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Objectives: This study aimed to investigate the prevalence of recurrent and active epistaxis in adult patients presenting to the Emergency Department (ED) and explored the association of recurrent epistaxis with demographic characteristics, comorbidities and medications, and types of emergency interventions in adult epistaxis patients. Methods: A retrospective cross-sectional study was conducted with data from Eds of two tertiary hospitals over three years, from January 2019 to January 2022. All adult patients aged ≥ 18 years with active epistaxis not resolved by pressure on the nose or head positioning were included. Demographic data, details of clinical presentation and clinical management were collected from the patient's electronic medical records. Results: Of 404 patients, 73 (18.1%) revisited the ED with recurrence of epistaxis within 28 days. There was a male predilection in the study, with an average age of 55.4 ± 18.03. Most patients had unilateral (n = 328, 81.2%) and anterior (n = 376, 93.1%) nasal bleeding. Heart failure as a comorbidity was associated with a significantly increased risk of recurrent epistaxis (p = 0.001). The most common treatments included expandable polyvinyl acetate packs (EPAP) (n = 198, 49%); topical xylometazoline (n = 108, 26.7%); and chemical cautery (n = 57, 14.1%). EPAP for controlling initial bleeding was significantly associated with ED revisits due to epistaxis (p = 0.033). Conclusion: The prevalence of recurrent epistaxis mostly occurs in older-aged males. Congestive heart failure may be an under-recognised risk factor for recurrent epistaxis. In patients with a high risk of epistaxis recurrence, other treatment modalities should be sought aside from expandable polyvinyl acetate packs as they can increase the risk of rebleeding. [ABSTRACT FROM AUTHOR]

Background/Objectives: Intensive care unit (ICU) e-referrals are an important indicator for exploring potential deficiencies in critical care resources. This study aimed to examine the epidemiology and patterns of ICU e-referrals across all regions of Saudi Arabia during the COVID-19 pandemic using routinely collected data from April 2020 to December 2021. Methods: This descriptive epidemiological study analyzed data from the Saudi Medical Appointments and Referrals Centre (SMARC). This study reveals novel regional ICU e-referral patterns for critical cases using national unique digital health data, adding insights beyond the existing literature. Variables included age, sex, referral timing, reason, specialty, and region of origin. Descriptive statistics and mapping of administrative areas were performed based on e-referral request rates per 10,000 population. Results: During the study period, 36,619 patients had ICU e-referral requests. The mean age was 54.28 years, with males constituting 64.81% of requests. Out-of-scope e-referrals comprised 71.44% of requests. Referrals related to medical specialties, such as cardiology and pulmonology, were the most common (62.48%). Referral patterns showed peaks in July–August 2020 and May 2021. The Northern Border and Albaha areas had the highest request rates per population, potentially reflecting a higher proportion of severe cases requiring ICU-level care compared to other regions. Conclusions: The temporal pattern and geographic distribution of ICU e-referrals mirrored previously reported critical COVID-19 cases in Saudi Arabia. Preventive measures and vaccination programs contributed to a significant decline in ICU e-referral requests, suggesting a positive impact on controlling severe COVID-19 cases. Population-adjusted analysis revealed regional disparities, highlighting the importance of considering population size in healthcare resource management and policy. [ABSTRACT FROM AUTHOR]

Introduction: Emergency departments (EDs) have been identified as the highest risk area within a hospital to be exposed to workplace violence (WPV). This study aimed to estimate the prevalence of WPV against healthcare providers in EDs in Saudi Arabia, to explore the experiences and attitudes of ED staff toward WPV, and to identify the possible risk factors for WPV. Methods: A cross-sectional survey study was conducted with physicians and nurses working in 37 EDs in three provinces in Saudi Arabia, using a convenient sampling method. Over a 1-year period, 787 ED staff members were contacted and a 60% response rate was achieved. Results: The 1-year prevalence of at least one violent act against ED staff was 45%. Verbal threats were the most common type of WPV (42%). The study found that the prevalence of WPV against physicians (47%) was higher than against nurses (41%). However, when comparing the physician and nurse groups, none of the types of WPV was statistically significant. More female participants were exposed to stalking compared to male participants (OR 0.38; 95% CI 0.150.92). Non Arabic speakers experienced more WPV in the form of verbal threats and physical assault than the Arabic speaking group (OR 0.14; 95% CI 0.030.75). Participants working at the Ministry of Health hospitals were more likely to be exposed to a confrontation when off-duty and to stalking. Conclusion: Almost half of the ED physicians and nurses experienced one or more WPV incident during a 12-month period. [SJEMed 2020; 1(1.000): 5-14]

Background: Healthcare medical dispatch systems play a fundamental role in the daily operations of prehospital services. This study aims to describe the curriculum development of the Emergency Medical Dispatch (EMD) Program to improve the training of dispatchers and to share the experience in the interest of better prehospital dispatch systems. Methods: A selected group of education experts and academics in emergency medical services dispatch were assigned to develop an EMD curriculum over 6 months. The data of this study was collected by reviewing approved documents of the EMD Program including program curriculum, syllabus, logbook, and exam blueprint after approval letters were received from the Health Academy, Saudi Commission for Health Specialties. Results: The development of the EMD program utilized a consecutive mixed approach starting with a competency-based with backward design method to ensure the achievement of targeted outcomes followed by the Kern Six-step curriculum development model, namely: (1) problem identification and general need assessment; (2) targeted need assessment; (3) goals and objectives; (4) educational strategies; (5) implementation; and (6) evaluation and feedback. This resulted in four comprehensive modules with a 14-week EMD Program. Conclusion: EMD services play a fundamental role in the daily operations of prehospital healthcare services. Developing an EMD Program with a consecutive mixed approach might improve the current operations of EMD services. [ABSTRACT FROM AUTHOR]

Background: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA). Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals. Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25– 64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value < 0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25– 64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50). Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy. [ABSTRACT FROM AUTHOR]

Objectives: Out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system. Methods: A retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR. Results: A total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively. Conclusion: T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers' locations could improve T-CPR performance. [ABSTRACT FROM AUTHOR]

Background: Pre-hospital care providers are the first line of contact when emergencies occur. They are at high risk of mental health disorders associated with trauma and stress. The magnitude of their stress could increase during difficult times such as the COVID-19 pandemic. Objectives: This study reports on the state of mental well-being and the degree of psychological distress among pre-hospital care workers (paramedics, emergency medical technicians, doctors, paramedic interns and other healthcare practitioners) during the COVID-19 pandemic in Saudi Arabia. Methods: The study was a cross-sectional survey study in Saudi Arabia. A questionnaire was distributed among pre-hospital care workers in Saudi Arabia during the first wave of the COVID-19 pandemic. The questionnaire was based on the Kessler Psychological Distress Scale (K10) and the World Health Organization Well-Being Index (WHO-5). Results: In total, 427 pre-hospital care providers completed the questionnaire; 60% of the respondents had scores of more than 30 in the K10 and were likely to have a severe disorder. The WHO-5 showed a similar percentage of respondents with a score of more than 50 and coded as having poor well-being. Conclusions: The findings of this study provide evidence around mental health and well-being for pre-hospital care workers. They also highlight the need to better understand the quality of mental health and well-being for this population and to provide appropriate interventions to improve their quality of life. [ABSTRACT FROM AUTHOR]

This study aimed at assessing the extent to which the general Saudi population has embraced digital health medical applications to meet their health-related needs so that the Saudi Ministry of Health and government can appropriately be guided on scaling up digital health across the country. As such, this study was guided by the question of to what extent the Saudi people use digital health mobile-based applications. This was a cross-sectional study utilizing snowballing sampling approach. Frequencies, Chi-square, and Spearman rank correlation statistics were used to offer descriptive and inferential analysis of the variables. The majority of the participants were economically able to afford smart devices that have medical apps, had at least an app on such devices, and highly regarded the benefits of the apps. Unfortunately, their understanding of how to use such apps was limited, and this posed a barrier to embracing digital health alongside difficulty downloading apps and medical ethical concerns. Although there is a willingness, extra effort is needed from the Saudi Ministry of Health and the government to promote the uptake of digital health in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management. Method: The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs' success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics' perception of advanced airway management. Result: In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1-5 TIs or SADs a year. Conclusion: Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a form of an infectious respiratory disease, discovered in November 2012 in Saudi Arabia. According to the World Health Organization (WHO; Geneva, Switzerland) reports, a total of 2,519 laboratory-confirmed cases and 866 MERS-CoV-related deaths were recorded as of March 5, 2016.1 The majority of reported cases originated from Saudi Arabia (2,121 cases). Also, MERS-CoV is believed to be of zoonotic origin and has been linked to camels in the Arabian area.1,2 In this report, the authors discuss the lessons learned from the MERS-CoV outbreak at King Abdul-Aziz Medical City-Riyadh (KAMC-R) from August through September 2015 from the Emergency Medical Services (EMS) perspective. The discussion includes the changes in policies and paramedic's practice, the training and education in infection control procedures, and the process of transportation of these cases. The authors hope to share their experience in this unique situation and highlight the preparedness and response efforts that took place by the division of EMS during the outbreak. [ABSTRACT FROM AUTHOR]

Corona virus disease 2019 is a global pandemic, which affects around 2million individuals with a high death rate that exceeds 90,000 death cases across the globe. The Saudi Heart Association and the national cardiopulmonary resuscitation committee developed a taskforce to discuss the magnitude of clinical situation and CPR management on COVID‑19 patients in a prehospital and in‑hospital settings. Meanwhile, the taskforce aims to develop a nation‑wide clinical guidance to be used by health care workers and untrained laypersons to resuscitate COVID‑19 suspected and diagnosed patients. [ABSTRACT FROM AUTHOR]

Background: Post-Traumatic Stress Disorder is characterized by directly experiencing traumatic events or witnessing, learning, or repetitively experiencing the details of these events. High risk occupations (i.e., EMS personnel) frequently encounter traumatic eventscoping with events exceeding the range of human experiences. Regional lack of studies necessitated the need to report the prevalence of PTSD among healthcare providers in Saudi Arabia (SA). Aims and Objective: To explore the prevalence of PTSD among EMS personnel Materials and Methods: This a descriptive cross-sectional study at King Abdul Aziz Medical City (KAMC), Riyadh, SA among 110 paramedics, emergency medical technicians (EMT), and ambulance drivers who were conveniently selected for this screening. Post-Traumatic Stress Disorder Checklist, the Civilian version, (PCL-C) was used to screen the participants, and cut-off point was 30-35. PTSD symptoms (present & absent) was considered as outcome measure. Results: Total of 110 participants were contacted, 74 (67%) agreed to participate. Around half of the participants were EMT (52%). Total number of screened individuals is 52, 14 (26.9%) had positive screening, of those, EMT had higher proportion than paramedics (32% vs 20.8%). Conclusion: This report is the first PTSD prevalence among healthcare providers in SA. The results showed that 26% of EMS personnel had positive screening for PTSD. Attention should be directed toward this issue by regular psychological evaluation and implementing psychological rehabilitation programs for EMS personnel. The study reflects only one center in the city, thus generalization would not be inappropriate. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal disorders (MSDs) are common among EMS personnel throughout the world. Objective: The aim of the study was to determine how common the (MSD) among the EMS personnel and its associated factors such as smoking, BMI and place of work (field-workers and hospital-workers) in Saudi Arabia, Riyadh. Methods: Cross-sectional study to measure the prevalence of (MSD) among the EMS personnel. The Nordic Musculoskeletal Disorders Questionnaires were distributed to collect the data from SRCA and tertiary hospitals. The required sample size was 180 from each group. Chi-square test was used to assess the association between the MSDs and categorical date. Results: Questionnaires of 360 participants were completed and analyzed. The most prevalent site affected was the lower back (60.3%) followed by knees (41.4%), neck (40.3%) and upper back (40%); the least frequent disorder was that of hip/thigh (10.3%). Hence, (37.2%) of the paramedics suffer low back pain during their duty. Also, BMI results have shown a prevalence of obesity (19.2%), overweight (41.4%) and only (36.1%) fall within the normal range of BMI and increased BMI is highly associated to lower back (p=0.009). Furthermore, smokers number were very high (65%) and it was associated with MSD with (P<0.05) in the lower back and knees. The result showed that there was no significant difference between work places. Conclusion: The very high prevalence of MSDs was found among paramedics. It is suggested that paramedics have to be engaged in programs at their work place. Such as, exercise, improve the manual handling techniques and encourage smoke cessation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the pattern of pediatric traumas at a tertiary hospital in Riyadh, Saudi Arabia, based on gender, age groups, mechanisms of injury, and anatomical regions. Methods: This retrospective observational study used the trauma registry of King Abdulaziz Medical City Trauma Center to review the data of all pediatric patients aged <14 years who were admitted to the hospital following trauma from January 2009 to April 2014. Demographic characteristics, date and time of admission, injury type and mechanism, body area involved, and the mortality rates were analyzed. Results: A total of 1762 patients were included, 68% of who were males. The most common mechanism of injury was blunt trauma (73%), followed by burns (17%) and penetrating injuries (10%). Road traffic injuries were the most common cause (50%) of blunt trauma, followed by fall (40%) and those caused by a physical object (10%). During the study, 305 patients with burns were treated with scalds accounting for the highest proportion (68%) of burn injuries. Sharp objects (79%) were the most frequent cause of penetrating injuries. A total of 50 mortality cases were recorded, which most commonly occurred among the school-aged group (40%) and male patients (78%). The leading cause of deaths among patients was blunt injury (92%). Conclusion: This study has shown the patterns of pediatric trauma injuries in a tertiary hospital in Riyadh, Saudi Arabia, illustrating the local variability across genders, age groups, injury types, and injury mechanisms. Such demographic data will be valuable for optimally resourcing health-care system locally. [ABSTRACT FROM AUTHOR]

BACKGROUND: Administering oxygen therapy (OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%-98% in most cases. This study aims to evaluate knowledge, attitude and practice (KAP) of nurses, paramedics, emergency medical technicians (EMTs) and Emergency Medical Services (EMS) physicians working at emergency departments (ED) in Riyadh, Saudi Arabia. METHODS: In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1-5, whereas practice was assessed as a yes/no categorical variable. RESULTS: A total of 444 emergency health-care workers (EHCWs) participated, of which 225 (50.7%) were male, with the majority (77%) in the age group of 20-35 years. Over half of the sample were nurses (266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was significantly better among paramedics - nurses group and EMT - nurses group. CONCLUSION: This study demonstrates that there is a gap in EHCWs' KAP, particularly regarding when to provide OT to a patient. This gap can affect patients' safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers. [ABSTRACT FROM AUTHOR]

Background: Saudi Board of Emergency Medicine (SBEM) graduates are involved in a 1-month rotation in emergency medical services (EMSs) and disaster medicine. The purpose of this study was to evaluate change in knowledge and attitude of EM residents after the introduction of the EMS and disaster medicine rotation. Materials and Methods: The study included 32 3rd-year SBEM residents. A pretest/posttest design and a five-point Likert scale were used. The data included a response to a questionnaire developed by EMS and disaster experts. The questionnaire was distributed on the 1st day of the rotation and 45 days after. Satisfaction questionnaires were distributed after the rotation. The data were analyzed using SPSS 20. Results: Twenty-five residents responded to the satisfaction survey (75%). The overall satisfaction with the course modules was high; the course content showed the highest level of satisfaction (96%), and the lowest satisfaction was for the air ambulance ride outs (56%). The results of the pre-/post-test questionnaire showed an increase of 18.5% in the residents mean score (P < 0.001). In the open-ended section, the residents requested that the schedule is distributed before the course start date, to have more field and hands-on experience, and to present actual disaster incidents as discussion cases. The residents were impressed with the organization and diversity of the lectures, and to a lesser extent for the ambulance ride outs and the mass casualty incident drill l. Seventy-one percent indicated that they would recommend this course to other residents. Conclusion/Recommendation: This study showed that a structured course in EMS and disaster medicine had improved knowledge and had an overall high level of satisfaction among the residents of the SBEM. Although overall satisfaction and improvement in knowledge were significant, there are many areas in need of better organization. [ABSTRACT FROM AUTHOR]

Background: The demand for critical care beds is increasing out of proportion to bed availability. As a result, some critically ill patients are kept in the Emergency Department (ED boarding) awaiting bed availability. The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU).Methods: This was a retrospective analysis of ICU data collected prospectively at King Abdulaziz Medical City, Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding. Patients were stratified into three groups according to the duration of boarding from ED. Those admitted less than 6 h were classified as Group I, between 6 and 24 h, Group II and more than 24 h as Group III. We carried out multivariate analysis to examine the independent association of boarding time with the outcome adjusting for variables like age, sex, APACHE, Mechanical ventilation, Creatinine, Platelets, INR.Results: During the study period, 940 patients were admitted from the ED to ICU, amongst whom 227 (25%) were admitted to ICU within 6 h, 358 (39%) within 6-24 h and 355 (38%) after 24 h. Patients admitted to ICU within 6 h were younger [48.7 ± 22.2(group I) years, 50.6 ± 22.6 (group II), 58.2 ± 20.9 (group III) (P = 0.04)]with less mechanical ventilation duration[5.9 ± 8.9 days (Group I), 6.5 ± 8.1 (Group II) and 10.6 ± 10.5 (Group III), P = 0.04]. There was a significant increase in hospital mortality [51(22.5), 104(29.1), 132(37.2), P = 0.0006) and the ICU length of stay(LOS) [9.55 days (Group I), 9.8 (Group II) and 10.6 (Group III), (P = 0.002)] with increase in boarding duration. In addition, the delay in admission was an independent risk factor for ICU mortality(OR for group III vs group I is 1.90, P = 0.04) and hospital mortality(OR for group III vs Group I is 2.09, P = 0.007).Conclusion: Boarding in the ED is associated with higher mortality. This data highlights the importance of this phenomenon and suggests the need for urgent measures to reduce boarding and to improve patient flow. [ABSTRACT FROM AUTHOR]

Summary Background Mass gatherings present enormous challenges for emergency preparedness. Planners must anticipate and prepare for communicable and non-communicable disease outbreaks, illnesses, and injuries to participants, crowd control, and disaster responses to unforeseen natural or man-made threats. The Hajj, the largest annually recurring mass gathering event on earth. It attracts about 3 million pilgrims from over 180 countries who assemble in Mecca over a 1-week period. Methods A literature review was conducted using Medline and OVID, while searching for published data concerning human stampedes and crowd control measures implemented to prevent human stampedes. The review was further extended to include media reports and published numbers and reports about Hajj from the Saudi Arabian government, in both the English and Arabic languages. Results Because millions of pilgrims undertake their religious ritual within strict constraints in term of space and time; this rigour and strictness have led to a series of large crowd disasters over several years, thus putting pressure on the authorities. In the past few years, the government of Saudi Arabia have put an enormous effort to solve this difficulty using state of the art innovative scientific means. The use of crowd simulation models, assessment of the best ways of grouping and scheduling pilgrims, crowd management and control engineering technologies, luggage management, video monitoring, and changes in the construction of the transport system for the event. Conclusions A large gathering such as the Hajj still holds an increasing risk for future disasters. International collaboration and continued vigilance in planning efforts remains an integral part of these annual preparations. The development of educational campaigns for pilgrims regarding the possible dangers is also crucial. Lessons gleaned from experiences at the Hajj may influence planning for mass gatherings of any kind, worldwide. [ABSTRACT FROM AUTHOR]

Background Early recognition of severe sepsis and septic shock is challenging. The aim of this study was to determine the diagnostic accuracy of an electronic alert system in detecting severe sepsis or septic shock among emergency department (ED) patients. Methods An electronic sepsis alert system was developed as a part of a quality-improvement project for severe sepsis and septic shock. The system screened all adult ED patients for a combination of systemic inflammatory response syndrome and organ dysfunction criteria (hypotension, hypoxemia or lactic acidosis). This study included all patients older than 14 years who presented to the ED of a tertiary care academic medical center from Oct. 1, 2012 to Jan. 31, 2013. As a comparator, emergency medicine physicians or the critical care physician identified the patients with severe sepsis or septic shock. In the ED, vital signs were manually entered into the hospital electronic heath record every hour in the critical care area and every two hours in other areas. We also calculated the time from the alert to the intensive care unit (ICU) referral. Results Of the 49,838 patients who presented to the ED, 222 (0.4%) were identified to have severe sepsis or septic shock. The electronic sepsis alert had a sensitivity of 93.18% (95% CI, 88.78% - 96.00%), specificity of 98.44 (95% CI, 98.33% - 98.55%), positive predictive value of 20.98% (95% CI, 18.50% - 23.70%) and negative predictive value of 99.97% (95% CI, 99.95% - 99.98%) for severe sepsis and septic shock. The alert preceded ICU referral by a median of 4.02 hours (Q1 - Q3: 1.25-8.55). Conclusions Our study shows that electronic sepsis alert tool has high sensitivity and specificity in recognizing severe sepsis and septic shock, which may improve early recognition and management. [ABSTRACT FROM AUTHOR]

Background: Myocardial infarction is the third leading cause of death in the developing countries. Thrombolysis as a reperfusion therapy is shown to have a great role in decreasing mortality. The efficacy of thrombolytic therapy lies in its ability to reduce the duration of occlusion by early administration. Many of the studies have supported pre-hospital thrombolysis (PHT) therapy and proven that it is beneficial in acute myocardial infarction (AMI) patients. Methodology: Questionnaires adopted from studies of Humphrey et al., were distributed to paramedics in Saudi Red Crescent Authority and Emergency Medical Services Departments at King Abdulaziz Medical City, King Fahad Medical City, Prince Sultan Medical Military City and Security Forces Hospital in Riyadh. A total of 7 questions were about the knowledge of risk and benefit of PHT and 12 questions were about the beliefs and attitudes of paramedics toward PHT in AMI patients. Results: The response rate was 87%. Nearly 72% were believed to be capable of performing PHT, 87% are confident about recording 12-lead electrocardiogram in pre-hospital settings and 77% are confident in the interpretation. 94% believe that PHT will have a significant impact on pain to needle time. 77% consider PHT to be safe for use by paramedics. 66% preferred on-line medical direction or telemedicine linked with the supervision of a physician. Regarding the knowledge part, majority gave a correct answer, but the major concern was that 43% of the paramedics overestimated direct relation of bleeding to thrombolysis therapy. Conclusion: Majority of paramedics in Riyadh support the principle of PHT in patients with AMI via online medical direction. They believe that they are confident in their ability to administer PHT despite the concern of authorities on their level of training, the related risks and medico-legal issues. Nevertheless, since the total duration of PHT course for paramedics is just 2 days, we consider that the procedure should be performed under expert supervision until they achieve expertise. [ABSTRACT FROM AUTHOR]

B ackground. Previous studies have demonstrated decreased rates of intubation and mortality with prehospital use of continuous positive airway pressure (CPAP). We sought to validate these findings in a larger observational study. Methods. We conducted a before and after observational study of consecutive patients transported by emergency medical services (EMS) during the 12 months before and the 12 months following implementation of a prehospital CPAP protocol for acute respiratory distress. Included were all patients transported by EMS meeting preestablished criteria indicative of acute respiratory distress and CPAP use (patient's problem specified as cardiac, respiratory distress, respiratory disease, or congestive heart failure [CHF]; age ≥ 12 years; chest sounds documented as wheezes or rales; Glascow Coma Scale [GCS] ≥ 11; respiratory rate ≥ 24 breaths per minute; systolic blood pressure ≥ 90 mmHg; and oxygen saturation < 90%). Data were abstracted from ambulance call reports (ACRs) and hospital records. All cases in which 'do not resuscitate' (DNR) was documented on the patient chart or ACR or whose in-hospital outcome (death or discharge) was unknown were excluded. Results. In all, 442 patients met the above criteria. The mean (SD) age was 73.0 (13.9) years, and 51.5% were women. In-hospital mortality rates did not differ for these patients: 17/228 (7.5%) in the before group and 17/214 (7.9%) in the after group ( p = 0.85). In-hospital intubation rates were similar for both groups (12.7 vs. 14.5%, p = 0.59). An analysis of the subgroup that had a hospital diagnosis of chronic obstructive pulmonary disease (COPD), CHF, or pulmonary edema ( n = 273) showed mortality was somewhat lower in the before group (3/138, 2.2%) than in the after group (8/135, 5.9%) ( p = 0.13). In-hospital intubation rates were also similar for both groups in this subgroup analysis (11.6 vs. 9.6%, p = 0.61). Conclusion. In contrast to previous studies, we were unable to demonstrate a decrease in intubation or mortality related to the use of prehospital CPAP. Our findings may be specific to our EMS system but suggest that further large-scale, randomized, controlled trials may be warranted to firmly establish the benefit of prehospital CPAP. Key words: airway; continuous positive airway pressure; emergency medical services; paramedic [ABSTRACT FROM AUTHOR]

Out of hospital cardiac arrest remains a leading cause of mortality. Well known components of good quality cardiopulmonary resuscitation (CPR) include proper chest compression rate and depth, and allowing full chest recoil. Recently, new metrics have been developed that will lead the transition from good to high quality CPR. These include hands-off time, peri-shock pause and chest compression fraction. This article discusses new findings that show how these new metrics are associated with improved survival from out of hospital cardiac arrest and how they can be implemented by paramedics performing cardiac arrest resuscitation using current and evolving defibrillator technology. [ABSTRACT FROM AUTHOR]

Poisoning is a major public health concern. In Saudi Arabia, information related to poisoning is limited. Herein, we report a large number of poisoning cases from across The Kingdom of Saudi Arabia. We reviewed cases of poisoning received by the Poison Control Center (PCC) at the Saudi Medical Appointments and referral Center. This was a retrospective review of all documented calls to the PCC between September 2020 and September 2021. A total of 39,439 cases were reported to the PCC during the study period. The mean patient age was 7.1 ± 12.6 years, 52.8% were men, and 36.9% were women, 10.3% of the study population did not specify their gender. More than half of the cases (61.7%) were children =5 years-of-age. Public calls accounted for 76.1% of the cases, of which 76.4% were managed at home. Exposures to poisons were mostly acute (84.9%) and unintentional (69.1%). Medications were implicated in 34.7% of cases, the most common medications were analgesics (9.3%). Moderate or major effects were reported by 18.4% of the study population. The vast majority of toxicology consultations received by the PCC involved the accidental exposure of poisons to children less than five years-of-age. Therefore, there is an urgent need to develop educational campaigns targeting the safe use and storage of medications and chemicals in the household. Our findings also demonstrate that PCCs play a major role in reducing visits to the emergency department and will also reduce healthcare cost related to poisoning and overdose. [ABSTRACT FROM AUTHOR]