferences over the multi-time phase parameters. Next, the technique for order of preference by similarity to ideal solution is applied to enable the calculation of the new distance measure resulting in the ranking of the student's knowledge level. Comparative analysis is done with two distance measures using the same aggregation operator and the weighted arithmetic aggregation operator as well. The result shows that regardless of applying different approaches of distance measures, the student who ranks first is the same, concluding in a manner that is consistent with previous findings. [ABSTRACT FROM AUTHOR]

Public health emergencies and disasters highlight gaps in health systems' emergency preparedness capabilities. Developing robust public health emergency management (PHEM) programs is crucial yet challenging. Existing assessment tools are limited in scope or lack standardized measurement. The aim of this study was to identify core domains of PHEM implementation status and key influencing factors. A scoping review. A literature review and focused desk review were conducted. We searched PubMed, Web of Science, Scopus, and Google Scholar to retrieve relevant studies that explored existing PHEM frameworks, core components, factors influencing implementation, and evaluation tools presented in empirical studies. Additionally, a systematic search of authoritative organizational websites was performed to identify relevant guidelines and frameworks. Subject matter experts consolidated the findings from these diverse data sources through a consultative desk review process. Out of 7232 studies identified, 50 studies met the eligibility criteria and were included in this review. Four core domains of PHEM implementation status were identified: overall implementation level; individual factors (capacity building, resources, engagement, and attitudes); organizational factors (information sharing, community involvement, planning, responsibilities, resources, leadership, monitoring/evaluation, coordination, infrastructure, and policies); and overarching factors (workforce, funding, governance, and collaboration. Nineteen key influencing factors emerged, including elements such as leadership, resource allocation, and stakeholder engagement. A conceptual framework was developed that incorporates these thematic domains from major health agencies and determinants identified through qualitative, quantitative, and mixed-methods research. This review developed a preliminary evaluation framework for PHEM programs based on a comprehensive synthesis of global evidence. The framework lays the groundwork for further validation and application to advance standardized assessments of PHEM capabilities across diverse contexts, ultimately aiming to strengthen health system resilience against emergencies. [ABSTRACT FROM AUTHOR]

Background: The Mpox, a zoonotic viral disease that has historically affected Central and West Africa, has been declared a Public Health Emergency of International Concern by the World Health Organization. Rapid transmission and recent dissemination in Africa may imply significant challenges to global health, including mental health. Methods: We reviewed the mental health implications of the Mpox outbreak according to the published literature. We also discussed the psychological effects of the global spreading of this infection and public health preparedness strategies. Key areas of intervention may include the epidemiological surveillance, vaccine development, and mental health strategies. Comments: The Mpox outbreak calls for a robust global preparedness to address potential health emergencies. Strengthening epidemiological surveillance, ensuring equitable vaccine distribution, and building resilient public health infrastructure are crucial. Additionally, addressing mental health consequences may require immediate, intermediate, and long-term strategies, including telepsychiatry, stress management training, and the integration of mental health into primary care. [ABSTRACT FROM AUTHOR]

The impact of celebrities on public awareness in health communication has been proved to be significant, making it a possible approach for risk communication during public health emergencies. In the early stages of COVID-19, some Chinese medical experts engaged with the public and became "celebrity scientists." It provides representative cases for studying celebrity-based risk communication approaches. With Dr. Wenhong Zhang as the primary case, this research investigates the construction process of celebrity scientists. Through semantic network analysis (SemNA) and other complementary methods, this study examines Dr. Zhang's articles (n1 = 45), relevant news reports (n2 = 360), and public tweets (n3 = 12,933), in order to identify the main agendas of media, public and expert during the construction process of celebrity scientists, as well as their similarities and differences. The results reveal three categories in the narratives around the celebrity scientist, highlighting unbalanced focuses and preferences. Notably, the agendas of celebrity scientists, media outlets and the general public are more alike than different, and tend to converge over time. The simultaneous resonance of the media and public is also crucial in the construction of celebrity scientists, as well as specific incidents or turning points. These findings shed light on the application of celebrity-based risk communication approach in emergencies, providing guidance and discussion points for health messaging strategies as well. [ABSTRACT FROM AUTHOR]

Purpose Oral health care professionals (OHCPs) have the potential to play critical roles in emergency response to public health disasters, both natural and manmade. The purpose of this study was to assess the beliefs, and associated factors, of OHCPs regarding their role in vaccination promotion and administration during the emergency response to the COVID-19 pandemic. Methods Faculty and students in the dental and dental hygiene programs at the University of Missouri-Kansas City (UMKC) School of Dentistry (n=729) were invited to participate in an anonymous electronic survey during the 2021 fall semester. The 24-item survey assessed immunization behaviors, COVID-19 opinions, vaccination training, and scope of practice beliefs. Descriptive statistics were used to summarize the data. Results A total of 150 surveys were returned for a 21% response rate. Most respondents agreed it was their professional responsibility to learn about COVID-19 vaccines (77%) and to recommend COVID-19 vaccines (61%), but fewer than half agreed it was their responsibility to administer COVID-19 vaccines (34%). Only 22% of dental hygiene student respondents agreed that recommending COVID-19 vaccines was their responsibility, significantly less than the dental students (61%) and faculty (73%) who held that belief. Vaccination training increased the odds of agreement that it was an OHCP's responsibility to administer COVID-19 vaccines by a factor of 2.44 (95% CI, 1.10-5.41, p=0.03). None of the respondents who delayed or refused to be vaccinated against COVID-19 themselves agreed it was their professional responsibility to administer COVID-19 vaccines. Conclusion Most OHCPs in this study did not view administering COVID-19 vaccines as their professional responsibility, with personal vaccine hesitancy playing a significant role. Future research is warranted to explore how dental hygiene and dental education can cultivate professional responsibility to engage in vaccination promotion and administration during public health emergencies. [ABSTRACT FROM AUTHOR]

Cancer is the second most common cause of death worldwide. Bowel emergencies in patients with cancer are becoming increasingly more prevalent due to advances in cancer therapy and longer overall patient survival. When these patients present acutely, they are often frail and may have pre-existing co-morbidities. This article discusses the imaging features of bowel emergencies commonly encountered in oncological patients in clinical practice. These include chemotherapy related colitis, neutropenia enterocolitis and typhlitis, toxic megacolon, bowel perforation, malignant bowel obstruction and gastrointestinal haemorrhage. The radiologist plays a key role in identifying these oncological emergencies and guiding further management. [ABSTRACT FROM AUTHOR]

Medical research and innovation to meet urgent demands in society is crucial, but the process contains many challenges. Moreso, impacts from medical research and innovation can take many years to materialise, not least because these activities are infused with various types of complexities due to heterogeneous networks, systems, and contexts. Although acceleration is currently a trending topic, little is known about the temporal complexities embedded in research and innovation processes. This paper analyses the time dimension of medical research and innovation through an empirical investigation of 30 research projects that were set up to respond quickly to the COVID-19 situation from June 2020 to July 2022. Funders and scientists were able to find ways to speed up many tasks, but many of the projects also saw delays and deceleration. An important explanation is that temporality is tied to a myriad of contextual characteristics that limit the opportunities of project leaders for coordinating and accelerating activities and outcomes. Attempts at acceleration seem to work best when substantial ongoing research activities can be shaped incrementally into new directions. Nevertheless, the results of the projects may be of limited value to the pandemic which served as their rationale, but they can serve as a foundation for better policies and practices that invoke the need for rethinking medical innovation in the future. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic provided lessons for health policies across the globe. We assessed the knowledge, attitudes and practices of vulnerable populations in an informal settlement in Mumbai, India, during the pandemic. We discuss the viability and effectiveness of communication strategies based on these results and offer suggestions for policy modifications regarding awareness generation and behavioral change during health emergencies. The study was conducted through a telephone survey among 460 respondents (233 men and 226 women) from April to May 2021. Television (94%) and family (70%) were the most common sources of information, but they were not the most trusted. Most respondents were aware of the causes and preventive measures of COVID-19, including vaccination. However, this awareness did not always result in changes in attitudes and behavior- 66% perceived low or no risk to COVID-19, while 93% did not consider it essential to wear masks in workspaces and 78% did not sanitize their hands before entering workspaces. More respondents were concerned about loss of employment (53%) than about their physical (10%) or mental (4%) health. The study highlights the need for context-specific communication strategies for vulnerable populations. This includes providing reliable and accessible sources of information, emphasizing accuracy and detail, and adopting a holistic and multidimensional approach to awareness and information sharing. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has brought various opportunities and challenges to critical care nurses, whose emergency abilities in caring for critically ill patients are related to their safety, clinical effectiveness, and improved prognosis. Currently, there is a lack of research on the actual situation and influencing factors of ICU nurses' emergency ability during the COVID-19 pandemic. Although empirical observations from different departments can provide valuable basis for the health system to formulate preventive measures, efficient training programs and future public emergencies. Design: A cross-sectional descriptive study. Methods: Data were collected from 486 subjects through electronic surveys from November 8 to 15, 2022, in seven general public hospitals (all tertiary A hospitals) in Beijing, China. Results: The emergency ability of ICU nurses hover at the intermediate level (145.42 ± 23.29). The variables of work experience, participated in PHE rescue activities, participated in PHE education, cumulative rescue more than 10 times and positive coping were associated with the emergency ability of ICU nurses. Conclusion: Despite the COVID-19 restrictions, the emergency ability of ICU nurses is acceptable, at a medium level. The ICU nurse of seniority, participated in PHE rescue activities, participated in PHE education, cumulative rescue more than 10 times had excellent emergency ability; The importance of positive coping style was also evident, which means that intervention in psychological is seen as necessary. [ABSTRACT FROM AUTHOR]

Background: Improvements in diagnostics and clinical care have allowed more women of childbearing age, suffering from neurological diseases, to safely have pregnancy, reducing peripartum complications. However, these patients remain at risk and are a constant challenge for anesthesiologists in the delivery room. Methods: To assess the type of anesthesiologic management performed for delivery in obstetric patients with preexisting neurological disease and who reported significant neurological symptoms during pregnancy, a retrospective observational study was carried out between 1 October 2008 and 30 September 2021. Results: Data from 49,202 pregnant women were assessed over 13 years; 239 pregnant women with a diagnosis of preexisting neurological disease and who reported significant neurological symptoms during pregnancy were identified (prevalence 0.49%). The main neurological disorders that affected pregnant women included vascular abnormalities and intracranial bleeding (N = 42, 17.6%), central nervous system tumors (N = 35, 14.6%), epilepsy and episodic and paroxysmal disorders of the central nervous system (N = 34, 14.2%), diseases of the neuromuscular junction and muscles (N = 26, 10.9%), demyelinating central nervous system diseases (N = 24, 10%). A total of 234 (97.9%) pregnant women with neurological disorders and significant neurological symptoms underwent cesarean section: 192 (80.3% of the total cesarean sections) were elective, 39 (16.3%) were urgent type 2 and 3; 3 (1.2%) were emergency cesarean sections. General anesthesia was administered to 73 patients (30.5%), while 166 patients (69.5%) were managed with neuraxial techniques. 2 patients who had had neuraxial block reported worsening neurological symptoms that required a change in medical therapy. Postoperative multiparameter monitoring was performed for less than 24 h in the recovery room for 226 patients (94.6%). 3 patients (1.2%) were observed with multiparameter monitoring in the post-anesthesia care unit (PACU) for more than 24 hours; 10 patients (4.2%) were moved to the postoperative intensive care unit (ICU). The median hospitalization duration was 4 days (with an interquartile difference of 3–6 days). Conclusions: In our experience, when neuraxial anesthesia was feasible, it proved to be a safe option for pregnant patients with symptomatic neurological disease, resulting in uncommon maternal complications. [ABSTRACT FROM AUTHOR]

Background: Colonic obstructions present a serious medical emergency that requires prompt surgical intervention to prevent life-threatening complications. Cecostomy, a procedure involving the creation of an opening in the cecum to decompress the colon, serves as one surgical approach for managing these obstructions. The aim of this review is to evaluate the effectiveness and benefits of cecostomies in emergency surgical settings, with a focus on recent clinical studies and case reports. Cecostomy is highlighted as a bridge procedure in cases such as obstructive carcinomas, providing data on success rates, relative survival, and clinical effectiveness. The importance of the patient's condition and surgeon expertise in selecting cecostomy as a procedure is emphasized. Further comparative research is suggested to optimize the selection criteria, providing a strong, clinically oriented conclusion. Methods: A comprehensive literature review was conducted to identify studies and case reports focusing on the application of cecostomies in cases of acute colonic obstruction. Articles were selected based on their relevance to emergency surgery, the effectiveness of cecostomies, and patient outcomes in various clinical scenarios, including obstructive carcinomas and colonic pseudo-obstructions. Results: The analysis reveals that cecostomies provide rapid decompression and effective relief from colonic obstruction, particularly when immediate intervention is needed to prevent bowel perforation or ischemia. In several cases, cecostomies act as a bridge to more definitive surgical treatments, such as resection and anastomosis, and are associated with reduced morbidity and mortality. The selection of cecostomy as a preferred procedure depends on the patient's condition, location of the obstruction, and surgeon expertise. Conclusions: Cecostomies play a crucial role in the emergency management of colonic obstructions, offering a viable and sometimes lifesaving alternative for rapid decompression. Understanding the indications and appropriate use of cecostomies can enhance patient outcomes and provide surgeons with effective strategies for managing acute colonic obstructions. Further research is warranted to refine selection criteria and to compare outcomes between cecostomies and other decompressive techniques in emergency settings. [ABSTRACT FROM AUTHOR]

Background The presence of some red blood cell (RBC) antigens may affect the preference for using type O blood in emergency situations because they may induce complex or multiple alloimmunization in special circumstances. Methods A subgroup of 77 type O blood Tunisian donors were genotyped for 19 common blood alleles using the single specific primer–polymerase chain reaction method. The statistical analysis was done using HaploView software. Results The study showed the dominance of the alleles RH*5 , KEL*2 , FY*2 , and CO*1 and the absence of the homozygous state of the KEL*1 and CO*2 alleles. Furthermore, a complete linkage disequilibrium between the RH*2/RH*4 and RH*3/RH*5 loci and the FY*Null/FY*Exp and FY*A/FY*B loci was detected. Additionally, it seems that sensitization to MNS:3, FY:1, and RH:3 may constitute a potential factor for alloimmunization after transfusion with O blood type units: the probabilities of simple alloimmunizations are 24.5 per 100, 18.5 per 100, and 18 per 100, respectively. Multiple alloimmunization against RH:1;KEL:1 or RH:1;KEL:1;RH:3 phenotypes may occur, with probabilities of 7 per 1000 and 2 per 1000, respectively. Conclusion Some O-type RBC units may contain blood with very immunogenic phenotypes, the use of which in an emergency requires great caution because it can be a step towards subsequent alloimmunization. [ABSTRACT FROM AUTHOR]

Background: The electronic cognitive aid for emergencies in anesthesia (eGENA) is an app that offers digital support in anesthesiological emergency situations as a cognitive aid tool via checklists for memory and making decisions. The eGENA was published by the German Society of Anesthesiology and has been implemented in the emergency management of the anesthesiological team of the clinic in Potsdam, Germany. Objective: The primary endpoint was to observe the influence of eGENA on the anesthesiological emergency management on the subjective feeling of assurance as well as on quality of treatment and, therefore, patient safety. Material and methods: All employees in the anesthesia department (nursing staff and physicians) took part in the initial implementation of eGENA. The implementation phase covered crew resource management (CRM) principles and eGENA use as well as 10 case studies that were discussed with help from eGENA. Afterwards in a randomized controlled simulation study, realistic case studies were processed and evaluated. In this, 18 cases were handled by 9 groups with 4 persons in each group. Treatment during these simulations was assessed using a predetermined 20-point evaluation form and 10 resuscitation-related and 10 case-related points were awarded. Significance tests were carried out using the Wilcoxon-test (significance level p < 0.05) and two evaluations were completed by the attendees at the beginning and the end of the eGENA implementation process. Results: Scenarios 1 and 2 showed comparable overall scores (14.9 vs. 16.3 points out of 20, not significant). Higher case-associated scores (7.6 vs. 5.6 out of 10, p = 0.03) and higher total scores were achieved with the help of eGENA (16.9 vs. 14.3 out of 20, p = 0.02). Resuscitation-associated scores did not differ significantly (9.3 vs. 8.8 of 10, p = 0.1). During eGENA use for cases the execution of the algorithm-based resuscitation measures was not delayed or accelerated. With eGENA, however, differential diagnoses were discussed significantly more frequently and expanded treatment and diagnostic measures were implemented. During simulation cases eGENA was mainly used by physicians. The initially very positive responses of the evaluations toned down over time. Planned eGENA use for self-study was less frequent (p = 0.006) and there was less approval of the quality of treatment by eGENA than in the first survey (p = 0.002). The cooperation between doctors and nurses in emergency treatment showed an improvement (p < 0.001). The questions about self-assessed safety in emergency treatment on a scale from 0 to 10 showed higher values in all categories at the second survey (except only circulatory emergencies and 'other' emergencies). The respondents were more likely to be involved in emergency treatment at the second time of the survey (p = 0.03) after a median of 20 months. Discussion: The sense of security and emergency involvement increased significantly over the observation period. The initial need to use eGENA in everyday life has diminished over time; however, these results cannot be causally associated with eGENA. The use of eGENA does not improve resuscitation efforts but does not delay them either. With the use of eGENA better case-associated results are achieved and advanced diagnostics and treatment are implemented more frequently in complex emergency situations. This increases the quality of treatment. Further studies should be carried out with a larger number of cases to confirm the shown effects. [ABSTRACT FROM AUTHOR]

This study presents a comprehensive methodology that combines resampling and oversampling techniques to address the challenges of limited and unbalanced data, specifically in the context of viral emergencies such as the COVID-19 pandemic. Utilizing advanced statistical techniques like Boot-strap and SMOTE, the study conducts aretrospective analysis of COVID-19 patients, identifying those at higher risk of mortality. The proposed methodology not only enhances the accuracy of predictions in scenarios with limited data but also facilitates better decision-making in clinical triage systems. By applying these methods, the study achieves early and accurate identification of high-risk individuals, optimizing resource allocation and timely medical interventions. The results demonstrate that this combination of statistical techniques effectively improves health systems and responses to new viral threats, providing arobust foundation for informed decision-making in medical emergencies. [ABSTRACT FROM AUTHOR]

Snake-related injury (SRI) is one of the most common medical emergencies encountered in tropical countries such as Malaysia. The majority of snake bites are nonvenomous, while the less common venomous snakebite can cause major disability or even death. There are 16 pit viper species documented in Malaysia which can be categorized based on their habitat. We report a case of a 41-year-old male who presented to a district hospital 1 h after being bitten twice by a pit viper snake (Trimeresurus sabahi fucatus) on the left side of his face. He was given green pit viper anti-venom (GPAV). He later underwent an emergency tracheostomy due to progressive local swelling causing upper airway obstruction and required a second regime of antivenom. In our opinion, early recognition of snake species, clinical syndrome, and life-threatening conditions in patients with SRI is important. While careful clinical, laboratory, and patient observation is important in determining the need for anti-venom, a life-saving procedure such as intubation, in this case, should not be delayed. From our experience, SRI at the head with progressive swelling to zone 2 of the neck may signal a red flag to the attending clinician for the possibility of impending upper airway obstruction. [ABSTRACT FROM AUTHOR]

Background: Disastrous situations in the emergency department (ED) or community can overwhelm even the best-prepared teams due to their complexity and dynamic nature. In this paper we propose an integrated approach to disaster management, combining six theoretical and practical frameworks to enhance decision-making and operational effectiveness. Discussion: The approach begins with "sensemaking," an instinctive process that helps leaders quickly gain situational awareness, a crucial foundation for the recognition-primed decision process (RPD). RPD enables swift, experience-based decisions without exhaustive analysis, aligning them with the appropriate domain in the Cynefin framework to guide subsequent interventions. In chaotic situations, rapid action is necessary, and the edge-of-chaos theory guides leaders to balance order and chaos for optimal adaptability. Complexity theory aids in managing the unpredictable elements of a crisis, highlighting the need for flexible responses. Finally, the Incident Command System ensures effective implementation by providing a standardized approach to command, control, and coordination. This cohesive strategy equips emergency physicians and incident commanders to manage both internal ED crises and broader community disasters effectively, with an emphasis on the importance of training in these frameworks to enhance the resilience of emergency medical services. Conclusion: This multifaceted approach should improve disaster management by better preparing responders for the unpredictable nature of emergencies, enabling effective evaluation and management of complex scenarios, and leading to a more rapid restoration of order. [ABSTRACT FROM AUTHOR]

Summary: Uterine torsion (UT) is a common obstetrical problem in Straight Egyptian Arabian mares, causing a medical emergency for both the mare and the fetus. This case report describes, for the first time, the management of a case of UT in both directions during a single gestation period in a 5‐year‐old Straight Egyptian Arabian mare. The mare was 8 months pregnant and experienced intermittent unresponsive colic signs. Rectal examination revealed clockwise 180° UT and ultrasonography showed a viable fetus. The haematological findings were within the normal range. The mare was surgically treated immediately by standing flank laparotomy (SFL) on the right side. 4 days later, the mare was returned to the clinic with the same complaint. Rectal and ultrasonography examinations revealed counterclockwise 180° UT and a viable fetus. The animal was subjected again to SFL on the left side. After surgeries, the mare recovered well, foaled at term and gave birth to a viable filly. She was bred again and conceived. This case is documented to demonstrate the occurrence of a UT in both directions during the same gestation period in mares, as well as the efficacy of SFL in rectifying the condition and allowing both the mother and foal to survive. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Harbin Institute of Technology. Social Sciences Edition / Haerbin Gongye Daxue Xuebao. Shehui Kexue Ban is the property of Harbin Institute of Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Automated external defibrillators (AEDs) are portable emergency medical devices critical for resuscitating individuals experiencing sudden cardiac arrest. The installation of AEDs in public spaces is essential for enhancing society's emergency response capabilities. However, many cities in China currently face issues such as inadequate AEDs deployment and uneven distribution. This study aims to explore a rational layout plan for AEDs through systematic site optimization. Initially, this paper evaluates the current spatial configuration of AEDs in the central urban district of Nanjing using various spatial analysis methods. Subsequently, a coverage model is constructed to simulate the coverage capacity of potential emergency needs for new facilities, and a genetic algorithm is utilized to solve it. Finally, an AED site selection experiment is conducted, and the site selection results are discussed and analyzed in conjunction with practical conditions. The research conclusions are as follows: (1) AED distribution in Nanjing's central urban district is clustered, with some areas lacking facilities, and the coverage rate of AEDs within 100 m and 200 m ranges is relatively low, particularly across different types of venues; and (2) the optimization experiment, with 90 new site selection points, effectively addressed AED distribution gaps, significantly improved coverage, and ameliorated the overall distribution across various public venues. This study provides a scientific basis for the rational placement of AEDs in urban public spaces through systematic analysis and optimization experiments. It enhances the efficiency of current AED deployment in the main urban areas of Nanjing and offers significant insights for the optimization of urban emergency resource allocation. [ABSTRACT FROM AUTHOR]

Objectives: Emergency medical services (EMS) serves a critical role in the delivery of services to children with out-of-hospital emergencies. The EMS clinicians' initial field diagnoses, termed "impressions," facilitate focused patient assessments, guide the application of prehospital treatment protocols, and help determine transport destination. We sought to evaluate the concordance of the EMS clinician impression to a child's hospital-based diagnosis. Methods: We retrospectively studied de-identified pediatric (<18 years old) scene runs transported to the hospital and with available linked hospital data from the 2021 ESO Data Collaborative, a multi-agency prehospital electronic health record dataset. EMS impressions and primary emergency department or admission-based diagnoses were categorized into one of twenty-one major groups in the Diagnosis Grouping System. We identified the most common hospital-based discharge diagnoses and evaluated for the agreement between EMS impression and hospital-based diagnosis using Cohen's Kappa statistic. Results: We included 35,833 pediatric transports from the scene with linked prehospital and in-hospital data (median age 11 years, interquartile range, 3-15 years; 50.9% male). The most common categories for both EMS impressions and hospital-based diagnoses were as follows respectively: trauma (26.1%; 24.6%), neurologic diseases (18.9%; 16.4%), psychiatric and behavioral diseases and substance use disorder (11.8%; 11.6%), and respiratory diseases (11.1% and 9.5%). A total of 23,224 out of 35,833 patients, or 64.8%, had concordant EMS impressions and hospital-based diagnoses. There was high agreement between common EMS impression and in-hospital diagnoses (trauma 77.3%; neurologic diseases 70.3%; respiratory diseases 64.5%; and psychiatric, behavioral disease and substance use disorder 73.9%). Hospital-based diagnoses demonstrated moderate concordance with prehospital data (Cohen's κ = 0.59). Conclusions: We found moderate concordance between EMS primary impression and hospital diagnoses. The EMS encounter is brief and without capabilities of advanced testing, but initial impressions may influence the basis of the triage assignment and interventions during the hospital-based encounter. By evaluating EMS impressions and ultimate hospital diagnoses, pediatric protocols may be streamlined, and specific training emphasized in pursuit of improving patient outcomes. Future work is needed to examine instances of discordance and evaluate the impact on patient care and outcomes. [ABSTRACT FROM AUTHOR]

Midwifery education is fundamental to ensure that midwives have the appropriate skills to manage critical situations and prevent maternal and neonatal mortality. To achieve Sustainable Development Goals (SDGs) 4 and 5 by 2030 and strengthen the professional role of midwives, Morocco has implemented a competency-based training programme. This study aimed to describe the level of competence in managing high-risk/emergency situations and the predictive factors of competence among newly graduated midwives. An anonymous online survey was conducted from 31 July to 26 October 2021 among 186 newly graduated midwives. Data were collected using a Demographic Characteristics Questionnaire, the Pre-Service Education Assessment Tool, and the Novice High-Risk/ Emergency Management Competence Self-Assessment Tool. Data were analysed using SPSS version 26.0. Pearson's correlation analysis was used to explore the association between high-risk/emergency management competence and its predictors. Stepwise multiple linear regression was used to explore the influencing factors. Results indicate that Moroccan newly graduated midwives were moderately com- petent in managing high-risk situations and emergencies. Insufficient support from teachers and supervisors, limited practical clinical experience, and lack of learning resources were significant predictors of high-risk/emergency management competence, explaining 73.2% of the variance in the high-risk/emergency management competence. The consistency of these findings across different educational settings worldwide suggests that this is a common challenge. Therefore, the implementation of a competence-based training programme as an independent action is insufficient to achieve the intended results. Building the capacity of midwifery teachers and supervisors and responding to the international call for enhanced resources in midwifery education, both in academic and clinical settings, is a critical step toward improving midwives' competencies. [ABSTRACT FROM AUTHOR]

Introduction: Intracerebral haemorrhage (ICH) is one of the lethal and most debilitating type of stroke affecting more than 1 million people globally every year. Most common cause of ICH is hypertension and responsible for about 70% of all ICH. Case report: Sealed dead body of 45 years old unknown male brought for autopsy to find out the cause of death. Patient was admitted to district hospital with unconscious state. Status of vital at time of admission was 210/110. Autopsy finding: No external injury was present on the body. No internal injury or abnormality seen on opening neck, chest and abdomen. Facial bone intact. No abnormality detected at scalp, cranial bone and meninges. Externals urface of brain was normal and intact. Brain was soft and congested. On sectioning of cerebral hemisphere huge hematoma of size 6.0×4.5 cm was present in deep left cerebral hemisphere. Conclusion: Hypertension is one of the most important risk factors for ICH. ICH is a medical emergency with high chances of morbidity as well as mortality. Advancement in early diagnosis and neurocritical care have improved and increased the survival. [ABSTRACT FROM AUTHOR]

To support older adults during the first wave of COVID-19, we rapidly adapted our effective health-promoting intervention (Choose to Move [CTM]) for virtual delivery in British Columbia, Canada. The intervention was delivered (April–October 2020) to 33 groups of older adults ("programs") who were a convenience sample (had previously completed CTM in person; n = 153; 86% female; 73 [6] years). We compared implementation outcomes (recruitment, dose received, retention, and completion of virtual data collection) to predetermined feasibility targets. We assessed mobility, physical activity, and social health outcomes pre- and postintervention (3 months) with validated surveys. We met most (dose received, retention, and virtual data collection), but not all (recruitment), feasibility targets. Approximately two thirds of older adults maintained or improved mobility, physical activity, and social health outcomes at 3 months. It was feasible to implement and evaluate CTM virtually. In future, virtual CTM could help us reach homebound older adults and/or serve as support during public health emergencies. [ABSTRACT FROM AUTHOR]

Human activity recognition (HAR) is one of the most important segments of technology advancement in applications of smart devices, healthcare systems & fitness. HAR uses details from wearable sensors that capture the way human beings move or engage with their surrounding. Several researchers have thus presented different ways of modeling human motion, and some have been as follows: Many researchers have presented different methods of modeling human movements. Therefore, in this paper, we proposed the CNN BiLSTM model with undersampling to improve the recognition of human actions. The model is evaluated using state-of-the-art metrics, including accuracy, precision, recall, and F1-score, on two publicly available datasets: For instance, the MHEALTH and Actitracker. This will enable the team to attain test accuracies of up to 98.5% on the MHEALTH dataset. The proposed CNN-BiLSTM model outperforms the conventional deep learning methods, as reported in the Actitracker dataset, by about 5% improvement. HAR has many applications, one of which is used to keep vigil over elderly people who live alone to alert when one has fallen or when any strange movement is noticed which could be a sign that the individual is experiencing a medical Emergency. It can also be applied in physiotherapy, where the patient's development throughout rehabilitation exercises can be accessed. [ABSTRACT FROM AUTHOR]

Introduction: Acute severe ulcerative colitis (ASUC) represents a medical emergency associated with high mortality and morbidity. While corticosteroids are the primary treatment, cases that are unresponsive often require rescue therapy with either infliximab or cyclosporine to reduce the rate of colectomy. Janus kinase inhibitors, such as tofacitinib and upadacitinib, are a highly efficacious therapy with rapid induction of clinical response in moderate to severe ulcerative colitis (UC). Limited data are available on its use on ASUC. We present the first case utilizing upadacitinib as sequential medical rescue therapy in ASUC as well as intestinal ultrasound as a useful tool for disease and response monitoring. Case Presentation: A 69-year-old female who presented with corticosteroid-refractory ASUC partially responded to dose-intensified infliximab and finally achieved clinical remission with upadacitinib. This resulted in swift clinical remission and significant improvement in her mucosal inflammation on intestinal ultrasound. Conclusion: This successful intervention not only avoided colectomy but demonstrated sustained clinical and sonographic remission 16 weeks of post-treatment. Upadacitinib, with its rapid action and efficacy, shows promise in ASUC and should be supported by registration trials and real-world studies. Despite successful outcomes in this case, further validation and long-term data are necessary. [ABSTRACT FROM AUTHOR]

Background: High-sensitive Troponin-T (hsTnT) is often increased in acute illness and may be of prognostic importance in patients with atrial fibrillation (AF). The aim of this study was to analyse the characteristics and data of patients attending the emergency department (ED) with AF to determine whether age-adjusted hsTnT levels can predict mortality. Methods: This retrospective, single centre, register-based cohort study included all patients ≥ 18 years attending the emergency department during 2018 and 2020 with a primary diagnosis at the ED of AF and sampled for hsTnT. Symptoms, comorbidities, lab results, and characteristics were registered. Patients were divided into groups based on hsTnT level (< 15, 15–50, and > 50 ng/L). Primary outcomes: 30-day and 1-year mortality. Results: A total of 625 patients were included (median age 72, and 45% female). All-cause mortality was 2% at 30 days and 8% at 1-year. The hazard ratio (HR) for 30-day mortality was 4.17 (95% confidence interval (CI) 0.49–35.79, p = 0.192) for hsTnT 15–50 ng/L and 9.64 (95% CI 0.98–95.30, p = 0.053) for hsTnT > 50 ng/L compared to hsTnT < 15 ng/L when adjusted for age. The HR for 1-year mortality was 4.82 (95% CI 1.81–12.82, p = 0.002) for hsTnT 15–50 ng/L and 9.70 (95% CI 3.27–28.74, p < 0.001) for hsTnT > 50 ng/L compared to hsTnT < 15 ng/L when adjusted for age. Conclusions: Elevated hsTnT levels increase the risk for 30-day and 1-year mortality independently of age. Both mild and major elevation of hsTnT levels is associated with increased risk for 1-year mortality regardless of age. [ABSTRACT FROM AUTHOR]

Background: Droperidol is a first-generation antipsychotic medication that has been used for various indications in the emergency department (ED); however, its use has been controversial due to reports of QT prolongation and the risk of torsades de pointes (TdP). The aim of the study is to evaluate the safety of droperidol administration in the ED. Methods: This was a retrospective study, conducted at an academic level I trauma center. System-generated reports were used to identify all droperidol administrations in the ED from the time that droperidol was reintroduced to the institutional formulary on July 1, 2019 through January 31, 2023. The major safety endpoint was a composite of the incidence of QTc interval prolongation, incidence of TdP, ventricular arrhythmia, or hypotension. Results: A total of 327 administrations of droperidol were identified in 245 patients in the ED. The composite safety endpoint occurred in 30 (9.1%) administrations. None of these events were classified as "probable" or "definite" on the Naranjo adverse drug reaction probability scale. No episodes of TdP or serious ventricular arrhythmia were reported. Higher cumulative droperidol dose and creatinine clearance < 60 mL/min were associated with an increased odds of developing QTc prolongation (OR 1.27 [CI 1.04–1.56]) and (OR 1.01 [CI 1.0-1.02]), respectively. Conclusions: The study supports the use of low dose droperidol for various indications in the ED. There were no serious adverse events reported that could be directly attributed to droperidol use; however, it is crucial to consider the potential dose dependent impact on QTc prolongation. [ABSTRACT FROM AUTHOR]

Background: Paediatric mortality rates in low- and middle-income countries account for over 80% of the global burden. In South Africa, one in every 33 children will not reach the age of five. Despite the high mortality rate, there is a paucity of data describing the prehospital paediatric under-five emergency care burden in South Africa. Such data are essential to inform the development of local prehospital emergency care guidelines and targeted prevention strategies. Aim: This study describes the prehospital paediatric under-five emergency care burden managed by the Western Cape Government Health and Wellness (WCGHW) Emergency Medical Services (EMS) in South Africa. Methods: A retrospective review of the prehospital records was conducted, extracting epidemiological and clinical data from the WCGHW EMS patient record database. The review included all paediatric cases under-five, managed between 1 January 2022 and 31 December 2023, in the Western Cape of South Africa. Results: In the 87 457 cases, there was a similar distribution between the primary cases (50.7%) and interfacility transfers (49.3%). Most activations emanated from rural areas (47 980, 54.9%), with respiratory emergencies (30 934, 35.4%), non-cardiac pain (11 381, 13.0%) and trauma (10 831,12.4%) being the most common presenting complaints. Most cases were prioritised as priority 2 (46 034, 52.6%), with most of these being older children between one and five years old (29 008, 63.0). Low acuity cases accounted for 67.2% (58 818) of the sample, with the highest mortality occurring between 29 days and 12 months (190, 52.9.%). Most patients spent less than one hour in the prehospital setting (64 431, 73.7%), with advanced airway management (748, 43.1%) being the most common airway intervention. Conclusion: This first description of the prehospital paediatric under-five emergency care burden managed by the WCGHW EMS reveals a unique burden, particularly regarding the high interfacility transfer rates. As illustrated in graphical abstract, these findings underscore critical considerations for healthcare planners and the prehospital training environment. Future research among this population should focus on characterising the reasons for the high interfacility transfer rates through assessments of healthcare access, EMS care quality and post-EMS follow-up. Key messages: • The study found a high rate of interfacility transfers (49.3%) among the prehospital paediatric under-five emergency care burden managed by the WCGHW EMS. This reflects the challenges of South Africa's tiered healthcare system and highlights a significant burden on EMS resources. • The predominance of medical emergencies over trauma: Unlike in high-income countries where trauma is often a leading cause of paediatric EMS activations, this study found that medical emergencies, particularly respiratory complaints (35.4%), were the most common reason for EMS usage. This aligns with WHO data on causes of paediatric morbidity and mortality in low- and middle-income countries. • A high proportion of low acuity cases: The majority (67.2%) of cases were categorized as low acuity (routine or non-urgent). This differs from patterns seen in high-income countries and suggests potential overuse of EMS for non-emergency situations, which has implications for resource allocation and healthcare system planning. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the incidence, predictors, and outcomes of medical emergencies in patients undergoing IR procedures at a tertiary care center. Materials and methods: Seven-year retrospective review of all medical emergencies in patients undergoing IR procedures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Medical emergencies included Cardiopulmonary arrest (CPA), or emergencies that required activation of the critical care response team (CCRT). Variables included demographics, procedure details and outcome data including complications and 30-day mortality. Multivariate logistic regression analysis was conducted to identify independent predictors of CPA and 30-day mortality. Results: Ninety-four patients (50% male) were included with a median age of 60.5 years. Recent or current ICU admission was recorded in 39 patients (43.8%). Comorbidities included diabetes (50%), hypertension (59.6%), coronary artery disease (25.5%), heart failure (21.5%), ESRD (28.7%), active infection 28 (31%), with ASA3 in 64 patients (68%) and ASA4 in 23 (24.5%). The incidence of CPA and CCRT activation was 0.045% and 0.049%, respectively, among 100,000 patients who underwent IR procedures during the study period. Half the events were with venous procedures, followed by non-vascular (33%) and arterial procedures (10.6%). 30-day mortality was 30.5%. Independent predictors of CPA included pulmonary disease (aOR 16.79, 95% CI 2.334–195.3, p = 0.0097), emergency procedures (aOR 11.63, 95% CI 2.517–72.46, p = 0.0035), general anesthesia (aOR 19.41, 95% CI 1.854–491.8, p = 0.0254), and sedation (aOR 13.04, 95% CI 2.081–118.8, p = 0.0108). Predictors of 30-day mortality were CPA (aOR 9.830, 95% CI 2.439–66.66, p = 0.0045) and hypotension as a complication (aOR 16.81, 95% CI 3.766–122.3, p = 0.0009). Conclusion: Our findings highlight the complexity of patients undergoing IR procedures and the importance of identifying high-risk patients to prevent adverse events in the IR setting. [ABSTRACT FROM AUTHOR]

Background: Administrative staff in primary care undertake numerous tasks to support patient care delivery. Although their roles are often overlooked, administrative staff are essential to the coordination and operations of primary care clinics. The COVID-19 pandemic introduced additional clinical and administrative tasks, including transitioning to virtual appointments and triaging patients for urgency, changing typical workflows. In Canada, existing pandemic plans for primary care did not account for these administrative tasks, nor the support that family physicians would require to continue to provide patient access to primary care. This research seeks to describe and understand the perceptions and experiences of family physicians of their administrative staff roles in primary care during the COVID-19 pandemic, to help inform future pandemic planning. Methods: We present findings from a qualitative case study across four regions in Canada: Vancouver Coastal health region in British Columbia, Ontario Health West region, the province of Nova Scotia, and the Eastern Health region of Newfoundland and Labrador. We conducted semi-structured qualitative interviews with family physicians (n = 68) across the four regions and thematically analysed the data. Results: We identified five salient themes in the data, including (1) applying public health guidelines, (2) educating patients on COVID-19 and COVID-19 services, (3) re-organizing patient visits, (4) maintaining adequate staffing, and (5) recognizing administrative staff contributions. During the COVID-19 pandemic, family physicians took on numerous additional roles to reduce the risk of transmission of the virus with the support of their administrative staff. Family physicians emphasized the challenges of maintaining adequate staffing, and the importance of administrative staff in enabling the provision of primary care. Conclusions: Existing pandemic plans do not account for increased administrative roles taken on by primary care administrative staff. Pandemic plans must include guidance for the roles taken on by primary care administrative staff, such as clinical tasks, as they will continue to play an important role in pandemic recovery. Supporting administrative staff would enhance primary care providers' ability to manage care during pandemics, facilitate resilience, and decrease provider and administrative burnout. [ABSTRACT FROM AUTHOR]

If the current rates of obesity continue, an estimated 38% of the world's adult population will be overweight and another 20% will be obese by 2030. And with increasing obesity, there has also been a gradual increase in bariatric surgery procedures like laparoscopic sleeve gastrectomy. In the USA, it was observed that the incidence of bariatric surgery increased from 43.5 per 100,000 in 2006 to 70.6 per 100,000 in 2009. But then, assessing the demographics and personalities of patients undergoing bariatric surgery, it has been found that such patients have a multitude of psychological issues like maladjustment in society, low self-worth, and depression that could be aggravated post-surgery when their expectations post-surgery are not met. And this leads to malpractice suits against the surgeon, substance abuse, alcoholism, and depression with suicidal ideation in the patient which needs to be highlighted, so that measures to tackle both surgeon and patient problems in the post-bariatric surgery setting can be planned and implemented. A literature review of existing journal articles does focus the need for a 'bariatric psychiatry' speciality in the bariatric surgery centres. [ABSTRACT FROM AUTHOR]

Background: Medical emergency complications may occur during dermatological, surgical, and cosmetic procedures. Aims: This study aimed to investigate the frequency of dermatologists who experienced emergency complications as well as their level of knowledge regarding emergencies and basic life support. Methods: The cross‐sectional descriptive study was conducted online among 240 dermatologists to whom a questionnaire was sent via email and a closed social media group. The survey instrument asked about emergency complications during dermatological, surgical, or cosmetic procedures and the dermatologists' level of knowledge regarding emergencies and basic life support. Results: Among the dermatologists, 53% reported emergency complications during dermatological and surgical procedures and 43.2% during cosmetic procedures. The most common complications were vasovagal syncope, hypotension/bleeding, and seizures. Emergency complications were more common among specialists, those with more than 15 years of professional experience, those working in their private clinics, and those performing an average of 10–50 dermatological/surgical procedures per week and fewer than 10 cosmetic procedures per week (p < 0.05). The knowledge level of dermatologists was highest among residents, dermatologists with 0–4 years of professional experience, those working in university hospitals, and those who had both theoretical and practical training in basic life support. Conclusions: This study shows a relatively high frequency of dermatologists who experienced emergency complications during dermatological, surgical, or cosmetic procedures. Although these complications seem to be common; most of them are mild, self‐limiting, and not life‐threatening. Nevertheless, dermatologists should be competent and prepared to intervene in medical emergencies in daily practice. [ABSTRACT FROM AUTHOR]

Background and Clinical Significance: Fever in the returning traveler is a medical emergency warranting prompt exclusion of potentially life-threatening infections such as malaria. Case Presentation: We describe a case of a febrile returned traveler to South Africa whose prompt initial diagnostic work-up was notable for a false-positive malaria rapid diagnostic test (RDT), and who nevertheless responded quickly to oral atovaquone-proguanil, despite an ultimate diagnosis of African tick bite fever. Subsequent RDT and malaria thick- and thin-film blood examination failed to corroborate a diagnosis of malaria and all other microbiological testing other than rickettsial serology remained non-contributory. Conclusions: The case presented highlights important points regarding diagnostic test performance characteristics and premature diagnostic closure. [ABSTRACT FROM AUTHOR]

Background/Aims: Most birth-related ambulance calls occur without difficulty, but in some cases, complications can arise. Paramedics' involvement in birth is infrequent; therefore, the knowledge and skills required to manage complications can atrophy over time, particularly without educational interventions. This may impact outcomes. The study's aims were to measure the knowledge, attitude, and practice of paramedics in managing obstetric cases. Methods: This cross-sectional questionnaire-based study was carried out with 264 paramedics. Spearman's measure of correlation was used to observe linear correlations between ranks of the observations. Results: The majority of participants were advanced care paramedics (81.1%). Participants reported infrequently attending births in the community, with under half feeling confident in managing these (44%). Antenatal complications and trauma in pregnancy were self-reported areas of weakness; this was consistent with assessed knowledge. Conclusions: Paramedics self-reported infrequently responding to obstetric calls and the majority lacked confidence in managing these. Few indicated an excellent level of obstetric knowledge, reporting a desire to receive more education in this area. Implications for practice: When paramedics lack confidence in managing obstetric emergencies, it can lead to delayed decision making, inadequate assessment, increased error rates and adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Injury and illness can occur in children. Since children spend a considerable amount of time in school, teachers must have the ability to assist when required. However, no research to date has examined Irish primary school teachers' experiences, training and knowledge in first aid. An online survey (n = 587) examined Irish male and female primary school teachers previous first aid experiences, training and knowledge. Respondents generally showed high levels of both previous first aid training and exposure to events requiring first aid. In addition, most teachers knew the location of the school's first aid equipment and were aware of their school's first aid policy. However, many felt ill-equipped to deal with these situations, particularly for serious incidents and over a third of teachers were not currently certified in first aid. While teachers displayed good overall knowledge, gaps were evident. The findings demonstrate the need to develop a multilevel school strategy to ensure teacher proficiency and school preparedness in managing situations requiring first aid. [ABSTRACT FROM AUTHOR]

Paediatric patients with epilepsy are at risk of experiencing an acute increase in seizure frequency, called seizure clusters. These events can lead to life-threatening status epilepticus and can have lasting negative physical and psychosocial effects if treatment is not promptly administered; thus, treatment should be administrable at home or in an outpatient/ambulatory care setting. In the USA, there are three medications approved for this indication: diazepam rectal gel, midazolam nasal spray and diazepam nasal spray. Nasal sprays are the preferred route of administration, offering an easier to use and more socially acceptable alternative to rectal gel treatment. This article reviews the efficacy and safety of these treatments for paediatric patients experiencing seizure clusters, as well as important considerations for treatment choice. [ABSTRACT FROM AUTHOR]

Identifying effective treatments and policies early in a pandemic is challenging because only limited and noisy data are available and biological processes are unknown or uncertain. Consequently, classical statistical procedures may not work or require strong structural assumptions. We present an information-theoretic approach that can overcome these problems and identify effective treatments and policies. The efficacy of this approach is illustrated using a study conducted at the beginning of the COVID-19 pandemic. We applied this approach with and without prior information to the limited international data available in the second month (24 April 2020) of the COVID-19 pandemic. To check if our results were plausible, we conducted a second statistical analysis using an international sample with millions of observations available at the end of the pandemic's pre-vaccination period (mid-December 2020). Even with limited data, the information-theoretic estimates from the original study performed well in identifying influential factors and helped explain why death rates varied across nations. Later experiments and statistical analyses based on more recent, richer data confirm that these factors contribute to survival. Overall, the proposed information-theoretic statistical technique is a robust method that can overcome the challenges of under-identified estimation problems in the early stages of medical emergencies. It can easily incorporate prior information from theory, logic, or previously observed emergencies. [ABSTRACT FROM AUTHOR]

Active bleeding is a clinical emergency that often requires swift action driven by efficient communication. Extravasation of intravenous (IV) contrast on computed tomography (CT) is a hallmark of active hemorrhage. This can be seen on exams performed for a variety of indications and can occur anywhere in the body. As both traumatic and non-traumatic etiologies of significant blood loss are clinical emergencies, exams demonstrating active bleeding are often performed in emergency departments and read by emergency radiologists. Prompt communication of these findings to the appropriate emergency medicine and surgical providers is crucial. Although many types of active hemorrhage can be managed by interventional radiology techniques, endoscopic and surgical management or clinical observation may be appropriate in certain cases. To facilitate optimal care, it is important for emergency radiologists to understand the scope of indications for embolization of bleeding by interventional radiologists (IR) and when an IR consultation is warranted. Similarly, timely comprehensive diagnostic radiology reporting including pertinent positive and negative findings tailored for IR colleagues can expedite the appropriate intervention. [ABSTRACT FROM AUTHOR]