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Introduction: The COVID-19 pandemic required a significant response from global healthcare systems. In Belgium, the crisis began in March 2020, prompting quick action in hospitals. This study assesses the effectiveness of Belgium's hospital emergency plans and compares them with global standards for potential enhancements., Methodology: An online survey targeting CEOs of 60 Flemish general hospitals evaluated the deployment of hospital emergency coordination cells during the pandemic's first and fourth waves, utilizing various statistical analyses., Results: Findings indicate a high establishment rate of COVID-19 coordination cells before the government's deadline. Despite this readiness, differences in leadership, involvement, and communication strategies were noted among hospitals. There was a notable shift towards hybrid meetings and an evolving role for coordination cells, highlighting the need for a more structured crisis management approach., Conclusion: The study concludes that while Flemish hospitals were quick to respond, the lack of a standardized framework suggests the potential for adopting models like the Hospital Incident Command System (HICS) for improved crisis management. Future research should examine the long-term effects of these strategies and the integration of comprehensive emergency management systems in Belgium's healthcare.

We report a case of a 19-year-old woman who ingested Digitalis purpurea leaves as a suicide attempt. She developed gastro-intestinal symptoms, loss of colour vision, cardiac conduction disturbances as well as an elevated serum potassium. Treatment was initiated in analogy to medicinal digoxin poisoning by means of digoxin-specific Fab-fragments with a good effect. However during the further course we faced difficulties of prolonged intestinal absorption and inability to estimate the ingested dose or half-life of the vegetal cardiac glycoside compounds. To prevent further absorption and interrupt enterohepatic recycling, multi-dose activated charcoal was administered. Because of a relapse of cardiac conduction disturbances and hyperkalemia, two supplementary doses of Fab-fragments were given, up to a total dose of nineteen vials (one vial containing 40 mg). The important diagnostic and therapeutic differences of vegetal digitalis intoxication as compared to medicinal intoxication and the applicability of existing guidelines on medicinal digitalis intoxication in the light of these differences will be discussed here.

Objectives : To test the feasibility of an evidence-based protocol for procedural sedation in adults at our emergency department, using a mixture of ketamine and propofol ('ketofol') in a 1 to 4 ratio. We hypothesize that the protocol is safe and effective and can facilitate procedural sedation. Methods : During 14 months, adults in need of procedural sedation at our university hospital emergency department were included in a prospective convenience sample study. Patients with important comorbidity were discussed with the anaesthesiology department for feasibility of sedation in the emergency department setting. Outcome measures were procedural success, respiratory and hemodynamic events, vomiting, agitation or hallucinations, recall and physician's satisfaction. Results : Sixty-one patients between 18 and 89 years were included. All but one procedure were successful. Six respiratory events were registered in 6 patients (9.8%). These consisted of airway obstruction alleviated by airway repositioning and without influence on vital signs except for one brief episode of desaturation. Neither hemodynamic events nor vomiting were reported. Five patients (8.2%) experienced pleasant hallucinations and one patient (1.6%) became agitated upon awakening but recovered rapidly without medication. Three patients (4.9%) had recall and physician satisfaction rate was 93.4%. Conclusion : A feasibility trial of an implemented protocol for ketofol procedural sedation in adults showed only minor respiratory events, a low incidence of agitation or hallucinations, minimal recall and a high success and physician satisfaction rate. Despite a non-consecutive and limited sample used, ketofol in a 1 to 4 ratio appears safe and effective for use in the emergency department.

Objectives: Training children in cardiopulmonary resuscitation (CPR) is one of the strategies to increase bystander CPR in society. Reinforcing knowledge and awareness and increasing willingness to perform bystander CPR contributes to a better outcome after cardiac arrest. We questioned schoolchildren, teachers and principals about their awareness of the importance of CPR and about their willingness to perform CPR., Methods: During a four-month period, Flemish schoolchildren aged 10-18 years, teachers and principals were invited to complete a survey consisting of three parts: (1) demographics, (2) CPR (training) experience and (3) attitude towards CPR teaching and training., Result: In total, 390 schoolchildren, 439 teachers and 100 principals completed the survey. Previous CPR training was reported by 33% of the schoolchildren (in 82% as part of the curriculum) and by 81% teachers and 82% principals. Willingness to participate in CPR training was 77% in schoolchildren, 79% in teachers and 86% in principals with 88% of the principals convinced that schoolchildren should learn how to perform CPR. Willingness to perform CPR in a real-life situation was 68% in schoolchildren, 84% in teachers and 92% in principals., Conclusion: Schoolchildren are well aware of the importance of CPR and are willing to acquire the related knowledge and skills. Noteworthy is the larger awareness among principals and teachers, establishing a strong base for increasing implementation of CPR training in schools. However, a majority of children indicated a lack of training opportunities, highlighting the need for a stronger implementation.

Objective: Alcohol abuse remains a major health concern. This study aimed to describe the characteristics of alcohol-related emergency department (ED) admissions in an elderly population., Methods: Between 1 September 2013 and 31 August 2014, we retrospectively analyzed patient charts of patients admitted with a blood alcohol concentration (BAC) of at least 0.5 g/L to the EDs of all five hospitals in two distinct areas. We focused on the population ≥65 years, divided in three subgroups (65-74, 75-84 and ≥85, respectively) and compared them to the 55-64 year group., Results: Of the 3918 included patients 645 (16.5%) were between 55 and 64, and 406 (10.4%) were ≥65 years (65-74: 267, 6.8%; 75-84: 128, 3.3%; ≥85: 11, 0.3%). The male-to-female ratio ranged between 2.1:1 and 2.7:1. BACs decreased with increasing age. In all age groups the majority of patients (71.0-77.8%) were transported by emergency medical services. The chief presenting complaint was trauma and its relative importance increased with age. Contextual factors consisted mostly of chronic abuse (43.1-57.8%). Most frequently patients could be discharged within 24 h, although hospital admission rates increased with age., Conclusion: Our study shows that alcohol-related ED admissions in the elderly are common, but less frequent than in younger age groups. More (preferentially prospective) studies are needed to give more insight in the living environment, prescription medication, socioeconomic cost, etc. Nonetheless, it is clear that a national action plan should be developed to tackle the alcohol abuse problem in all age groups.

In the literature, possible systemic effects on health of inhalation or ingestion of white spirit are well described. Only a few case reports discuss the toxic skin effects that can occur following massive ingestion. Ingestion of large amounts of white spirit produces a watery diarrhoea with a high concentration of white spirit, resulting in perineal skin burns when there is prolonged contact. We describe a patient who developed partial thickness perineal skin burns after ingestion of white spirit and review the literature. The present data indicate that conservative therapy of the skin burns is recommended.

We describe a nonlethal, delayed onset case of combined acute inhalation of hydrofluoric acid (HFA) and nitric acid (NA) together with a review of the literature. Our patient was exposed to fumes of a 12% HFA and 22% NA solution in a closed environment and suffered during several months after the incident from exertional dyspnoea but recovered completely. Since HFA and NA are dangerous and widely used substances, preparedness for exposure is mandatory. After inhalational exposure, the principles of decontamination with attention to treatment of the skin for HFA burns together with general medical incident management should be applied. The severity of combined NA and HFA intoxication depends on the concentration, the nature of the contact and the duration of exposure but other factors may also be involved. Therapy resistant hypoxia and death have been reported in the literature. Inhalation injury from HFA alone is rare but systemic toxicity should be anticipated. Calcium is advocated as the cornerstone of local and systemic therapy. NA inhalation alone is very rare and causes heavy pulmonary irritation. Massive pulmonary secretions seem a sign of very severe intoxication and treatment appears to be mainly supportive.

Objectives: It is known that tension pneumoperitoneum (TPP) can lead to cardiopulmonary arrest but it does not figure in the advanced life support algorithms. Therefore we discuss a case of TPP together with the literature review of its aetiology and treatment., Patient: We describe an out of hospital cardiac arrest due to a spontaneous TPP secondary to a perforated duodenal ulcer., Conclusion: Emergency personnel should consider the possibility of TPP in a patient with a distended abdomen and a cardiac arrest, even in the absence of known traumatic and iatrogenic causes for TPP. We believe that TPP should be added as a reversible cause for pulseless electrical activity in the resuscitation guidelines.