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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerging infectious disease pandemic developed in Lombardy (northern Italy) during the last week of February 2020 with a progressive increase of patients presenting with serious clinical findings. Despite the efforts of the Central Italian Government, regional resources were rapidly at capacity. The solution was to plan the medical evacuation (MEDEVAC) of 119 critically ill patients (median age 61 years) to in-patient intensive care units in other Italian regions (77) and Germany (42). Once surviving patients were deemed suitable, the repatriation process concluded the assignment. The aim of this report is to underline the importance of a rapid organization and coordination process between different nodes of an effective national and international network during an emerging infectious disease outbreak and draw lessons learned from similar published reports.
To describe the health-care resources implemented during the Italian Formula 1 Grand Prix (F1GP) and to calculate the patient presentation rate (PPR) based on both real data and a prediction model.
Observational and descriptive study conducted from September 9 to September 11, 2022, during the Italian F1GP hosted in Monza (Italy). Maurer’s formula was applied to decide the number and type of health resources to be allocated. Patient presentation rate (PPR) was computed based on real data (PPR_real) and based on the Arbon formula (PPR_est).
Of 336,000 attendees, n = 263 requested medical assistance with most of them receiving treatment at the advanced medical post, and n = 16 needing transport to the hospital. The PPR_real was 51 for Friday, 78 for Saturday, 134 for Sunday, and 263 when considering the whole event as a single event. The PPR_est resulted in 85 for Friday, 93 for Saturday, 97 for Sunday, and 221 for the total population.
A careful organization of health-care resources could mitigate the impact of the Italian F1GP on local hospital facilities. The Arbon formula is an acceptable model to predict and estimate the number of patients requesting medical assistance, but further investigation needs to be conducted to implement the model and tailor it to broader categories of MGE.
Coronavirus disease 2019 (COVID-19) has dramatically changed the epidemiology of several diseases. Much evidence on this has been published in the pandemic phase. In addition, many studies have shown that phenomena such as stress, substance abuse, and burnout increased in the general population during the lockdown. Unfortunately, few studies analyze the post-pandemic phase.
The study aimed to evaluate the trend of broad social problems, such as a diagnosis by the emergency department (ED), in the post-pandemic phase in the Lombardy (Italy) region.
The study is a retrospective observational cohort study. All admissions to emergency rooms in the Lombardy region registered in the Emergency Urgency OnLine (EUOL) portal made from January through June 2019 were analyzed, having as main causes: psychiatric disorders, self-harm, substance abuse, social disadvantage, and violence. All accesses in emergency rooms in the Lombardy region registered in the EUOL portal made from January 1, 2019 through June 30, 2019 were analyzed and compared with the same period in 2022.
The study recorded an increase in the likelihood of events of self-harm (OR = 2.1; 95% CI, 1.8-2.6; P <.0001), substance abuse (OR = 1.2; 95% CI, 1.1-1.3; P <.0001), violence by others (OR = 1.3; 95% CI, 1.2-1.4; P <.0001), and social disadvantage (OR = 1.2; 95% CI, 1.1-1.4; P = .0045). The events are more concentrated in suburban areas (OR = 1.3; 95% CI, 1.2-1.4; P <.001).
The increase in diagnoses of these social problems in the ED is only the culmination of a phenomenon that hides an underlying rise in social illness. In the post-COVID-19 phase, there is a need to invest in community care and social illness prevention policies.
We report the development, implementation, and results of a sustainable region-wide mass-casualty management prehospital training program implemented by the Regione Lombardia emergency medical services (EMS) agency AREU in Italy.
The educational program learning objectives are: (1) command and control, communications, and resource management; (2) mass casualty triage and the START triage protocol; (3) on-scene management; (4) Regione Lombardia and AREU Mass Casualty standard operating procedures; and (5) inter-agency communications and relations. For each course edition data on participants’ summative assessment, participants’ feedback and costs were collected.
Between June 26, 2013, and December 31, 2020, a total of 84 editions of the provider training event were delivered, training an overall 1329 prehospital providers; 1239 (93%) passed the summative assessment and were qualified as being operationally “ready.” Regarding participant feedback, the overall program was rated 4.4 ± 0.7 out of 5. The overall cost of running the provider program during the study period was €321 510 (circa US $382 000). The average cost per edition was €3828 and €242 per participant.
We have described a simple yet interactive simulation and blended-learning approach, which has yielded good pass rates, good participant satisfaction, and contained costs to systematically train emergency medical service personnel.
During the COVID-19 pandemic, a total lockdown was enforced all over Italy starting on March 9, 2020. This resulted in the shrinking of economic activities. In addition, all formal occupational security-training courses were halted, among them the 81/08 law lectures and Basic Life Support-Defibrillation (BLS-D) laypersons training courses. The aim of this study was to evaluate the impact of the pandemic on BLS-D laypersons training courses in the Lombardy region.
BLS-D training courses records for the Lombardy region were analyzed. The analysis was conducted from 2016 to 2020 as part of the Hippo project.
In the period between 2017 and 2019, BLS-D trained laypersons kept increasing, moving from 53500 trained individuals up to 74700. In 2020, a stark reduction was observed with only 22160 individuals trained. Formal courses were not halted completely during 2020. Still, in the months available for training, the number of individuals enrolled showed a sharp 50% reduction.
Laypersons training courses for emergency management are a fundamental component of primary prevention practice. The 81/08 and 158/12 Italian laws have decreed this practice mandatory in the workplace. Following the enforcement of the lockdown and the subsequent interruption of emergency management courses, efforts will be necessary to re-establish and guarantee the high quality training of the pre-pandemic period.
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