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As smart connected vehicles become increasingly common and pave the way for the autonomous vehicles of the future, their ability to provide enhanced safety and assistance services has improved. One such service is the emergency transport of drivers in medical distress: as a positive solution of the distress is typically more likely after timely response, an autonomous vehicle could cut on emergency response times, and thus play a key role in saving the life of its driver. In this paper, we show how such an autonomous emergency transport service can be run from a wireless cellular network, and discuss the importance of having a human in the loop in order to expedite driving. We present a Monte-Carlo-based driver assessment system that the network can use when selecting the most suitable candidate to wirelessly tow an autonomous vehicle with an incapacitated driver. We show that this mechanism results in a selection policy that ensures better cohesion between the vehicles, thereby significantly improving service reliability by reducing the chances of disruptions by intervening traffic. TRUE pub

Objective: Summarize the experience of transporting patients in the pre-hospital emergency center of our hospital from January 20, 2020 to May 2020 during the outbreak of novel coronavirus pneumonia in Zhuzhou City, and formulate a series of transport strategies. Methods: During the novel coronavirus pneumonia epidemic, review the relevant experience of the medical staff and drivers in the pre-hospital emergency center of Zhuzhou Central Hospital to improve the procedures for the transfer of patients during the epidemic. Results: As of the time when patients with novel coronavirus pneumonia in our city are cleared, none of the medical staff in the pre-hospital emergency center of Zhuzhou Central Hospital has been infected, and the city's patients in need of pre-hospital emergency treatment have been treated in an orderly manner. In conjunction with our hospital's epidemic prevention and control expert team, combined with the actual situation in the region, we jointly formulated a series of transfer procedures for Zhuzhou Central Hospital to comply with the region during the epidemic. Conclusion: During the novel coronavirus pneumonia epidemic, all patients received by the pre-hospital emergency center of our hospital were transferred in a timely and safe manner, and a series of transfer procedures were developed.

In these last 25 years, the Neonatal Emergency Transport (NET) service has been widely improved in Italy. To date, all National areas are covered by a NET service; 53 NET centers have been activated in all the Italian territory. Herein, the authors present an observational study to evaluate the rate of infantile mortality after introduction of NET in Sicily, and to study the efficiency of this service in reducing these rates of mortality in vulnerable neonates, transported from primary care birth centers to tertiary facilities to undergo to specialized NICU assistance. All neonates who required an emergency transport by NETS were included. No exclusions criteria were applied. Demographic and regional infantile mortality data, expressed as infant mortality rate, were selected by the official government database (ISTAT- National Statistic Institute—http://www.istat.it). All data were respectively divided into three groups: data concerning transport, clinical condition, and mortality of the transported patients. We transported by NET 325 neonates. The analysis of the infant mortality rate (per 1.000 live births) in Catania from 2016 to 2018 was reduced compared to the same rate calculated before NETS activation (4.41 index before 2016 vs 4.17 index after 2016). These data showed an increase in other provinces (Enna, Caltanissetta, and Agrigento). 61% of neonates showed a respiratory disease. During the study period the proportion of neonates with a Mortality Index for Neonatal Transportation—MINT

Koji Shimizu, Masahiro Wakasugi, Toshiomi Kawagishi, Tomoya Hatano, Takamasa Fuchigami, Hiroshi Okudera Emergency and Disaster Medicine, University of Toyama, Toyama, JapanCorrespondence: Masahiro WakasugiEmergency and Disaster Medicine, University of Toyama, 930-0194 Sugitani, Toyama, JapanTel +81 76-434-7786Fax +81 76-434-5110Email mwaka@med.u-toyama.ac.jpPurpose: To obtain effective systemic blood flow and coronary perfusion by chest compressions during cardiopulmonary resuscitation, it is recommended that the interruption time of chest compressions be kept to a minimum, and that the chest compression fraction (CCF) should be kept high. In this study, we examined the effects of advanced airway management by paramedics in out-of-hospital cardiac arrest (OHCA) cases on CCF and on return of spontaneous circulation (ROSC) before arrival at the hospital.Participants and Methods: A total of 283 adult, non-traumatic OHCA cases who were in cardiopulmonary arrest at the time of EMS contact between April 2015 and March 2017 were registered for this study. We retrospectively investigated the presence or absence of advanced airway clearance, CCF and ROSC during CPR. CCF was calculated by measuring the chest compression interruption time from the ECG waveform recorded on a semiautomatic defibrillator (Philips HeartStart MRX). The data obtained were recorded on a computer, and comparisons between groups were examined using an untested t-test and χ2- test.Results: Of the 283 patients with OHCA, 159 were included in the analysis. The CCF of the AAM group was 89.4%, which was significantly higher than that in the BMV group (84.3%) (P< 0.01). Forty-one patients had ROSC at the time of arrival at the hospital, and the CCF of ROSC patients was 89.7%, which was significantly higher than that of non-ROSC patients (87.2%) (P< 0.01). ROSC was also obtained in 31.8% of the patients in the AAM group, which was significantly higher than that in the BMV group (12.2%).Conclusion: In this study, we found that advanced airway management during prehospital emergency transport by paramedics showed high CCF and ROSC rates and contributed to improving the prognosis of OHCA patients through high-quality resuscitation.Keywords: cardio pulmonary resuscitation, endotracheal intubation, supraglottic airways devices, outcome

The present article shows the current neonatal air transport organization and activity in Italy. The results were obtained on the basis of a recent 2019 survey (year of activity 2018) performed by the Neonatal Transport Study Group of the Italian Society of Neonatology. The total number of newborn transports during the year 2018 was 6,464. The air-suitable transports were 512 of 5,852 (8.74%), and among them, 101 of 512 (19.72%) were performed by helicopter and 34 by airplane. Besides the availability of air transport, the interfacility distance, weather and traffic conditions, and rural mountainous roads were the main factors in determining the vehicle choice. Neonatal air transport in Italy is not homogeneously distributed and needs organizational corrections. The high density of neonatal emergency transport services on the national territory indicates the need to overcome the limits imposed by regional administrative borders, thus expanding the geographic area of competence.

We analyzed the changes in patients’ clinical characteristics and transport refusal pre- and post-COVID-19 and identified the reasons for transport refusal using emergency medical services run sheet data from pre-COVID-19 (April–December 2019) and post-COVID-19 (April–December 2020) in Gyeonggi Province, South Korea. We included patients aged ≥18 years. Univariate and multivariate logistic regression analyses were performed to identify the relationship between patients’ personal factors and clinical characteristics and emergency transport refusal. During the control and study periods, 612,681 cases were reported; the transport refusal rates during the control and study periods were 6.7% and 8.2%, respectively. Emergency transport refusal was associated with younger age, the male sex, a normal mental status, a shock index < 1, and trauma in both the pre- and post-COVID-19 periods. Although fever prevented transport refusal during the pre-COVID-19 period (aOR, 0.620; 95% CI, 0.567–0.679), it became a significant risk factor for transport refusal during the post-COVID-19 period (aOR, 1.619; 95% CI, 1.534–1.709). The most common reason for transport refusal by critically ill patients was “because it was not accepted within the jurisdiction and remote transport was required.” It is necessary to expand the response capacity of patients with fever in the community to reduce the refusal of transport by critically ill patients.

In the Global South, community emergency transport systems (CETS) are typically in response to inadequate National Ambulance Services and a poor transport network, particularly in rural areas. In G...

Background: There are some restrictions in Japan regarding end-of-life care. For example, only physicians can legally issue death certificates. By law, ambulance staff members perform cardiopulmonary resuscitation (CPR) for all patients with cardiopulmonary arrest (CPA). Therefore, it is difficult to transport patients to hospitals without CPR, even in cases of terminal patients with do-not-attempt-resuscitation (DNAR) order. Furthermore, there is no 24-hour home care nursing system in our area. Therefore, terminal patients are unable to spend their last moments at their home in the Kuji area. Objective: To design a system in which terminal patients who wish to spend their final moments at their home can be transported to the hospital without CPR after at-home CPA and a system to avoid confusion between ambulance staff and family members using instructions provided by the physician. Setting/Subjects: The subjects were terminal patients with DNAR order who wanted to stay at home. The instruction to not perform CPR after CPA was created as a document by physicians. Patient information was shared with the fire department; patients were transported to our hospital without CPR after at-home CPA. Results: In total, 26 patients died during the study period; eight received emergency transport to the hospital without CPR after CPA. CPR was not performed for any patient. Conclusion: A system transporting terminal patients without CPR after CPA was necessary in our area. This instruction allows terminal patients to spend their last moments where they wish and avoids unwanted CPR and troubles after CPA.

Few studies have investigated the influence of the Coronavirus Disease 2019 (COVID-19) pandemic on emer-gency medical service (EMS) systems, especially in areas less affected or unaffected by COVID-19. In this study, we investigated changes in prehospital EMS activity and transport times during the COVID-19 pandemic. All patients transported by EMS in the city of Okayama from March–May 2019 or March–May 2020 were included. Interfacility transports were excluded. The primary outcome was the time from a patient’s first emergency call until hospital arrival (total prehospital time). Secondary outcomes included three segments of total prehospital time: the response time, on-scene time, and transportation time. Total prehospital time and the durations of each segment were compared between corresponding months in 2020 (COVID19-affected) and 2019 (control). The results showed that total prehospital times in April 2020 were significantly higher than those in 2019 (33.8 ± 11.6 vs. 32.2 ± 10.8 min, p < 0.001). Increases in total prehospital time were caused by longer response time (9.3 ± 3.8 vs. 8.7 ± 3.7 min, p < 0.001) and on-scene time (14.4 ± 7.9 vs. 13.5 ± 6.2min, p < 0.001). The COVID-19 pandemic was thus shown to affect EMS and delayed arrival/response even in a minimally affected region. A system to minimize transportation delays should be developed for emerging pandemics.

Objective This study evaluated patterns of utilization and costs of emergency transport among women with a diagnosis of preterm labor in the US. Methods The IBM® Treatment Pathways® tool was used to interrogate a cohort randomly selected from the IBM's MarketScan ® dataset. Differences in costs and utilization patterns were assessed by the type of emergency transport service and geography. Results A cohort of 12,995 women between the ages of 16 and 45 met the inclusion criteria. About 1,029 (7.9%) of these women had evidence of emergency transport within a day of the preterm labor diagnosis. In this cohort, the median cost of emergency ground transportation was US$834; air transport had a median cost of US$22,922. Additionally, 3.1% (284) women out of a cohort of 8,728 women ages of 16 and 45 with a diagnosis of false labor required emergency transport within 7 days suggesting that they were discharged too soon. Discussion The prevalence of emergency transport for preterm labor in rural areas is significantly higher compared to non-rural areas. In addition, the disproportionate use of air transport in rural areas increases the costs of the preterm labor event. Moreover, disparities in both utilization rates and costs were identified for different parts of the country.

External mechanical forces, if properly timed and of sufficient energy, have rarely been reported to convert tachyarrhythmias to sinus rhythm. We report a case of a patient with a wide-complex tachycardia that spontaneously converted to sinus rhythm after an ambulance ran over a pothole during emergency transport to the hospital. (Level of Difficulty: Beginner.), Graphical abstract, External mechanical forces, if properly timed and of sufficient energy, have rarely been reported to convert tachyarrhythmias to sinus rhythm…

Kosuke Kiyohara, Junya Sado, Tasuku Matsuyama, Yusuke Katayama, Sumito Hayashida, Ken Nakata, Tetsuhisa Kitamura, Characteristics of Sports-Related Emergency Transport: A Population-Based Descriptive Study in Osaka City, Journal of Epidemiology, 2020, Volume 30, Issue 6, Pages 268-275, Released June 05, 2020, [Advance publication] Released May 18, 2019, Online ISSN 1349-9092, Print ISSN 0917-5040, https://doi.org/10.2188/jea.JE20190019, https://www.jstage.jst.go.jp/article/jea/30/6/30_JE20190019/_article/-char/en, Background: Little is known about the characteristics of emergency patients transported to hospital while participating in sports activity. Hence, we identified characteristics of emergency patients transported to hospital by emergency medical service (EMS) while participating in sports activity in Osaka City. Methods: Population-based ambulance records of Osaka Municipal Fire Department were reviewed. All sports-related emergency transport cases (ie, patients experiencing external injury or illness during=immediately after participation in sports activity and then transported to hospital by the EMS) were enrolled, including both athletes and recreational sports participants. The study was performed from January 1, 2013 to December 31, 2015. Data of patient characteristics were described according to the type of sports. Results: During the study, 661,190 patients required emergency transport in Osaka city; 2,642 (0.4%) were sports-related emergency transport, including 2,453 external injuries and 298 illnesses. Overall, 79.0% of patients were men and 44.4% were less than 18 years. Emergency transport during ball games accounts for the majority of cases (71.5%, 1,888=2,642), including baseball (n = 380), soccer (n = 368), and futsal (n = 209). The leading diagnosis=symptom of external injury was fracture=bone contusion (n = 701) and that of illness was heatstroke=dehydration (n = 184). Serious acute illness, such as sudden cardiac arrest, accounted for 0.6% (16=2,751) of all accidents, with half of them (n = 8) related to long-distance running. Conclusion: Characteristics of sports-related accidents widely varied by type of sports. Measures to prevent serious accidents during sports activities should be established based on the information on patient characteristics of each type of sports.

Background: The referral system plays a crucial role in antenatal care and childbearing by providing access to emergency obstetric care. Excess referral from primary care and bypassing secondary levels of care leads to overcrowding of high risk and normal mothers in tertiary centers. Hence, this study aims to assess the gaps in the referral of patients with obstetric emergency from primary care to tertiary care. Methodology: In this hospital-based descriptive study, all obstetric patients referred to the Obstetric emergency facility and admitted in postnatal wards during the study period were included. They were interviewed using a pretested questionnaire. Data entry was performed using EpiData version 3.1 and analysis was done using SPSS version 22 software. Results: Of the 505 eligible women who attended the facility, 286 (56%) were referred from other institutions, while 44% were self-referred. Among those referred, one-third were from tertiary level facility and 40% from primary care facility. More than half of the referral was through verbal communication to the patient (60%); only one-third had referral slips. Around 40.4% chose bus and private vehicles (37.6%) as their means of transport; only around 10% traveled in 108 ambulances. Conclusions: Measures to improve the capacity building at primary setting, hierarchy of referral, quality of documentation, and emergency transport mechanism for obstetric patients are vital. The deficits identified in the existing referral system will be useful to give feedback to the health systems of the neighboring regions on emergency obstetrics referrals and to propose referral guidelines.

We retrospectively evaluated the rectal temperature of 297 hypoxic-ischemic encephalopathy (HIE) outborn newborns who were passive-cooling transported by Neonatal Emergency Transport Service (Genoa and Rome, Italy) at their arrival in Neonatal Intensive Care Unit. By a total of 1461 transports, 297 were for suspected HIE. Transferring suspected HIE newborn does not mean with certainty directing him/her to cooling treatment, but rather to monitoring and deepening in the hypothesis of starting hypothermia. This is the main reason why we have chosen 35°C (±0.5°C) as the temperature target to be maintained during transport. Our study demonstrated that 263/297 patients (88.55%) passively cooled during transport were within the target limit of 35°C (±0.5°C), whereas 15 newborns were at rectal temperature35.5°C (5.05%) and 19 were34.5°C (6.39%); no patients were33°C. In our opinion, these are satisfactory results. Overcooling, failed temperature target, and unstable temperature values are the main problems claimed to occur during passive cooling in transport. We would like to conclude underlining that a well-experienced neonatal transport team can use passive cooling expecting appropriate performances.

Objective: Linking emergency medical services (EMS) data to hospital outcomes is important for quality assurance and research initiatives. However, non-linkage due to missing or incomplete patient information may increase the risk of bias and distort findings. The purpose of this study was to explore if an optimization strategy, in addition to an existing linkage process, improved the linkage rate and reduced selection and information bias.Methods: 4,150 transported patients in a metropolitan EMS system in Alberta, Canada from 2016/17 were linked to two Emergency Department (ED) databases by a standard strategy using a unique health care number, date/time of ED arrival, and hospital name. An optimized strategy added additional linkage steps incorporating last name, year of birth, and a manual search. The strategies were compared to assess the rate of linkage, and to describe event and patient-level characteristics of unlinked records.Results: The standard strategy resulted in 3,650 out of 4,150 (88.0%) linked records (95% CI 86.9%-88.9%). Of the 500 non-linked records, an additional 381 were linked by the optimized strategy (n = 4,031/4,150 [97.1%; 95% CI: 96.6%-97.6%]). There were no false positive linkages. The highest linkage failure was in 25 to 34 year-old patients (n = 93/478, 19.5%), males (n = 236/1975, 12.0%), Echo level events (n = 15/77, 19.5%), and emergency transport (45/231, 19.5%). The optimized strategy improved linkage in these groups by 68.8% (64/93), 79.2% (187/236), 40.0% (6/15), and 51.1% (23/45) respectively. For dispatch card, the highest linkage failure occurred in Card 24-Pregnancy/Childbirth/Miscarriage (n = 30/44, 68.2%), Card 27-Stab/Gunshot/Penetrating Trauma (n = 6/17, 35.3%), and Card 9-Cardiac/Respiratory Arrest/Death (n = 12/46, 26.1%). The optimized strategy improved linkage by 10.0% (3/30), 83.3% (5/6), and 41.7% (5/12) respectively. For the 119 unlinked records, 71 (59.7%) had sufficient information for linkage, but no appropriately matching records could be found.Conclusion: An optimized sequential deterministic strategy linking EMS data to ED outcomes improved the linkage rate without increasing the number of false positive links, and reduced the potential for bias. Even with adequate information, some records were not linked to their ED visit. This study underscores the importance of understanding how data are linked to hospital outcomes in EMS research and the potential for bias.

Pressure injuries are a significant problem following spinal cord injury (SCI). High interface pressures while lying on a spine board during emergency transport appear to play a major role in their formation. The aim of the present study was to assess the interface pressures and sensing area between the body and the standard spine board (SSB) and a proof of concept spine board prototype (P-5). Twenty-one able-bodied subjects were assessed on each board. Interface pressures and sensing area were recorded every minute over 15 min. The mean peak pressure was higher on the SSB at the head, scapulothoracic (S-T), sacroiliac (S-I), and heels (227.6 mmHg, 148.9 mmHg, 360.3 mmHg, and 179.3 mmHg) compared to P-5 (51.9 mmHg, 60.1 mmHg, 66.8 mmHg, and 60.2 mmHg). The peak pressure index (PPI) at the head, S-T and S-I was higher on the SSB (100.2 mmHg, 101.6 mmHg, and 270.6 mmHg) compared to P-5 (41.6 mmHg, 51.9 mmHg and 58.7 mmHg). An analysis using pairwise comparisons for repeated measures showed that interface pressures (p < .05) and PPI (p < .001) were reduced at all locations. Modifications of a spine board incorporated in P-5 can dramatically reduce interface pressures and reduce pressure injury formation.

Olugbenga Oguntunde,1,2 Farouk Musa Yusuf,1,3 Jabulani Nyenwa,1,4 Dauda Sulaiman Dauda,1,2 Abdulsamad Salihu,1,3 Irit Sinai5 1UKAid/Nigeria MNCH2 Programme, Kano, Nigeria; 2Palladium, Abuja, Nigeria; 3Society for Family Health, Abuja, Nigeria; 4Palladium, London, UK; 5Palladium, Washington, DC, USA Purpose: Ensuring adequate access to skilled birth attendants during and after childbirth is a key strategy to reducing maternal and newborn mortalities. Transportation difficulties in emergency situations continue to be a significant barrier to accessing emergency obstetric care, especially in rural and hard-to-reach areas. Emergency transport schemes (ETS) have been introduced in various settings to increase access to emergency care and reduce the second obstetric delay with varying degrees of success. This qualitative study assessed the perceptions of stakeholders and beneficiaries of ETS in two states in northern Nigeria, comparing two models of ETS: one in which the ETS were introduced as a stand-alone intervention, and another in which ETS were part of a package of interventions for increasing demand and improving utilization of maternal and newborn health services.Methods: We carried out focus group discussions with ETS drivers, mothers who delivered in the past year and utilized ETS, husbands of women who benefited from the schemes in the past year, health care providers, traditional birth attendants, and religious leaders, supplemented by in-depth interviews with program focal persons.Results: Demand creation activities – especially working with traditional birth attendants and religious leaders – provided a strong linkage between the ETS and families of women in need of emergency transport services. Community members perceived the ETS model that included demand-generating activities as being more reliable and responsive to women’s needs.Conclusion: ETS remain a key solution to lack of transport as a barrier to utilizing maternal and newborn health services in emergency situations in many rural and hard-to-reach communities. Programs utilizing ETS to improve access to emergency obstetric care should explore the potential of increasing their utility and reach by integrating the schemes with additional demand-side interventions, especially engagement with traditional birth attendants and religious leaders. Keywords: emergency transport, maternal health, emergency obstetric care, access, northern Nigeria

Objective To derive and characterize the performance of various metrics of emergency transport time in assessing for sociodemographic disparities in the setting of residential segregation. Secondarily to characterize racial disparities in emergency transport time of suspected stroke patients in Austin, Texas. Data sources We used a novel dataset of 2518 unique entries with detailed spatial and temporal information on all suspected stroke transports conducted by a public emergency medical service in Central Texas between 2010 and 2018. Study design We conducted one-way ANOVA tests with post-hoc pairwise t-tests to assess how mean hospital transport times varied by patient race. We also developed a spatially-independent metric of emergency transport urgency, the ratio of expected duration of self-transport to a hospital and the measured transport time by an ambulance. Data collection/extraction We calculated ambulance arrival and destination times using sequential temporospatial coordinates. We excluded any entries in which patient race was not recorded. We also excluded entries in which ambulances' routes did not pass within 100 m of either the patient's location or the documented hospital destination. Principal findings We found that mean transport time to a hospital was 2.5 min shorter for black patients compared to white patients. However, white patients' transport times to a hospital were found to be, on average, 4.1 min shorter than expected compared to 3.4 min shorter than expected for black patients. One-way ANOVA testing for the spatially-independent index of emergency transport urgency was not statistically significant, indicating that average transport time did not vary significantly across racial groups when accounting for variations in transport distance. Conclusions Using a novel transport urgency index, we demonstrate that these findings represent race-based variation in spatial distributions rather than racial bias in emergency medical transport. These results highlight the importance of closely examining spatial distributions when utilizing temporospatial data to investigate geographically-dependent research questions.

COVID-19 has had a significant impact on Italian healthcare, including perinatal care. We describe the effects on the Italian neonatal emergency transport system (NETS) from the first lockdown in March 2020 to the end of December 2020.

Emergency transport data from Tottori Prefecture, Japan were used to evaluate the indirect impact of coronavirus disease 2019 (COVID-19) restrictions on heat stroke. There were 426 cases of emergency transport owing to heat stroke in summer 2020 compared with 1465 cases combined for the summers of 2017–2019. The mean age of cases in 2020 was 66.2 years—significantly higher than the 60.0 years in 2017 (p = 0.004), 57.4 years in 2018 (p < 0.001), and 57.6 years in 2019 (p < 0.001). In 2020, 47.7% of cases were older than 75 (previously, 35.6–44.2%), and 36.9% were transported from their residence, (previously, 26.6–29.3%). Thus, COVID-19 measures, such as “stay at home” requests, may have increased the risk of heat stroke in older adults.

Although maternal antenatal transfer is the preferred option, some infants inevitably need urgent transport to a tertiary neonatal care facility after birth. This study aimed to investigate trends over time in patient characteristics and respiratory management in a large series of neonatal emergency transfers, in order to provide health caregivers an up-to-date profile of such patients and their therapeutic needs. Trends in patient characteristics and respiratory management were evaluated in 3337 transfers by the Eastern Veneto Neonatal Emergency Transport Service in 2000–2019. Joinpoint regression analysis was performed to evaluate trends and to estimate annual percentage changes (APCs). Proportions of preterm neonates increased (APC2000–2012 2.25%), then decreased (APC2012–2019 − 6.04%). Transfers at birth increased (APC2000–2013 2.69%), then decreased (APC2013–2019 − 5.76%). Proportion of neonates with cardiac and surgical diseases declined (APCs2000–2019 − 6.82% and − 3.32%), while proportion of neonates with neurologic diseases increased (APC2000–2019 8.62%). Use of nasal-continuous-positive-airway-pressure (APC2000–2019 9.72%) and high-flow-nasal-cannula (APC2007–2019 58.51%) at call, and nasal-continuous-positive-airway-pressure (APC2000–2019 13.87%) and nasal-intermittent-mandatory-ventilation (APC2000–2019 32.46%) during transfer increased. Mechanical ventilation during transfer decreased (APC2014–2019 − 10.77%). Use of oxygen concentrations at 21% increased at call and during transfer (APCs 2000–2019 2.24% and 2.44%), while oxygen concentrations above 40% decreased at call and during transfer (APCs 2000–2019 − 3.93% and − 5.12%). Conclusion: Our findings revealed a shift toward a more “gentle” approach and the reduced use of oxygen in respiratory management. Equipment and team expertise should meet the requirements of such changing patients and their therapeutic needs.

The coronavirus disease 2019 (COVID-19) pandemic has affected presentations of conditions unrelated to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection itself. We investigated the pandemic's effect on incidence and characteristics of pulmonary embolism (PE) cases without the infection. We retrospectively compared non-COVID PE patients during January 16-August 31, 2020 (COVID period) with PE patients during the same period in 2017-2019 (Pre-COVID period). The number of out-of-hospital onset cases was significantly higher during the pandemic than during each of the pre-COVID years. Also, the patients in the COVID period were older, more likely to be free of thrombotic predispositions, had higher mortality risks of PE, and were more likely to arrive at the hospital on emergency transport. Sedentary lifestyles during the pandemic seem to have had considerable effects on presentations of PE.

Cannabis use is a modifiable risk factor for the development and exacerbation of mental illness. The strongest evidence of risk is for the development of a psychotic disorder, associated with early and consistent use in youth and young adults. Cannabis-related mental health adverse events precipitating Emergency Department (ED) or Emergency Medical Services presentations can include anxiety, suicidal thoughts, psychotic or attenuated psychotic symptoms, and can account for 25–30% of cannabis-related ED visits. Up to 50% of patients with cannabis-related psychotic symptoms presenting to the ED requiring hospitalization will go on to develop schizophrenia. With the legalization of cannabis in various jurisdiction and the subsequent emerging focus of research in this area, our understanding of who (e.g., age groups and risk factors) are presenting with cannabis-related adverse mental health events in an emergency situation is starting to become clearer. However, for years we have heard in popular culture that cannabis use is less harmful or no more harmful than alcohol use; however, this does not appear to be the case for everyone. It is evident that these ED presentations should be considered another aspect of potentially harmful outcomes that need to be included in knowledge mobilization. In the absence of a clear understanding of the risk factors for mental health adverse events with cannabis use it can be instructive to examine what characteristics are seen with new presentations of mental illness both in emergency departments (ED) and early intervention services for mental illness. In this narrative review, we will discuss what is currently known about cannabis-related mental illness presentations to the ED, discussing risk variables and outcomes both prior to and after legalization, including our experiences following cannabis legalization in Canada. We will also discuss what is known about cannabis-related ED adverse events based on gender or biological sex. We also touch on the differences in magnitude between the impact of alcohol and cannabis on emergency mental health services to fairly present the differences in service demand with the understanding that these two recreational substances may impact different populations of individuals at risk for adverse events.

Aims: This study aimed to assess the number of patients with acute stroke seeking medical emergency care since the declaration of the state of emergency in the COVID-19 pandemic in the Tokyo metropolitan area of Japan.Methods: In this combined retrospective and prospective multicenter survey, data on the numbers of hospital admissions due to acute ischemic stroke, of large vessel occlusion (LVO) cases, and of reperfusion therapies performed from February to July 2020, restrictions of the medical care system, and comprehensive stroke center (CSC) scale scores were collected in 19 stroke centers in Tokyo.Results: In the survey period, 3,456 patients were admitted with acute stroke. There was a decrease in the number of admissions (−22%), LVO (−22%), thrombolysis (−6%), and thrombectomy (−23%) during the state of emergency, but the ratio of thrombectomy to LVO cases was not different. The acceptance of acute stroke cases by emergency transport and emergent operations in the central eastern area of Tokyo, was also significantly decreased to Conclusion: The COVID-19 pandemic had a major impact on stroke care in Tokyo, including stroke admissions and medical care systems, resulting in a significant reduction in thrombolysis and thrombectomy. The extent of the drop may be the result of the number of COVID-19 patients.

Objective The purpose of this study was to find a predictive equation for estimating the optimal nasal endotracheal tube insertion depth in extremely low–birth weight infants (ELBWs) requiring invasive ventilation in the critical care interfacility transport setting. Methods We retrospectively calculated the optimal tube insertion depth in a cohort of neonates ≤ 1,000 g born at our neonatal intensive care unit and nasally intubated within the first 24 hours of life from January 2019 to May 2020. Results A total of 75 ELBW infants were included, with a median gestational age of 26.6 weeks (range, 22.1-32.6 weeks) and a median birth weight of 780 g (range, 410-990 g). The linear regression of the estimated optimal endotracheal tube insertion depth showed a good correlation when plotted against weight (R2 = 0.491); thus, a new weight-based formula was obtained. Conclusion The proposed weight-based formula (the “Genoa formula”) may help in predicting optimal insertion depths for nasal intubation in ELBW neonates, especially when a prompt radiologic confirmation of the tube position is not available, as during neonatal critical care transport.