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Effect of the First Wave of the Belgian COVID-19 Pandemic on Physician-Provided Prehospital Critical Care in the City of Antwerp (Belgium)
- Tina Lavigne, Brecht De Tavernier, Niels Van Regenmortel, Wouter De Tavernier, Jan Christiaen, Ives Hubloue, Kurt Anseeuw
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- Journal:
- Prehospital and Disaster Medicine / Volume 37 / Issue 1 / February 2022
- Published online by Cambridge University Press:
- 22 November 2021, pp. 12-18
- Print publication:
- February 2022
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Introduction:
There is evidence to suggest that patients delayed seeking urgent medical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A delay in health-seeking behavior could increase the disease severity of patients in the prehospital setting. The combination of COVID-19-related missions and augmented disease severity in the prehospital environment could result in an increase in the number and severity of physician-staffed prehospital interventions, potentially putting a strain on this highly specialized service.
Study Objective:The aim was to investigate if the COVID-19 pandemic influences the frequency of physician-staffed prehospital interventions, prehospital mortality, illness severity during prehospital interventions, and the distribution in the prehospital diagnoses.
Methods:A retrospective, multicenter cohort study was conducted on prehospital charts from March 14, 2020 through April 30, 2020, compared to the same period in 2019, in an urban area. Recorded data included demographics, prehospital diagnosis, physiological parameters, mortality, and COVID-status. A modified National Health Service (NHS) National Early Warning Score (NEWS) was calculated for each intervention to assess for disease severity. Data were analyzed with univariate and descriptive statistics.
Results:There was a 31% decrease in physician-staffed prehospital interventions during the period under investigation in 2020 as compared to 2019 (2019: 644 missions and 2020: 446 missions), with an increase in prehospital mortality (OR = 0.646; 95% CI, 0.435 – 0.959). During the study period, there was a marked decrease in the low and medium NEWS groups, respectively, with an OR of 1.366 (95% CI, 1.036 – 1.802) and 1.376 (0.987 – 1.920). A small increase was seen in the high NEWS group, with an OR of 0.804 (95% CI, 0.566 – 1.140); 2019: 80 (13.67%) and 2020: 69 (16.46%). With an overall decrease in cases in all diagnostic categories, a significant increase was observed for respiratory illness (31%; P = .004) and cardiac arrest (54%; P < .001), combined with a significant decrease for intoxications (-58%; P = .007). Due to the national test strategy at that time, a COVID-19 polymerase chain reaction (PCR) result was available in only 125 (30%) patients, of which 20 (16%) were positive.
Conclusion:The frequency of physician-staffed prehospital interventions decreased significantly. There was a marked reduction in interventions for lower illness severity and an increase in higher illness severity and mortality. Further investigation is needed to fully understand the reasons for these changes.
Are Dutch Hospitals Prepared for Chemical, Biological, or Radionuclear Incidents? A Survey Study
- Luc J.M. Mortelmans, Menno I. Gaakeer, Greet Dieltiens, Kurt Anseeuw, Marc B. Sabbe
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- Journal:
- Prehospital and Disaster Medicine / Volume 32 / Issue 5 / October 2017
- Published online by Cambridge University Press:
- 08 May 2017, pp. 483-491
- Print publication:
- October 2017
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Introduction
Being one of Europe’s most densely populated countries, and having multiple nuclear installations, a heavy petrochemical industry, and terrorist targets, the Netherlands is at-risk for chemical, biological, or radionuclear (CBRN) incidents. Recent world and continental events show that this threat is real and that authorities may be underprepared.
HypothesisThe hypothesis of this study is that Dutch hospitals are underprepared to deal with these incidents.
MethodsA descriptive, cross-sectional study was performed. All 93 Dutch hospitals with an emergency department (ED) were sent a link to an online survey on different aspects of CBRN preparedness. Besides specific hospital information, information was obtained on the hospital’s disaster planning; risk perception; and availability of decontamination units, personal protective equipment (PPE), antidotes, radiation detection, infectiologists, isolation measures, and staff training.
ResultsResponse rate was 67%. Sixty-two percent of participating hospitals were estimated to be at-risk for CBRN incidents. Only 40% had decontamination facilities and 32% had appropriate PPE available for triage and decontamination teams. Atropine was available in high doses in all hospitals, but specific antidotes that could be used for treating victims of CBRN incidents, such as hydroxycobolamine, thiosulphate, Prussian blue, Diethylenetriaminepentaacetic acid (DTPA), or pralidoxime, were less frequently available (74%, 65%, 18%, 14%, and 42%, respectively). Six percent of hospitals had radioactive detection equipment with an alarm function and 22.5% had a nuclear specialist available 24/7 in case of disasters. Infectiologists were continuously available in 60% of the hospitals. Collective isolation facilities were present in 15% of the hospitals.
Conclusion:There is a serious lack of hospital preparedness for CBRN incidents in The Netherlands.
,Mortelmans LJM ,Gaakeer MI ,Dieltiens G ,Anseeuw K .Sabbe MB Are Dutch Hospitals Prepared for Chemical, Biological, or Radionuclear Incidents? A Survey Study . Prehosp Disaster Med.2017 ;32 (5 ):483 –491 .
Are Tertiary Care Paediatricians Prepared for Disaster Situations?
- Luc J.M. Mortelmans, Sofie Maebe, Greet Dieltiens, Kurt Anseeuw, Marc B. Sabbe, Patrick Van de Voorde
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 2 / April 2016
- Published online by Cambridge University Press:
- 09 February 2016, pp. 126-131
- Print publication:
- April 2016
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Introduction
Children, with their specific vulnerabilities and needs, make up to more than 20% of society, so they are at risk of getting involved in disasters. Are the specialists treating them for medical problems in daily life also capable to deal with them in disaster situations?
Hypothesis/ProblemThe goals of this study were to evaluate perceived knowledge and capability of tertiary pediatricians to deal with disasters, to identify promoting factors, and to evaluate education need and willingness to work.
MethodsA survey looking for demographics, hospital disaster planning, estimated risk and capability for disasters, training, and willingness to work, and a set of six content assessment questions to evaluate knowledge, were presented to emergency pediatricians and pediatric emergency physicians in specialized tertiary centers.
ResultsThe response rate was 51%. Thirty-five percent had disaster training and 53% felt that disaster education should be obligatory in their curriculum. Risk for disasters was estimated from 2.4/10 for nuclear incidents to 7.6/10 for major trauma. Self-estimated capability for these situations ranged from 1.8/10 in nuclear incidents to 7.6/10 in major trauma. Unconditional willingness to work ranged from 37% in nuclear situations to 68% in pandemics. Mean score on the questions was 2.06/6. Training, knowledge of antidote and personal protective equipment (PPE) use, self-estimated capability, and exposure were significant predictors for higher scores. Willingness to work correlated significantly with age, self-estimated capability, and risk estimation. In case of chemical and nuclear incidents, there was correlation with knowledge on the use of decontamination, PPE, and radio-detection devices.
ConclusionDespite a clear perception of the risks and a high willingness to work, preparedness is limited. The major conclusion is that basics of disaster management should be included in pediatric training.
,Mortelmans LJM ,Maebe S ,Dieltiens G ,Anseeuw K ,Sabbe MB .Van de Voorde P Are Tertiary Care Paediatricians Prepared for Disaster Situations? Prehosp Disaster Med.2016 ;31 (2 ):126 –131 .