A Region-Wide All-Hazard Training Program for Prehospital Mass Casualty Incident Management: A Real-World Case Study.

OBJECTIVE: We report the development, implementation, and results of a sustainable region-wide mass-casualty management prehospital training program implemented by the Regione Lombardia emergency medical services (EMS) agency AREU in Italy. METHODS: The educational program learning objectives are: (1) command and control, communications, and resource management; (2) mass casualty triage and the START triage protocol; (3) on-scene management; (4) Regione Lombardia and AREU Mass Casualty standard operating procedures; and (5) inter-agency communications and relations. For each course edition data on participants' summative assessment, participants' feedback and costs were collected. RESULTS: Between June 26, 2013, and December 31, 2020, a total of 84 editions of the provider training event were delivered, training an overall 1329 prehospital providers; 1239 (93%) passed the summative assessment and were qualified as being operationally "ready." Regarding participant feedback, the overall program was rated 4.4 ± 0.7 out of 5. The overall cost of running the provider program during the study period was €321 510 (circa US $382 000). The average cost per edition was €3828 and €242 per participant. CONCLUSIONS: We have described a simple yet interactive simulation and blended-learning approach, which has yielded good pass rates, good participant satisfaction, and contained costs to systematically train emergency medical service personnel.

Missed training, collateral damage from COVID 19?

BACKGROUND: during the COVID-19 pandemic a total lockdown was enforced all over Italy starting on March 9th. This resulted in the shrinking of economic activities. In addition, all formal occupational security-training courses were halted, among them the 81/08 law lectures and Basic Life Support-Defibrillation (BLS-D) laymen training courses. The aim of the study was to evaluate the impact of the pandemic on BLS-D laymen training courses in the Lombardy region. METHODS: BLS-D training courses records for the Lombardy region were analysed. The analysis was conducted from 2016 to 2020 as part of the Hippo project. RESULTS: between 2017 and 2019 BLS-D trained laymen kept increasing, moving from 53,500 trained individuals up to 74,700. In 2020 a stark reduction was observed with only 22,160 individuals trained. Formal courses were not halted completely during 2020. Still, in the months available for training, the number of individuals enrolled showed a sharp 50% reduction. CONCLUSIONS: laymen training courses for emergency management are a fundamental component of primary prevention practice. The 81/08 and 158/12 Italian laws have decreed this practice mandatory on the workplace. Following the enforcement of the lockdown and the subsequent interruption of emergency management courses, efforts will be necessary to re-establish and guarantee the high quality training of the pre-pandemic period.

Prejudice between triage nurses and emergency medical technicians: is it a big deal?

The transmission of information between registered nurses (RNs) and emergency medical technicians (EMTs) in triage plays a fundamental role in patient care. Despite their common purpose is to assure patients to get the best diagnostic, therapeutic and care pathway, triage RNs and EMTs hold different perspectives during the process. One aspect that has not been investigated in the international literature concerns the possible presence of prejudice, meant as a preconceived opinion capable of causing people to adopt unjust attitudes toward EMTs by triage RNs. To investigate this phenomenon a survey was conducted among 740 healthcare workers (197 triage RNs and 543 EMTs), in 14 hub and spoke hospitals in Lombardia region (Italy) in October 2019. The 21.9% of RNs reported negative prejudice toward EMTs (particularly if they are volunteer), while 71% of EMTs perceived negative prejudice from triage RNs. This survey did not investigate the phenomenon exhaustively but witnessed a slippery scenario that is worth to be further explored, also evaluating whether it can affect outcomes in patients.

Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?

PURPOSE: Non-invasive continuous positive airway pressure (CPAP) is effective in reducing intubation rate and mortality of patient with acute cardiogenic pulmonary edema (ACPE). We report our experience on pre-hospital application of CPAP by helmet as an adjunct to medical therapy or as a stand alone procedure in patient with presumed ACPE. METHODS: In pre-hospital treatment of 62 patients with presumed ACPE, CPAP was added to standard medical treatment while in another 59 patients, CPAP was used as a sole therapy. RESULTS: Helmet CPAP was feasible in all patients. No patient required pre-hospital intubation. In both groups, CPAP significantly improved oxygenation (SpO(2) went from 79 +/- 12 to 97 +/- 3% and from 81 +/- 13 to 98 +/- 3%), reduced respiratory rate (from 26 +/- 4 to 21 +/- 3 bpm and from 30 +/- 9 to 22 +/- 8 bpm) and improved hemodynamics, with a more pronounced decrease in blood pressure in the group with medical treatment than in the one without it. In the two cohorts, four and five patients were, respectively, intubated in Emergency Department and 11 and 9 eventually died. CONCLUSIONS: Helmet CPAP is feasible, efficient and safe in pre-hospital treatment of presumed ACPE. A significant improvement of physiological variables was observed also in the group treated with CPAP in the absence of a drug therapy. We propose helmet CPAP as first line pre-hospital treatment of presumed severe ACPE.