Emergency Medical Procedures Research Articles

Impact of the life-sustaining treatment decision act on organ donation in out-of-hospital cardiac arrests in South Korea: a multi-centre retrospective study

BackgroundThe demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA’s impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors.MethodsWe conducted a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1–4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation.ResultsOf the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09–12.12), with non-medical aetiology as associated factors.ConclusionThe enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions.

Medical Emergency In Dentistry By Local Anaesthetics

Justification: Local anaesthesia is widely used in various procedures in dental specialties. However, even though it is rare, a medical emergency may occur. Objective: The article aims to show the necessary care in the administration of local anaesthetic in dentistry and the medical emergencies, signs and symptoms and first procedures. Show the importance of the dental surgeon be alert to any signs and symptoms during the application of anaesthetic, and able to intercede in any risk to health or the patient's death and knowing the formula and possible side effects of anaesthetic use and their medicine interactions with legal and/or illegal drug. Methodology: research on the main electronic health platforms, BIREME, LILACS and Medline, using as descriptors: LOCAL ANAESTHETIC /+/ ODONTOLOGY and MEDICAL EMERGENCIES/AND/ODONTOLOGY, in Portuguese, French, Spanish and English, and the professional experience of the authors in First Aid and Medical Emergency in Dental Offices. Conclusion: There are risks in the administration of local anaesthetics, however they are minimal and can be predicted when there is a correct anamnesis and treatment plan and/or surgical adequate for each identified situation. Knowledge of the anatomy of irrigation and drainage, foramen, among others, besides of the physiology and neuroanatomy of the region where the anaesthetic will be applied, is important to minimise the risks. The dental surgeon should be alert to any signs and symptoms during the application of anaesthetic, and able to intercede in any risk to health or of the patient's death and knowing the formula and possible side effects of anaesthetic use and their medicine interactions with legal and/or illegal drug. The most serious side effects of a local anaesthetic focus on the central and peripheral nervous system, the cardiovascular tract and renal tract. Hence, there need to know both the physiology of the systems and the interaction of the medications with the specific anaesthetics. However, the patient may not always be able to receive anaesthetics with vasoconstrictors, and surgery is not always elective to know such medicine interactions, and not always is possible to know if there is any allergy to any specific anaesthetic without prior testing before surgery. Hence, there is needed to know emergency medical procedures in dental offices and clinics

Perlindungan Hukum terhadap Dokter dalam Memberikan Pelayanan Kesehatan Bagi Pasien yang Menolak Tindakan Medis yang Mengakibatkan Kematian

This research examines the legal protection of doctors in the context of healthcare services at the Sultan Agung Islamic Hospital in Semarang, especially in situations where patients refuse emergency medical procedures recommended by doctors, which could potentially result in death. Through an empirical juridical approach, this study analyzes the applicable legal framework, hospital readiness, and factors influencing the provision of legal protection to doctors. The research findings indicate that Indonesian positive law provides a strong foundation for the legal protection of doctors, while the Sultan Agung Islamic Hospital in Semarang has demonstrated its readiness through well-established standard procedures and effective communicative approaches. However, there are still inhibiting factors such as a lack of legal awareness among medical staff and issues with medical record documentation. Therefore, this research is expected to contribute to a more comprehensive understanding of the dynamics of legal protection for doctors in the practice of healthcare services

CT reconstruction based 3D model of the digital cushion's blood supply in the hind foot of an African savanna elephant (Loxodonta africana).

Foot health is crucial for elephants, as pathological lesions of the feet are a leading cause of euthanasia in captive elephants, which are endangered species. Proper treatment of the feet, particularly in conditions affecting the digits and the digital cushion, requires a thorough understanding of the underlying anatomy. However, only limited literature exists due to the small population and the epidemiological foot diseases which often precludes many deceased elephants from scientific study. The aim of this study was to provide a detailed anatomical description of the blood supply to the African elephant's hindfoot. The healthy right hindlimb of a 19-year-old deceased female African savanna elephant was examined using computed tomography. Following a native sequence, 48 mL of barium-based contrast agent was injected into the caudal and cranial tibial arteries, and a subsequent scan was performed. The images were processed with 3D Slicer software. The medial and lateral plantar arteries run in a symmetrical pattern. They each have a dorsal and a plantar branch, which reach the plantar skin before turning toward the axial plane of the sole to reach the digital cushion from the proximal direction. An accurate 3D model of the arteries and the bones of the foot, a set of labeled images and an animation of the blood supply have been created for ease of understanding. In contrast to domestic ungulates, the digital cushion of the hindlimb is supplied differently from that of the forelimb. The lack of large vessels in its deeper layers indicates a slow regeneration time. This novel anatomical information may be useful in the planning of surgical interventions and in emergency medical procedures.

A Pilot Randomized Controlled Trial of Augmented Reality Just-in-Time Guidance for the Performance of Rugged Field Procedures.

Medical resuscitations in rugged prehospital settings require emergency personnel to perform high-risk procedures in low-resource conditions. Just-in-Time Guidance (JITG) utilizing augmented reality (AR) guidance may be a solution. There is little literature on the utility of AR-mediated JITG tools for facilitating the performance of emergent field care. The objective of this study was to investigate the feasibility and efficacy of a novel AR-mediated JITG tool for emergency field procedures. Emergency medical technician-basic (EMT-B) and paramedic cohorts were randomized to either video training (control) or JITG-AR guidance (intervention) groups for performing bag-valve-mask (BVM) ventilation, intraosseous (IO) line placement, and needle-decompression (Needle-d) in a medium-fidelity simulation environment. For the interventional condition, subjects used an AR technology platform to perform the tasks. The primary outcome was participant task performance; the secondary outcomes were participant-reported acceptability. Participant task score, task time, and acceptability ratings were reported descriptively and compared between the control and intervention groups using chi-square analysis for binary variables and unpaired t-testing for continuous variables. Sixty participants were enrolled (mean age 34.8 years; 72% male). In the EMT-B cohort, there was no difference in average task performance score between the control and JITG groups for the BVM and IO tasks; however, the control group had higher performance scores for the Needle-d task (mean score difference 22%; P = .01). In the paramedic cohort, there was no difference in performance scores between the control and JITG group for the BVM and Needle-d tasks, but the control group had higher task scores for the IO task (mean score difference 23%; P = .01). For all task and participant types, the control group performed tasks more quickly than in the JITG group. There was no difference in participant usability or usefulness ratings between the JITG or control conditions for any of the tasks, although paramedics reported they were less likely to use the JITG equipment again (mean difference 1.96 rating points; P = .02). This study demonstrated preliminary evidence that AR-mediated guidance for emergency medical procedures is feasible and acceptable. These observations, coupled with AR's promise for real-time interaction and on-going technological advancements, suggest the potential for this modality in training and practice that justifies future investigation.

Immersive haptic simulation for training nurses in emergency medical procedures

The use of haptic simulation for emergency procedures in nursing training presents a viable, versatile and affordable alternative to traditional mannequin environments. In this paper, an evaluation is performed in a virtual environment with a head-mounted display and haptic devices, and also with a mannequin. We focus on a chest decompression, a life-saving invasive procedure used for trauma-associated cardiopulmonary resuscitation (and other causes) that every emergency physician and/or nurse needs to master. Participants’ heart rate and blood pressure were monitored to measure their stress level. In addition, the NASA Task Load Index questionnaire was used. The results show the approved usability of the VR environment and that it provides a higher level of immersion compared to the mannequin, with no statistically significant difference in terms of cognitive load, although the use of VR is perceived as a more difficult task. We can conclude that the use of haptic-enabled virtual reality simulators has the potential to provide an experience as stressful as the real one while training in a safe and controlled environment.

Perception of post-MBBS interns toward their internship and skill developed during internship: A cross-sectional observational study in a tertiary care hospital

Background: In India, MBBS programs span 5½ years, with 1-year mandatory internship during which interns acquire essential medical skills. However, recent literature has highlighted that interns lack the knowledge and confidence to perform routine and emergency medical procedures. Aim and Objectives: This study aimed to investigate the perceptions of post-MBBS interns regarding their internship experience and the skills they developed during this period. Materials and Methods: An observational, cross-sectional, questionnaire-based study was conducted with 100 participants. The study utilized a pre-validated questionnaire consisting of 13 questions related to attitudes and 30 questions related to skills acquired during internship. Descriptive statistics were applied to analyze the data using SPSS version 24.0. Results: Among participants, 57 were male and 43 were female. The majority perceived the internship as a challenging phase, which significantly improved their skills and contributed to their development as independent practitioners. Internship experiences strongly influenced postgraduate specialization choices. The workload during the internship was considered high by most participants, with some postings deemed unnecessary. 94 participants reported performing menial tasks. While certain skills, such as blood pressure measurement, blood collection, intramuscular, intravenous, subcutaneous injections, and respiratory therapy insertion, were performed by over 80% of interns, other skills such as arterial blood gas interpretation, episiotomy, pleural tapping, and endotracheal intubation were only performed independently by very few participants. Conclusion: This study sheds light on the perceptions and skill development of post-MBBS interns during their internships, underscoring the importance of practical experiences for professional growth.

COVID-19 Screening Score for Patients without Acute Respiratory Symptoms Undergoing Emergency Medical Procedures in Indonesia.

To rule out coronavirus disease-2019 (COVID-19) in patients scheduled to undergo emergency medical procedures, SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) must be performed. In developing countries, the use of SARS-CoV-2 RT-PCR has been limited by its unavailability and long processing time. Hence, a quick screening score to predict COVID-19 may help healthcare practitioners determine which patients without acute respiratory symptoms can safely undergo an emergency medical procedure. We conducted a cross-sectional study of adult patients without acute respiratory symptoms who were admitted to the emergency department and underwent an emergency medical procedure within 24 hours after admittance. We collected baseline demographic data, COVID-19 screening variables, and SARS-CoV-2 RT-PCR as the gold standard for COVID-19 diagnosis. Bivariate and multivariate analyses were performed, and a scoring system was developed using statistically significant variables from the multivariate analysis. With data from 357 patients, multivariate backward stepwise logistic regression analysis resulted in two significant COVID-19 predictors: the presence of SARS-CoV-2-IgM antibody (adjusted odds ratio [aOR]: 7.02 [95% CI: 1.49-32.96]) and typical chest x-ray (aOR: 23.21 [95% CI: 10.01-53.78]). A scoring system was developed using these predictors with an area under the receiver operating characteristic curve of 0.71 (95% CI: 0.64-0.78). For a cutoff point of ≥ 2, the scoring system showed 42.5% sensitivity and 97.1% specificity but had poor calibration (Hosmer-Lemeshow test P value < 0.001). We believe that the development of this COVID-19 quick screening score may be helpful in a resource-limited clinical setting, but its moderate discrimination and poor calibration hinder its use as a replacement for the SARS-CoV-2 RT-PCR test for COVID-19 screening.

Researches Advanced in Intubation Based on SLAM

Intubation is an emergency medical procedure used to rescue people who are unconscious or unable to breathe on their own. In the process of tracheal intubation, traditional intubation is difficult due to narrow viewing angle, trachea bending, and occlusion of internal structures. Thanks to the rapid development of simultaneous localization and mapping (SLAM) and virtual reality (AR) technologies, intubation aids are also developing towards intelligence and automation. Based on the collection and analysis of a large number of literatures, this paper conducts an in-depth study of the existing SLAM-based intubation-assisted technology. Specifically, on the basis of analyzing the current research on the application of equipment, visualization schemes, and algorithm schemes in tracheal intubation and intubation training, this paper studies the application progress in terms of efficiency, versatility, accuracy, and user feedback. Further, we summarize the existing key issues and discuss future developments.

Complicated pregnancy in the experience of Emergency Medical Services Teams – hypertension

Aim:To present the characteristics of Emergency Medical Services (EMS) team interventions in cases of women with a hypertensive disorder of pregnancy (HDP). Material and methods: The study was based on a retrospective analysis of interventions by basic and specialist EMS teams in cases of pregnant women with a hypertensive disorder carried out between 1 January 2018 and 30 June 2021. Results: Most of the women studied were pregnant for the first time (52.3%), in their III trimester (76.6%). The most commonly reported symptom was swelling (12.0%). The majority of interventions were carried out by a basic (only paramedics), two-person (55.0%) EMS team and were assigned urgency code 2 (65.8%). Emergency medical procedures most commonly provided by EMS teams to pregnant patients were pulse oximetry (95.5%) and blood pressure measurement (73.3%). Further management involved providing assistance to the pregnant patient and transferring her to hospital (94.7%). Basic EMS teams (only paramedics) were more likely than specialist EMS teams (with physician) to be dispatched to women with HDP who were in their second pregnancy (23.7%) and had no history of giving birth (53.5%). Most interventions by basic EMS teams (only paramedics) were assigned urgency code 2 (70.0%) and were carried out by a two-person EMS team (81.1%). The associations identified were statistically significant (p&lt;0.05). Conclusions: Further studies on out-of-hospital obstetric emergencies are necessary in order to gain a better understanding of the subject and ensure that EMS teams provide the best possible care to pregnant patients.

AN EVALUATIVE STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME ON KNOWLEDGE REGARDING BASIC LIFE SUPPORT AMONG STUDENTS IN SELECTED SCHOOL OF AMRITSAR PUNJAB.

Basic life support is an emergency medical procedure for a victim with cardiac arrest or some emergency circumstances because of respiratory arrest. Cardio pulmonary resuscitation may be performed in clinical setup or in the periphery by common man or by emergency trained healer personnel. The main purpose of cardiopulmonary resuscitation is to maintain a flow of oxygenated blood to the brain and heart, there by delaying tissue death without permanent brain damage. Video assisted teaching provides a big avenue for research on innovative methods of creating awareness among the students on Basic life support. An evaluative study was conducted on 100 students in selected school of Amritsar. Total enumerative sampling technique was used to collect data by using self structured questionnaire tool. The data was analyzed by using descriptive and inferential statistics. Finding of the study showed that the post test mean knowledge value (25.51) was higher than pre-test mean knowledge value (12.04).

Cardiopulmonary resuscitation of pregnant patients in the rescue service

Die kardiopulmonale Reanimation einer schwangeren Patientin stellt in der prähospitalen Notfallmedizin eine Rarität und für das Rettungsteam eine außerordentliche Herausforderung dar. Neben der Modifikation notfallmedizinischer Maßnahmen bei schwangerschaftsbedingten physiologischen Veränderungen sind auch spezielle reversible Ursachen zu bedenken und psychosoziale Schwierigkeiten zu managen. Der vorliegende Beitrag hat zum Ziel, ein standardisiertes Vorgehen für diese speziellen Situationen darzustellen. Grundzüge des Crew Resource Management (CRM) sind für das Rettungsteam besonders hilfreich und werden im Folgenden erwähnt.

PEDIATRIC PATIENT DURING EMERGENCY MEDICAL TEAM INTERVENTION

Aim: Analysis of Emergency Medical Teams’ responses to patients below 18 years of age in operational region of Kato¬wice Emergency Service between January 1st, 2014 and December 31st, 2017. Material and methods: Retrospective analysis of medical documentation issued by the dispatcher and by the P and S type EMS teams of Katowice Emergency Service between January 1st, 2014 and December 31st, 2017 (n = 974839). Documents regarding response to patients below 18 years of age were included in research (n = 53643). Results: EMS teams’ responses to patients below 18 years of age were selected by patients’ date of birth. These came out to be 5,38% of all responses in the defined time period. P-type EMS teams were dispatched to pediatric patients most frequently. This number decreased in months of summer vacation (July and August). The average number of re¬sponses was calculated for 10 months, January-June and September-December (n = 2322,75) and for July and August (n = 1797). Comparing the average results revealed decrease of responses in summer vacation period by n = 22.63%. Further patients below 18 years of age were divided into 4 age groups. It has been observed that among group I and III there is no statistical significance regarding responses in given daytime interval and given year in the time of research. However among group II and IV significance is high (p = 0.016) for group II and (p = 0.028) for group IV. Distribution between responses by EMS-S teams and EMS-P teams in daytime intervals shows that at night (12:00 am-5:59 am) EMS-S team is most frequently dispatched to patients from first three age groups: group I (69% vs. 31%), group II (64% vs. 36%) and group III (57% vs. 43%). In each age group there is high statistical significance. Conclusions: Patient below 18 years of age is a problem for Emergency Medical Team because of very few responses, leading to lack of experience in examining such patients and undertaking emergency medical procedures. Research revealed relationship between EMS team responses in given months, daytime intervals, age and gender. Number of responses to patients aged 8-13 and 13-18 decreases during summer vacation months and also decreases at night; there are more responses to male patients.

РОЛЬ ТА МІСЦЕ «DAMAGE CONTROL SURGERY» У ВІЙСЬКОВІЙ ЛІКУВАЛЬНО-ЕВАКУАЦІЙНІЙ ДОКТРИНІ ПІД ЧАС БОЙОВИХ ДІЙ В СУЧАСНІЙ ВІЙНІ.

Introduction: The severity of the combined injury, traumatic shock, blood loss and traumatic prolonged primary surgery are the cause of high mortality injured patients. In civilian medicine, damage control technology is widely used to treat patients with severe polytrauma, which has improved the survival of this group of patients. Objective: Analyze the effectiveness of using "damage control" technology in wounded with polytrauma at the second level of medical care during war conflict in Eastern Ukraine and organization of combat casualty care. Methods: Medical and statistical analysis of the effectiveness medical treatment for patients combat-ralated injuried and polytrauma performed on the basis of a mobile military hospital during 2015-2019 period. Results: In 660 patients with combat multiple and combined injuries and in 1027 - with severe military combined trauma, medical tratment was provide by "damage control" technology. The main task of the first stage of surgery intervention was to stop the bleeding and stabilize the patient condition. 130 patients with intra-abdominal bleeding underwent laparotomy, temporary stop of bleeding, blood sampling for autotransfusion and temporary closure of the abdominal cavity. For the purpose of temporary hemostasis in 15 patients abdominal tamponade was performed, in 26 - liver tamponade, in 24 - splenectomy, in 6 - nephrectomy and in 6 - put the clamps were applied to bleeding vessels. In 14% injured patients definitive stage of surgical procedures were performed at the second level of medical care on the background of abdominal compartment syndrome in 10, visceral edema in 14 and peritonitis in 40 patients. Conclusions: Providing emergency medical treatment, surgical procedures and intensive care at the second level of medical tretment using the technology of "damage control" and timely patients evacuation are the key to reducing mortality and complications of military surgical trauma

Suspected Labour as a Reason for Emergency Medical Services Team Interventions in Poland-A Retrospective Analysis.

The purpose of this study was to present the characteristics of Emergency Medical Services (EMS) team responses to calls regarding suspected labour in out-of-hospital settings in Poland. We performed a retrospective analysis of EMS team interventions in cases of suspected onset of labour outside a hospital setting. The analysis included 12,816 EMS team responses to calls regarding women in suspected labour in the period between January 2018 and December 2019. The mean age of the patients studied was 28.24 years (SD = 6.47). The majority of patients were at term (76.36%) and in their second pregnancy (29.96%). EMS teams were most often dispatched in the summer (25.95%) and in urban areas (63.26%). Most EMS teams were basic (68.99%) and interventions most often took place between 19:00 and 06:59 (63.14%). Significant differences were observed between preterm and term pregnant women attended by EMS teams in terms of variables such as the age of the patient, number of previous labours, history of miscarriage, presence of vaginal bleeding, time of year, location of call, type and composition of EMS team dispatched, urgency code and time of call, duration of intervention, selected emergency medical procedures performed and test results.

Analysis of Medical Management in Geriatric Patients in the Hospital Emergency Department by Example of Selected Cities with County Status in Poland: A Retrospective Cohort Study.

The aim of this study was to analyse medical management in geriatric patients in the Hospital Emergency Departments in the Biała Podlaska County and Chełm County (Poland) between 2016 and 2018 in a group of patients ≥65 years of age. We analysed medical records of 829 patients transported to Hospital Emergency Departments by Medical Emergency Teams. The research was conducted in the period from June 2019 to March 2020. We analysed emergency medical procedure forms and medical records of patients transported to the hospitals. Cardiovascular diseases were diagnosed in 40% of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the Hospital Emergency Departments in more than 2/3 of cases. The concordance between the diagnoses made by the Medical Emergency Teams and those made at the Hospital Emergency Departments was confirmed for 78% patients admitted to the department (n = 647), whereas the concordance of classification at the group level was estimated at 71.7% (n = 594). Further in-patient treatment was initiated in some of the patients admitted to the department (n = 385). The mean time of hospital stay was 10.1 days. In conclusion, differences between the initial diagnosis made by the heads of the Medical Emergency Teams and the diagnosis made by the doctor on duty in the Hospital Emergency Departments depended on the chapter of diseases in the ICD-10 classification, but they were acceptable. The majority of the patients were transported to Hospital Emergency Departments. The most common groups of diseases that require Hospital Emergency Departments admission include cardiovascular diseases, injuries due to external causes, and respiratory diseases. A moderate percentage of patients were qualified for further specialist treatment in hospital departments.

Suspected Miscarriage in the Experience of Emergency Medical Services Teams-Preliminary Study.

Vaginal bleeding and abdominal pain are symptoms indicative of a threat to pregnancy that prompt women to seek assistance from health care professionals. The purpose of the study was to present the characteristics of Emergency Medical Services (EMS) team interventions in cases of suspected miscarriage. The study involved a retrospective analysis of EMS team interventions in cases of suspected miscarriage carried out between January 2018 and December 2019 in Poland. Data obtained from Poland’s National Monitoring Center of Emergency Medical Services included emergency medical procedure records and EMS team dispatch records in electronic format. The mean patient age was 30.53 years. Most were primiparous (48.90%) and up to the 13th gestational week (76.65%). The most commonly reported symptom was vaginal bleeding (80.71%). EMS teams were most commonly dispatched in the winter (27.03%), between 7 A.M. and 6:59 P.M. (51.87%), in urban areas (69.23%), with urgency code 2 (55.60%), and in most cases, they transferred the patient to a hospital (97.53%). The present study addresses very important issues concerning the characteristics of Polish suspected miscarriage cases handled by different EMS team types, in different locations (urban vs. rural areas), and concerning patients in a different obstetric situation (gestational week, gravidity, parity). Our findings suggest a need for further studies in this field and for gestational health promotion activities to be implemented, specifically including actions to reduce the risk of vaginal bleeding during pregnancy.

Differences in Perceived Occupational Stress by Demographic Characteristics, of European Emergency Medical Services Personnel during the COVID-19 Virus Pandemic-An International Study.

Objectives: The outbreak of the COVID-19 pandemic has brought commercial, social, and economic consequences in every country that has experienced substantial SARS-CoV-2 infection rates. The complete change in the environment that took place due to the outbreak of the pandemic can lead to stressful situations, especially among healthcare personnel. Material and methods: The research were conducted during the COVID-19 pandemic between the 27 March 2020 and the 20 April 2020. The research included 1984 employees of emergency medical systems in seven European countries. An internet-based questionnaire format was adopted for the study (ΩMc-Donald > 0.7). Results: The highest level of stress was experienced by personnel in the United Kingdom M = 4.03, and the lowest by Norwegian employees M = 2.89. High levels of stress were also experienced by nurses from Spain and Poland. Women actively working in the healthcare system during the pandemic experienced higher stress levels than men. Conclusions: Women working in European emergency medical systems are more vulnerable to work-related stress, while carrying out emergency medical procedures during the pandemic. Differences in the level of stress experienced while carrying out duties in pre-hospital conditions were only found among Spanish emergency medical system personnel.

Predictors of stress among emergency medical personnel during the COVID-19 pandemic.

The COVID-19 pandemic has forced emergency services to implement new standards of practice around the world. The dynamic and unpredictable nature of many clinical situations has placed emergency service personnel in direct danger of contracting the disease. This work uses a validated survey developed for the study to assess the predictors of stress that paramedics, nurses and doctors experience in the face of the COVID-19 pandemic. The study group included 955 medical staff, and the level of significance adopted for statistical analysis was p = 0.05. Non-parametric Mann-Whitney and Kruskal-Wallis tests were used to analyze the qualitative variables divided into groups. The selection of tests was carried out based on the distribution of variables, verified using the Shapiro-Wilk test. In order to determine the predictors that caused the feelings of stress, it was necessary to use the linear regression model. During the COVID-19 pandemic, stress among emergency medical personnel has increased considerably due to new factors that did not previously exist. The predictors of stress in the professional environment include the fear of contracting COVID-19, a decrease in the level of safety while conducting emergency medical procedures, and the marginalization of treatment for patients not suffering from COVID-19. Additional socio-demographic factors that increase stress among emergency medical personnel are being female and working in the nursing profession. Appropriate training, the supply of personal protective equipment and opinions on the preparedness of the system to deal with the outbreak of the pandemic did not affect the level of stress among health service personnel. The factors that can be considered to act as predictors of occupational stress include the fear of contracting COVID-19, a decrease in the level of safety and security while conducting emergency medical procedures, and the marginalization of patients not suffering from COVID-19. Int J Occup Med Environ Health. 2021;34(2):139-49.

Exploratory research on asthma exacerbation risk factors using the Japanese claims database and machine learning: a retrospective cohort study

Objective: Analytical studies of risk factor assessment using machine learning have recently been reported. We performed an exploratory detection study of asthma exacerbation-related factors using health insurance claims data and machine learning to explore risk factors that have high generalizability and can be easily obtained in daily practice. Methods: A dataset of asthma patients during May 2014-April 2019 from the Japanese insurance claims database, MediScope® (DB) was used. Patient characteristics and disease information were extracted, and association with occurrence of asthma exacerbation was evaluated to comprehensively search for exacerbation risk factors. Asthma exacerbations were defined as the co-occurrence of emergency medical procedures, such as emergency transport and intravenous steroid injections, with asthma claims, which were recorded in the database. Results: In total, 5,844 (13.7%) subjects had exacerbations in 42,685 eligible cases from the DB. Information on approximately 3,300 diseases was subjected to a machine learning, and 25 variables were extracted as variable importance and targeted for risk assessment. As a result, sex, days without exacerbation from cohort entry date at look-back period, Charlson Comorbidity Index, allergic rhinitis, chronic sinusitis, acute airway disease (upper airway), acute airway disease (lower airways), Chronic obstructive pulmonary disease/chronic bronchitis, gastroesophageal reflux disease, and hypertension were significantly associated with exacerbation. Dyslipidemia and periodontitis were detected as associated factors of reduced exacerbation risk. Conclusions: A comprehensive analysis of claims data using machine learning showed asthma exacerbation risk factors mostly consistent with those in previous studies. Further examination in other fields is warranted. Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.1923740 .