The global community needs to be aware of the potential psychosocial consequences that may be experienced by healthcare workers who are actively managing patients with COVID-19. These healthcare workers are at increased risk for experiencing mood and trauma-related disorders, including Posttraumatic Stress Disorder. In this concept article, strategies are recommended for individual healthcare workers and hospital leadership to aid in mitigating the risk of PTSD as well as to build resilience in light of a potential second surge of COVID-19.

There are a variety of educational tools used to teach Disaster Medicine in EM residencies today, with a larger focus on the use of lectures and hospital drills. There is no indication of a uniform educational approach across all residencies. The results of this survey demonstrate an opportunity for the creation of a standardized model for resident education in Disaster Medicine. Sarin RR , Cattamanchi S , Alqahtani A , Aljohani M , Keim M , Ciottone GR . Disaster education: a survey study to analyze disaster medicine training in emergency medicine residency programs in the United States. Prehosp Disaster Med. 2017;32(4):368-373.

Objective: Protecting healthcare workers is an essential component of a successful response to the COVID-19 pandemic. The resource intensive nature of infectious disease protection, budgetary constraints, and global shortages of personal protective equipment (PPE) make this a daunting task. Practical, easily implemented strategies for healthcare workers (HCW) protection are needed. Methods: We cross-reference the “Systems, Space, Staff, and Stuff” paradigm from disaster management and the “Hierarchy of Controls” approach to infection prevention from the Center for Disease Control and Prevention (CDC) to generate a narrative overview of worker protection strategies relevant to COVID-19. Results: Alternative types of PPE, management of hazards, and reorganizing how people work can optimize HCWs protection. Conclusions: A comprehensive PPE strategy can utilize the “systems, space, staff, stuff” paradigm of disaster management to identify new or underutilized solutions to HCWs protection.

Background:Early recognition of Stroke is one of the key concepts in the “Chain of Survival” as described by the American Heart Association/American Stroke Association Stroke guidelines. The most commonly used tools for prehospital assessment of stroke are “The Cincinnati Prehospital Stroke Scale,” (CPSS) the “Face, Arm, Speech Test,” and “The Los Angeles Prehospital Stroke Screen.” The former two are used to identify stroke using physical findings while the latter is used to rule out other causes of altered consciousness.Aim:The aim of this study is to validate the CPSS in the prehospital setting by correlating with computed tomography scan findings. (1) To determine if these scores can be implemented in the Indian prehospital setting. (2) To determine if it is feasible for new emergency departments (EDs) to use these protocols for early detection of stroke.Methodology:A prospective, observational study from December, 2015 to March, 2016. Patients with suspected stroke were enrolled. Data were collected prehospital in patients that arrived to the ED in an ambulance. Sensitivity, specificity, positive predictive value, and negative predictive value of the score were calculated using standard formulae.Results:CPSS showed good sensitivity of 81% (confidence interval [CI] – 68.5%–97%) when combined and a positive predictive value (PPV) of 100% (CI: 91.9%–100%). Individually, they showed a sensitivity of 75.8%, 79%, and 74.1%, respectively, with a PPV of 100% and specificity of 95%–100%.Conclusion:As a prehospital screening tool, CPSS can be extremely useful as any diagnosis is only provisional until confirmed by an appropriate investigation in a hospital.

Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

Background: Breast abscess develops as a complication of lactational mastitis. Recently, there is an increase in the incidence of non-lactational breast abscess. The aim of the study was to analyse the microbial flora in the lactational and non-lactational breast abscess in the ED and to elucidate the susceptibility of flora to different antibiotics.Methods: This is a retrospective cohort study of breast abscess patients registered in the ED over two years. The case records of these patients were retrieved, and the details of their age, clinical presentation, investigation, and treatment were recorded. Specifically, the pus culture sensitivity and antibiotics used in the management of these patients were noted, and the pattern of microbiological flora analyzed.Results: A total of 124 patients were included in the study, with 97 women were categorized into lactational breast abscess, and 27 women were classified as a non-lactational breast abscess. Mean age was 24 years of age (Range 18 to 56 years). The majority of the women were young between 18 and 34 years of age (83%). The culture was grown in 92% of the patient pus specimens. Staphylococcus aureus (83%) was common organisms cultured in lactational breast abscess. Mixed Flora including Staphylococcus aureus and Group B Streptococci were grown in non-lactational breast abscess.Conclusions: Appropriate antibiotic choices are of immense importance in the management of breast abscess. Mixed flora is common in non - lactational breast abscess when compared with a lactational breast abscess. Staphylococcus Aureus is the most common isolate in both groups.

Background: Poisoning is a global public health issue and one of the common causes for visiting an emergency department (ED). A high index of suspicion based on etiology and clinical features is required to diagnose different types of poisons and their compounds. Aims: To define the epidemiological profile of patients registered in the ED with complaints of ingestion of poison, and to identify different types of poisons consumed, the duration of hospital stay and mortality due to these poisons. Methods: A retrospective analysis of patients presenting to the ED with complaints of poisoning. All patients registered in the ED with complaints of consumption of poison were included in the investigation. Patient charts with snake bites or scorpion stings were excluded. The medical charts with a discharge diagnosis of Poisoning during the study period were identified using the ICD-10-CM diagnosis codes categories T36-T65. Data was collected in a preformatted questionnaire. Results: In this study, 317 patients were enrolled, with a female predominance of 54.8%. Thirty-one percent of the patients are 15 to 24 years old, and 11.35% are below five years. Thirty percent were students, 18.3% housewives and 6.62% were farmers, with 59.3% having access to poisons at their homes, 19.87% from the pharmacy and 14.9% from a neighborhood store. The intent of poisoning in 85.8% of the patients was suicidal. 34.7% patients ingested pesticides, 30.28% patients, presented with tablet overdose, 14.82% patients consumed rodenticides and insecticides, and 3.47% patients presented with oleander seed poisoning. About 32.17% of the patients were admitted to ICU. Nearly 53.94% patients were discharged within three days of hospitalization. The mortality rate due to poisoning was 4.1%. Conclusion: This research article defines the epidemiological profile of poisoning patients registered in the emergency department, along with the common poisons used, duration of hospital stay and mortality due to poisoning.

Background: Although the incidence of Out-of-Hospital Cardiac Arrest (OHCA) is increasing, mortality is decreasing due to, in large part, early recognition and initiation of the chain of survival including prompt CPR and defibrillation, followed by advanced cardiac life support and transport to an appropriate cardiac center. Israel is an ethnically varied society with a large proportion of the population spread between urban centers and rural areas. Magen David Adom (MDA) is the Israeli national EMS organization with first responders, EMTs and Paramedics as providers. In contrast with most EMS dispatch centers which follow algorithms to provide instructions, MDA employs EMTs and Paramedics who answer emergency calls and provide CPR instructions to lay first responders in cases of OHCA. Methods: Retrospective analysis of emergency-call recordings during the first half of each month in a 6-month duration. Efficacy was measured by time to cardiac arrest diagnosis, time to initiation of compressions, absence of barriers and cooperation, and spontaneous return of consciousness/circulation. Results: Preliminary analysis of the results shows a significant inverse relationship, between average time to recognition of cardiac arrest and initiation of compressions, to years of experience. Nevertheless, the average time to recognition and initiation of compressions was not significantly different for Paramedics than for EMTs. Moreover, dispatchers with more years of service experienced greater cooperation from callers. Conclusion: This study shows that centers with dispatchers with field experience, are able to provide high quality direction for OHCA DCPR. Years of service and overall experience correlate with higher cooperation and possibly improved patient outcome. More research and further studies are necessary to compare the efficacy in comparison to algorithm-based DCPR, as well as to determine the actual improvement in patient outcome. Study/Objective: To describe the lessons learned from the first two years of "Lehiwot Menor" (Living for Life), a radio show aimed at teaching basic emergency care principles to the general public in Ethiopia. Background: In Ethiopia, despite a national initiative to standardize and strengthen prehospital and emergency care, the general public still lacks basic awareness regarding emergency care. Methods: "Lehiwot Menor" is a twice weekly, one-hour radio show at Bisrat FM 101.1, broadcasting throughout Addis Ababa and neighboring cities since September 26, 2014. Founded and hosted by two nurses trained in emergency medicine and critical care. Lehiwot Menor seeks to educate the public on harm reduction and injury prevention, as well as appropriate use of prehospital ambulance and emergency services. This was a qualitative assessment on the impact of the show through discussions, text messaging, and social media portals with a station audience. Results: Weekly live radio discussions with the public have helped disseminate information about the importance of emergency care in Ethiopia. Dis...