Ramadan-Associated Circadian Census Variation In A Busy Middle Eastern Emergency Department.

BACKGROUND: An important goal for the Emergency Department operations is planning for changes in patient volume and assuring staffing accordingly. We hypothesized that understanding the Emergency Department census changes during the month-long Ramadan holiday each year could facilitate operations planning for Emergency Department's serving a largely Muslim population. METHODS: This was an observational study conducted at an academic centre, over 83 weeks of analysis that included two Ramadan months (those occurring during 2016 and 2017). The data was from an electronic medical record that records presentation time as well as age, sex, nationality, and acuity. Chi-square and mediandifferences testing (p<.05 defining significance) were used to compare overall patient characteristics between cases seen during Ramadan vs. non-Ramadan. RESULTS: For the 83 study weeks, the Emergency Department volume was 689,140 (annualized volume 431,750). Graphic depiction of weekly census showed Ramadan-associated census impact varied markedly over the course of a day's 24 hours. Statistically significant hourly census increase (of up to 83%) or decrease (of as much as 50%) were identified for 21 of 24 hours of the day. Ramadan was not associated with change in patient age or proportion of high-acuity cases. However, it was associated with increase in proportion of males, paediatrics, and Qatari national's patient visits. CONCLUSIONS: As compared to non-Ramadan baseline, Ramadan was associated with substantial changes in overall census and in proportions of various patient subgroups. Therefore, Emergency Department's serving large Muslim population should undertake studying major operations changes that can be expected for the month.

Cardiopulmonary resuscitation of out-of-hospital traumatic cardiac arrest in Qatar: A nationwide population-based study.

BACKGROUND: Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. METHODS: An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). RESULTS: A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. CONCLUSION: The incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival.

Epidemiology and outcomes of out-of-hospital cardiac arrest in Qatar: A nationwide observational study.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) studies from the Middle East and Asian region are limited. This study describes the epidemiology, emergency health services, and outcomes of OHCA in Qatar. METHODS: This was a prospective nationwide population-based observational study on OHCA patients in Qatar according to Utstein style guidelines, from June 2012 to May 2013. Data was collected from various sources; the national emergency medical service, 4 emergency departments, and 8 public hospitals. RESULTS: The annual crude incidence of presumed cardiac OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence was 87.8 per 100,000 population. Of the 447 OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51years (IQR=39-66). Frequently observed nationalities were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Bystander cardiopulmonary resuscitation (CPR) was carried out in 92 (20.6%) OHCA patients. Survival rate was 8.1% (n=36) and multivariable logistic regression indicated that initial shockable rhythm (OR 13.4, 95% CI 5.4-33.3, p=0.001) was associated with higher odds of survival while male gender (OR 0.27, 95% CI 0.1-0.8, p=0.01) and advanced cardiac life support (ACLS) (OR 0.15, 95% CI 0.04-0.5, p=0.02) were associated with lower odds of survival. CONCLUSIONS: Standardized incidence and survival rates were comparable to Western countries. Although expatriates comprise more than 80% of the population, Qataris contributed 20% of the total cardiac arrests observed. There are significant opportunities to improve outcomes, including community-based CPR and defibrillation training.