Epidemiology of prehospital emergency calls according to patient transport decision in a middle eastern emergency care environment: Retrospective cohort-based.

Background and Aim: Though emergency medical services (EMS) respond to all types of emergency calls, they do not always result in the patient being transported to the hospital. This study aimed to explore the determinants influencing emergency call-response-based conveyance decisions in a Middle Eastern ambulance service. Methods: This retrospective quantitative analysis of 93,712 emergency calls to the Hamad Medical Corporation Ambulance Service (HMCAS) between January 1 and May 31, 2023, obtained from the HMCAS electronic system, was analyzed to determine pertinent variables. Sociodemographic, emergency dispatch-related, clinical, and miscellaneous predictors were analyzed. Descriptive, bivariate, ridge logistic regression, and combination analyses were evaluated. Results: 23.95% (N = 21,194) and 76.05% (N = 67,285) resulted in patient nontransport and transportation, respectively. Sociodemographic analysis revealed that males predominantly activated EMS resources, and 60% of males (n = 12,687) were not transported, whilst 65% of females (n = 44,053) were transported. South Asians represented a significant proportion of the transported patients (36%, n = 24,007). "Home" emerged as the primary emergency location (56%, n = 37,725). Bivariate analysis revealed significant associations across several variables, though multicollinearity was identified as a challenge. Ridge regression analysis underscored the role of certain predictors, such as missing provisional diagnoses, in transportation decisions. The upset plot shows that hypertension and diabetes mellitus were the most common combinations in both groups. Conclusions: This study highlights the nuanced complexities governing conveyance decisions. By unveiling patterns such as male predominance, which reflects Qatar's expatriate population, and specific temporal EMS activity peaks, this study accentuates the importance of holistic patient assessment that transcends medical histories.

Enhancing Patient Safety in Prehospital Environment: Analyzing Patient Perspectives on Non-Transport Decisions With Natural Language Processing and Machine Learning.

OBJECTIVE: This research explored the experiences and perspectives of patients declining hospital transportation after receiving prehospital emergency care using advanced computational techniques. METHOD: Between 15th June and 1st August 2023, 210 patients in Qatar, treated by Hamad Medical Corporation Ambulance Service (HMCAS) but refusing transportation to hospital, were interviewed. Key outcome variables stratified by demographics included "reasons for refusing transport," "satisfaction with HMCAS service," and "postrefusal actions." Responses underwent sentiment analysis and topic modeling using latent Dirichlet allocation. Machine learning models, such as Naïve Bayes, K-nearest neighboring, random forest, and support vector machine, were used to predict patients' subsequent actions. RESULTS: Participants had an average age of 38.61 ± 19.91 years. The chief complaints were primarily chest and abdominal pains (18.49%; n = 39). Sentiment Analysis revealed a generally favorable perception of HMCAS-provided service. Latent Dirichlet allocation identified two main topics pertaining to refusal reasons and service satisfaction. Naïve Bayes and support vector machine algorithms were most effective in predicting postrefusal actions with an accuracy rate of 81.58%. CONCLUSIONS: This study highlighted the utility of Natural Language Processing and ML in enhancing our understanding of patient behaviors and sentiments in prehospital settings. These advanced computational methodologies allowed for a nuanced exploration of patient demographics and sentiments, providing insights for Quality Improvement initiatives. The study also advocates for continuously integrating automated feedback mechanisms to improve patient-centered care in the prehospital context. Continuous integration of automated feedback systems is recommended to improve prehospital patient-centered care.

Understanding patient non-transport decision theories in the pre-hospital setting: a narrative review.

BACKGROUND: In pre-hospital emergency care, decisions regarding patient non-conveyance emerged as significant determinants of healthcare outcomes and resource utilization. These complex decisions became integral to the progress of emergency medical services, thus warranting an evolving exploration within the medical discourse. OBJECTIVES AND METHODS: This narrative review aimed to synthesize and critically evaluate various theoretical stances on patient non-conveyance in the pre-hospital emergency. The focus on studies published between January 2012 and August 2022 was intentional to capture contemporary practices and insights. PubMed and Google Scholar served as the primary databases for the investigation, while the AL-Rayyan® software facilitated a thorough screening process. RESULTS AND DISCUSSION: Twenty-nine studies-encompassing articles, books, and theses-were discovered through our search, each presenting unique perspectives on patient non-transport, thus highlighting its criticality as a healthcare concern. Predominant factors influencing non-transport decisions were classified into patient-initiated refusals (PIR), clinician-initiated decisions (CID), and dispatcher-initiated decisions (DID). CONCLUSIONS: The issue of patient non-conveyance to hospitals continues to pose a crucial challenge to the seamless operation of emergency healthcare systems, warranting increased attention from various healthcare entities. To comprehend and pinpoint potential areas of improvement, a comprehensive analysis of pre-hospital non-transport events is imperative. A well-informed, strategic approach could prevent resource waste while ensuring patients receive the required and definitive care. KEY MESSAGES: Why is this topic important? Some studies have suggested that non-transport to hospitals following emergency calls is safe. However, it is a concerning issue for health systems. It is also considered a key performance metric for health systems. What does this review attempt to show? This review aimed to map the various factors discussed in the literature regarding the decisions not to transport patients following emergency calls in a pre-hospital setting. What are the key findings? The existing theories regarding non-transport to hospitals after the provision of emergency care in the pre-hospital setting were identified. Non-transport due to non-clinical decisions jeopardizes emergency care outcomes for paediatric and elderly patients in particular. Hence, further research is required to identify and control the factors governing these decisions. How is patient care impacted? The decisions regarding patient transport following emergency calls in a pre-hospital setting are crucial for patient outcomes. They could impact the pre-hospital emergency care outcomes as well as patient safety. They can also affect the emergency services resources' ability to respond to other critical emergencies.

Epidemiological Determinants of Patient Non-Conveyance to the Hospital in an Emergency Medical Service Environment.

BACKGROUND: The increasing prevalence of comorbidities worldwide has spurred the need for time-effective pre-hospital emergency medical services (EMS). Some pre-hospital emergency calls requesting EMS result in patient non-conveyance. Decisions for non-conveyance are sometimes driven by the patient or the clinician, which may jeopardize the patients' healthcare outcomes. This study aimed to explore the distribution and determinants of patient non-conveyance to hospitals in a Middle Eastern national Ambulance Service that promotes the transportation of all emergency call patients and does not adopt clinician-based non-conveyance decision. METHODS: Using R Language, descriptive, bivariate, and binary logistic regression analyses were conducted for 334,392 multi-national patient non-conveyance emergency calls from June 2018 to July 2022, from a total of 1,030,228 calls to which a response unit was dispatched. RESULTS: After data pre-processing, 237,862 cases of patient non-conveyance to hospital were retained, with a monthly average of 41.96% (n = 8799) of the emergency service demands and a standard deviation of 5.49% (n = 2040.63). They predominantly involved South Asians (29.36%, n = 69,849); 64.50% (n = 153,427) were of the age category from 14 to 44 years; 61.22% (n = 145,610) were male; 74.59% (n = 177,424) from the urban setting; and 71.28% (n = 169,552) had received on-scene treatment. Binary logistic regression with full variables and backward methods identified the final models of the determinants of patient non-conveyance decisions with an Akaike information criterion prediction estimator, respectively, of (250,200) and (250,169), indicating no significant difference between both models (Chi-square test; p-value = 0.63). CONCLUSIONS: Despite exercising a cautious protocol by encouraging patient transportation to hospital, patient non-conveyance seems to be a problem in the healthcare system that strains the pre-hospital medical response teams' resources. Policies and regulations should be adopted to encourage individuals to access other primary care centers when required rather than draining emergency services for non-emergency situations.

Exploring pre-hospital healthcare workers' readiness for chemical, biological, radiological, and nuclear threats in the State of Qatar: A cross-sectional study.

Background: Hazardous Material-Chemical, Biological, Radiological, and Nuclear (HazMat-CBRN) incidents, though infrequent, are environmentally precarious and perilous to living beings. They can be deliberate or accidental or follow the re-emergence of highly contagious diseases. Successful management of such incidents in pre-hospital settings requires having well-trained and prepared healthcare workers. Aims: This study aimed to explore the reliability and validity of a satisfaction survey, answered by Specialized Emergency Management (SEM) personnel from a national Middle Eastern ambulance service, with a "Hazardous Material Incident Management" course offered to them as a continuing professional development activity and seek their opinion regarding Hamad Medical Corporation Ambulance Service personnel needs for other HazMat-CBRN related training topics. Method: In the cross-sectional study, we conducted an online satisfaction survey for this group of course participants to obtain their feedback as subject matter experts. Aiken's content validity coefficient (CVC) was calculated to assess the content validity. Cronbach's α coefficient was determined to explore the survey's reliability. IBM®-SPSS® version 26 was utilized to explore the data. Results: The SEM satisfaction survey demonstrated important satisfaction with the implemented training with its robust reliability and content validity (Cronbach's α = 0.922 and CVC = 0.952). The participants also recommended additional related topics. Conclusion: Sustaining and reinforcing the HazMat-CBRN Incident Management course was strongly recommended, considering the increase of HazMat-CBRN threats worldwide.

Characterization of Two Cactus Formulation-Based Flocculants and Investigation on Their Flocculating Ability for Cationic and Anionic Dyes Removal.

Dye invasion in wastewaters is undeniably one of the crucial environmental concerns in addition to the supplement of toxic synthetic chemical flocculants used for color removal using the conventional coagulation-flocculation process. With the aim to improve the flocculation stage in terms of reagents safety and ensure dyes removal, the present study explores the flocculating effectiveness of two natural, stable, and eco-friendly cactus formulations, namely 60 °C oven-dried (DP) and lyophilized (LP) cladodes. Both formulations were assessed to treat cationic (Methylene blue; MB) and anionic (Methyl Orange; MO) dye solutions as a substitution attempt for the currently questioned employed synthetic chemical flocculants. Obtained results demonstrate that, in conjunction with alum as coagulant, the lyophilized powder (LP) bio-based flocculant appears to be the most efficient cactus formulation, showing a significant color (83%) and a turbidity (69%) abatement for the cationic dye (MB) and, respectively, 63% and 62% for the anionic one (MO). Additionally, the flocculation activity of the LP formula remained high over an eight-month period of storage. Moreover, based on the Fourier transform infrared (FTIR) spectroscopic analysis and the chemical characterization of cactus formulations, the occurring flocculation mechanisms of the dye removal are presumed to be based on both adsorption and bridging phenomena. Further, the significant color and turbidity decline achieved upon the addition of the lyophilized cactus cladodes powder (LP), enhancing thus the coagulation performance of the alum-based coagulant, proved the effectiveness of this bio-flocculant compared to the commonly used chemical flocculant (polyacrylamide). Hence, it was suggested that lyophilized cactus cladodes as a natural flocculant could be one of the effective surrogates to chemical flocculants conventionally used in wastewater treatment for the sake of a safer and sustainable environment.

Risk assessment of occupational exposure to heavy metal mixtures: a study protocol.

BACKGROUND: Sfax is a very industrialized city located in the southern region of Tunisia where heavy metals (HMs) pollution is now an established matter of fact. The health of its residents mainly those engaged in industrial metals-based activities is under threat. Indeed, such workers are being exposed to a variety of HMs mixtures, and this exposure has cumulative properties. Whereas current HMs exposure assessment is mainly carried out using direct air monitoring approaches, the present study aims to assess health risks associated with chronic occupational exposure to HMs in industry, using a modeling approach that will be validated later on. METHODS: To this end, two questionnaires were used. The first was an identification/descriptive questionnaire aimed at identifying, for each company: the specific activities, materials used, manufactured products and number of employees exposed. The second related to the job-task of the exposed persons, workplace characteristics (dimensions, ventilation, etc.), type of metals and emission configuration in space and time. Indoor air HMs concentrations were predicted, based on the mathematical models generally used to estimate occupational exposure to volatile substances (such as solvents). Later on, and in order to validate the adopted model, air monitoring will be carried out, as well as some biological monitoring aimed at assessing HMs excretion in the urine of workers volunteering to participate. Lastly, an interaction-based hazard index HIint and a decision support tool will be used to predict the cumulative risk assessment for HMs mixtures. DISCUSSION: One hundred sixty-one persons working in the 5 participating companies have been identified. Of these, 110 are directly engaged with HMs in the course of the manufacturing process. This model-based prediction of occupational exposure represents an alternative tool that is both time-saving and cost-effective in comparison with direct air monitoring approaches. Following validation of the different models according to job processes, via comparison with direct measurements and exploration of correlations with biological monitoring, these estimates will allow a cumulative risk characterization.

Cactus juice as bioflocculant in the coagulation-flocculation process for industrial wastewater treatment: a comparative study with polyacrylamide.

Most industries in the world treat their wastewaters with a conventional coagulation-flocculation process using alum as coagulant, polyacrylamide (PAM) as flocculant and lime as coagulant aid. To reduce the use of chemical products in the process, experiments were conducted to substitute the PAM with cactus juice (CJ) as flocculant. From the obtained data, it was concluded that the substitution of PAM with CJ in the coagulation-flocculation process was very effective, compared with PAM. Depending on the wastewater's origin, the bioflocculant showed removal efficiencies of 83.3-88.7% for suspended solids (SS) and 59.1-69.1% for chemical oxygen demand (COD). Lime addition enhanced the coagulation-flocculation process in the presence of CJ similarly to the PAM with efficiencies greater than 90% for both SS and COD. The CJ powder's infrared (IR) spectrum showed the main functional groups present in PAM. It was concluded that CJ as a flocculant fits well with the definition of sustainability and it is appropriate for countries that have regions where cactuses grow naturally.

Risk assessment of heavy metal toxicity of soil irrigated with treated wastewater using heat shock proteins stress responses: case of El Hajeb, Sfax, Tunisia.

Heavy metal contamination of soil resulting from treated wastewater irrigation can cause serious concerns resulting from consuming contaminated crops. Therefore, it is crucial to assess hazard related to wastewater reuse. In the present investigation, we suggest the use of biomarker approach as a new tool for risk assessment of wastewater reuse in irrigation as an improvement to the conventional detection of physicochemical accumulation in irrigated sites. A field study was conducted at two major sites irrigated with treated wastewater and comparisons were made with a control site. Different soil depths were considered to investigate the extent of heavy metal leaching, the estrogenic activity, and the biomarker response. Results have shown that a longer irrigation period (20 years) caused a slight decrease in soil metal levels when compared to the soil irrigated for 12 years. The highest levels of Cr, Co, Ni, Pb, and Zn were detected at 20 and 40 cm horizons in plots irrigated with wastewater for 12 years. The latter finding could be attributed to chemical leaching to deeper plots for longer irrigation period. Furthermore, the treated wastewater sample showed a high estrogenic activity while none of the soil samples could induce any estrogenic activity. Regarding the stress response, it was observed that the highest stress shown by the HSP47 promoter transfected cells was induced by a longer irrigation period. Finally, the treated wastewater and the irrigated soils exhibited an overexpression of HSP60 in comparison with reference soil following 1 h exposure. In conclusion, in vitro techniques can be efficiently used to assess potential hazard related to wastewater reuse.

A case study on co-exposure to a mixture of organic solvents in a Tunisian adhesive-producing company.

OBJECTIVES: to assess environmental and biological monitoring of exposure to organic solvents in a glue-manufacturing company in Sfax, Tunisia. METHODS: Exposure of volunteer workers, in the solvented glue-work-stations, in the control laboratory and in the storage rooms of the finished products, was assessed through indoor-air and urine measurements. Informed consent of the workers was obtained. RESULTS AND DISCUSSION: The exposure indexes were found with high values in the solvented workshop as well as in the control laboratory and were respectively, 8.40 and 3.12. These indexes were also correlated with hexane and toluene indoor air concentrations. As to urine, the obtained results for the 2,5-hexandione and hippuric acid, metabolites of hexane and toluene, respectively, were in accord with the indoor-air measurements, with an average of 0.46 mg/l and 1240 mg/g of creatinine. CONCLUSION: This study assessed for the first time biological exposure to organic solvents used in Tunisian adhesive industries. Although values are likely to underestimate true exposure levels, some figures exceed European and American occupational exposure guidelines.

Effect of chronic and subchronic organic solvents exposure on balance control of workers in plant manufacturing adhesive materials.

High-level occupational exposure to volatile organic solvents may elicit neurotoxic effects, especially on central and peripheral structures involved in balance ability. Studies on balance control in relation with exposure levels close to the threshold limit values are scarce. This study aimed to assess the neurotoxic effects of chronic and subchronic exposure to organic solvents among workers in plant manufacturing adhesive materials. Balance control was evaluated in 18 subjects, mainly exposed to n-hexane and toluene, with current median exposure levels of 222 and 102 mg/m(3), respectively, and a median exposure duration of 21 years, and in 32 nonexposed controls, using posturography tests with and without sensory conflicting situations. Tests were undergone at the beginning of the work shift (chronic exposure) following a week end, and after 72 h (subchronic exposure). Balance control performance was lower in chronically exposed workers compared to controls, and got worse after subchronic exposure, particularly during situations, where vestibular information was important. Our study suggests that a low-level and prolonged exposure to volatile organic solvents, mainly n-hexane and toluene, in the workplace is associated with deleterious central effects involved in postural regulation. This neurotoxicity is characterized by difficulties to use the most relevant information to control balance, leading to altered management of sensory conflicting situations.