Effects of COVID-19 lockdown strategies on emergency medical services.

INTRODUCTION: The aim of this study is to evaluate the change in the number of EMS cases by comparing the lockdown period, the non-lockdown period, and the pre-pandemic period. METHODS: In our study, 3 periods of EMS cases were compared to evaluate the effect of lockdown. The first period (Period A) included in the study was the lockdown period (01-12-2020 and 31-01-2021. The second period (period B) is the period between 01 and 10-2020 and 30-11-2020, where there was no lockdown despite the pandemic. The third period (period C) in the study is the period between 01 and 12-2019 and 31-01-2020 before the pandemic. RESULTS: A total of 120,989 cases in 3 periods were included in the study. It was determined that the highest number of patients were in period C (42,703, 35.3%), while the least was in period A (39,054, 32.2%). On the other hand, it was found that the number of calls was highest in period A (246,200, 35.1%), while the least was in period C (212,267, 30.2%). Response times were longer in the pandemic period than in the pre-pandemic period. Mean talk time were longer during the pandemic period. The most frequent diagnosis in period A (21.6%) and B (42.2%) was COVID-19. The second most frequent disease group in these two periods was cardiovascular diseases. CONCLUSION: While the number of EMS cases decreased during the pandemic period, it decreased even more during the lockdown period. However, the number of calls increased significantly during the lockdown period, and the response times and talk times increased accordingly.

Analysis of Suicide Cases from Ankara Province: A 3-year Emergency Medical Services Experience.

AIM: While the term "completed suicide" refers to suicides that have resulted in death,"suicide attempts" refers to all attempts that do not result in death.Analyzing EMS cases is a reliable method of obtaining data on suicide attempts and completed suicides. We aimed to determine the relationship between the occurrence of cases on weekdays, weekends, public holidays or long holidays and case characteristics. METHODOLOGY: We evaluated EMS data of Ankara Province on completed suicide and suicide attempts including the date range 01.01.2017- 31.12.2019. We evaluated the data in terms of age, gender, mortality at the scene, and suicide method. In addition, we  evaluated the data according to the hour, day, month, season, and year of the cases. We classified the suicide cases according to their occurrence on weekdays, weekends, public holidays or long holidays. RESULTS: During the 3-year period included in the study, Ankara EMS assigned ambulances to a total of 940,546 cases. Of these cases, 8231 (0.875%) were suicide attempts and completed suicides. Suicide attempts were most frequent in males, in the 20-24 age group, in summer, in July, on Sundays, and between the hours 18:00 and 24:00. The most common method in suicide attempts was self-poisoning by drugs. Completed suicides were most frequent in males, in the 30-34 age group, in spring, in May, on Mondays and Tuesdays, and between the hours 18:00 and 24:00. CONCLUSION: We evaluated different characteristics of suicide cases of EMS. In Turkey, there are few studies in the EMS field on this issue. Therefore, we believe that this study will contribute to the epidemiological evaluation of suicides. We hope that results of this study will help to prevent both suicides and suicide attempts.

Prolonged Extracorporeal Membrane Oxygenation Support as a Bridge to Heart Transplant.

Heart transplant is in high demand, but the wait list exceeds 6 months in Turkey. Until a donor heart can be procured, venoarterial extracorporeal membrane oxygenation is an important support option to bridge patients on the wait list or as a rescue therapy for patients with right ventricular failure after implant of left ventricular assist device; it is less expensive than other options, provides benefits such as simple percutaneous insertion, and requires neither sternotomy nor biventricular and respiratory support. We present a case of a patient bridged to transplant with 5 months of extracorporeal membrane oxygenation support.

Manual cardiopulmonary resuscitation versus mechanical cardiopulmonary resuscitation: Which one is more effective during ambulance transport?

OBJECTIVES: Although studies in the field of emergency medical services (EMS) generally compare survival and hospital discharge rates, there are not many studies measuring the quality of cardiopulmonary resuscitation (CPR). In this study, we aimed to compare the mechanical chest compression device and paramedics in terms of CPR quality. METHODS: This is an experimental trial. This study was performed by the EMS of Ankara city (capital of Turkey). Twenty (ten males and ten females) paramedics participated in the study. We used LUCAS™ 2 as a mechanical chest compression device in the study. Paramedics applied chest compression in twenty rounds, whereas mechanical chest compression device applied chest compression in another set of twenty rounds. The depth, rate, and hands-off time of chest compression were measured by means of the model's recording system. RESULTS: The median chest compression rate was 120.1 compressions per minute (interquartile range [IQR]: 25%-75% = 117.9-133.5) for the paramedics, whereas it was 102.3 compressions per minute for the mechanical chest compression device (IQR: 25%-75% = 102.1-102.7) (P < 0.001). The median chest compression depth was 38.9 mm (IQR: 25%-75% = 32.9-45.5) for the paramedics, whereas it was 52.7 mm for the mechanical chest compression device (IQR: 25%-75% = 51.8-55.0) (P < 0.001). The median hands-off time during CPR was 6.9% (IQR: 25-75 = 5.0%-10.1%) for the paramedics and 9% for the mechanical chest compression device (IQR: 25%-75% = 8.2%-12.5%) (P = 0.09). CONCLUSION: During patient transport, according to the chest compression performed by the health-care professionals, it was found that those performed by the mechanical chest compression device were more suitable than that performed by the guides in terms of both speed and duration.

Role of lung ultrasonography in the diagnosis of COVID-19 patients admitted to the emergency department.

Introduction: In this study, the use of lung ultrasonography (LUS) to diagnosis lung findings was evaluated in patients with suspected COVID-19 who were admitted to the emergency department (ED). Methods: This observational clinical study was conducted in the ED of the Ankara City Hospital during the period April 1-30, 2020. Patients who were admitted to the ED were triaged as COVID-19 infected and who agreed to undergo LUS/LCT (lung computed tomography) were included in the study. Results: Included in the study were 40 patients who had been prediagnosed with COVID-19. Pneumonia was detected with LCT in 32 (80%) patients, while the LUS examination identified pneumonia in 23 patients. The most common finding in LCT was ground-glass opacity (n = 29, 90.6%). Of the 23 patients with pneumonia findings in LUS, 15 (65.2%) had direct consolidation. Among the 32 patients who were found to have pneumonia as a result of LCT, 20 (62.5%) had signs of pneumonia on LUS examination, and 12 had no signs of pneumonia. In addition, 3 patients showed no signs of pneumonia with LCT, but they were misdiagnosed with pneumonia by LUS. The sensitivity of LUS in the diagnosis of pneumonia in the COVID-19 patients was 62.5%, while its specificity was 62.5%. In addition, its positive predictive value was 87.0%, and its negative predictive value was 29.4%. Conclusion: LUS may also be used in the diagnosis of pneumonia in COVID-19 patients because it is a valuable and accessible bedside diagnostic tool.

Effects of COVID-19 Pandemic on Emergency Medical Services.

INTRODUCTION: In this study, we aimed to analyse the changes that occurred after the COVID-19 pandemic using the data of EMS of Ankara province. MATERIALS AND METHODS: EMS data for the same time interval (March 11-April 24) in the last 3 years (2018, 2019 and 2020) were compared. RESULTS: While the number of calls increased by 90.9% during the pandemic period (from 2019 to 2020), the number of cases increased by 9.8%. Of all cases transported to hospital, 15.2% were suspected of and 2.9% were diagnosed with COVID-19. In the pandemic period, case frequency decreased in the 0-6 age group (-4.1%) and 7-18 age group (-39.9%) while the number of patients in the 19-65 age group (12.9%) and 65+ age group (21.5%) increased. There was a statistically significant difference between pre-pandemic and pandemic period in terms of rural area case frequency. During the pandemic period, case frequency of angina pectoris (-35.2%), myocardial infarction (-45%), acute abdomen (-23.8%) and cerebrovascular diseases (-2.9%) decreased contrary to pre-pandemic period (2019). During the same period, symptoms of fever (+14.1%) and cough (+956.3%) increased. There was a statistically significant difference between pre-pandemic and pandemic period in terms of forensic case frequency (P < .05). In addition, there was a statistically significant difference between these periods in terms of the frequency of patients who died at the scene. CONCLUSION: Although the use of ambulances has increased in the pandemic process, the use of EMS for time-sensitive diseases has decreased.

Transport of awake hypoxemic probable COVID 19 patients in the prone position.

OBJECTIVE: We aimed to investigate the effects of transport with prone position on hypoxemia in hypoxemic and awake probable COVID 19 pneumonia patients. METHODS: Hypoxic and awake patients with probable COVID 19 pneumonia who were referred to the Ankara City Hospital Emergency Department from 1 April to 31 May 2020 were included in this prospective study. Patients were transported in prone position and fixed on the stretcher. During the transport, patients continued receiving 2 l per minute oxygen with nasal cannula. Arterial blood gases were obtained from the patients before and after transport. The transport time was recorded as minutes. The primary outcome of the study is the increase of partial oxygen value in the arterial blood gas of patients after transport. RESULTS: It was found that pO2 and SpO2 end values were statistically significantly higher in the patient group compared to the initial values. In the group with transport duration of more than 15 min, a difference was found between the initial and end values in pO2 and SpO2 parameters similar to the whole group. However, there was no statistically significant difference between the initial and end values in the group with transport duration of 15 min or below. CONCLUSIONS: Awake hypoxemic patients can be transported without complications in prone position during transport. Transports more than 15 min, prone position may be recommended because the partial oxygen pressure of the patients increases.

The Effect of the COVID-19 Pandemic on the Anxiety Level of Emergency Medical Services Professionals.

INTRODUCTION: Healthcare professionals are one of the groups most affected by a pandemic that affects the whole world. This study aimed to determine the anxiety level of emergency medical services professionals in Ankara, Turkey after the emergence of the COVID-19 pandemic. SUBJECTS AND METHODS: In the first part of the survey, the participants of the study were asked about their socio-demographic characteristics and their contact with the COVID-19 patients. In the second part, a survey with 20 questions that determined the state anxiety level derived from the State Anxiety Inventory was performed after obtaining verbal consent. RESULTS: The mean age of the participants was 33.1±6.9, while 52.7% of all participants were males. In this study, the mean STAI Anxiety Score was 50.7±11.6. Anxiety scores were higher in females and those who had family members at risk of COVID-19 infection (p<0.05). The majority of those who had family members at risk of the infection started to stay in guesthouses instead of going home. Participants were worried about transmitting the infection to their family members (p<0.05). They felt more anxious when treating COVID-19 diagnosed or other patients (p<0.05). In addition, they thought that their anxiety level increased in general (p<0.05). CONCLUSION: The COVID-19 pandemic caused an anxiety increase in EMS workers in Turkey. Protecting the physical and mental health of the EMS employees who work at the front line against the COVID-19 pandemic and who have a high risk of infection, and ensuring their efficient work should be the main priority.

Role of hematological parameters in COVID-19 patients in the emergency room.

Aim: In this study, the roles of biomarkers from a peripheral blood sample in the diagnosis of COVID-19 patients who have visited the emergency room have been evaluated. Materials & methods: Peripheral blood parameters, systemic inflammatory index (SII), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio were compared in patients with and without confirmed COVID-19 infection. Results: Comparisons made according to real-time PCR test results revealed that while no statistically significant difference was observed between test groups (negative-positive) regarding lymphocyte and platelet lymphocyte ratio values (p > 0.05), a statistically significant difference (p < 0.05) was found between the test groups regarding platelet, hemoglobin, leukocyte, neutrophil, NLR and SII values. Conclusion: Leukocyte, neutrophil, platelet count, NLR and SII values can be used in the diagnosis of COVID-19.

Quality Comparison of the Manual Chest Compression and the Mechanical Chest Compression During Difficult Transport Conditions.

BACKGROUND: Although there are several studies comparing the quality of manual and mechanical chest compressions, we decided to conduct this study because results of previous studies were not sufficient for us to arrive at a definite conclusion. OBJECTIVE: In this study, our goal was to evaluate the quality of cardiopulmonary resuscitation (CPR) performed manually and by mechanical chest compression device (MCCD) when removing out-of-hospital cardiac arrest patients from their homes via stairs. METHODS: A total of 20 paramedics participated in the study. The patient simulator manikin was moved down the stairs while each of 20 paramedics performed chest compressions, then it was moved down the stairs again 20 times while the MCCD performed chest compressions. Compression depth, compression rate, and hands-on times were recorded and the data were compared. RESULTS: The median chest compression rate was 142.0 compressions/min (interquartile [25th to 75th percentile] range [IQR] 134.9-148.7 compressions/min) for the paramedics and 102.3 compressions/min for the MCCD (IQR 102.2-102.5 compressions/min) (p < 0.01). The median chest compression depth was 25.2 mm (IQR 23.2-30.9 mm) for the paramedics and 52.0 mm for the MCCD (IQR 51.4-52.6 mm) (p < 0.001). The rate of hands-on time for chest compressions performed by the paramedic participants was 92.0% (IQR 86.5-100%). Hands-on rate of the MCCD was 100% (p = 0.09). CONCLUSIONS: In our study, while carrying the patient simulator manikin to the lower floor, it was found that the MCCD achieved high-quality CPR targets recommended by resuscitation guidelines in terms of compression rate, depth, and hands-on-time.

BLUE protocol ultrasonography in Emergency Department patients presenting with acute dyspnea.

OBJECTIVE: Dyspnea is a common Emergency Department (ED) symptom requiring prompt diagnosis and treatment. The bedside lung ultrasonography in emergency (BLUE) protocol is defined as a bedside diagnostic tool in intensive care units. The aim of this study was to investigate the test performance characteristics of the BLUE-protocol ultrasonography in ED patients presenting with acute dyspnea. METHOD: This study was performed as a prospective observational study at the ED of a tertiary care university hospital over a 3-month period. The BLUE-protocol was applied to all consecutive dyspneic patients admitted to the ED by 5 emergency physicians who were certified for advanced ultrasonography. In addition to the BLUE-protocol, the patients were also evaluated for pleural and pericardial effusion. RESULTS: A total of 383 patients were included in this study (mean age, 65.5 ±â€¯15.5 years, 183 (47.8%) female and 200 (52.2%) male). According to the BLUE-protocol algorithm, the sensitivities and specificities of the BLUE-protocol are, respectively, 87.6% and 96.2% for pulmonary edema, 85.7% and 99.0% for pneumonia, 98.2% and 67.3% for asthma/COPD, 46.2% and 100% for pulmonary embolism, and 71.4% and 100% for pneumothorax. Although not included in the BLUE-protocol algorithm, pleural or pericardial effusion was detected in 82 (21.4%) of the patients. CONCLUSION: The BLUE-protocol can be used confidently in acute dyspneic ED patients. For better diagnostic utility of the BLUE-protocol in EDs, it is recommended that the BLUE-protocol be modified for the assessment of pleural and pericardial effusion. Further diagnostic evaluations are needed in asthma/COPD groups in terms of the BLUE-protocol.

Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war.

PURPOSE: Aimed to analyze demographical data and injury characteristics of patients who were injured in the Syrian Civil War (SCW) and to define differences in injury characteristics between adult and pediatric patients. METHODOLOGY: Patients who were injured in the SCW and transferred to our emergency department were retrospectively analyzed in this study during the 15-month period between July 2013 and October 2014. RESULTS: During the study period, 1591 patients who were the victims of the SCW and admitted to our emergency department due to war injury enrolled in the study. Of these patients, 285 were children (18%). The median of the injury severity score was 16 (interquartile range [IQR]: 9-25) in all patients. The most frequent mechanism of injury was blunt trauma (899 cases, 55%), and the most frequently-injured region of the body was the head (676 cases, 42.5%). Head injury rates among the children's group were higher than those of the adult group (P < .001). In contrast, injury rates for the abdomen and extremities in the children's group were lower than those in the adult group (P < .001, P < .001). CONCLUSION: The majority of patients were adults, and the most frequent mechanism of injury was blunt trauma. Similarly, the children were substantially affected by war. Although the injury severity score values and mortality rates of the child and adult groups were similar, it was determined that the number of head injuries was higher, but the number of abdomen and extremity injuries was lower in the children's group than in the adult group.

Effects of fast-track in a university emergency department through the National Emergency Department Overcrowding Study.

OBJECTIVE: To determine the impact of a fast track area on emergency department crowding and its efficacy for non-urgent patients. METHODS: The prospective cross-sectional study was conducted in an adult emergency department of a university-affiliated hospital in Turkey from September 17 to 30, 2010. Non-urgent patients were defined as those with Canadian Triage Acuity Scale category 4/5. The fast track area was open in the emergency department for one whole week, followed by another week in which fast track area was closed. Demographic information of patients, their complaints on admission, waiting times, length of stay and revisits were recorded. Overcrowding evaluation was performed via the National Emergency Department Overcrowding Study scale. In both weeks, the results of the patients were compared and the effects of fast track on the results were analysed. Continuous variables were compared via student's t test or Mann Whitney U test. Demographic features of the groups were evaluated by chi-square test. RESULTS: A total of 249 patients were seen during the fast track week, and 239 during the non-fast track week at the emergency department. Satisfaction level was higher in the fast track group than the non-fast track group (p < 0.001). The waiting times shortened from 20 minutes to 10 minutes and length of stay shortened from 80 minutes to 42 minutes during the fast track week. Morbidity and mortality rates remained unchanged. CONCLUSION: Owing to fast track, overcrowding in the emergency department was lessened. It also improved effectiveness and quality measures.

Endogenous carboxyhemoglobin concentrations in the assessment of severity in patients with community-acquired pneumonia.

INTRODUCTION: Previous studies have shown that carbon monoxide, which is endogenously produced, is increased in community-acquired pneumonia (CAP). However, it has not been studied enough whether severity of pneumonia is correlated with increased carboxyhemoglobin (COHb) concentrations in CAP. The aim of this study was to determine whether endogenous carbon monoxide levels in patients with CAP were higher compared with the control group and, if so, to determine whether COHb concentrations could predict severity in CAP. MATERIALS AND METHODS: Eighty-two patients with CAP were evaluated in this cross-sectional study during a 10-month period. Demographic data, pneumonia severity index and confusion, uremia, rate respiratory, pressure blood, age>65 (CURB-65) scores, hospital admission or discharge decisions, and 30-day hospital mortality rate were recorded. In addition, 83 control subjects were included to study. The COHb concentration was measured in arterial blood sample. RESULTS: The levels of COHb in patients with CAP were 1.70% (minimum-maximum, 0.8-3.2), whereas those in control subjects, 1.40% (minimum-maximum, 0.8-2.9). The higher COHb concentrations in patients with CAP were statistically significant (P < .05). Concentration of COHb correlated with pneumonia severity index (P = .04, r = 0.187); however, it did not correlate with CURB-65 (P = .218, r = 0.112). CONCLUSION: Although COHb concentrations show an increase in patients with pneumonia, it was concluded that this increase did not act as an indicator in diagnosis process or prediction of clinical severity for the physicians.