Emergency Health Care Research Articles

Telemedicine Research Trends in 2001-2022 and Research Cooperation Between China and Other Countries Before and After the COVID-19 Pandemic: Bibliometric Analysis.

Advancements in technology have overcome geographical barriers, making telemedicine, which offers remote emergency services, healthcare, and medication guidance, increasingly popular. COVID-19 restrictions amplified its global importance by bridging distances. This study aimed to analyze Chinese and global literature data, present new global telemedicine research trends, and clarify the development potential, collaborations, and deficiencies in China's telemedicine research. We conducted bibliometrics and network analyses on relevant documents from the Web of Science database from 2001 to 2022. Data collection was completed on October 30, 2023. Considering COVID-19's impact, 2020 was used as a baseline, dividing the data into 2 periods: 2001-2019 and 2020-2022. The development potential was determined based on publication trends. An international coauthorship network analysis identified collaboration statuses and potential. Co-occurrence analysis was conducted for China and the world. We identified 25,333 telemedicine-related research papers published between 2001 and 2022, with a substantial increase during the COVID-19 period (2020-2022), particularly in China (1.93-fold increase), moving its global publication rank from tenth to sixth. The United States, the United Kingdom, and Australia contributed 62.96% of the literature, far ahead of China's 3.90%. Globally, telemedicine research increased significantly post-2020. Between 2001 and 2019, the United States and Australia were central in coauthor networks; post-2020, the United States remained the largest node. Network hubs included the United States, the United Kingdom, Australia, and Canada. Keyword co-occurrence analysis revealed 5 global clusters from 2001 to 2019 (system technology, health care applications, mobile health, mental health, and electronic health) and 2020 to 2022 (COVID-19, children's mental health, artificial intelligence, digital health, and rehabilitation of middle-aged and older adults). In China, the research trends aligned with global patterns, with rapid growth post-2020. From 2001 to 2019, China cooperated closely with Indonesia, India, Japan, Taiwan, and South Korea. From 2020 to 2022, cooperation expanded to Japan, Singapore, Malaysia, and South Korea, as well as Saudi Arabia, Egypt, South Africa, Ghana, Lebanon, and other African and Middle Eastern countries. Chinese keyword co-occurrence analysis showed focus areas in system technology, health care applications, mobile health, big data analysis, and electronic health (2001-2019) and COVID-19, artificial intelligence, digital health, and mental health (2020-2022). Although psychology research increased, studies on children's mental health and middle-aged and older adults' rehabilitation were limited. We identified the latest trends in telemedicine research, demonstrating its significant potential in China and providing directions for future development and collaborations in telemedicine research.

Feasibility and acceptability of a culturally adapted psychological first aid training intervention (Preparing Me) to support the mental health and well-being of front-line healthcare workers in China: a feasibility randomized controlled trial

ABSTRACT Background: Psychological first aid (PFA) training helps to prepare healthcare workers (HCWs) to manage trauma and stress during healthcare emergencies, yet evidence regarding its effectiveness and implementation is lacking. Method: A two-arm feasibility randomized controlled trial design was conducted in a Chinese tertiary hospital. Participants were randomly allocated to receive either a culturally adapted PFA training (the intervention arm) or psychoeducation (the control arm). Feasibility indicators and selected outcomes were collected. Results: In total, 215 workers who expressed an interest in participating in the trial were screened for eligibility, resulting in 96 eligible participants being randomly allocated to the intervention arm (n = 48) and control arm (n = 48). There was a higher retention rate for the face-to-face PFA training session than for the four online group PFA sessions. Participants rated the PFA training as very helpful (86%), with a satisfaction rate of 74.25%, and 47% reported being able to apply their PFA skills in responding to public health emergencies or providing front-line clinical care. Positive outcome changes were observed in PFA knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth. Their scores on depression, anxiety, stress, and burnout measures all declined. Most of these changes were sustained over 3 months (p < .05). Repeated measures analysis of variance found statistically significant interaction effects on depression (F 2,232 = 2.874, p = .046, η p 2 = .031) and burnout (F 2,211 = 3.729, p = .018, η p 2 = .037), indicating a greater reduction in symptoms of depression and burnout with PFA compared to psychoeducation training. Conclusion: This culturally adapted PFA training intervention was highly acceptable among Chinese HCWs and was feasible in a front-line care setting. Preliminary findings indicated positive changes for the PFA training intervention on knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth, especially a reduction of depression and burnout. Further modifications are recommended and a fully powered evaluation of PFA training is warranted.

Fever education for caregivers in the emergency room (The FEVER study)–an interventional trial

BackgroundDespite the vast majority of fevers representing benign self-limiting illnesses, caregiver anxiety regarding fever is high. Empowering caregivers with knowledge to safely and appropriately manage fever at home has the potential to reduce demands upon healthcare services.AimTo improve caregiver knowledge about fever and its management in children via an educational intervention.MethodsCaregivers of children over 6 months presenting with fever to a Paediatric Emergency Department were recruited. A pre-intervention survey was completed to ascertain caregiver knowledge about fever and its management. The intervention of (i) an infographic about fever, with (ii) a short video on fever was viewed. A post-intervention survey re-assessed knowledge. The primary outcome was the correct definition of fever as a temperature ≥38 °C.ResultsCaregivers (n = 51) who correctly defined fever increased from 41% (n = 21) pre-intervention to 94% (n = 48) post-intervention. There was a reduction in common misconceptions about fever, including a higher fever representing a more serious infection (76% vs. 8%). Caregivers reported they were less likely to seek emergency healthcare due to the height and nature of the fever alone.ConclusionsA simple brief educational intervention can rapidly increase caregiver knowledge about fever in children. There is a continuing need for clear, easily-accessible information for caregivers on this topic.ImpactParental knowledge about fever and how to manage it in their children is low.A simple brief educational intervention can significantly increase caregiver knowledge about fever.A combined written and audiovisual approach is effective and well-received by parents.Educating caregivers has the potential to improve the management of childhood fever at home and to reduce the burden on healthcare services, as well as reduce unpleasant hospital visits for children and their caregivers.

Dynamics of Link Importance through Normal Conditions, Flood Response, and Recovery

As climate change influences flood frequency, transportation damage and disruptions will become more common. Given the network’s expanse and cost of construction, communities’ mitigation efforts should be informed by analyses that span normal conditions and disaster management phases. This paper analyzes road segment criticality in normal, flood response, and recovery phases in Anderson County, South Carolina, considering impacts on emergency services, healthcare, industry, education, recreation, and transit. A 100-year event provides context for analyzing flood impacts to the time-based shortest paths, determined using ArcGIS Pro 3.1.3. Local and secondary roads were especially affected, with rerouting concentrating around the Anderson City area. Blocked road sections identified potentially vulnerable roads, and normalized betweenness centrality metrics identified community dependence on road segments for daily and emergency operations. While the quantity and dispersion of parks and grocery stores mitigated rerouting distance, other purposes faced challenges from impassable routes. The analysis revealed the southeastern and southern regions as most impacted across purposes, suggesting targeted mitigation. I-85, State Routes 28 and 81, and Federal Routes 29, 76, and 178 were the most critical roads before, during, and after the flood. This study highlights commonalities in road criticality across phases to support resilient transportation planning and sustainability.

Mapping clinical interactions in an Australian tertiary hospital emergency department for patients presenting with risk of suicide or self-harm: Network modeling from observational data.

Reliable assessment of suicide and self-harm risk in emergency medicine is critical for effective intervention and treatment of patients affected by mental health disorders. Teams of clinicians face the challenge of rapidly integrating medical history, wide-ranging psychosocial factors, and real-time patient observations to inform diagnosis, treatment, and referral decisions. Patient outcomes therefore depend on the reliable flow of information through networks of clinical staff and information systems. This study aimed to develop a quantitative data-driven research framework for the analysis of information flow in emergency healthcare settings to evaluate clinical practice and operational models for emergency psychiatric care. We deployed 2 observers in a tertiary hospital emergency department during 2018 for a total of 118.5 h to record clinical interactions along patient trajectories for presentations with risk of self-harm or suicide (n = 272 interactions for n = 43 patient trajectories). The study population was reflective of a naturalistic sample of patients presenting to a tertiary emergency department in a metropolitan Australian city. Using the observational data, we constructed a clinical interaction network to model the flow of clinical information at a systems level. Community detection via modularity maximization revealed communities in the network closely aligned with the underlying clinical team structure. The Psychiatric Liaison Nurse (PLN) was identified as the most important agent in the network as quantified by node degree, closeness centrality, and betweenness centrality. Betweenness centrality of the PLN was significantly higher than expected by chance (>95th percentile compared with randomly shuffled networks) and removing the PLN from the network reduced both the global efficiency of the model and the closeness centrality of all doctors. This indicated a potential vulnerability in the system that could negatively impact patient care if the function of the PLN was compromised. We developed an algorithmic strategy to mitigate this risk by targeted strengthening of links between clinical teams using greedy cumulative addition of network edges in the model. Finally, we identified specific interactions along patient trajectories which were most likely to precipitate a psychiatric referral using a machine learning model trained on features from dynamically constructed clinical interaction networks. The main limitation of this study is the use of nonclinical information only (i.e., modeling is based on timing of interactions and agents involved, but not the content or quantity of information transferred during interactions). This study demonstrates a data-driven research framework, new to the best of our knowledge, to assess and reinforce important information pathways that guide clinical decision processes and provide complementary insights for improving clinical practice and operational models in emergency medicine for patients at risk of suicide or self-harm. Our findings suggest that PLNs can play a crucial role in clinical communication, but overreliance on PLNs may pose risks to reliable information flow. Operational models that utilize PLNs may be made more robust to these risks by improving interdisciplinary communication between doctors. Our research framework could also be applied more broadly to investigate service delivery in different healthcare settings or for other medical specialties, patient groups, or demographics.

Factors associated with emergency department visits for asthma resulting in hospital admission—United States, 2020

Objective To identify risk factors associated with hospital admission following an ED visit for asthma at the time of discharge among U.S. children and adults. Methods Asthma emergency department visits resulting in hospital admissions using discharge data among children (aged 0–17 years) and adults (aged 18 years or older) from the 2020 Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality were examined. Risk factors associated with hospital admission following ED visits were identified using univariable and multi-variable logistic regression models. Results Among children, hospital admission after asthma-related ED visits was higher for females, ages less than 12 years, and discharged in January–March or in October–December and lower for Black children, Hispanic children, Medicaid or Medicare beneficiaries, other/no charge/self-pay, and in metropolitan non-teaching or non-metropolitan hospitals. Among adults, asthma ED visits resulting in hospital admissions were higher for females, ages 35 years or older, discharged in January–March, and for Medicare beneficiaries and lower for Black adults, Hispanic adults, adults of other races, other/no charge/self-pay, in metropolitan non-teaching or non-metropolitan hospitals, and median household income quartiles for patient’s ZIP Code of less than $59,000 were lower. Conclusions Sociodemographic factors, healthcare use, and household income were significantly associated with hospital admissions at the time of discharge from the ED. Examining hospital admission after an ED visit for asthma is important in identifying these groups and better addressing their healthcare needs.

Paramedic Workforce Disparities Marked by Geographical Positioning

Introduction: Effective service delivery and the wellbeing of the paramedic workforce is reliant on confounding factors and is effectuated by geographical positioning. It is important to be aware that there may be several disparities between the rural and urban workforce due to differences in circumstances. However, there is limited literature available examining these. The objective of this review was to investigate where and how these disparities exist to make recommendations in achieving equity in the paramedic workforce and thus achieve patient-centred care universally across rural and urban populations.&#x0D; Methods: The JBI approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, EMT, urban OR metro*, rural OR remote and disparit* were inserted into the search engines MEDLINE, CINAHL Plus and Scopus. Titles and abstracts of the 282 results were screened by two authors and inclusion and exclusion criteria applied. The full text of the remaining 77 results were screened to inform the results of the review.&#x0D; Results: The search identified 282 potentially relevant articles, of which 33 informed the results of the review. The included studies identified emerging themes relevant to the objective including: (1) the skills, training availability and confidence of the workforce (2) resourcing of ambulances inclusive of both workload and case load; (3) timings of each group regarding response, scene, and transport; and (4) the health status of paramedics in each subset location.&#x0D; Conclusion: This review identified several disparities between rural and urban paramedic locations. However, it does not allow us to understand the extent at which these influence paramedics health and wellbeing and their ability to provide optimal patient-centred care which is equitable across locations. Further research is recommended to establish the extent to which these disparities are impacting the lives of paramedics and provision of emergency healthcare.

An in situ dressing material containing a multi‐armed antibiotic for healing irregular wounds

AbstractAcute and infected wounds resulting from accidents, battlefield trauma, or surgical interventions have become a global healthcare burden due to the complex bacterial infection environment. However, conventional gauze dressings present insufficient contact with irregular wounds and lack antibacterial activity against multi‐drug‐resistant bacteria. In this study, we develop in situ nanofibrous dressings tailored to fit wounds of various shapes and sizes while providing nanoscale comfort and excellent antibacterial properties. Our approach involves the fabrication of these dressings using a handheld electrospinning device that allows for the direct deposition of nanofiber dressings onto specific irregular wound sites, resulting in perfect conformal wound closure without any mismatch in 2 min. The nanofibrous dressings are loaded with multi‐armed antibiotics that exhibit outstanding antibacterial activity against Staphylococcus aureus (S. aureus) and methicillin‐resistant S. aureus. Compared to conventional vancomycin, this in situ nanofibrous dressing shows great antibacterial performance against up to 98% of multi‐drug‐resistant bacteria. In vitro and in vivo experiments demonstrate the ability of in situ nanofibrous dressings to prevent multi‐drug‐resistant bacterial infection, greatly alleviate inflammation, and promote wound healing. Our findings highlight the potential of these personalized nanofibrous dressings for clinical applications, including emergency, accident, and surgical healthcare treatment.

A Qualitative Research Survey on Cardiologist's Ethical Stance in Cases of Moral Dilemmas in Cardiology Clinics.

This study sought to determine cardiologists' degrees of ethical awareness and preferred courses of action for ethical dilemmas frequently encountered in clinical settings. For this evaluation, an online survey was created and sent to cardiologists affiliated with various academic posts in Ankara, Turkey. The survey included ten cases with various ethical considerations selected from our book, "Clinic Ethics with Cases from Cardiology." Four possible action choices were defined for each case. Participants were asked to choose one or more of these preferences. In addition, a fictional change was made in each case's context without changing the original ethical issue, and participants were asked whether an attitude different from the first chosen one was preferred. The participation ratio was 49/185 (26%), consent ratio 47/185 (25,4%), and completion ratio 44/185 (23,7%). Nine of the ten scenario changes did not change participants' preferred action. For most questions, action preferences were concentrated between the two options. Although legal regulations did not reduce ethical dilemmas, they clarified physicians' action preferences. Similarly, as an obscure moral issue gained prominence, physicians were forced to draw clearer lines in their actions. External factors such as healthcare emergencies can change physicians' ethical dilemma-solving attitudes.

Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization.

Telehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March-June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018-2022). We used difference-in-differences methodology adjusting for patients' characteristics, comorbidities, COVID-19 infection status, and number of in-person visits. We found that using telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by -$1814 per person), number of emergency department visits (by -88.6 per 1000 persons), and number of inpatient admissions (by -32.4 per 1000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days' drug supply (by 0.773 days). These associated benefits of telehealth use can inform decision makers, insurance companies, and health care professionals, especially in the context of disrupted health care access.

COVID-19 outcomes in patients with pre-existing cardiovascular disease and risk factors: perspectives from a hospital in Ireland

Background/Aims COVID-19 has led to substantial changes in the provision of emergency healthcare services. International data suggest that COVID-19 is associated with increased morbidity and mortality in patients with pre-existing cardiovascular disease and cardiovascular risk factors. This study aimed to explore the association between pre-existing cardiovascular disease and/or cardiovascular risk factors and COVID-19 disease severity and outcomes in an Irish hospital. Methods This retrospective study obtained data from a bioresource database of patients with confirmed COVID-19 infection (n=649) in a large hospital in Dublin. Data were collected on patients' demographic characteristics, cardiovascular diseases, cardiovascular disease risk factors and medications taken for cardiovascular conditions. The World Health Organization progression scale was used to assess the severity of COVID-19 infection in each patient. Cross-tabulation analysis was used to analyse associations between variables, with a P value of ≤0.05 indicating significance. Results Mortality rates were six times greater in patients with cardiovascular disease compared to those without cardiovascular disease (18.6% vs 3.1%). A higher percentage of patients with one or more cardiovascular risk factors had moderate (53.4%) or severe (19.1%) COVID-19 and higher mortality rates (10.7%) than those without cardiovascular risk factors. Of the patients who died from COVID-19 (n=40), 60.0% (n=24) had one or more cardiovascular diseases, while 80.0% (n=32) had one or more cardiovascular risk factors. Conclusions Existing cardiovascular disease and cardiovascular risk factors increase the risk of more severe disease and worse clinical outcomes in patients with COVID-19. Many cardiovascular risk factors are modifiable, so it is important to consider preventative education strategies designed to reduce modifiable risk factors to improve outcomes for patients with COVID-19.

Socioeconomic inequities during COVID 19 pandemic increase preterm birth and low birth weight in the most underprivileged

Background The mitigation measures implemented to face the healthcare emergency brought by COVID 19 pandemic generated an increase in socioeconomic inequities in the most underprivileged population which is also the most threatened in their human rights. In Uruguay, this population is assisted in the public health care system. To analyze how these measures impacted on these mothers and their neonates we selected outcomes that most contributed to neonatal mortality. Objective To analyze the incidence of Preterm Birth (PB), Intrauterine Growth Restriction (IUGR) and Low Birth Weight (LBW) in the public health care system in Uruguay, during the period of time in which the strictest measures were adopted to mitigate the COVID 19 pandemic in 2020 (para-pandemic period) compared to the same period in 2019 (pre-pandemic). Methods A retrospective, cross sectional, descriptive study was performed to compare PB, IUGR and LBW from 15 March to 30 September 2019 (before COVID 19 pandemic) to the same period of 2020 (when COVID 19 pandemic bloomed), in the public health care subsystem. The analysis was performed with data from the national perinatal database system (SIP). Results In 2020, a significative increase in PB, RR: 1.14 (CI 95%: 1.03–1.25), and in LBW, RR: 1.16 (CI 95% 1.02–1.33), was registered compared to 2019 (pre-pandemic period). IUGR also showed an increase, but without statistical significance (4.6% in 2019 vs 5.2% in 2020, RR 1.13 CI 95% 0.98–1.31). The compared groups showed no differences in the distribution of biological confounding variables that could explain the increase in incidence of the main outcomes. Conclusions In the absence of other factors that could explain the results we consider that social crisis associated to the restrictive measures implemented in the country to dwindle the effect of the pandemic exacerbated the adverse conditions that affect the reproductive process for those underprivileged women assisted in the public sector, increasing PB and LBW. It is important to consider the future impact of these results on neonatal and infant mortality and to implement social measures to reduce the damage as soon as possible.

Enhancing health care through medical cognitive virtual agents.

The modern era of cognitive intelligence in clinical space has led to the rise of 'Medical Cognitive Virtual Agents' (MCVAs) which are labeled as intelligent virtual assistants interacting with users in a context-sensitive and ambient manner. They aim to augment users' cognitive capabilities thereby helping both patients and medical experts in providing personalized healthcare like remote health tracking, emergency healthcare and robotic diagnosis of critical illness, among others. The objective of this study is to explore the technical aspects of MCVA and their relevance in modern healthcare. In this study, a comprehensive and interpretable analysis of MCVAs are presented and their impacts are discussed. A novel system framework prototype based on artificial intelligence for MCVA is presented. Architectural workflow of potential applications of functionalities of MCVAs are detailed. A novel MCVA relevance survey analysis was undertaken during March-April 2023 at Bhubaneswar, Odisha, India to understand the current position of MCVA in society. Outcome of the survey delivered constructive results. Majority of people associated with healthcare showed their inclination towards MCVA. The curiosity for MCVA in Urban zone was more than in rural areas. Also, elderly citizens preferred using MCVA more as compared to youths. Medical decision support emerged as the most preferred application of MCVA. The article established and validated the relevance of MCVA in modern healthcare. The study showed that MCVA is likely to grow in future and can prove to be an effective assistance to medical experts in coming days.

Enhancing healthcare security measures in IoTT applications through a Hesitant Fuzzy-Based integrated approach

&lt;abstract&gt; &lt;p&gt;Due to their impact on transportation, Internet of Transportation Things (IoTT) devices have garnered attention recently. Their most notable use is in healthcare, where transportation has been significantly influenced by Internet of Things (IoT) devices. However, threats to infrastructure integrity, medical equipment vulnerabilities, encryption, data integrity threats, and various other security issues make these devices particularly vulnerable. They transmit a considerable amount of sensitive data via sensors and actuators. Given their susceptibility to various attacks, securing the application security of IoTT is crucial. Consequently, IoTT device-based applications must undergo thorough security screening before integration into the healthcare network. Additionally, the authentication technique employed must be robust and reliable. IoTT device evaluation should be impartial and take into account security risk issues. This study proposes an evaluation approach for IoTT devices that utilizes key security risk factors to ensure reliable and secure authentication. Employing hybrid multicriteria decision-making, the suggested strategy evaluates authentication features to select the optimal hospital information system. The hesitant fuzzy analytic hierarchy process-technique for order of preference by similarity to ideal solution (Hesitant Fuzzy AHP-TOPSIS) method is used to systematically examine security risks in a real-time case study with seven alternatives. Results indicate that mediXcel electronic medical records are the most viable, while the Caresoft hospital information system is the least viable, providing valuable insights for future studies and IoTT application professionals. This research addresses security issues to enhance patient data integrity and privacy, facilitating the seamless integration of IoTT applications into healthcare, particularly in emergency healthcare.&lt;/p&gt; &lt;/abstract&gt;

Application of Metacombination Technique in the Financial Flow Based on Blockchain Technology in the Hospital Ecosystem

Using blockchain technology, citizens can participate in health study programs. In addition, better research and shared data on public welfare will enhance treatment for diverse communities. A centralized database is used to manage the entire health care system and organizations. The aim of the research is to apply the hybrid technique for financial flow based on blockchain technology in the hospital ecosystem. The researcher has analyzed the results and findings of previous researchers by applying a systematic review approach and identified the effective factors by performing the 7 steps of the Sandelovski and Barroso method. Among the 270 articles, 25 articles were selected based on the CASP method, and the validity of the analysis was confirmed with the Kappa coefficient value of 0.776. In this context, in order to measure reliability and quality control, the transcription method was used, and its value was identified for the indicators identified at the level of excellent agreement. The results of data analysis collected in MAXQDA software led to the identification of 42 primary codes in 9 categories. Based on the metacomposition technique, 9 categories were also categorized based on these concepts. The 9 categories are: access control and privacy, data integration, emergency and specific healthcare, data compatibility, governance and compliance, payment management, cost management, asset management and medication management. The use of blockchain technology in the hospital ecosystem, as a new solution in financial and operational flow management, leads to significant benefits. This technology allows hospitals to track their assets and drugs more accurately and provide more efficient management of supply and resource utilization. Also, by providing a reliable platform for recording and transferring various data, blockchain can play an effective role in creating digital governance systems and increasing data privacy. In addition, blockchain is also very effective in managing hospital payments and costs, as it can help track and verify payments in a transparent and highly reliable manner. This technology can also be effective in increasing the hospital's financial efficiency and reducing resource wastage, which improves healthcare services and enhances the patient experience.

Emergency medical service interventions and experiences during pandemics: A scoping review.

The global impact of COVID-19 has been profound, with efforts to manage and contain the virus placing increased pressure on healthcare systems and Emergency Medical Services (EMS) in particular. There has been no previous review of studies investigating EMS interventions or experiences during pandemics. The aim of this scoping review was to identify and present published quantitative and qualitative evidence of EMS pandemic interventions, and how this translates into practice. Six electronic databases were searched from inception to July 2022, supplemented with internet searches and forward and backward citation tracking from included studies and review articles. A narrative synthesis of all eligible quantitative studies was performed and structured around the aims, key findings, as well as intervention type and content, where appropriate. Data from the qualitative studies were also synthesised narratively and presented thematically, according to their main aims and key findings. The search strategy identified a total of 22,599 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 90 studies were included. The quantitative narrative synthesis included seven overarching themes, describing EMS pandemic preparedness plans and interventions implemented in response to pandemics. The qualitative data synthesis included five themes, detailing the EMS workers' experiences of providing care during pandemics, their needs and their suggestions for best practices moving forward. Despite concerns for their own and their families' safety and the many challenges they are faced with, especially their knowledge, training, lack of appropriate Personal Protective Equipment (PPE) and constant protocol changes, EMS personnel were willing and prepared to report for duty during pandemics. Participants also made recommendations for future outbreak response, which should be taken into consideration in order for EMS to cope with the current pandemic and to better prepare to respond to any future ones. The review protocol was registered with the Open Science Framework (osf.io/2pcy7).

Changes in urgent and emergency care activity associated with COVID-19 lockdowns in a sub-region in the East of England: Interrupted times series analyses.

Access to and use of urgent and emergency care in the United Kingdom's National Health Service reduced during COVID-19 related lockdowns but demand reportedly increased since then. We investigated the impact of COVID-19 on urgent and emergency health care services activity in an eastern England population of 1.1 million. We used health care activity data from a municipal health department, recorded at the level of discrete events (such as visits to hospital or ambulance calls) to compare system activity between 2018-2020 (pre-COVID), 2020-2021 (lockdown) and 2021-2023 (post-lockdown), carrying out interrupted time series analyses to describe changes in activity. Daily emergency department (ED) attendances were 10% (95% confidence interval 9-12%) lower during the lockdown period, and 7% (6-8%) higher in the post-lockdown period than pre-COVID. Attendances arriving by ambulance were 13% (12-14%) lower post-lockdown than pre-COVID, while attendances of arrivals by other means were 17% (16-19%) higher. Post-lockdown, overall attendances were continually reducing. ED waiting times were 45% (44-47%) longer in the post-lockdown period compared to the pre-COVID period and continued to increase post-lockdown. There was a 15% (14-16%) reduction in daily ambulance dispatches post-lockdown versus pre-COVID. Ambulance arrivals with delayed handover to hospital care exceeding 60 minutes increased by 17% (16-18%) post-lockdown versus pre-COVID, and probability of delay showed a continuously upward trend post-lockdown of 20% (19-21%) per year. Patients are facing long waits in EDs to be admitted to hospital, discharged or transferred. This results in delays in ambulances handing over patients and attending to other calls, which may explain decreasing rates of ambulance dispatches. Potential solutions are likely to involve enhancing the flow through and discharge of patients from hospital, and a whole systems approach which considers the capacity of the local health and care infrastructure, including intermediate care and social care.

Evaluation of the Situations of Coping With Mental Trauma and Trauma in Emergency Service Personnel Who Medically Intervened to Earthquake Affected People in the 2020 Izmir Earthquake.

This study aimed to evaluate the mental trauma and coping status of emergency health care workers who responded to the earthquake affected people in the October 2020 Izmir earthquake. This was a descriptive and cross-sectional study. State-Trait Anxiety Inventory (STAI), Posttraumatic Cognition Inventory, Strategies for Coping with Earthquake Stress Scale (SCESS), and Post-earthquake Trauma Level Determination Scale (PETLDS) were used. Independent t-test, analysis of variance, Tukey's test, and Pearson's correlation analysis were used for statistical analysis. Statistical significance was accepted as P ≤ 0.05. A total of 113 health-care professionals participated in the study. There is a positive and high degree of correlation between the religious coping sub-dimension of the SCESS and the PETLDS (P < 0.001). There was a moderate positive correlation between the religious coping sub-dimension of the SCESS and the state anxiety (P < 0.001) and trait anxiety (P < 0.001) subscales of the STAI. In our study, mental trauma and post-traumatic coping levels of health-care workers who were exposed to earthquakes differed according to age, gender, and educational status. We found that post-earthquake trauma levels were directly related to state and trait anxiety levels and religious coping levels. We found that, after the earthquake, social support seeking behavior, state and trait anxiety levels increased; negative cognitions about self, negative cognitions about the world, and self-blame increased.Practice implications: This study draws attention to the evaluation of emergency health workers who work at the forefront of disasters in terms of subsyndromal post-traumatic stress disorder (PTSD). It is recommended to make plans for psychologically protective and preventive interventions for health-care workers especially after disasters.

Reliability of ChatGPT for performing triage task in the emergency department using the Korean Triage and Acuity Scale.

Artificial intelligence (AI) technology can enable more efficient decision-making in healthcare settings. There is a growing interest in improving the speed and accuracy of AI systems in providing responses for given tasks in healthcare settings. This study aimed to assess the reliability of ChatGPT in determining emergency department (ED) triage accuracy using the Korean Triage and Acuity Scale (KTAS). Two hundred and two virtual patient cases were built. The gold standard triage classification for each case was established by an experienced ED physician. Three other human raters (ED paramedics) were involved and rated the virtual cases individually. The virtual cases were also rated by two different versions of the chat generative pre-trained transformer (ChatGPT, 3.5 and 4.0). Inter-rater reliability was examined using Fleiss' kappa and intra-class correlation coefficient (ICC). The kappa values for the agreement between the four human raters and ChatGPTs were .523 (version 4.0) and .320 (version 3.5). Of the five levels, the performance was poor when rating patients at levels 1 and 5, as well as case scenarios with additional text descriptions. There were differences in the accuracy of the different versions of GPTs. The ICC between version 3.5 and the gold standard was .520, and that between version 4.0 and the gold standard was .802. A substantial level of inter-rater reliability was revealed when GPTs were used as KTAS raters. The current study showed the potential of using GPT in emergency healthcare settings. Considering the shortage of experienced manpower, this AI method may help improve triaging accuracy.

IoT emergency healthcare system using ML-based triage

IoT emergency healthcare system using ML-based triage