Mobile Medical Teams Research Articles

Timing and Identification of the Cause and Treatment of a Cardiac Arrest: A Potential Survival Benefit

Objective: The aim of this study was to evaluate how mobile medical teams (MMTs) search for the etiology of a cardiac arrest (CA) and to investigate the association between the discovery of etiology and patient outcome. Subjects and Methods: Resuscitations of all adult patients who experienced an in- or out-of-hospital CA between 2016 and 2018 were video recorded. All video recordings were reviewed. The time to start of “cause analysis” and time to treatment by the MMT were analyzed. Also, investigations performed during etiologic evaluation were examined: heteroanamnesis, medical history-taking, clinical examinations, technical investigations, and the use of the 4Hs and 4Ts method. Results: Of the 139 CA events included in this study, the MMTs performed etiologic evaluation in only 75% of the resuscitations, and in 20% of the evaluations, they did not use the recommended 4Hs and 4Ts method. Medical history-taking and heteroanamnesis were performed in the large majority, but often without clear cause. A presumptive etiology was found in 46.8% of out-of-hospital CAs and 65.2% of in-hospital CAs. A significant association was found between return of spontaneous circulation and the discovery of presumable etiology for out-of-hospital CAs (p < 0.001). The median time to treatment was 492 s (recommended: 130–250 s) for nonshockable rhythms and 422 s (recommended: 270–390 s) for shockable rhythms, up to twice the time advised according to the guidelines. Conclusion: The current approach for etiologic evaluation is not ideal. Further research is needed to establish a more structured and simplified approach.

The medical support of large-scale international events

The medical support is one of the most important components of effectiveness of international sports events. The purpose of the study is to analyze results of implementation of organizational approaches to medical support of international sports competitions at the World Skills Championship 2019 in Kazan, previously developed and successfully approved on the model of the 2013 World's Students Games (Kazan). The medical support plan included preparation of regulatory base, resources of medical infrastructure at sports venues, including personnel training and measures to eliminate the medical and sanitary consequences of emergencies. At the objects of the Championship, 21 medical aid posts, 23 mobile medical teams functioned, and 22 ambulance teams were on duty. The estimated number of medical staff involved in work at the Championship venues was 120 people, or 8.9 people per 100 contestants. There were 1883 registered medical requests. The largest percentage of requests fell on staff (29.6%), volunteers (20.4%), contestants (18.1%) and visitors (10.7%). Among the accredited persons, the most requested medical assistance was for respiratory diseases (8.5 ‰), diseases of the nervous system (8.4 ‰) and injuries (7.2 ‰). The application of developed approaches to medical support of international sports competitions for the World Skills World Championship allowed to organize provision of medical care to client groups at high level.

Organization of medical care in FMBA institutions of the siberian federal district during the pandemic of new coronavirus infection (COVID-19): challenges and solutions

Introduction. The experience of organization of medical activity in the medical institutions subordinate to the FMBA of Russia in the Siberian Federal District during the I-III epidemic waves of COVID-19, the procedure for making and implementing organization and managerial decisions on building the health care system; the analysis of the experience gained in the formation and operation of consolidated mobile emergency response teams was made.Materials and methods. The study was performed on the basis of the statistical data, regulations on the organization of medical care for patients diagnosed with COVID-19, including medical care provision in the extreme conditions.Results and Discussion. The rational distribution of infectious diseases hospitals, human resources and equipment made it possible to create bed capacity reserve, as a result of which, even during the peak episodes of the pandemic process, the average occupancy of beds in the serviced area was no more than 92-93% and there was always the possibility to receive new patients in hospitals; the capacity of the laboratory was gradually increased 25 times: from 200 tests per day in the pre-pandemic period to 5,000 tests per day. Thanks to the introduction of the new management solutions, digitalization of medical processes has been ensured: accounting of results in the medical information system, transmission of results directly to medical institutions within 12-14 hours, which is 4 times faster than the standard time. The legal regulations of interaction with the rescue centres of the Ministry of Emergency Situations of Russia, the Ministry of Defense and other power structures, the improvement of the material and technical equipment of basic mobile hospitals and emergency medical teams were proposed for discussion.Conclusion. A scheme has been worked out for the involvement of the MOF of the Federal Medical and Biological Agency of Russia in the timely organizational measures for mobilization of forces and means in order to ensure the re-profiling of medical activities to work on providing medical care in the COVID-19 pandemic conditions.

Prehospital predictors for return of spontaneous circulation in traumatic cardiac arrest.

Traumatic cardiac arrests (TCAs) are associated with high mortality and the majority of deaths occur at the prehospital scene. The aim of the present study was to assess, in a prehospital physician-led emergency medical system, the factors associated with sustained return of spontaneous circulation (ROSC) in TCA, including advanced life procedures. The secondary objectives were to assess factors associated with 30-day survival in TCA, evaluate neurological recovery in survivors, and describe the frequency of organ donation among patients experiencing a TCA. We conducted a retrospective study of all TCA patients included in the French nationwide cardiac arrest registry from July 2011 to November 2020. Multivariable logistic regression analysis was used to identify factors independently associated with ROSC. A total of 120,045 out-of-hospital cardiac arrests were included in the registry, among which 4,922 TCA were eligible for analysis. Return of spontaneous circulation was sustained on-scene in 21.1% (n = 1,037) patients. Factors significantly associated with sustained ROSC were not-asystolic initial rhythms (pulseless electric activity (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.40-2.35; p < 0.001), shockable rhythm (OR, 1.83; 95% CI, 1.12-2.98; p = 0.016), spontaneous activity (OR, 3.66; 95% CI, 2.70-4.96; p < 0.001), and gasping at the mobile medical team (MMT) arrival (OR, 1.40; 95% CI, 1.02-1.94; p = 0.042). The MMT interventions significantly associated with ROSC were as follows: intravenous fluid resuscitation (OR, 3.19; 95% CI, 2.69-3.78; p < 0.001), packed red cells transfusion (OR, 2.54; 95% CI, 1.84-3.51; p < 0.001), and external hemorrhage control (OR, 1.74; 95% CI, 1.31-2.30; p < 0.001). Among patients who survived (n = 67), neurological outcome at Day 30 was favorable (cerebral performance categories 1-2) in 72.2% cases (n = 39/54) and 1.4% (n = 67/4,855) of deceased patients donated one or more organ. Sustained ROSC was frequently achieved in patients not in asystole at MMT arrival, and higher ROSC rates were achieved in patients benefiting from specific advanced life support interventions. Organ donation was somewhat possible in TCA patients undergoing on-scene resuscitation. Prognostic and epidemiologic, Level III.

Measuring non-technical skills during prehospital advanced cardiac life support: A pilot study

AimTo analyse non-technical skills of mobile medical teams during out-of-hospital cardiac arrests (OHCA) using the validated Team Emergency Assessment Measure (TEAM) tool. To research the correlation between non-technical skills and patient outcome. MethodsAdult patients who experienced an out-of-hospital cardiac arrest between July 2016, and June 2018, and were treated by a mobile medical team from the University Hospital Leuven, were eligible for the study. Resuscitations were video recorded from the team leader’s perspective. Video recordings were reviewed and scored by emergency physicians, using the TEAM evaluation form. ResultsIn total 114 OHCAs were analysed. The mean TEAM score was 34.4/44 (SD = 5.5). The mean item score was 3.1/4 (SD = 0.8). On average, ‘effective team communication’ had the lowest score (2.4), while ‘acting with composure and control’ and ‘following of approved standards/guidelines’ scored the highest (3.4). The average non-technical skills theme scores were 2.9 (SD = 0.9) for ‘Leadership’, 3.1 (SD = 0.8) for ‘Teamwork’ and 3.3 (SD = 0.7) for ‘Task management’. ‘Leadership’ was rated significantly lower than ‘Teamwork’ (p = 0.004) and ‘Task management’ (p < 0.001). No significant correlation was found between TEAM and return of spontaneous circulation (p = 0.574) or one month survival (p = 0.225). ConclusionThe mean overall TEAM score was categorized as good. Task management scored high, while leadership and team communication received lower scores. Future training programs should thus focus on improving leadership and communication. In this pilot study no correlation was found between non-technical skills and survival.

Perimetry as a technique from the standpoint of practicing ophthalmologists

PURPOSE. To study the needs of practical ophthalmologists concerning the functionality and performance of automatic perimeters, and offer a possible solution to meet these needs.METHODS. An online survey of Russian ophthalmologists was organized and conducted. The survey was attended by specialists representing various medical institutions and medical research centers. As a result of the survey, 132 filled questionnaire forms were received and analyzed using the Kano and 4C models.RESULTS. According to experts, it is necessary for ophthalmologists to have an accessible automatic perimeter equipped with the screening (for the initial examination of patients) and threshold (to clarify the depth of photosensitivity disturbance of detected visual field defects) strategies. The general requirements for the functional characteristics of the screening and threshold tests of the automatic perimeter have been determined: small variability of repeated results, the speed and simplicity of the study — particularly, by employing the Frequency Doubling Technology (FDT), a non-standard perimetry technique. The requirements of users for the operational method of the automatic perimeter have been determined: absence of the need for a specially prepared room and place, mobility, portability, maximum ease of use to ensure the possibility of performing screening and primary diagnostics outside medical institutions, including by mobile medical teams, and also to allows examinations of individuals with disabilities, including bedridden patients, both in the hospital and at home.CONCLUSION. Based on the study data, the needs of ophthalmologists in the functional and operational characteristics of modern automatic perimeters were identified showing that the automatic perimeters presently used by modern medical institutions are far from optimal in terms of their properties/characteristics. These devices do not allow perimetry to be performed on patients with disabilities, including bedridden patients, neither at home nor in the hospitals. In addition, these devices require a darkened room, they are difficult to use, while their licensing documentation states that only ophthalmologists can conduct the examinations. Manufacturers do not offer solutions tailored to the individual needs of specific user groups — outpatient ophthalmologists who in particular work with disabled patients.

Assessment of peak inspiratory flow in the management of acute inspiratory dyspnoea

Assessment of inspiratory dyspnoea associated with upper airway obstruction is based on subjective clinical and nasal fibreoptic laryngoscopy (NFL) signs. The aim of this study was to determine whether peak inspiratory flow (PIF) measurement could indicate the need for upper airway release surgery in patients with acute inspiratory dyspnoea during emergency. A retrospective single-institution study (February 2018-March 2020) of 48 patients with acute inspiratory dyspnoea and PIF measurement (Peak Flow In-Check Dial G16®-Harlow-England) was conducted. The surgical decision was based on the clinical evaluation of the patient's respiratory tolerance and NFL. Forty-eight patients were included in this study. Thirty-five patients underwent surgery (PIF: 36 L/min), and 13 patients did not (PIF: 58 L/min) (p = 0.0009). Three of these 13 patients underwent an operation later (PIF value: 42 L/min versus 63 L/min for the 10 others [p = 0.25]). PIF measurement is a quantitative, objective, inexpensive, non-invasive, and quick test that is potentially useful for general practitioners, mobile medical teams, or for ear-nose-and-throat specialists. A threshold of 42 L/min can help doctors in emergency decision making to refer patients to an ear-nose-and-throat specialist to release the upper airway and perform surgery or to choose medical monitoring for patients with emergency inspiratory dyspnoea.

Caring for nursing home residents with COVID-19: a \u201chospital-at-nursing home\u201d intermediate care intervention

BackgroundNursing home (NH) residents have been dramatically affected by COVID-19, with extremely high rates of hospitalization and mortality.AimsTo describe the features and impact of an assistance model involving an intermediate care mobile medical specialist team (GIROT, Gruppo Intervento Rapido Ospedale Territorio) aimed at delivering “hospital-at-nursing home” care to NH residents with COVID-19 in Florence, Italy.MethodsThe GIROT activity was set-up during the first wave of the pandemic (W1, March–April 2020) and became a structured healthcare model during the second (W2, October 2020–January 2021). The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2.ResultsThe GIROT activity involved 21 NHs (1159 residents) and 43 NHs (2448 residents) during W1 and W2, respectively. The percentage of infected residents was higher in W2 than in W1 (64.5% vs. 38.8%), while both hospitalization and lethality rates significantly decreased in W2 compared to W1 (10.1% vs 58.2% and 23.4% vs 31.1%, respectively).DiscussionPotentiating on-site care in the NHs paralleled a decrease of hospital admissions with no increase of lethality.ConclusionsAn innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents.

Assessment of chest compression interruptions during advanced cardiac life support

AimTo identify potentially avoidable factors responsible for chest compression interruptions and to evaluate the influence of chest compression fraction on achieving return of spontaneous circulation and survival to hospital discharge. MethodsIn this prospective observational study, each resuscitation managed by mobile medical teams from August 1st, 2016, to August 1st, 2018 was video recorded using a body-mounted GoPro camera. The duration of all chest compression interruptions was recorded and chest compression fraction was calculated. All actions causing an interruption of at least 10 s were analyzed. ResultsTwo hundred and six resuscitations of both in- and out-of-hospital cardiac arrest patients were analysed. In total 1867 chest compression interruptions were identified. Of these, 623 were longer than 10 s in which a total of 794 actions were performed. In 4.3% of the registered pauses, cardiopulmonary resuscitation was interrupted for more than 60 s. The most performed actions during prolonged interruptions were rhythm/pulse checks (51.6%), installation/use of mechanical chest compression devices (11.1%), cardiopulmonary resuscitation provider switches (6.7%) and ETT placements (6.2%). No statistically significant relationship was found between chest compression fraction and return of spontaneous circulation or survival. ConclusionThe majority of chest compression interruptions during resuscitation were caused by prolonged rhythm checks, cardiopulmonary resuscitation provider switches, incorrect use of mechanical chest compression devices and ETT placement. No association was found between chest compression fraction and return of spontaneous circulation, nor an influence on survival. This was presumably caused by the high baseline chest compression fraction of >86%.

Zero Healthcare-Associated COVID-19

Background: The ongoing COVID-19 pandemic tests the healthcare system in many ways. The scarcity of resources poses challenges to infection prevention (IP) practices. We describe our experience in managing such scarcity in our care of COVID-19 patients in the hospital as well as community settings. Methods: The hospital pandemic plan traditionally included only plans for healthcare delivery management within the hospital. However, on March 25, 2020, a decision was made by the Ministry of Health to set up swab isolation (SIFs) and community care facilities (CCFs) to meet the growing demand for isolation beds for migrant workers infected by COVID-19. The CCFs were located in convention halls and resort centers and the SIFs were located in facilities previously functioning as hotels. Mobile medical teams were activated to run clinics at the dormitories housing 200,000 migrant workers. The IP team of an acute- and tertiary-care hospital in Singapore was activated to oversee IP measures at facilities managed by medical teams from the hospital, with the goal of zero healthcare-associated COVID-19 cases among staff. Two IP leaders were set up to oversee the IP program at 8 dormitories, 4 SIFs, and 2 CCFs. In total, 12 IP staff and 15 infection prevention liaison officers (IPLOs) were deployed from 2 acute-care hospitals and 3 specialty centers to conduct training in hand hygiene and the use of personal protective equipment, and to conduct daily audits of compliance to practice guidelines. Education on personal hygiene was also given to patients in these facilities in at least 7 languages. In the SIFs and dormitories, IPLOs were recruited to perform daily audits and feedback to the IP team on issues related to IP at the sites. Results: Since our first COVID-19 patient on January 23, 2020, there has been no report of healthcare-associated COVID-19 within the hospital nor among the medical, administrative, and support service staff working in the external operation facilities. Daily audits showed an average of 99.4% compliance to IP guidelines. Conclusions: IPLOs or IP champions play a significant role in ensuring compliance to IP guidelines. This compliance allows the IP professional to focus on the evaluation of the IP program, managing IP consultations, and planning and implementation of the IP program in nontraditional healthcare settings. The key success factors of the program included the ability to contextualize the planning and implementation of IP programs in various settings, strong leadership support, cohesive teamwork, and effective communication at various levels.Funding: NoDisclosures: None

Outcomes of Patients Treated with Prehospital Noninvasive Ventilation: Observational Retrospective Multicenter Study in the Northern French Alps.

Noninvasive ventilation (NIV) improves the outcome of acute cardiogenic pulmonary edema (AcPE) and acute exacerbation of chronic obstructive pulmonary disease (aeCOPD) but is not recommended in pneumonia. The aim of this study was to assess the appropriateness of the use of NIV in a prehospital setting, where etiological diagnostics rely mainly on clinical examination. This observational multicenter retrospective study included all the patients treated with NIV by three mobile medical emergency teams in 2015. Prehospital diagnoses and hospital diagnoses were extracted from the medical charts. The appropriateness of NIV was determined by matching the hospital diagnosis to the current guidelines. Among the 14,067 patients screened, 172 (1.2%) were treated with NIV. The more frequent prehospital diagnoses were AcPE (n = 102, 59%), acute respiratory failure of undetermined cause (n = 46, 28%) and aeCOPD (n = 17, 10%). An accurate prehospital diagnosis was more frequent for AcPE (83/88, 94%) than for aeCOPD (14/32, 44%; p < 0.01). Only two of the 25 (8%) pneumonia cases were diagnosed during prehospital management. Prehospital NIV was inappropriate for 32 (21%) patients. Patients with inappropriate NIV had a higher rate of in-hospital intubation than patients with appropriate NIV (38% vs. 8%; p < 0.001). This high frequency of inappropriate NIV could be reduced by an improvement in the prehospital detection of aeCOPD and pneumonia.

Risk Factors for Hospitalization and Death From COVID-19 in South Sudan and Eastern Democratic Republic of the Congo

Background: Our study described demographic characteristics, exposures, and symptoms, and comorbidities to evaluate risk factors of hospitalization and mortality among cases in Juba, South Sudan (SSD) and North and South Kivu in eastern Democratic Republic of the Congo (DRC).Methods: This observational cohort of COVID-19 cases enrolled individuals presenting for care at one of five study facilities in SSD (n=1) or DRC (n=4) or referred from home-based care by mobile medical teams between December 2020– June 2021. Demographic characteristics, COVID-19 exposures, symptoms at presentation, as well as acute and chronic comorbidities were evaluated using a standard questionnaire at enrollment. Disease progression was characterized by location of care using mixed-effects regression models.Findings: 751 individuals were eligible for enrollment. Among cases followed to discharge or death (n=519), 375 were enrolled outpatients (75.7%). A similar number of cases were enrolled in DRC (n=262) and South Sudan (n=257). Overall mortality was 4.8% (95% CI: 3.2-6.9%); there were no outpatient deaths. Patients presenting with any symptoms had higher odds of hospitalization (AOR 2.78, 95% CI 1.47 –5.27) and all deaths occurred among symptomatic individuals. Odds of both hospitalization and mortality were greatest among cases with respiratory symptoms; presence of low oxygen levels on enrollment was strongly associated with both hospitalization (AOR 7.77, 95% CI: 4.22– 14.29) and mortality (AOR 25.29, 95% CI 6.42– 99.54). Presence of more than one chronic comorbidity was associated with 4.96 (95% CI 1.51– 16.31) times greater odds of death; neither infectious comorbidities evaluated (malaria, TB, and HIV) nor malnutrition were significantly associated with increased mortality.Interpretation: Consistent with prior literature, older age, low oxygen level, other respiratory symptoms, and chronic comorbidities were all risk factors for mortality. Patients presenting with these characteristics were more likely to be hospitalized, providing evidence of effective triage and referral. Clinical Trial Registration Details: The study is registered with ClinicalTrials.gov (NCT04568499). Funding Information: Funded by USAID (award 72OFDA20GR0221).Declaration of Interests: All authors have signed the IJCME declaration of interest forms and have no conflicts of interest to report.Ethics Approval Statement: This study was reviewed and approved by the Johns Hopkins University Institutional Review Board, the South Sudan Ministry of Health Ethics Committee, the University of Kinshasa School of Public Health , and the US CDC.

Influence of demographic parameters and time delays among patients with ACS and OHCA in non-urban areas

Out-of-hospital cardiac arrest (OHCA) represents a major public health. Acute coronary syndrome (ACS) is the leading precipitant of collapse. Predictors of survival have been described in the literature. However, most studies have been conducted in city areas. Less is known about resuscitation performance of mobile medical team (MMT) in non-urban areas. Established in 1903, our institution was initially founded to treat patients suffering from tuberculosis. Built at the top of a hill, the location of the ancient sanatorium consists of rural areas with a low population density. To perform a quality control assessment on the management of OHCA after ACS in non-urban areas. To identify quantitative variables influencing 30-day outcome. Retrospective single-center study including 40 patients resuscitated from OHCA after ACS. Baseline characteristics, resuscitation settings, time delays, blood samples, cardiac findings and clinical outcomes were analyzed. 30-day mortality was more likely associated with the following parameters: age, no-bystander CPR, no use of AED, non-convertible rhythm, recurrent cardiac arrest, epinephrine dose, shock, lactate level, LVEF, culprit lesion, no-flow & low-flow duration, kilometres and time delays (MMT arrival, ER - CathLab - ICU admission). Particularly, high lactate, long duration of RCP, remoteness from hospital and prolonged pre-hospital management (MMT arrival, ER admission) were predictors of early mortality (see bold type in Table 1 ). Beyond the usual prognostic factors, it would appear that demographic parameters and time delays represent major determinants of mortality after OHCA in non-urban areas. Therefore, shortening response times and prompt delivery to hospital facilities may help to improve the prognosis, rather than prolonged pre-hospital care. Further RCTs are needed to assess the effect of the ‘scoop & run’ approach vs the ‘stay & play’ approach in this setting.

Assessment of changes in cardiopulmonary resuscitation practices and outcomes on 1005 victims of out-of-hospital cardiac arrest during the COVID-19 outbreak: registry-based study

BackgroundThe COVID-19 outbreak requires a permanent adaptation of practices. Cardiopulmonary resuscitation (CPR) is also involved and we evaluated these changes in the management of out-of-hospital cardiac arrest (OHCA).MethodsOHCA of medical origins identified from the French National Cardiac Arrest Registry between March 1st and April 31st 2020 (COVID-19 period), were analysed. Different resuscitation characteristics were compared with the same period from the previous year (non-COVID-19 period).ResultsOverall, 1005 OHCA during the COVID-19 period and 1620 during the non-COVID-19 period were compared. During the COVID-19 period, bystanders and first aid providers initiated CPR less frequently (49.8% versus 54.9%; difference, − 5.1 percentage points [95% CI, − 9.1 to − 1.2]; and 84.3% vs. 88.7%; difference, − 4.4 percentage points [95% CI, − 7.1 to − 1.6]; respectively) as did mobile medical teams (67.3% vs. 75.0%; difference, − 7.7 percentage points [95% CI, − 11.3 to − 4.1]). First aid providers used defibrillators less often (66.0% vs. 74.1%; difference, − 8.2 percentage points [95% CI, − 11.8 to − 4.6]). Return of spontaneous circulation (ROSC) and D30 survival were lower during the COVID-19 period (19.5% vs. 25.3%; difference, − 5.8 percentage points [95% CI, − 9.0 to − 2.5]; and 2.8% vs. 6.4%; difference, − 3.6 percentage points [95% CI, − 5.2 to − 1.9]; respectively).ConclusionsDuring the COVID-19 period, we observed a decrease in CPR initiation regardless of whether patients were suspected of SARS-CoV-2 infection or not. In the current atmosphere, it is important to communicate good resuscitation practices to avoid drastic and lasting reductions in survival rates after an OHCA.

Use of out-of-hospital cardiac arrest registries to assess COVID-19 home mortality

BackgroundIn most countries, the official statistics for the coronavirus disease 2019 (COVID-19) take account of in-hospital deaths but not those that occur at home. The study’s objective was to introduce a methodology to assess COVID-19 home deaths by analysing the French national out-of-hospital cardiac arrest (OHCA) registry (RéAC).MethodsWe performed a retrospective multicentre cohort study based on data recorded in the RéAC by 20 mobile medical teams (MMTs) between March 1st and April 15th, 2020. The participating MMTs covered 10.1% of the French population. OHCA patients were classified as probable or confirmed COVID-19 cases or as non-COVID-19 cases. To achieve our primary objective, we computed the incidence and survival at hospital admission of cases of COVID-19 OHCA occurring at home. Cardiac arrests that occurred in retirement homes or public places were excluded. Hence, we estimated the number of at-home COVID-19-related deaths that were not accounted for in the French national statistics.ResultsWe included 670 patients with OHCA. The extrapolated annual incidence of OHCA per 100,000 inhabitants was 91.9 overall and 17.6 for COVID-19 OHCA occurring at home. In the latter group, the survival rate after being taken to the hospital after an OHCA was 10.9%. We estimated that 1322 deaths were not accounted in the French national statistics on April 15, 2020.ConclusionsThe ratio of COVID-19 out-of-hospital deaths to in-hospital deaths was 12.4%, and so the national statistics underestimated the death rate.

Effect of gender on out-of-hospital cardiac arrest survival: a registry-based study.

The aim of the study was to compare outcomes after out-of-hospital cardiac arrest (OHCA) between comparable female and male OHCA cohorts in a large nationwide registry. This was a national multicentre retrospective, case-control propensity score-matched study based on French National Cardiac Arrest Registry data from 1 July 2011 to 21 September 2017. Female and male survival rates at D30 were compared. At baseline 66 395 OHCA victims were included, of which 34.3% were women. At hospital admission, survival was 18.2% for female patients and 20.2% for male patients [odds ratio (OR), 1.138 (1.092-1.185)]; at 30 days, survival was 4.3 and 5.9%, respectively [OR, 1.290 (1.191-1.500)]. After matching (14 051 patients within each group), female patients received less advanced life support by mobile medical team (MMT), they also had a longer no-flow duration and shorter resuscitation effort by MMT than male patients. However, 15.3% of female patients vs. 9.1% of male patients were alive at hospital admission [OR, 0.557 (0.517-0.599)] and 3.2 vs. 2.6% at D30 [OR, 0.801 (0.697-0.921)], with no statistically significant difference in neurological outcome [OR, 0.966 (0.664-1.407)]. In this large nationwide matched OHCA study, female patients had a better chance of survival with no significant difference in neurological outcome. We also noticed that female patients received delayed care with a shorter resuscitation effort compared to men; these complex issues warrant further specific investigation. Encouraging bystanders to act as quickly as possible and medical teams to care for female patients in the same way as male patients should increase survival rates.

Using Video Telehealth to Deliver Patient-Centered Collaborative Care: The G-IMPACT Pilot

ABSTRACT Objectives: This pilot project aimed to explore a new model of healthcare delivery to older adult medically complex Veterans by combining telehealth technology with an interdisciplinary medical team operating in real time. Methods: The Geriatric-Interdisciplinary Mobile Patient Access Team (G-IMPACT) was comprised of a field team including a nurse practitioner and technology assistant who visited enrolled patients in their homes using synchronous video to link to a suite of geriatric specialists in a video-enabled room at a Veterans Affairs hospital. Clinicians interacted with patients, caregivers, and each other to develop mutually agreed upon treatment plans that were then immediately implemented in the field. Results: 11 total visits were conducted with 9 Veteran patients aged 55–91 (mean = 75.3 years). Both patients and clinicians reported a high level of satisfaction across multiple metrics, including visit quality, and positive indirect indicators of effectiveness were apparent from qualitative data. Conclusions: Nurse practitioner facilitated video visits allowed geriatric patients to meet with multiple specialists simultaneously with both high patient satisfaction and increased real-time care coordination. Clinical Implications: This project identified challenges and opportunities afforded by this type of real-time telehealth care delivery and can inform the development of future interdisciplinary mobile medical teams.

Mobile medical unit as a rational model of modern mobile medical formation operating in the metropolis in emergency situations

Purpose of the study. Substantiation of organizational principles of development of the health system of the population of the megalopolis in emergency situations. The article analyzes the stages of creation, testing and practical implementation of the modern organizational and staff structure of mobile medical formation and its functioning to meet the needs of the peaceful population of Moscow in Moscow pre-hospital period (2013-2017).Materials and methods. A survey of 112 respondents from 57 industry-specific metropolitan organizations and enterprises of the state healthcare system was conducted on the main indicators of the activities of institutions involved in the formation of a mobile medical unit. The result of this questionnaire was an assessment of the personnel potential of outpatient polyclinic establishments-shapers of mobile medical units, as well as the provision of full-time property and material resources of organizations and enterprises of the Moscow City Health Department involved in their formation. 24 research exercises were conducted on the formation and use of mobile medical teams to eliminate the health consequences of emergencies.Results. The article considers the issues of resource support of organizations and enterprises of the state healthcare system of Moscow. The calculation of the internal reserves of outpatient clinics of the Moscow Department of Health has been prepared, reflecting the personnel potential of the medical organizations that form the units. Research exercises have been carried out on the formation of mobile medical units, the issuance of medical equipment and sanitary equipment for them from medical warehouses, as well as the functioning of the units of mobile medical units during the mass arrival of people of various profiles.Conclusion. The study showed that the organizational foundations in the field of medical support for the population in emergencies make it possible to ensure the formation of a mobile medical unit with labor and material resources with the maximum use of internal reserves of regional health care. The proposed model of the organizational structure of a modern medical formation is an alternative to the bulky and inactive first aid unit that has existed for more than 40 years.

Which Patients Require Physician-Led Inter-Hospital Transport in View of Endovascular Therapy?

Introduction: The current guidelines advocate the implementation of stroke networks to organize endovascular treatment (ET) for patients with acute ischemic stroke due to large vessel occlusion (LVO) after transfer from a Primary Stroke Centre (PSC) to a Comprehensive Stroke Centre (CSC). In France and in many other countries around the world, these transfers are carried out by a physician-led mobile medical team. However, with the recent broadening of ET indications, their availability is becoming more and more critical. Here, we retrospectively analysed data of patients transferred from a PSC to a CSC for potential ET to identify predictive factors of major complications (MC) at departure and during transport that absolutely require the presence of a physician during interhospital transfer. Methods: This observational, single-centre study included patients with evidence of intracranial LVO transferred for ET from Perpignan to a 156 km-distant CSC between January 1, 2015 and ­December 31, 2018. We compared 2 groups: MC group (patients who required emergency intervention by the medical team due to life-threatening complications, including need of mechanical ventilation at departure) and non-MC group (all other patients who experienced no or only minor complications that could be managed by the emergency paramedics alone). Results: Among the 253 patients who were transferred to the CSC, 185 (73.1%) had no complication, 57 (22.6%) minor complications, and 11 (4.3%) had MC. In multivariate analysis, MC was associated with basilar artery (BA) occlusion (p < 0.0001), initial National Institute of Health Stroke Scale (NIHSS) score >22 (p < 0.005), and history of atrial fibrillation (p < 0.04). Among the 168 patients treated with intravenous thrombolysis (IVT), only 1 patient (0.6%) had MC due to an IVT-related adverse event during transfer. Conclusions: Physician-led inter-hospital transports are warranted for patients with BA occlusion, initial NIHSS score >22, or history of atrial fibrillation. For the other patients, transfer without a physician may be considered, even if treated with IVT.

GyanPrakashEmergency Chronicles: Indira Gandhi and India's Turning PointPrinceton: Princeton University Press, 2019. 439 pp. Index.

GyanPrakashEmergency Chronicles: Indira Gandhi and India's Turning PointPrinceton: Princeton University Press, 2019. 439 pp. Index.