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Healthcare systems play a key role in the response to everything from day-to-day events to overwhelming disasters. There are common challenges worldwide which include the presence of multiple players, a lack of clarity with regard to the chain of command, the absence of important components to make the system work, and a lack of specialized training and education. Given these challenges, the ability to respond adequately requires an integrated emergency management system. Several countries may have different components of the emergency services but occasionally not well integrated. The Emergency Management Integrated Roadmap Aimed Toward Every healthcare System framework is a simplified conceptual framework to help the healthcare decision-makers in different systems to plan the approach to any day-to-day emergencies or disasters with a structured system that can be customized further according to their needs. Continue Reading

Background: Secondary spinal injury induced in trauma patients during transfer is of major concern. The logroll technique is used to transfer immobilize patients in many trauma centers. Healthcare trainees require a reliable objective tool for ensuring high competency and safety when handling trauma patients. This study aimed to develop and validate a novel method for assessing and evaluating the log-roll technique. Methods: This experimental validation study was conducted at the clinical skill lab of the Faculty of Medicine of Umm Al-Qura University from March 2018 to July 2019. A log-roll technique assessment sheet was developed using revised input from 20 content experts, current guidelines, and relevant literature. Simulated trials were filmed and reviewed by 10 content experts using the index and reference tests. Content validity, concurrent validity, internal consistency, and reliability were tested against the modified Global Rating Scale (GRS). Results: The current sheet was valid, reliable, and internally consistent... Continue Reading

Background: Basic vaccinations are essential for child well-being and delaying these vaccines during coronavirus disease-2019 (COVID-19) pandemic will lead to vaccine-preventable diseases. This study was conducted to identify the factors that contribute to delay of vaccination during COVID-2019 pandemic and assess the prevalence of participants who have positive attitude towards continuing the vaccination during the pandemic. Methods: A cross-sectional study was conducted during May 2020 in all regions of Saudi Arabia through a self-administered intent-based questionnaire. Data were acquired from participants who take care of a child from birth to 4 years old, reside in Saudi Arabia. The questionnaire was structured to collect socioeconomic data, child information, vaccination information, and reasons of delaying vaccination schedule during the pandemic. Results: A total of 820 were included in the study, where 75.6% of participants in our survey had a positive attitude toward completing their children’s vaccination even during the COVID-19 pandemic. Participants... Continue Reading

Background: Scorpion stings are a significant public health issue in many underdeveloped tropical and subtropical countries. The aim of this study was to review the demographics of scorpion stings in Riyadh region, the current practice of management, the utility of the laboratory investigations, and their effect on hospitalizations, length of stay in the emergency department (ED), and return visits. Methods: This is a retrospective observational descriptive chart review study. Data were collected from the electronic health system (BEST Care2.0A.Ink) during January 2016-April 2019. We included all adult patients (>14 years old) who presented to King Abdul-Aziz Medical City (KAMC) complaining of clinical manifestations of scorpion envenomation. Results: We collected 286 patients; the mean age was 34.5 (±13.8). Male patients represented 85.66% of the sample. All the patients presented with either Grade 1 (83.6%) or Grade 2 (16.4%) envenomation severity, and all of them had different pain control interventions. Antivenom was... Continue Reading

Background: The prevalence of discharge against medical advice (DAMA) ranges from 1% to 2% in inpatient admissions and may reach up to 25.9% in some hospitals. The aim of this meta-analysis was to assess the prevalence, causes, and predictors of DAMA in the emergency departments. Methods: We conducted a systematic electronic database search for suitable studies from inception till 20th January 2020 in nine databases. Meta-analysis was used to pool the results. Results: Of the total 180 records screened, we included 14 studies. The overall prevalence rate of DAMA was 6.3% [95% confidence intervals (CI) = 3.41%-11.63%]. The most common cause of DAMA was not being content with the treatment or not agreeing with the diagnosis/treatment (19.93%; 95% CI = 11.02%-33.34%), followed by long waiting time (8.6%; 95% CI = 0.97%-47.45%) and financial problems (7.15%; 95% CI = 1.45-28.78). Regarding predictors, the reported significant unadjusted predictors were local emergency center... Continue Reading

Background: Status epilepticus (SE) is a serious neurological emergency that is associated with high mortality and morbidity. Significant data describing SE in the Middle East and North Africa regions are lacking. This study is a review of adult SE cases managed at the emergency department (ED) of Al Mafraq Hospital, Abu Dhabi, United Arab Emirates, from January 2011 to April 2016. Methods: A retrospective chart review of adult patients, who were 18 years of age and older, and who presented to the ED with SE, between January 2011 and April 2016, was conducted. Data were collected from the electronic medical records system after obtaining institutional research ethical approval. Results: Overall, 38 subjects were identified within the study period of 64 months. Demographic data reflected a male predominance of 74%. Multiple nationalities were involved, with the majority being the local Emiratis (34%). A previous history of epilepsy was present in 68%... Continue Reading

Background: Only a few studies investigated the evolution of characteristics of patients presenting at the emergency department (ED) due to alcohol intoxication. The aim of this study was to investigate the evolution of three patient characteristics: age, gender, and blood alcohol concentration (BAC). Methods: A retrospective review of medical records of patients visiting the ED at two large university hospitals in Belgium was performed. All patients older than 16 years, presenting to the ED with a primary diagnosis of alcohol intoxication in 2009 were compared with those presenting in 2014. Results: Both hospitals had a marked increase in visits due to alcohol intoxication. Male-to-female ratio in one hospital showed a redistribution toward women, whereas this remained stable in the other hospital. Average BAC remained stable in both sexes and hospitals. More severe BAC-levels (>3 g/l) diminished in male patients of one hospital but kept stable in women. The other hospital... Continue Reading

Background: According to the National Highway Traffic Safety Administration, the risk of accident-related fatalities in the rear of an ambulance is more than five times greater than it is in the front seat. The main objective of this research was to assess ambulance design safety and identify limitations that endanger emergency medical service (EMS) providers in Saudi Arabia during their day-to-day work, especially in the rear cabin. Methods: An observational cross-sectional study was conducted via online surveys filled by EMS providers and a checklist filled out by supervisors, section heads, and chiefs, in Saudi Arabia, from March 2020 to April 2020. Additionally, a retrospective review was also conducted on reports by various US and international safety organizations. Results: A total 861 participants (832 surveys and 29 checklists) were enrolled. EMS providers expressed significant challenges in terms of ensuring their own safety as well as that of the patients due to... Continue Reading

Background: The novel coronavirus 2019 (COVID-19) emerged in December 2019 in Wuhan, China, and rapidly spread worldwide. The Bahrain National COVID Team has released a screening tool called Visual Triage to alert healthcare workers in the Kingdom of Bahrain about the possibility of occurrence of COVID-19 infections among patients presenting to healthcare facilities. The aim of this research is to identify the accuracy rate of nurses in using Visual Triage and to evaluate points of improvement among nurses using the Visual Triage system. Methods: A cross-sectional study was conducted using a scenario-based questionnaire in the Emergency Department (ED) of Bahrain Defense Force Hospital in the Kingdom of Bahrain. The participants were all Visual Triage nurses and ED triage nurses. The data collected through the self-administered questionnaires were analyzed using Excel and SPSS version 26 programs. Results: The number of nurses who participated was 57. Nurses rated 66.89% of the cases... Continue Reading

Background: Middle East respiratory syndrome (MERS) is a severe respiratory illness that was first identified in 2012, following the outbreaks in the Kingdom of Saudi Arabia (KSA). The main aim of this study was to determine the prognosis of MERS patients with comorbidities, through the measurement of the fatality rate. Methods: This is a retrospective cohort study that included patients diagnosed with MERS, from 2012 to 2019, within the KSA. The fatality rate was measured for cases with and without comorbidities, based on various classifications of chronic disease. Results: Of the patients diagnosed with MERS and comorbidities, 327 (45%) patients were deceased, whereas only 49 (21%) of the MERS cases without comorbidities died. Based on the fatality rates, MERS cases with endocrine diseases, renal diseases, other comorbidities (including septic shock and obesity), and cardiovascular diseases were the most vulnerable, with fatality rates of 49% (247), 48% (41), 47% (77), and... Continue Reading

Background: Cardiac arrest in the emergency department (ED) has not been well studied; however, the existing literature shows that there are better survival and neurological outcomes with cardiac arrest in the ED than out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrests. The aim of this study was to examine the cardiac arrests managed in a tertiary care center ED and identify the characteristics of patients who had good outcomes. Methods: This was a retrospective chart review of patients who had cardiac arrest in ED from January 2018 to June 2019 Results: There were 209 cardiac arrests reported in the ED. A total of 189 patients were excluded because they presented with OHCA. Twenty patients had cardiac arrests in the ED. The survival to discharge from the hospital for the total patients analyzed was 40% (8/20). 60% (12/20) of patients were male with a median age of 60.5 years. Altered mental... Continue Reading

Background: Patients with hematological disorders are among the highly affected patient groups during the COVID-19 pandemic worldwide. Therefore, this study aimed to evaluate how physicians mitigated patients with hematological disorders during the COVID-19 pandemic in Saudi Arabia. In addition, the impact of the lockdown on hematologists and their recommendations according to their current experience was also assessed. Methods: This was a questionnaire-based cross-sectional survey conducted among 62 hematologists in Saudi Arabia during the COVID-19 pandemic from 6th to 29th June 2020. Results: The most common method of contact between physicians and their patients was the use of actual and virtual clinics and WhatsApp (22.6%). In addition, the most common cases that contacted the physicians were those suffering from hematological malignancies (such as lymphoma and leukemia) (37.1%), followed by sickle cell anemia (17.7%). Interestingly, majority of patients had contacted their physicians for general concerns (41.9%), followed by assurance purposes (35.5%). Furthermore,... Continue Reading

Secondary spinal cord injury is a major concern for trauma patients. Thereby, proposing the necessity for the development and application of spinal immobilization techniques to guarantee minimal motion during transfer of the patients from the trauma scene to the trauma care center. Thus, this review aimed to provide an updated summary of the different techniques and tools used for the transfer of trauma patients with suspected spine injury. A retrospective PubMed search was conducted to collect the data for the most common methods used and effective tools and techniques for spinal immobilization. The log roll technique is commonly used in trauma settings and is recommended for prone patients. However, the hardboard is still preferable transferring tool, and the scoop stretcher is recommended to aid a more successful lift and slide. The trauma care providers should be aware of different transfer techniques to provide the appropriate care. Continue Reading

Background: Status epileptics are classically defined as seizures that are continuous for 30 minutes or longer or repetitive seizures between which the patient does not regain consciousness. This study reports a case of a boy with a 2-hour seizure. Case Presentation: We present the case of a 7-year-old boy, who is known to have tuberous sclerosis (TSC2 gene mutation). On the day of presentation, the seizure had started with aura (epigastric pain with weakness in the face), then started to seize in a form left focal jerky movement with generalization associated with rolling up of the eyes, and lasted for 5 minutes; it was aborted clinically by lorazepam 0.1 mg/kg IV. However, the electroencephalography (EEG) showed subclinical seizure. The patient received a loading dose of phenytoin, 20 mg/kg IV, with no changes in the EEG; then Keppra (three doses) with a total of 40 mg/kg IV was given, but subclinical... Continue Reading

Background: Granisetron is a popular antiemetic medication used in the emergency department to control nausea and vomiting with an excellent side effect profile among adults and pediatric, in both healthy and oncology patients. Case Presentation: Our patient received granisetron for nausea and vomiting then developed torsional nystagmus, asymmetrical abnormal muscle contractions, and electrocardiography showed QTc prolongation 487 ms. The patient did improve after IV lorazepam and magnesium sulphate administration. Conclusion: QTc prolongation increases the risk of developing Torsades de Pointes and sudden death. Extrapyramidal syndrome caused by granisetron is rare and should not be confused with seizure. Both are significant effects associated with 5-HT3 antagonists administration to be aware of and if they occurred, should be managed in a timely fashion. Continue Reading

Background: Takotsubo cardiomyopathy is frequently presented as acute coronary syndrome after a significant history of exposure to emotional, physical, or combined stress. Case Presentation: An 84-year-old-man was presented to the emergency department of a tertiary hospital with features of acute urine retention, which was relieved by inserting a Foley’s catheter. The patients’ electrocardiogram showed ST elevation in the anterior leads with T-wave inversion in the lateral leads, the Troponin-T was 608 ng/l. The patient was taken for cardiac catheterization where the left ventricular angiogram showed severely hypokinetic mid to distal anterior wall and mid to distal inferior wall with dyskinetic LV apex (Apical ballooning). The subsequent echocardiography after 2 months showed almost complete recovery of left ventricular function proving it to be a case of takotsubo cardiomyopathy. Conclusion: The emergency physicians should include takotsubo cardiomyopathy in the differential diagnosis of such cases which have ECG changes and elevated cardiac enzymes. Continue Reading