BMC Emergency Medicine最新文献

Background: Interfacility transfer (IFT) of neonates and infants is common in South Africa, with many needing respiratory support. Recently, interest in non-invasive ventilation, particularly nasal continuous positive airway pressure (nCPAP), during IFTs has increased; however, local evidence is limited. This study aimed to describe the characteristics of neonates and infants requiring respiratory support and to evaluate the introduction of nCPAP during IFTs by the South African Red Cross Air Mercy Service (AMS) in the Western Cape between 2017 and 2019.

Methods: A retrospective descriptive review of all neonates (≤ 28 days) and infants ( > 28 days to ≤ 1 year) requiring respiratory support during AMS IFTs was conducted between 2017 and 2019.

Results: Respiratory support was required for 70.4% (435/618) of all neonates and infants transported during the study period. Of the 435 IFTs, 61.4% (n = 267) were neonates and 51.9% (n = 224) males. Approximately two-thirds (n = 296, 68.0%) were transported by rotor-wing (RW) aircraft, and Emergency Care Practitioners (n = 344, 79.1%) were the most common primary crew member. The median stabilisation time for RW and fixed-wing (FW) aircraft IFTs was > 60 mins, with median RW mission times approximately 3 hrs and > 5.5 hrs for FW. Common diagnoses included respiratory distress syndrome in neonates and pneumonia in infants. During IFTs, 174 (40.0%) patients received oxygen (O₂) therapy, 141 (32.4%) nCPAP, and 120 (27.6%) positive pressure ventilation, predominantly mechanical ventilation (n = 116, 26.6%). Neonates more commonly received nCPAP during IFTs and infants' oxygen therapy (p < 0.001). Additionally, in neonates, the use of nCPAP increased over the three years, while O₂ therapy declined (p < 0.001).

Conclusion: This study highlights the frequency of neonatal and infant aeromedical IFTs requiring respiratory support and the increasing adoption of nCPAP during aeromedical IFTs in one South African province. The findings suggest that nCPAP is a feasible respiratory support modality in the aeromedical IFT context; however, the safe and effective implementation relies on careful patient selection, adequately trained personnel, and appropriate equipment. Further research is warranted to evaluate the overall safety and clinical outcomes of nCPAP during IFTs and develop robust protocols and guidelines tailored to the South African context.

Purpose: This study aimed to determine the cognitive, affective, and behavioral attitudes of healthcare professionals involved in the initial intervention, treatment, and reporting of electric vehicle accidents (EVAs) and to compare these attitudes on the basis of their individual characteristics.

Design and methods: A descriptive cross-sectional design was employed. The sample consisted of 402 healthcare workers in Turkey. Data were collected via a survey that included demographic questions and the Electric Vehicle Accident Attitude Scale, a 27-item instrument developed by Kayhan et al. Attitudes were measured across cognitive, affective, and behavioral dimensions. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used alongside t tests and ANOVA, and MANOVA to compare attitudes by personal and professional variables. Cluster analysis was used to group participants according to their EVA-related attitudes.

Results: The participants demonstrated moderate overall attitudes toward EVAs. While cognitive and affective attitudes were low, behavioral attitudes were relatively high. No significant differences were found profession, marital status, age, or years of experience (p > 0.05); however, attitudes varied significantly by work unit and gender (p < 0.05). Compared with dispatch and emergency department staff, ambulance teams had more favorable behavioral (M = 3.77) and overall (M = 3.15) attitudes.

Conclusions: EVAs pose unique risks due to their battery structure and limited control, distinguishing them from conventional vehicle incidents. Knowledge gaps and emotional hesitation among healthcare workers highlight the need for targeted training programs that extend beyond healthcare providers to include other frontline responders, such as firefighters and traffic police. In addition, forensic specialists involved in injury assessment and cause-of-death determination should receive EVA-specific awareness training to enhance their preparedness for such cases. Furthermore, the implementation of structured EVA-specific training programs-shaped by the attitudes identified in this study-may not only improve the quality of emergency care but also serve a preventive function in potential future legal risks related to patient care.

Introduction: Acute spinal cord injury (ASCI) often leads to severe disability and post-traumatic stress disorder (PTSD), yet evidence on early psychological prevention during the emergency stage is limited.

Aim: This study aimed to evaluate whether emergency psychological intervention can effectively prevent PTSD in ASCI patients and improve rehabilitation outcomes, addressing a key gap in current trauma management research.

Methods: A retrospective cohort study was conducted among 191 ASCI patients admitted to the emergency department of the Affiliated Hospital of Xuzhou Medical University from June 2023 to December 2024. Patients were divided by injury severity (ISS ≥ 16 or ISS < 16) and exposure to emergency psychological intervention. Primary outcome was PTSD incidence; secondary outcomes included exercise compliance, muscle strength recovery, emergency stay time, readmission rate, and medical costs.

Results: The incidence of PTSD was significantly lower in the severe intervention group than in controls (26.7% vs. 51.8%, P = 0.024). Exercise compliance and muscle strength recovery were higher in intervention groups, and average medical expenses per patient decreased by ¥3,953 in the severe group.

Conclusion: Early emergency psychological intervention can effectively prevent PTSD and enhance rehabilitation outcomes in ASCI patients, while reducing healthcare costs and improving efficiency in emergency care. These findings support integrating a "physiological-psychological" management model into routine trauma practice.

Clinical trial number: Not applicable.

Objective: To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) for confirming endotracheal tube (ETT) placement in pediatric patients within emergency and critical care settings, compared with standard methods such as chest radiography and capnography.

Methods: A systematic search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception to May 2025. Prospective studies assessing POCUS for confirmation of endotracheal placement in pediatric patients (birth to 18 years) within acute care settings (including emergency departments, intensive care units, and operating rooms) were included. Data on diagnostic accuracy (Sensitivity, Specificity, Summary receiver operating characteristic (SROC) curve, and Diagnostic odds ratio (DOR)), POCUS success rate, Confirmation of ETT placement, Time to adequate view, Reintubation rate, as well as baseline and summary characteristics of the studies were extracted. A bivariate random-effects model was used to pool diagnostic accuracy estimates, and heterogeneity and publication bias were evaluated. Sensitivity analyses were performed using the leave-one-out method to assess the robustness of the findings. The Quality Assessment of Diagnostic Accuracy Studies-2 tool assessed bias risk.

Results: Ten studies involving 697 pediatric patients met the inclusion criteria. The pooled sensitivity of POCUS for confirming endotracheal placement was 0.95 (95% CI: 0.88-0.98; I² = 84.6%), and specificity was 0.70 (95% CI: 0.34-0.92; I² = 84.5%). The pooled DOR was 37.14 (95% CI: 6.17-223.47), and the AUC was 0.95 (95% CI: 0.91-0.99). Time to adequate ETT visualization was 45.8 s, the pooled procedural success rate was 97% (95% CI: 80-100%), and the reintubation rate was 2% (95% CI: 1-4%).

Conclusion: POCUS is a highly sensitive, rapid, radiation-free, and feasible adjunct method for confirming endotracheal placement in critically ill pediatric patients. This integration could reduce the risk of complications associated with ETT misplacement, thereby improving patient outcomes. This meta-analysis finds that POCUS is a highly sensitive adjunct for confirming pediatric ETT placement. However, the pooled specificity was only moderate, and significant heterogeneity across studies in populations, settings, and techniques was a major finding. This variability currently limits its utility as a standalone test. Our results underscore the need for standardized protocols and operator training to improve specificity and consistency before POCUS can be more broadly relied upon for this critical task.

Background: Community-based disaster risk management has emerged as a highly effective approach, emphasizing the importance of local institutions. As integral parts of communities, schools possess valuable resources that can play a crucial role in supporting government agencies in managing disasters efficiently. Therefore, this study identified the dimensions and components of schools participation in disaster risk management.

Methods: A comprehensive search was conducted across key electronic databases, including PubMed, Web of Science, and Scopus, focusing on English-language articles published up to June 8, 2024. Additionally, searches were performed on organizational websites such as WHO, CDC, FEMA, IFRC, UN, INEE, and Save the Children. Study selection followed the PRISMA 2020 guidelines, and thematic analysis was employed to examine the findings.

Results: Finally, of 7824 selected records, 17 papers were included in the final analysis. Six main themes, 26 categories, and 61 subcategories were revealed. The main themes included planning and preparedness, education and awareness, Communication and Collaboration, Equipment and Infrastructure, Evaluation and Improvement, Challenges and Solutions.

Conclusions: Schools are central to disaster risk management and must be integrated into national frameworks through formal legislation. Strengthening preparedness requires investment in infrastructure, regular assessments, and inclusive education programs. Stakeholder collaboration especially with families, NGOs, and local authorities enhances coordination and community awareness. Sustainable funding and flexible, localized strategies are essential, particularly in underserved areas. Future research should focus on cost-effective models, digital tools, and scalable practices across diverse contexts.

Background: Choking is a critical medical emergency caused by the obstruction of airway due to foreign objects. Timely and appropriate first aid is essential to prevent further complications and save the lives of choking victims, especially children. However, inadequate knowledge of first aid management in choking can lead to delayed or incorrect interventions, resulting in significant morbidity and mortality among children. Therefore, this study aimed to determine the level of knowledge and identify the sources of information regarding first aid management of choking among parents whose children were admitted to a Specialized Children Hospital, Sri Lanka.

Methods: A descriptive cross-sectional study was carried out including 425 parents of children admitted to Sirimavo Bandaranayake Specialized Children Hospital, Peradeniya, Sri Lanka. An interviewer-administered questionnaire was used to collect data on socio demographic characteristics, awareness of potential choking hazards and first aid management. Collected data were analyzed using SPSS software. The knowledge was categorized as good or poor using a 50% cut-off value.

Results: Majority of caregivers were mothers (n = 343, 80.7%). Overall, 38.8% of participants demonstrated good knowledge regarding choking first aid with the mean knowledge score (12.8 ± 3.95). Although general awareness of choking first aid was high (87.8%), only 18.8% had received prior first aid training. The main sources of information included healthcare professionals (53.1%), media (46.9%), and family members (41.6%). Notably, 21.9% correctly identified universal sign of choking as clutching the throat, and 50.8% recognized the symptoms of complete airway obstruction. However, only 10.4% were aware that first aid for choking should be initiated within three minutes. However, no significant association was identified between the knowledge of first aid for choking children with first aid training, male gender, age and educational attainment of their parents.

Conclusions: Parental knowledge regarding the first-aid management of choking is insufficient. Parents with prior first-aid training demonstrated better knowledge. Implementing parental education programs and comprehensive first aid training would enhance knowledge and skills in managing choking incidents and reducing childhood morbidity and mortality.