RESUMO
In France, the organisation of aid involves the intervention of the emergency medical services (Samu), which coordinate the medical regulation platforms for site 15 and the mobile emergency and intensive care services (Smur). Since they were created, the Samu have been tirelessly adapting their response to the various characteristics of pre-hospital assignments. Pre- and inter-hospital paediatrics has seen the development of specialised teams with the aim of providing effective aid which is adapted to the youngest and most vulnerable patients.
Assuntos
Serviços de Saúde da Criança/organização & administração , Cuidados Críticos/organização & administração , Serviços Médicos de Emergência/organização & administração , Especialização , Criança , França , HumanosRESUMO
BACKGROUND: The association between air pollution exposure and cardiovascular events is well established, and the effect of short-term exposure on out-of-hospital cardiac arrest (OHCA) has received some attention. The effect of air pollution exposure and the activation of mobile intensive care units (MICUs) for cardiac arrest have never been studied. OBJECTIVE: We analyzed associations between air pollutants and MICU activation for OHCA. METHOD: This is a retrospective study including 4558 patients with OHCA and MICU activation from 2007 to 2012. A time-stratified case crossover design was used. Particulate matter (PM) of median aerodynamic diameter less than 2.5 µm (PM2.5), less than 10 µm, and ozone were the 3 main pollutants used to determine the effects of pollution exposure on the event. RESULTS: A daily average increase of 27.6 µg/m(3) in ozone was associated with an increase of MICU activation for OHCA the following day (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.03-1.22). For women, a daily average increase of 27.6 µg/m(3) in ozone was associated with an increase of MICU activation for OHCA the following day (OR, 1.19; 95% CI, 1.01-1.37). An hourly average increase of 10.5 µg/m(3) in PM2.5 was associated with an increase of MICU activation for OHCA in the current hour (OR, 1.11; 95% CI, 1.02-1.19). For men, an increase in PM2.5 was associated with an increase in MICU activation for OHCA the current hour (OR, 1.10; 95% CI, 1.01-1.20). No association was found with PM of median aerodynamic diameter less than 10 µm. CONCLUSION: An association was found between air pollution and MICU activation for OHCA (ozone and PM2.5).
Assuntos
Poluição do Ar/estatística & dados numéricos , Ambulâncias/estatística & dados numéricos , Cuidados Críticos/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Ozônio , Material Particulado , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores SexuaisRESUMO
During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators related to the epidemic. To determine the performance of keyword-search algorithm in call reports to emergency medical communication centers (EMCC) to describe trends in symptoms during the COVID-19 crisis. We retrospectively retrieved all free text call reports from the EMCC of the Gironde department (SAMU 33), France, between 2005 and 2020 and classified them with a simple keyword-based algorithm to identify symptoms relevant to COVID-19. A validation was performed using a sample of manually coded call reports. The six selected symptoms were fever, cough, muscle soreness, dyspnea, ageusia and anosmia. We retrieved 38,08,243 call reports from January 2005 to October 2020. A total of 8539 reports were manually coded for validation and Cohen's kappa statistics ranged from 75 (keyword anosmia) to 59% (keyword dyspnea). There was an unprecedented peak in the number of daily calls mentioning fever, cough, muscle soreness, anosmia, ageusia, and dyspnea during the COVID-19 epidemic, compared to the past 15 years. Calls mentioning cough, fever and muscle soreness began to increase from February 21, 2020. The number of daily calls reporting cough reached 208 on March 3, 2020, a level higher than any in the previous 15 years, and peaked on March 15, 2020, 2 days before lockdown. Calls referring to dyspnea, anosmia and ageusia peaked 12 days later and were concomitant with the daily number of emergency room admissions. Trends in symptoms cited in calls to EMCC during the COVID-19 crisis provide insights into the natural history of COVID-19. The content of calls to EMCC is an efficient epidemiological surveillance data source and should be integrated into the national surveillance system.
Assuntos
COVID-19 , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Comunicação , Estudos Transversais , Humanos , Estudos Retrospectivos , SARS-CoV-2RESUMO
OBJECTIVES: During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators in order to monitor both the epidemic growth and potential public health consequences of preventative measures such as lockdown. We assessed whether the automatic classification of the content of calls to emergency medical communication centers could provide relevant and responsive indicators. METHODS: We retrieved all 796,209 free-text call reports from the emergency medical communication center of the Gironde department, France, between 2018 and 2020. We trained a natural language processing neural network model with a mixed unsupervised/supervised method to classify all reasons for calls in 2020. Validation and parameter adjustment were performed using a sample of 39,907 manually-coded free-text reports. RESULTS: The number of daily calls for flu-like symptoms began to increase from February 21, 2020 and reached an unprecedented level by February 28, 2020 and peaked on March 14, 2020, 3 days before lockdown. It was strongly correlated with daily emergency room admissions, with a delay of 14 days. Calls for chest pain and stress and anxiety, peaked 12 days later. Calls for malaises with loss of consciousness, non-voluntary injuries and alcohol intoxications sharply decreased, starting one month before lockdown. No noticeable trends in relation to lockdown was found for other groups of reasons including gastroenteritis and abdominal pain, stroke, suicide and self-harm, pregnancy and delivery problems. DISCUSSION: The first wave of the COVID-19 crisis came along with increased levels of stress and anxiety but no increase in alcohol intoxication and violence. As expected, call related to road traffic crashes sharply decreased. The sharp decrease in the number of calls for malaise was more surprising. CONCLUSION: The content of calls to emergency medical communication centers is an efficient epidemiological surveillance data source that provides insights into the societal upheavals induced by a health crisis. The use of an automatic classification system using artificial intelligence makes it possible to free itself from the context that could influence a human coder, especially in a crisis situation. The COVID-19 crisis and/or lockdown induced deep modifications in the population health profile.
Assuntos
COVID-19 , Serviço Hospitalar de Emergência , Linhas Diretas/tendências , Processamento de Linguagem Natural , Redes Neurais de Computação , Adulto , Controle de Doenças Transmissíveis , Feminino , França/epidemiologia , Humanos , Masculino , Vigilância em Saúde Pública , SARS-CoV-2 , Comportamento Autodestrutivo/epidemiologia , Isolamento Social/psicologia , Estresse Psicológico/epidemiologiaRESUMO
BACKGROUND: Chest pain is a frequent reason for calls in emergency medical communication centre (EMCC). Detecting a coronary origin by phone is a challenge. This is especially so as the presentations differ according to gender. We aimed to establish and validate a sex-based model to predict a coronary origin of chest pain in patients calling an EMCC. METHODS: This prospective cohort study enrolled patients at 18 years of age or older who called the EMCC because of non-traumatic chest pain. The main outcome was the diagnosis of acute coronary syndrome (ACS) determined by expert evaluation of patient files. RESULTS: During 18 months, 3727 patients were enrolled: 2097 (56%) men and 1630 (44%) women. ACS was diagnosed in 508 (24%) men and 139 (9%) women. For men, independent factors associated with an ACS diagnosis were age, tobacco use, severe and permanent pain; retrosternal, breathing non-related and radiating pain; and additional symptoms. The area under the receiver operating characteristic curve (AUC) was 0.76 (95% confidence interval [CI] 0.73-0.79) for predicting ACS. The accuracy of the male model to predict ACS was validated in a validation dataset (Hosmer-Lemeshow test: p = 0.554); the AUC was 0.77 (95%CI 0.73-0.80). For women, independent factors associated with an ACS diagnosis were age ≥ 60 years, personal history of coronary artery disease, and breathing non-related and radiating pain. The AUC was 0.79 (95%CI 0.75-0.83). The accuracy of the female model to predict ACS was not validated in the validation dataset (Hosmer-Lemeshow test: p = 0.035); the AUC was 0.67 (95%CI 0.60-0.74). CONCLUSIONS: Predictors of an ACS diagnosis in patients calling an EMCC for chest pain differ between men and women. We developed an accurate predictive model for men, but for women, the accuracy was poor. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov ( NCT02042209 ).
Assuntos
Síndrome Coronariana Aguda/diagnóstico , Call Centers , Dor no Peito/etiologia , Síndrome Coronariana Aguda/epidemiologia , Adulto , Fatores Etários , Estudos de Coortes , Doença da Artéria Coronariana/epidemiologia , Feminino , França/epidemiologia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , FumantesRESUMO
AIM OF THE STUDY: While several techniques are used for the management of difficult intubation (DI) in planned conditions in the operating theatre, they are not always suitable or usable in pre-hospital emergencies. We decided to assess the intubating laryngeal mask airway (ILMA) after failure of tracheal intubation (TI) under direct laryngoscopy. MATERIAL AND METHODS: After emergency physicians of the mobile intensive care unit were trained (theory and training on manikin) in using the ILMA (Fastrach), prospective data were collected after each use from March 2002 to December 2005. Data included patient's age, clinical status, number of direct laryngoscopies before using ILMA, Cormack and Lehane grade, subjective and objective evaluation of ease of ILMA insertion and TI (analogue scale from 1 to 10, attempts required, failure rate). RESULTS: Over 46 months, the ILMA was used 45 times (24: cardio-respiratory arrest, 21: anaesthesia with rapid sequence induction). Median age was 59 years [range 20-86]. The number of direct laryngoscopy attempts was 3 [0-4] (76% Cormack 4). The success of ILMA insertion and TI were 96 and 91%, respectively. CONCLUSION: Emergency physicians were satisfied with using the ILMA. It allowed TI in 91% of cases of DI. The ILMA can be recommended to be included in the algorithm of DI in pre-hospital emergencies after initial training.