The Epidemiology of Prehospital Ambulance Crashes: A National Experience Across Saudi Red Crescent Authority.

Introduction Road traffic injuries (RTIs) have a significant impact on the healthcare system as well as the global economy. RTIs involving ambulance crashes not only cause delays in patient transfers but also endanger ambulance occupants and other road users. Due to the rising numbers of RTIs in the Kingdom of Saudi Arabia (KSA), the country's primary provider of prehospital services the Saudi Red Crescent Authority (SRCA) has established a new Trauma Epidemiology Center (TEC) following the KSA 2030 vision. Objective This current study was conducted to determine the causes and management-related aspects of RTIs involving ambulance crashes in KSA. We aim to highlight the current status and guide further efforts to fill gaps in knowledge and on-ground changes to prevent ambulance crashes, enhance patient care, and reduce morbidity and mortality. Method This is a descriptive, retrospective cross-sectional observational study of ambulance crashes in Saudi Arabia between January 2020 and July 2022. The data was extracted from the SRCA electronic database platform. Results One hundred and sixty accidents were recorded between 2020 and 2022 with the highest proportion of accidents recorded in Riyadh 44.29%; followed by the Eastern Province and Makkah, 15% and 12%, respectively. Ninety percent of ambulance crashes were due to direct collisions and caused by other parties in 58% of cases. It is worth mentioning that ambulance drivers fastened their seat belts in 99% of crashes. Conclusion This study highlights the epidemiology and distribution of prehospital ambulance crashes in the KSA. Most crashes occurred in urban areas with a reasonable contribution of the public in such crashes. Understanding contributing factors related to the vector, driver behaviors, and the surrounding environment is crucial to guide national preventive measures and help decision-makers to implement proper corrective actions.

Do crashes happen more frequently at sunset in Ramadan than the rest of the year?

Objectives: Because the epidemiology of road traffic injuries (RTIs) can differ in time due to differences in traffic dynamics or behaviors, this paper aims to examine whether RTIs are more likely to occur at sunset in Ramadan than in other months in KSA. Methods: A nationwide cross-sectional study of all RTIs recorded in the Saudi Red Crescent Authority database. Cases were those who sought emergency care following any RTI in 2021. Differences in counts of RTIs between Ramadan and other months were compared using Chi-2 tests. A logistic regression model was constructed to evaluate the association between Ramadan and the likelihood of sunset RTIs. Results: The total number of RTIs was 112,188, of which 9922 (8.8%) occurred in Ramadan. Higher percentages of RTIs during Ramadan as compared to other months were observed among males (82.2% vs. 79.6%; P < .01) and non-Saudis (42.7% vs. 38.9%; P < .01). Interaction effects between Ramadan and region were significant in the regression model (P < .01). RTIs in Ramadan were almost two times more likely to occur at sunset than in other months in the Northern Borders (OR = 2.14; 95% CI:1.44-3.17), while a negative association was found in Bahah region (OR = 0.67; 95% CI: 0.44-0.99). Conclusion: RTI burden is higher in Ramadan than in other months, and that varies by region. Further investment in prevention strategies, such as increased enforcement and awareness programs, is warranted in regions with a higher RTIs burden to improve traffic safety and population health.

Epidemiology of Traffic Injuries before, during and 1 Year after the COVID-19 Pandemic Restrictions: National Findings from the Saudi Red Crescent Authority.

Background: Road traffic injuries are a leading cause of death in Saudi Arabia. Studies have examined the impact of the COVID-19 pandemic on traffic injuries treated in healthcare institutions, but its impact on patients seeking emergency medical transport for traffic injuries remains unclear. Objective: This study aimed to determine changes in traffic injuries' distribution and outcomes among patients seeking emergency medical transport before, during, and after the COVID-19 restrictions were imposed in Saudi Arabia. Methods: This is a nationwide retrospective study of all injuries reported to the Saudi Red Crescent Authority (SRCA) between January 1st, 2020, and May 31st, 2021. The cases in the study were categorized based on the following three time periods: (1) Pre-restriction (January 1 to March 23, 2020), (2) restriction (March 24 to June 21, 2020), and (3) post-restriction (June 22, 2020, to May 31, 2021). Results: A total of 142,763 cases of traffic-related injuries were recorded at the SRCA during the study period: pre-restriction, 27,811 (19.5%); restriction, 14,414 (10.1%); post-restriction, 100,538 (70.4%). Males accounted for most cases throughout the study period, but a significant increase in the number of females was observed in the post-restriction period compared with the first two timeframes (12.2% vs. 3.4% and 3.4%, respectively; P < 0.01). During the restriction period, the rate of mortality was the highest, and rollover crashes were significantly higher (18.2% vs. 14.0% and 14.6%; P < 0.01). Overall, pedestrians were almost three times more likely to die following injuries than occupants or drivers (OR = 2.7). Conclusions: Further prevention programs to reduce traffic injuries are needed to improve traffic safety and improve population health.

Preparing for the Second Surge: Preventing Posttraumatic Stress Disorder and Building Resilience for Health Care Workers in the Face of COVID-19.

The global community needs to be aware of the potential psychosocial consequences that may be experienced by health care workers who are actively managing patients with coronavirus disease (COVID-19). These health care workers are at increased risk for experiencing mood and trauma-related disorders, including posttraumatic stress disorder (PTSD). In this concept article, strategies are recommended for individual health care workers and hospital leadership to aid in mitigating the risk of PTSD, as well as to build resilience in light of a potential second surge of COVID-19.

Out of Hospital Cardiac Arrest: Saudi Red Crescent Experience Throughout COVID-19 Era.

PURPOSE: The quality of resuscitation for out hospital cardiac arrest (OHCA) during the COVID-19 era could be affected. We aim to describe prehospital healthcare providers' resuscitative efforts for OHCA cases and their definitive outcomes. PATIENTS AND METHODS: This retrospective cross-sectional study included all OHCA cases between April and June 2021 across all regions in the Kingdom of Saudi Arabia (KSA). Demographic variables, response times, CPR providers, initial rhythm, use of AED/Defibrillator, medical interventions, ROSC data, and dispatch codes were extracted from a central electronic platform. RESULTS: A total of 1307 OHCA cases were included in this study, males constituted 65% and 42% were ≥65 years. Although the median response time to initiate CPR was 13 min, 11% of OHCA cases had a response time between 0 and 6 min. About 75% of CPR was provided on scene by BLS units, 78% of OHCA cases had asystole as their initial rhythm, an AED/Defibrillator was used more than 90% of the time for pulseless VT/VF rhythm, and ROSC was achieved in 8% of OHCA patients. CONCLUSION: During the COVID-19 pandemic, maintaining resuscitative efforts for OHCA continues in KSA. Closing knowledge gaps in the community and a better description of OHCA for the dispatcher could guide dispatch-assisted CPR and minimize OHCA response times.

Practical Solutions for Healthcare Worker Protection During the COVID-19 Pandemic Response in the Ambulatory, Emergency, and Inpatient Settings.

OBJECTIVE: Protecting healthcare workers is an essential component of a successful response to the COVID-19 pandemic. The resource intensive nature of infectious disease protection, budgetary constraints, and global shortages of personal protective equipment (PPE) make this a daunting task. Practical, easily implemented strategies for healthcare workers (HCW) protection are needed. METHODS: We cross-reference the "Systems, Space, Staff, and Stuff" paradigm from disaster management and the "Hierarchy of Controls" approach to infection prevention from the Center for Disease Control and Prevention (CDC) to generate a narrative overview of worker protection strategies relevant to COVID-19. RESULTS: Alternative types of PPE, management of hazards, and reorganizing how people work can optimize HCWs protection. CONCLUSIONS: A comprehensive PPE strategy can utilize the "systems, space, staff, stuff" paradigm of disaster management to identify new or underutilized solutions to HCWs protection.

A Proposed COVID-19 Testing Algorithm.

The 2019 coronavirus disease (COVID-19) pandemic has led to physical distancing measures in numerous countries in an attempt to control the spread. However, these measures are not without cost to the health and economies of the nations in which they are enacted. Nations are now looking for methods to remove physical distancing measures and return to full functioning. To prevent a massive second wave of infections, this must be done with a data-driven methodology. The purpose of this article is to propose an algorithm for COVID-19 testing that would allow for physical distancing to be scaled back in a stepwise manner, which limits ensuing infections and protects the capacity of the health care system.

Muslim female gender preference in delaying the medical care at emergency department in Qassim Region, Saudi Arabia.

BACKGROUND: Hospitals are responsible for considering patients religious beliefs and spiritual ideas as part of their rights in emergency department (ED), where the urgent seek of medical intervention usually needed, these rights can be sometimes violated. This study is designed to take female Muslim patients view and their consideration when it comes to receiving health care from the same physician's gender or sex. MATERIALS AND METHODS: This research is a cross-sectional study, which was conducted at three hospitals in Saudi Arabia, Qassim region. The collection of the data by using a questionnaire distributed to 393 patients and visitor in ED, mostly female which represent 87.5% of the entire sample in this study. RESULTS: Indicated that more than half of female patient prefer to be seen by female physicians. The same preference with a male when the case involves one of their first-degree female relatives with exceptions in life-threatening cases, where more than half of the patients have not choose gender preference and want to rely on the available physician in ED either male or female physician. CONCLUSION: The study result shows an obvious considerable preference of the presence of a female physician in the ED to handle gastrointestinal disease, clinical assessment, non-life-threatening cases, and physical examination. However, in few situations such as life-threatening, psychiatric illnesses, and history taking, there was no preference for female over male physician. The religion was the main factor that affects in participants decisions. The intervention from the religious leader is mandatory to correct patient's beliefs, therefore, improve the outcome.

Assessment of readiness of academic emergency departments in the central region of Saudi Arabia to receive a sick child.

OBJECTIVE: We sought to assess the readiness of general emergency departments (EDs) in academic hospitals in the central region of the Kingdom of Saudi Arabia (KSA) to manage pediatric patients using an international tool: The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association guidelines, which include facilities, personnel, safety, and other components. METHODS: We assessed eligible centers during multiple visits from January 2016 to May 2016 in which we inspected the EDs and conducted interviews with their respective leadership in which we independently recorded our observations. We meet afterward to reach a consensus. Four centers were eligible for enrollment out of eight. RESULTS: 437,548 patient visits were recorded in 2015 in four academic EDs served by 176 beds. 193 parameters as well as basic demographic data were evaluated. The average travel time from an academic ED to an affiliated pediatric ED was 4.2 min (standard deviation: 1.25). Only two centers had a dedicated pediatric resuscitation bed and none had a separate pediatric crash cart. Overall performance for all centers was 53% in all test parameters. Average scores were 75% for administration and staffing and 49.6% for equipment and medications. None of the centers had a weighing scale or a hypothermia monitor, and all centers neither had policies for family-centered care nor care of children during disasters. CONCLUSION: Evaluation of academic EDs in the central region of the KSA using an international tool revealed low overall scores with critical components needed for pediatric emergency care missing.

Emphysematous Pyelonephritis in Renal Allograft - a case report.

Emphysematous pyelonephritis (EPN) is a rare disease with devastating outcomes in healthy adults. It may affect renal allografts resulting in higher mortality rate, graft loss and permanent dialysis. Presentation is highly variable and non-specific requiring higher degree of suspension. Optimal management of EPN is controversial with recent case reports challenging a previously suggested management pathway. We report a case of a 71-year-old man who presented in septic shock who was diagnosed with EPN in an allograft kidney in the emergency department, treated with antibiotics and medical support but died on the 6th day of presentation. Based on the scarce literature of EPN in allograft kidneys, a nephrectomy might be indicated in a similar patient presentation.