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Background: Globally nearly 20% of cardiovascular disease deaths were attributable to air pollution. Out-of-hospital cardiac arrest (OHCA) represents a major public health problem, therefore, the identification of novel OHCA triggers is of crucial relevance. The aim of the study was to evaluate the association between air pollution (short-, mid- and long-term exposure) and out-of-hospital cardiac arrest (OHCA) risk, during a 7 years-period from a highly polluted urban area with a high density of automated external defibrillators (AEDs). Methods and results: OHCA were prospectively collected from the "Progetto Vita Database" between 01/01/2010 to 31/12/2017; day-by-day air pollution levels were extracted from the Environmental Protection Agency (ARPA) stations. Electrocardiograms of OHCA interventions were collected from the AEDs data cards. Day-by-day particulate matter (PM) 2.5 and 10, ozone (O3), carbon monoxide (CO) and nitrogen dioxide (NO2) levels were measured. A total of 880 OHCAs occurred in 748 days. A significantly increased in OHCA risk with the progressive increase in PM 2.5, PM 10, CO and NO2 levels was found. After adjustment for temperature and seasons, a 9% and 12% increase of OHCA risk for each 10 ?g/m3 increase of PM 10 (p< 0.0001) and PM 2.5 (p< 0.0001) levels was found. Air pollutants levels were associated with both asystole and shockable rhythm risk while no correlation was found with pulseless electrical activity. Conclusions: Short-term and mid-term exposure to PM 2.5 and PM 10 is independently associated with the risk of OHCA due to asystole or shockable rhythm.

Ambulance crew's choosing of appropriate destination hospital for trauma patients can affect survival and morbidity outcomes. Aim of the present study is to devise a decision-making algorithm in order to allow the best choice of destination hospital for trauma patients and to apply it on an electronic device able to facilitate the decision made by ambulance staff. The method used was analysis of literature data, context and workload with a retrospective observational study. A comparison between the destination hospitals actually chosen and those that could have been chosen with the Piacenza trauma algorithm has been applied. The data shows a 9.5% (P>0.10) more advantageous change in appropriateness in the choice of medical facility and a 1.4% increase in admissions to the Emergency Department of the provincial hospital. The creation and use of a medical protocol and its consequent installation on an electronic device (tablet) that can be shared over a computer platform could help medical staff make appropriate pre-hospital choices as regards the destination hospital for trauma patients.

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The study examined the intubation manoeuvres performed by Piacenza local health authority ambulance service nurses in patients with sudden cardiac arrest of nontraumatic origin. The study has a retrospective observational design and analyzes all the intubation manoeuvres performed by ambulance service nurses in patients with non-traumatic cardiac arrest between January 2010 and December 2013. The success of the procedure with subglottic tubes was 97.7% (P>0.60), while it was 100% (P>0.50) with supraglottic devices. The success rate of the procedures is encouraging and the statistical analysis showed that there are no significant differences between literature data and the experience of Piacenza ambulance system crews. An increase in the use of supraglottic devices was also observed. The results show that the Piacenza ambulance service nursing staff has a good level of skills and competence in advanced airway management. A future development of this ability could involve intubation also in situations other than cardiac arrest using specific medication.