Use of Ambulance Dispatch Calls for Surveillance of Severe Acute Respiratory Infections.

Ambulance dispatches for respiratory syndromes reflect incidence of influenza-like illness in primary care. Associations are highest in children (15%-34% of respiratory calls attributable to influenza), out-of-office hours (9%), and highest urgency-level calls (9%-11%). Ambulance dispatches might be an additional source of data for severe influenza surveillance.

Ambulance dispatch calls attributable to influenza A and other common respiratory viruses in the Netherlands (2014-2016).

BACKGROUND: Ambulance dispatches could be useful for syndromic surveillance of severe respiratory infections. We evaluated whether ambulance dispatch calls of highest urgency reflect the circulation of influenza A virus, influenza B virus, respiratory syncytial virus (RSV), rhinovirus, adenovirus, coronavirus, parainfluenzavirus and human metapneumovirus (hMPV). METHODS: We analysed calls from four ambulance call centres serving 25% of the population in the Netherlands (2014-2016). The chief symptom and urgency level is recorded during triage; we restricted our analysis to calls with the highest urgency and identified those compatible with a respiratory syndrome. We modelled the relation between respiratory syndrome calls (RSC) and respiratory virus trends using binomial regression with identity link function. RESULTS: We included 211 739 calls, of which 15 385 (7.3%) were RSC. Proportion of RSC showed periodicity with winter peaks and smaller interseasonal increases. Overall, 15% of RSC were attributable to respiratory viruses (20% in out-of-office hour calls). There was large variation by age group: in <15 years, only RSV was associated and explained 11% of RSC; in 15-64 years, only influenza A (explained 3% of RSC); and in ≥65 years adenovirus explained 9% of RSC, distributed throughout the year, and hMPV (4%) and influenza A (1%) mainly during the winter peaks. Additionally, rhinovirus was associated with total RSC. CONCLUSION: High urgency ambulance dispatches reflect the burden of different respiratory viruses and might be useful to monitor the respiratory season overall. Influenza plays a smaller role than other viruses: RSV is important in children while adenovirus and hMPV are the biggest contributors to emergency calls in the elderly.

[Frail elderly women following traffic accident: a specific approach to the trauma care chain]. / Kwetsbare, hoogbejaarde vrouwen na een ernstig verkeersongeval: specifieke aanpak in de traumaketenzorg.

Three octogenarian women suffered severe blunt trauma because of a car crash. The first patient was 81 years old. She had an instable dens fracture, multiple rib fractures, a haematopneumothorax and multiple extremity fractures. The second patient was 82 years old and was diagnosed with a flail chest because of multiple rib fractures, pelvic fractures, and thoracic spine fractures. Before the crash, she already needed help for her daily functioning. The third patient, 84 years old, developed a bradycardia at the site of the crash. In the hospital she was diagnosed with multiple rib fractures, a sternum fracture and a pneumothorax. After appropriate treatment, the second patient had no prospect of recovery and the care was primarily aimed at comfort, until she died. The other two patients remained in a rehabilitation clinic for months after the accident. The necessary approach to first trauma care, ICU care and rehabilitation differs between young and octogenarian patients. These octogenarian female patients constitute a special group of patients because of their frailty. Due to demographic developments and the changes in trauma care, such patients will be treated more often and further in the care chain. During the ICU stay they will require extensive support because of their frailty. The patient's own efforts will also be tremendous. The balance between quality of life adjusted years won and the toll paid by the patient has to be guarded with great care.