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Introduction: The quality of care and patient outcome of out-of-hospital cardiac arrest (OHCA) are affected by different factors, one of which is the hospital teaching status. This study aims to assess the association between teaching status of hospitals and  survival rates.Methods: This retrospective observational study utilized the Nationwide Emergency Department Sample (NEDS) database of the year 2014 (released in 2016). The study sample included OHCA 122,776 patients. Descriptive analysis was performed. Patients’ characteristics were compared according to the hospital teaching status. This was followed by a multivariate analysis to assess the impact of the hospital teaching status on the patients’ survival at hospital discharge after controlling for confounding factors.Results: A total of 122,776 patients with OHCA were included in this study. The average age was 65.91 years with male predominance (61.7%). Around 62.1% of patients were admitted to metropolitan teaching hospitals. Overall survival to hospital discharge was 6.4%. Survival was higher in patients who were treated in a metropolitan teaching hospital in comparison with those who presented to a metropolitan non-teaching hospital (7.2 % versus 4.9%, p

Introduction: Sudden cardiac arrest accounts for 5% to 10% of deaths among children. Survival following out-of-hospital cardiac arrest depends on quick recognition, early cardiopulmonary resuscitation (CPR) and defibrillation. In Lebanon, the survival rate of children following such arrests is low (16.7%). Consequently, this study assesses availability of automated external defibrillators (AED) and CPR/AED training in Lebanese schools.Methods: This is a cross-sectional phone-based survey study conducted using a randomized sample of 175 private, private-free and public schools - representative of all of the country regions.Results: Among surveyed schools, 99 responded with a complete participation (56.6% response rate). Most surveyed schools were public. 28% had at least one individual who underwent CPR or/and AED training, and only 2 schools had an AED. 4 schools reported a history of SCA, 3 of them were confirmed dead, and those 4 schools did not have an AED. The main perceived barriers for not having an AED included lack of recommendations and regulations implementing such programs at schools (24.7%), no previous cardiac arrest cases at the school (22.7%) and absence of support from authorities (21.6%). Moreover, 86.9% of participant schools were interested in CPR/AED training and 89% found it essential.Conclusion: The results of the study suggest that Lebanese schools are affected by the lack of sufficient legislations and requirements for SCA. This calls for promotion of basic life support training, as well as large-scale evaluation for emergency preparedness.

Introduction: This study aims to assess follow-up behaviors of patients who leave without being seen (LWBS) from a hybrid point of service (POS) collection model Emergency Department (ED).Methods: A cross-sectional survey was administered to patients who LWBS from a hybrid POS collection model ED, one-week post-ED visit, at an academic tertiary care medical center in Lebanon, between June 2016 and May 2017.Results: LWBS patients were found to be young, males, and present with conditions of lower urgency and presenting mainly with a musculoskeletal chief complaint. Majority (66.8%) left because of third party payer denial of visit coverage followed by cost of visit (12.6%) and wait times (12.6%). A greater percentage of those who LWBS due to financial reasons were male (64.1% vs 33.3%, p

Introduction: During the COVID-19 pandemic, screening asymptomatic admitted patients for COVID-19 became routine in order to minimize the potential risk of these individuals as silent but infectious hosts in the propagation of this pandemic. However, testing is costly and the value of this indiscriminate testing was not studied. Hence, our study aimed to determine the rates of positive COVID-19 PCR results in patients presenting to the emergency department (ED) with no suspicion for a COVID-19 infection at different times during the pandemic.Methods: This was a retrospective cohort study of asymptomatic patients presenting to the ED with no COVID infection risk factors, in an urban, tertiary care hospital in Lebanon, from March 2020 to January 2021, representing periods with different national incidence rates of COVID-19. We included patients of all ages, from the last 15 days of each month, who were tested for COVID-19 by PCR in the ED and who fulfilled the following “screening group” criteria: no travel within the last 14 days; no known COVID-19 exposure within the last 14 days; and no symptoms or physical exam findings that could be associated with a COVID-19 infection. We collected data on age, and PCR result.Results: We identified 3,853 patients who underwent COVID-19 PCR test during the above time intervals in our ED. The rate of test positivity in the community during this study period ranged from 1.1% to 21.8%. Out of the 743 (19.3%) patients that fit our inclusion criteria, none had a positive COVID-19 test.Conclusion: Even during high countrywide incidence rates of COVID-19, all patients in the screening group had a negative PCR. Algorithms identifying this group can be used to minimize a costly test, to avoid delaying inpatient care or surgeries and to reduce patient’s length of stay in already overwhelmed EDs.

Introduction: Firearm-related spinal cord injuries are commonly missed in the initial assessment as they are often obscured by concomitant injuries and emergent trauma management. These injuries, however, have a significant health and financial impact. The objective of this study was to examine firearm-related spinal cord injuries and identify predictors of presence of such injuries in adult trauma patients.Methods: This retrospective cohort study examined adult trauma patients (≥16 years) with injuries from firearms included in the 2015 United States National Trauma Data Bank. We performed descriptive and bivariate analyses and compared two groups: patients with no spinal cord injury (SCI) or vertebral column injury (VCI); and patients with SCI and/or VCI. Predictors of SCI and/or VCI in patients with firearm-related injuries were identified using a multivariate logistic regression analysis.Results: There were 34,898 patients who sustained a firearm-induced injury. SCI and/or VCI were present in 2768 (7.9%) patients. Patients with SCI and/or VCI had more frequently severe injuries, higher Injury Severity Score (ISS), lower mean systolic blood pressure, and lower Glasgow Coma Scale (GCS). The mortality rate was not significantly different between the two groups (14.7%, N = 407 in SCI and/or VCI vs 15.0%, N = 4,811 in no SCI or VCI group). Significant general positive predictors of presence of SCI and/or VCI were as follows: university hospital; assault; public or unspecified location of injury; drug use; air medical transport; and Medicaid coverage. Significant clinical positive predictors included fractures, torso injuries, blood vessel or internal organ injuries, open wounds, mild (13-15) and moderate GCS scores (9 – 12), and ISS ≥ 16.Conclusion: Firearm-induced SCI and/or VCI injuries have a high burden on affected victims. The identified predictors for the presence of SCI and/or VCI injuries can help with early detection, avoiding management delays, and improving outcomes. Further studies defining the impact of each predictor are needed.

The first article in this series (Part I) discussed the abundant exposure of our emergency department (ED) to mass casualty incidents (MCIs), particularly over the past 14 years. This experience led us to define practical strategies that emergency departments can use to develop their own MCI response plans. In the first part, our main focus was to highlight the abrupt nature of MCIs and the subsequent need to use disaster drills. Additionally, we discussed the importance of having a tiered response and activation as well as other lessons learned from our experience to maximize the preparedness of the emergency department to receive mass casualty.In this article, we discuss the optimal way to triage patients. In addition, we will tackle the best methods for documentation and communication, which are vital yet overlooked during mass casualty incidents. We will also elaborate on what we learned from dealing with outbursts of anger and violence in the ED during MCIs and how to ensure the safety of the ED staff.

Over the last century, mass casualty incidents (MCIs) affected many nations and their emergency departments. The unscheduled arrival of large number of injured victims over a short period of time often causes major chaos and crowding. When a rapid surge in operational needs overwhelms available Emergency Department (ED) resources and personnel, the chaos and overwhelming mismatch between needs and resources can quickly spread to the rest of the hospital.1, 2 Nonetheless, as the front door of the hospital, the ED plays a pivotal role in determining the quality and effectiveness of an institution’s MCI response. This requires effective planning, which translates into preparedness. Unfortunately, many EDs are overburdened even on regular days. Damaged infrastructure further compounds the challenge.

Introduction: Asphyxiation or suffocation injuries can result in multi-organ damage and are a major cause of morbidity and mortality among different age groups. This study aims to describe characteristics of patients presenting with suffocation injuries to emergency departments (EDs) in the U.S and to identify factors associated with mortality in this population.Methods: We conducted a retrospective cross-sectional study using the 2013 U.S National Emergency Department Sample database. ED visits with primary diagnoses of intentional or accidental suffocation injury, and injury by inhalation and aspiration of foreign bodies or food (ICD-9-CM codes) were included. We performed descriptive statistics to describe the study population. This was followed by multivariate analyses to identify factors associated with mortality.Results: We included a total of 27,381 ED visits for suffocation injuries. Most suffered from either inhalation and ingestion of food causing obstruction of respiratory tract or suffocation (51.6%), or suicide and self-inflicted injury by hanging, strangulation, and suffocation (39.4%). Overall mortality was 10.9%. Over half (54.7%) of the patients were between 19 and 65 years old. Males were more common than females (59.1% vs. 40.9%). Over half of the patients (54.9%) were treated and released from the ED. Factors associated with increased mortality included male gender, young age (4-18 years), diseases of the cardiac, respiratory, genitourinary and neurologic systems, intentional self-harm, and self-payer status.Conclusion: Mortality from suffocation injuries remains high with significant burden on children and adolescents and on patients with intentional injuries. Tailored initiatives targeting identified modifiable factors through implementation of behavioral and environmental change can reduce the risk of suffocation injury and improve clinical outcomes of affected victims.

Little is known about survival outcomes after traumatic cardiac arrest in Asia, or the association of Utstein factors with survival after traumatic cardiac arrests. This study aimed to describe the epidemiology and outcomes of traumatic cardiac arrests in Asia, and analyze Utstein factors associated with survival. Traumatic cardiac arrest patients from 13 countries in the Pan-Asian Resuscitation Outcomes Study registry from 2009 to 2018 were analyzed. Multilevel logistic regression was performed to identify factors associated with the primary outcomes of survival to hospital discharge and favorable neurological outcome (Cerebral Performance Category (CPC) 1-2), and the secondary outcome of return of spontaneous circulation (ROSC). There were 207,455 out-of-hospital cardiac arrest cases, of which 13,631 (6.6%) were trauma patients aged 18 years and above with resuscitation attempted and who had survival outcomes reported. The median age was 57 years (interquartile range 39–73), 23.0% received bystander cardiopulmonary resuscitation (CPR), 1750 (12.8%) had ROSC, 461 (3.4%) survived to discharge, and 131 (1.0%) had CPC 1-2. Factors associated with higher rates of survival to discharge and favorable neurological outcome were arrests witnessed by emergency medical services or private ambulances (survival to discharge adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI) = 1.99–4.38; CPC 1-2 aOR = 2.57, 95% CI = 1.25–5.27), bystander CPR (survival to discharge aOR = 2.16; 95% CI 1.71–2.72; CPC 1-2 aOR = 4.98, 95% CI = 3.27–7.57), and initial shockable rhythm (survival to discharge aOR = 12.00; 95% CI = 6.80–21.17; CPC 1-2 aOR = 33.28, 95% CI = 11.39–97.23) or initial pulseless electrical activity (survival to discharge aOR = 3.98; 95% CI = 2.99–5.30; CPC 1-2 aOR = 5.67, 95% CI = 3.05–10.53) relative to asystole. In traumatic cardiac arrest, early aggressive resuscitation may not be futile and bystander CPR may improve outcomes. [ABSTRACT FROM AUTHOR]