Plan for Establishing a Safe Perinatal Transport System

There is a rapidly growing interest in emergency medicine (EM) and emergency out-of-hospital care throughout the world. In most countries, the specialty of EM is either nonexistent or in an early stage of development. Many countries have recognized the need for, and value of, establishing a quality emergency health care system and are striving to create the specialty. These systems do not have to be high tech and expense but can focus on providing appropriate emergency training to physicians and other health care workers. Rather than repeatedly "reinventing the wheel" with the start of each new emergency care system, the preexisting knowledge base of EM can be shared with these countries. Since the United States has an advanced emergency health care system and the longest history of recognizing EM as a distinct medical specialty, lessons learned in the United States may benefit other countries. In order to provide appropriate advice to countries in the early phase of emergency health care development, careful assessment of national resources, governmental structure, population demographics, culture, and health care needs is necessary. This paper lists specific recommendations for EM organizations and physicians seeking to assist the development of the specialty of EM internationally.

Integrated transport systems are a perfect form of transportation organization, because they allow integrated use of competing modes of transport, providing a high level of transportation service at affordable prices and savings in transportation costs. With the increasing demand for such transportation, the issue of transport safety assessment is becoming more important, particularly in preservation of cargo and vehicles in each section of the transportation process. In the process of technical progress, it becomes increasingly difficult to achieve a high enough level of transport safety, which allows to ensure national security and interests in the field of transport activities. Unfortunately, transport safety management today is mainly carried out at organizational level, which needs to be supplemented with safety assessment of transport system’s objects. The development of methods for transport safety assessment remains a complex scientific task, the solving of which depends on the economic efficiency and safety of the transportation process. Since transport safety is the state of the transport system, its assessment includes the safety assessments of various transport infrastructures. Thus, there is some imaginary protection field of the object of transport infrastructure, which provides counteraction to a set of existing or perceived threats. The proposed algorithm for safe freight transportation routes development may be divided into two cyclical stages: optimal transport hub determination from the alternatives; optimal transportation route choosing between selected transport hubs. The method provides a comprehensive and rational framework for structuring a decision problem, for representing and quantifying its elements, for relating those elements to overall goals, and for evaluating alternative solutions. The practical use of the proposed approach allows at the designing stage of multimodal transportation routes to evaluate their alternatives, according to the selected criteria and take the necessary measures in order to improve transport safety.

BackgroundThe Lombardy region has been the Italian region most affected by the coronavirus disease 2019 (COVID-19) pandemic in 2020. The emergency healthcare system was under deep stress throughout the past year due to the admission of COVID-19 patients to the emergency department (ED) and had to be thoroughly reorganized.MethodsWe performed a retrospective descriptive analysis of patients admitted into the ED recorded in the Lombardy online regional portal called EUOL (Emergenza e Urgenza OnLine). We compared the data registered in the EUOL with the patients admitted to the EDs from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020.ResultsThe number of admissions to the ED decreased by 32.5% in 2020 compared with 2019, reaching the lowest number in March and April. However, the percentage of patients hospitalized after ED significantly increased in 2020 compared with 2019 (P < 0.0001), reflecting the management of patients with a more severe clinical condition. More patients arrived at the ED by ambulance in 2020 (21.7% in 2020 versus 15.1% in 2019; P < 0.0001), particularly during March and April.ConclusionsThis analysis showed the importance of monitoring the pandemic’s evolution in order to treat more critically ill patients, despite a lower number of patients.

This review paper explores the role of predictive analytics in enhancing emergency healthcare systems, emphasizing the potential benefits of reducing response times and improving patient care. Emergency healthcare systems often grapple with inefficiencies that can adversely affect patient outcomes, especially during critical situations. This paper presents a conceptual framework that leverages predictive analytics to address these challenges by integrating diverse data sources, utilizing real-time analysis, and providing decision-support tools. The findings suggest that predictive analytics can significantly enhance operational efficiency by optimizing resource allocation, streamlining patient prioritization, and enabling timely interventions. Additionally, practical recommendations are proposed for healthcare institutions to successfully implement predictive analytics, including investing in data infrastructure, fostering a culture of analytics, and collaborating with technology partners. This framework paves the way for improved emergency response and contributes to a data-driven healthcare environment that enhances overall patient outcomes.

Health crises—ranging from pandemics and natural disasters to armed conflicts—pose significant threats to the stability and functionality of healthcare systems. This review examines the frameworks, strategies, and structural capacities that shape effective emergency preparedness and healthcare system resilience. Drawing on global case studies and recent literature, the paper explores how countries prepare for, respond to, and recover from health emergencies. It highlights critical factors such as inter-agency coordination, workforce readiness, infrastructure adaptability, digital innovation, and community engagement. Evidence suggests that integrated planning, sustained investment, and responsive governance are essential for strengthening health system resilience. The findings underscore the need for healthcare systems to transition from reactive crisis management to proactive and adaptive preparedness strategies. This review provides practical insights for policymakers, health administrators, and emergency planners aiming to enhance systemic resilience in the face of evolving global health threats.

In response to large-scale health crises, emergency healthcare infrastructure projects (EHIPs) have been implemented to provide healthcare services rapidly. However, few studies have systematically explored the success of these projects. This study aims to assess the success of EHIPs throughout the whole life cycle using a cloud matter-element model (CMEM). Considering multiple performance indicators that measure the success of EHIPs, a hierarchy model of the project success index is proposed through eight rounds of Delphi surveys. This model comprises 10 key performance indicators (KPIs) that are most appropriate for measuring the success of EHIPs and 20 quantitative metrics aligned with these KPIs across the life cycle. Based on the hierarchy model, the CMEM is applied to evaluate the success of EHIPs, which effectively addresses the fuzziness and randomness inherent in the Delphi process. Two cases were then utilized for verifying the practicality of the proposed project success assessment model. The findings demonstrate that the CMEM-based assessment offers not only significant flexibility but also high accuracy, robustness, and scalability. The CMEM-based assessment seamlessly integrates numerous incompatible indexes and their characteristic values, without being limited by the number of evaluation indexes. Further, sensitivity analyses are conducted to test the robustness of the assessment model and its results. These analyses confirmed that the CMEM is a robust, reliable, and adaptable tool for assessing the success of EHIPs. Theoretically, this study should set an exemplar of aggregating the performance measurement with emergency management and healthcare systems, facilitating an efficient response to major crises. It also provides a novel approach to evaluating multiple-criteria decision-making problems. Practically, this study should enable project management teams to identify and improve weak areas, ensuring continuous success in the EHIP-related domain.

Due to its critical nature, emergency healthcare (e-emergency) systems should be totally reliable, efficient and support real-time traffic. Therefore e-emergency networks must provide proper quality of service (QoS) levels. After assessing the relevance of QoS deployment in different e-health contexts, this paper presents a pragmatic case-study intended to be deployed in a hospital room containing patients with high risk abnormalities, whose vital signals are being monitored by personal wireless body sensor networks. After justifying the unsuitability of ZigBee standard in this e-emergency scenario, the use of Low-Power, Real-Time (LPRT) protocol for wireless sensor networks, is proposed as an adequate candidate for such task. For the present case-study, the protocol is able to fulfill quantitatively the required QoS levels.

The intensive development of digital technologies, their active implementation in the field of transport and logistics necessitates the study of their impact on the transport system, in particular on the level of its intellectualization. This will allow us to determine which technologies of Industry 4.0 need to be implemented first of all in order to achieve the best parameters for the development of intelligent transport systems. In this regard, the paper analyzes various tech-nologies of Industry 4.0, identifies possible ways of their application to solve problems in the context of the functioning of intelligent transport systems and their elements. Based on the analysis, possible parameters of the impact of technologies on the development of intelligent transport systems are identified, which include physical and environmental safety of transport, information security, speed and accuracy of decision-making, physical safety of transport, resource efficiency, convenience and comfort, the presence of an entertainment component, etc. Based on the compari-son of the identified parameters with specific types of digital technologies, it is determined which technologies have a greater impact on the intellectualization of transport systems. These technologies include the Internet of Things, augmented reality AR and cloud solutions. The parameters that are more susceptible to the effects of digital technologies are also determined: the safety and efficiency of transport systems. The results obtained are of practical importance for the development of strategic solutions in the implementation of the concept of Industry 4.0 in the field of transport and logistics.

Introducing the Advanced Burn Life Support (ABLS) course in Italy

Musculoskeletal urgent care centers (MUCCs) are an increasingly common alternative to emergency departments for patients with orthopedic injuries. As there is a lack of longitudinal data regarding MUCCs' impact on the emergency health care system, our study seeks to understand recent trends in MUCC growth and their acceptance of Medicaid insurance. Over the last 6 years, at 2-year intervals (2019, 2021, and 2023), we performed a search to identify all MUCCs in the United States. We determined the affiliation and Medicaid acceptance status of all MUCCs, including those that closed/opened between 2019, 2021, and 2023, to analyze trends in MUCC availability and Medicaid acceptance. In 2019, there were 558 MUCCs, which increased to 596 MUCCs in 2021 and then decreased to 555 MUCCs in 2023, representing a growth and then decline of approximately 7%. Overall, since June 2019, 90 MUCCs have opened and 95 MUCCs have closed. Medicaid acceptance increased nationally between 2019 and 2023, from 58% to 71%. Medicaid acceptance increased for both nonaffiliated and privately affiliated MUCCs. Medicaid acceptance has increased nationally from 2019 to 2023, while MUCC availability has gone through a period of growth and then reversion to 2019 levels. As MUCCs have demonstrated limited Medicaid acceptance previously, it is promising that Medicaid acceptance has improved and MUCCs are providing patients with an additional avenue to access orthopedic care.

BackgroundThe failure of randomised controlled trials to adequately reflect areas of highest health need have been repeatedly highlighted. This has implications for the validity and generalisability of findings, for equity and efficiency, but also for research capacity-building. Rai et al. (BMC Med Res Methodol 21:80, 2021) recently argued that the poor alignment between UK clinical research activity (specifically multi-centre RCTs) and local prevalence of disease was, in part, the outcome of behaviour and decision-making by Chief Investigators involved in trial research. They argued that a shift in research culture was needed. Following our recent multi-site mixed methods evaluative study about NHS 111 online we identify some of the additional structural barriers to delivering health research “where populations with the most disease live”, accounting for the Covid-19 disruption to processes and delivery.MethodsThe NHS 111 study used a mixed-method research design, including interviews with healthcare staff and stakeholders within the primary, urgent and emergency health care system, and a survey of users and potential users of the NHS 111 online service. This paper draws on data collated by the research team during site identification and selection, as we followed an action research cycle of planning, action, observation and reflection. The process results were discussed among the authors, and grouped into the two themes presented.ResultsWe approached 22 primary and secondary care sites across England, successfully recruiting half of these. Time from initial approach to first participant recruitment in successful sites ranged from one to ten months. This paper describes frontline bureaucratic barriers to research delivery and recruitment in the local Clinical Research Network system and secondary care sites carrying large research portfolios, alongside the adaptive practices of research practitioners that mitigate these.ConclusionsThis paper augments the recommendations of Rai et al., describing delays encountered during the COVID-19 pandemic, and suggesting in addition to cultural change, it may be additionally important to dismantle infrastructural barriers and improve support to research teams so they can conduct health research “where populations with the most disease live”.

Mexico City's Petroleos Mexicanos Explosion: Disaster Management and Air Medical Transport

Objective: Telehealth capacity may be an important component of pandemic response infrastructure. We aimed to examine changes in the telehealth use by the US emergency departments (EDs) during COVID-19, and to determine whether existing telehealth infrastructure or increased system integration were associated with increased likelihood of use. Methods: We analyzed 2016-2020 National ED Inventory (NEDI)-USA data, including ED characteristics and nature of telehealth use for all US EDs. American Hospital Association data characterized EDs' system integration. An ordinary least-squares regression model obtained one-step-ahead forecast of the expected proportion of EDs using telehealth in 2020 based on growth observed from 2016 to 2019. Among EDs without telehealth in 2019, we used logistic regression models to examine whether system membership or existing telehealth infrastructure were associated with odds of innovation in telehealth use in 2020, accounting for ED characteristics. Results: Of 4,038 EDs responding to telehealth questions in 2019 and 2020 (73% response rate), 3,015 used telehealth in 2020. Telehealth use by US EDs increased more than expected in 2020 (2016: 58%, 2017: 61%, 2018: 65%, 2019: 67%, 2020: 74%, greater than predicted 71%, p = 0.004). Existing telehealth infrastructure was associated with increased telehealth innovation (OR = 1.88, 95% CI: 1.49-2.36), whereas hospital system membership was not (odds ratio [OR] = 1.00, 95% confidence interval [CI]: 0.80-1.25). Conclusions: Telehealth use by US EDs in 2020 grew more than expected and preexisting telehealth infrastructure was associated with increased innovation in its use. Preparation for future pandemic responses may benefit from considering strategies to invest in local infrastructure to facilitate technology adoption and innovation.

COVID-19 is a disease first reported in Wuhan, China, as viral pneumonia on 31 December 2019. The disease has since spread worldwide, leading to an ongoing pandemic. This disease is caused by a new coronavirus called SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). COVID-19 is transmitted when people breathe in air contaminated by droplets and tiny airborne particles containing the virus. Airborne, surface, and fecal-oral transmission are the other three uncommon transmission types. Nurses play a vital role in health care and are often unsung heroes in emergency responses and health care systems. Nursing includes preventing deceases, promoting health, and the care of diseased, disabled, or dying persons. Nurses are at the forefront of the Covid- 19 battle; they risk their lives and their physical and mental health. This quantitative exploratory study thoroughly examined three significant challenges in nurses' lives during the pandemic: psychological, psychical, and social challenges. The study was conducted in twenty hospitals in Ernakulam district, Kerala. This study is descriptive and survey-based. Primary data was collected through a questionnaire. The Secondary data was collected from journals, books, magazines, internet, articles, etc. A questionnaire was sent to the nurses through Google Forms, and they filled those forms and sent them back. The study revealed that nurses faced psychosocial challenges during the COVID-19 pandemic. It is concluded that the social challenges, family challenges, and work challenges of nurses during the covid19 pandemic are highly correlated to each other.

<b>Background:</b> Nutritional disorders still represent a major problem faced by developing countries. Surveying such problems is a step towards planning proper interventions, which contributes significantly to declines in under-five mortality rates. <b>Aims:</b> To study the state of nutritional trends in children under five years of age, attending a primary healthcare center in Al Shoula district, Iraq, in 2006 and 2012. Demographic features and feeding practices that may have had an effect on the nutritional status of children were also studied. <b>Subjects and methods:</b> Two cross-sectional surveys were conducted on children aged two to five years, in a primary healthcare center in Baghdad. Children attending for immunization were included (500 in 2006 and 570 in 2012), their mothers were interviewed, and the body mass index of the child was calculated. Children who were overweight and obese were identified, according to the Centers for Disease Control and Prevention charts, as those suffering from stunting. Nutritional parameters were compared between the two study groups, using the chi-square test, as well as various epidemiological factors that may have affected the outcomes. <b>Results:</b> The prevalence of both types of nutritional disorders (stunting and overweight and obesity) declined remarkably according to the 2012 survey; overweight and obesity declined from 20% to 7.2%, while stunting decreased from 51.2% to 30.9%. The age group showing the highest rate of improvement were the four to five year olds, as well as children from lower-income families. A higher rate of breastfeeding was reported in 2012, and breastfed babies suffered the least from both types of nutritional disorders, in both study groups. Overall, the study findings showed a high prevalence of stunting (30.9%), together with a significant level of overweight and obesity (7.2%). <b>Conclusion:</b> Children in Iraq suffer from high rates of stunting. With a moderately high rate of obesity, there is an urgent need to evaluate local data available and plan for an active intervention to combat these nutritional problems.