The burden of road traffic injuries (RTIs) continues to impact healthcare systems, with considerable economic losses worldwide. Risk factors associated with RTIs include young age, male sex, speeding, driving under the influence, non-use of seatbelts, unsafe road infrastructure, unsafe vehicles, diminished post-crash care, and inadequate traffic law enforcement. The rate of RTIs in the Kingdom of Saudi Arabia (KSA) has increased with more than 25,000 injuries and approximately 13.2 deaths per 100,000 population in 2020. In line with the KSA 2030 vision, a new trauma epidemiology center was established by the Saudi Red Crescent Authority, the national provider of prehospital services in KSA. It aims to reinforce traffic safety by identifying high-risk groups, providing updated traffic safety-related scientific materials, and reducing the mortality rate caused by vehicular crashes. Continue Reading

In the prehospital era, the provision of targeted educational and training programs for certain population sets was essential for maintaining healthcare services and ensuring favorable outcomes. During the coronavirus disease pandemic of 2019 (COVID-19), the prehospital educational and training programs for overcoming the challenges and reaching the targeted audience in the Saudi Red Crescent Authority (SRCA) differed significantly. In the Kingdom of Saudi Arabia, sharing the experiences and lessons learned in relation to the selection of priorities and the development of new strategies for implementing prehospital educational and training programs during pandemics will assist other educational and training entities in building their programs without compromising the learning outcomes. In this review, we discuss the types of educational and training programs, main learning outcomes, targeted audiences, and new strategies adopted by the SRCA during the COVID-19 pandemic. Preserving and advancing essential prehospital knowledge and skills for targeted population sets during pandemics... Continue Reading

Background: Road traffic accidents are the eighth leading cause of mortality globally and the second in Saudi Arabia. Trauma patients need specialized care and access to health care facilities. Early intervention by a multidisciplinary team results in better outcomes in terms of mortality and morbidity. The aim of this study was to analyze the association between the different mechanisms of injury that resulted in trauma team activations (TTAs) and the time in the 24-hour day over a 3-year period in a tertiary trauma center. Methods: A single center retrospective study with trauma patients triggering the TTA was conducted. The study was conducted over a 3-year period, and the sample size was 587. Results: The highest volume of TTA's during the 3 years occurred from 20:00 and 23:00 and the busiest single hour was 21:00. Pedestrian trauma was more prevalent at the end of the day from 18:00 to 22:00. Our... Continue Reading

Background: Community-acquired bacterial pneumonia (CAP), skin and soft-tissue infection (SSTI), and urinary tract infection (UTI) are frequently encountered in the emergency department (ED) but treated with varied antibiotic regime. We aimed to assess the antibiotic prescribing practice in ED for CAP, SSTI, and UTI based on hospital guideline adherence (choice, dose, and duration of antibiotic). To the authors' knowledge, this is the first study to address this issue by a dual model of physician survey and prescription review from the ED perspective. Methods: One hundred ED physicians were surveyed followed by a cross-sectional study of 300 uncomplicated adult ED outpatient infections (100 CAP, 100 SSTI, and 100 UTI) from August 2017 to August 2018 retrospectively at Rashid Hospital in Dubai. Results: Most of the participants (91%) had never been in an antibiotic stewardship. 30%, 52%, and 48% were not aware of CAP, SSTI, and UTI hospital guidelines, respectively. Majority (58%)... Continue Reading

Background: Cardiac arrest is a major global health concern. It accounts for almost 30% of the global mortality rate, with a poor survival rate for In-Hospital Cardiac Arrest, with worse survival rate for Out-Hospital Cardiac Arrest (OHCA). We aimed to establish an OHCA in Saudi Arabia, to provide a benchmark to determine the best practice protocols for out of hospital cardiac arrest in the country. Methods and Analysis: Saudi Out of Hospital Cardiac Arrest Registry (SOHAR) collects data in two phases, namely prehospital and receiving hospital, and the data will be linked internally. SOHAR was established a year ago, and the registry already contains more than 1,100 cases and is growing rapidly. The patient data will be entered by the regional coordinators in an on-line data management system, designed exclusively for this project. Ethics and Dissemination: The study was approved and funded by King Abdullah International Medical Research Center (IRBC/0748/20).... Continue Reading

Background: Burnout among health-care workers have become a notable global health and safety challenge. This phenomenon reflects mental and physical burden on healthcare staff. The Maslach Burnout Inventory tool is a structured and validated tool that has been used to objectively assess burnout. The aim of this study was to determine the prevalence of burnout among physicians working in Mafraq Hospital, Abu Dhabi, United Arab Emirates (UAE) and to understand the possible underlying factors. Methods: A cross-sectional survey study was conducted incorporating the Maslach Burnout Inventory Human Services Survey for Medical Personnel tool. A questionnaire was sent via an anonymous e-mail to all physicians at Mafraq Hospital. Participating physicians were categorized as part of a 5-class profile continuum ranging from "engaged" to "burnout". Results: Burnout prevalence among Mafraq physicians was 11.24% (19 of the 169). The rate of burnout was higher among resident physicians (17%) than non-resident physicians (8.5%). Majority... Continue Reading

Background: Burns are one of the leading causes of trauma globally, and they require immediate management by the primary caregivers. The first hours are the most critical as the patient is susceptible to complications, if first line healthcare is insufficient. Therefore, this study evaluated the effectiveness of practice provided by emergency physicians regarding burn cases. Methods: A cross-sectional study was conducted in February 2020. Data were collected via an assembled online questionnaire that was distributed among emergency physicians attending the fifth Saudi Society of Emergency Medicine conference. Results: This study included 89 physicians, of which 59 (66.3%) claimed to be comfortable in dealing with different classifications of burns. The participants were asked if they could manage the patients according to the World Health Organization burn guidelines and 69 (77.5%) answered yes. Disconcertingly, the study showed that only 28.1% of the participants adhered to the initial management of the burn patients.... Continue Reading

Background: The absence of experienced physicians in certain specialties and the lack of medical services necessitates the need for interfacility transfer of patients with traumatic injuries. This study aimed to identify the incidence of interfacility transfers in trauma patients within a 28-day period and to evaluate the types and reasons of traumatic injuries requiring lifesaving transfer. Methods: This was a retrospective noninterventional chart review study. Data were acquired from the Saudi Medical Appointments and Referrals Center in Saudi Arabia. Only lifesaving-labeled trauma patients were included in this study. Results: A total of 370 trauma patients were included in this study. Most of the patients were male (325; 87.8%) with a mean age of 31 years. Blunt injuries were the most reported type of injury (213; 57.6%) and motor vehicle accidents were most common mechanism of injury (164; 44.3%). Head and neck injuries accounted for majority of the cases (144; 38.9%).... Continue Reading

Background: Although many studies highlighted the clinical features of coronavirus disease (COVID-19), still the clinical profile and associated factors of critically ill patients is limited. Thus, it was aimed to evaluate the clinical characteristics and outcomes of COVID-19-infected patients admitted to the intensive care units (ICU) in the Kingdom of Saudi Arabia (KSA). Methods: This study was a retrospective noninterventional chart review. Charts and data of all COVID-19-infected patients who required admission to ICU in KSA between August 2020 and April 2021 were obtained from the National Health Observatory Portal of ICU Bed Management System, KSA. Results: A total of 9,111 patients were included with a mean age of 59.26 ± 16.08. Nearly half of them (N = 4,706, 51.7%) had diabetes and 47.1% had hypertension. Totally 3,114 (34.2%) patients received invasive ventilation. Among the studied patients, 81 (0.9%) received extracorporeal membrane oxygenation, while 415 (4.6%) required hemodialysis in the... Continue Reading

Background: Cardiopulmonary resuscitation (CPR) skills are simple and can be mastered easily. Knowledge about these interventions and their potential benefits can aid resuscitative efforts and improve survival. These facts mandate that all healthcare providers, irrespective of their specialty, level of training, or work setting, be competent in initiating and performing CPR. Aim: To assess the level of knowledge of healthcare providers about which CPR modalities, interventions, and medications for nontraumatic cardiac arrest have been proven beneficial in terms of return of spontaneous circulation, intact neurological function, and mortality. Methods: This was a cross-sectional study. A standardized electronic questionnaire was formed based on a literature review to assess the knowledge of healthcare providers working in Saudi Arabia about CPR interventions and medications. Responses of the participants were collected via Google Forms and SurveyMonkey. The data were analyzed in Statistical Package for the Social Science V27 to answer the questions of interest.... Continue Reading

Background: Approximately 356,000 out-of-hospital cardiac arrests occur yearly (AHA, 2019), and prehospital providers must rely on their training to successfully resuscitate these patients. Despite advancements in their training, providers tend to hyperventilate patients, which has been linked to adverse health sequelae. While studies have briefly explored provider hand size as a variable, none have conclusively connected hand size and hyperventilation rates. Furthermore, minute ventilation (MV) has not been explored as a parameter of ventilation performance. Methods: A focused revisit of this relationship between hand size and ventilation performance through manikin simulation testing of 122 emergency medical services professionals in Maryland evaluated the ventilator parameters of breath rate (BR), tidal volume (TV), and MV. Results: The cohort's hyperventilation rate was 29%. In this study, evidence approaching statistical significance exists that participants with small hands (as determined by glove size) provide greater MV than other participants, yet no size-specific relationship was found... Continue Reading

Background and Objective: High-risk unscheduled return visits (HRURVs) are a key quality metric in the Emergency Department (ED). We, therefore, aimed to determine their incidence and clinical predictors in the pediatric ED. Design: This is a case control study. Setting: This study was conducted in the pediatric ED of an Eastern Mediterranean tertiary care hospital. Participants: Cases included HRURVs ≤18 years old that presented to the ED between November 1, 2014, and October 31, 2015. Controls included patients discharged from the ED during this period and who did not return within 72 hours. Controls were matched 1:1 based on age, gender and date of presentation (±7 days). Out of 14,805 Pediatric ED visits, 142 were HRURVs, with an incidence of 0.96% [95% confidence intervals (CI) 0.81 to 1.13]. Our final analysis included 139 HRURV cases and 139 controls. 3 were excluded because of incomplete charts. Main Outcome Measures: The outcome,... Continue Reading

Background: Few studies have examined health literacy in the United Arab Emirates and a limited number of tools for use in Arabic speaking populations exist. The aim of this study was to describe health literacy level and related factors such as education and exposure to nutrition education, among patients visiting the emergency room. Methods: Data were collected from 590 patients in 2018 at the emergency department in a multinational setting. Univariate and logistic regression analyses were used to determine the association between health literacy, education and other demographic variables. Results: The mean age of patients was 32.9 (±10.7), of whom 44.3% had less than a college education. The average Newest Vital Sign score was 2.69 (±2.33) out of 6. Over a third of the patients (38.5%) had a high likelihood of limited health literacy, 17.2% had the possibility of limited health literacy and 44.3% had adequate health literacy. Multivariable logistic... Continue Reading

Epidemiology and factors affecting resident's burnout at the emergency department: a systematic review Emergency medicine is a highly stressful field of medicine, with emergency department physicians exhibiting some of the highest rates of burnout, anxiety, and other stress-related conditions. This results in a decrease in quality of life of emergency health professionals and negatively affects the care of the patients. Six databases were searched using specific search terms. We included studies that assessed the prevalence and risk factors for burnout in emergency health professionals, or those that included proposed steps to address the issue. The studies were assessed for the quality of evidence using the National Institute of Health software utility. Twenty-one studies were found that met all inclusion criteria. A detailed review of these confirmed a high prevalence of burnout in emergency healthcare but evidenced that factors such as location influenced the overall values. It also evidenced a correlation... Continue Reading

Background: Ketamine is one of the safest medications used in emergency medicine procedural sedation due to its minimal effects on respiratory and cardiovascular systems. This case raises concerns about potential ketamine-delayed respiratory complications in obese patients. Case Presentation: We report the case of an 11-year-old child who underwent emergency department sedation for cut wound repair using ketamine administered intravenously. The patient developed apnea 2 hours after an uneventful sedation while he was in the observation period. The apnea was managed by supplemental oxygen and physical stimulation, and the patient was put on continuous positive airway pressure. He was admitted to the critical care unit for observation and was discharged the next day without complications. Conclusion: Our case highlights the possibility of delayed respiratory complications due to ketamine use in obese children. Continue Reading

Background: Cerebrospinal fluid (CSF) rhinorrhea is a potentially life-threatening condition and it is a rare emergency presentation. Most cases have been related to head trauma. However, CSF leak post COVID swab has been rarely reported. Case Presentation: We report a 10-year-old male, who presented to emergency department complaining of unilateral clear watery nasal discharge for 14 days, the discharge started after COVID-19 nasopharyngeal swab. The patient was a known case of Malpuech-Michels-Mingarelli-Carnevale syndrome and had undergone surgical repair for cleft lip and cleft palate. From the history and physical examination, CSF rhinorrhea was highly suspected and nasal endoscopy confirmed the diagnosis of cribriform defect on the left side. The patient underwent surgical repair and the symptoms resolved after the surgery. Conclusion: COVID-19 nasopharyngeal swab can cause potential life-threatening complications and one should consider the contraindications and the alternative methods available to detect COVID-19 to minimize the potential risks. Continue Reading

Background: Fibromatosis colli is a benign uncommon condition of infancy, usually manifested at the age of 2-4 weeks of life as a lump in the neck (mostly on the right side) or head tilt. It can be easily diagnosed by ultrasound (US). Case Presentation: A 3-day-old full-term male neonate was brought to the emergency department with a complaint of left side neck swelling. On examination, the child was normocephalic with open flat anterior fontanelle, normal head, throat and ears, the neck was not tilted with no apparent signs of trauma. Locally, a ½ cm mass which was firm, non-warm, and non-tender was felt on the left sternocleidomastoid without cervical lymphadenopathy. The patient was sent for US. Result: US examination showed a fusiform mass-like lesion within the left sternomastoid muscle, which showed similar echogenicity to the muscle and muscle striation within the lesion, with no abnormal cysts or suspicious features, suggestive... Continue Reading