Implementation of a drive-through testing clinic in Qatar for residents having recently returned from a country with a Covid-19 travel warning

© 2020 Alinier, Morris, Abu, Shaikh, Owen, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.INTRODUCTION: The spread of the SARS-CoV-2 virus has caused chaos around the world. At the onset of the virus' detection in the State of Qatar, a free-testing system was rapidly established to invite individuals who had recently returned from countries with a COVID-19 disease travel warning to avoid putting other people at risk. The testing site needed to be accessible to individuals without requiring them to enter the hospital and congregate in a waiting area. The aim of this article is to share our experience with the early implementation of a drive-through testing clinic using the invited person's vehicle as an isolation compartment during screening to minimize person-to-person contamination. METHODS: A Hamad Medical Corporation site was selected to stage a drive-through testing facility to avoid congestion and offer space to facilitate the process. A process was rapidly agreed upon, and staff received the required training regarding infection control measures and documentation. At the testing site, individuals were subjected to the following steps: registration and history taking, temperature measurement, swabbing, and receipt of a sick leave certificate and a flyer about self-quarantine. RESULTS: Over the first six days of implementation, the relevant authorities determined that 687 individuals had to be contacted, 103 attended their testing appointment in that period, and an additional 327 people (close relations of the individuals contacted or individuals contacted but without a health card) also subjected themselves to the testing process, which took a median time of 11 minutes 39 seconds. No individual exhibited symptoms that warranted immediate isolation while they were at the drive-through testing clinic. However, four individuals were diagnosed with COVID-19 following laboratory analysis of the swab taken and followed up. The median time between swab collection and laboratory testing was 13 hours 41 minutes 59 seconds. CONCLUSIONS: Collaboration among various key health, governmental, and travel industry partners was essential to the successful and rapid implementation of a COVID-19 drive-through testing clinic in the early days of the pandemic in Qatar. The general public reacted well to this process. Communication, coordination, and planning were identified as critical factors at every step of the process. It started from the initial call to the travelers who had recently returned from a country with a newly instituted travel warning and concluded by them leaving with their sick leave certificate and an information flyer with reminders about preventative infection control measures and encouraging them to self-quarantine after having been swabbed.Peer reviewe

Critical Care Network in the State of Qatar

© 2019 Hijjeh, Al Shaikh, Alinier, Selwood, Malmstrom, Hassan, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.Peer reviewe

A protocol to investigate the stability of 0.9% sodium chloride IV fluid bags in the prehospital setting of Qatar

Background: 0.9% sodium chloride (NaCl) fluid bags are commonly stored in ambulances. Despite that the ambulances normally use air-conditioning during operational shifts, NaCl bags are exposed to deviations from the controlled environmental conditions that could affect their integrity 1,2 , as all ambulances are not constantly in use. Although stress tests performed in a laboratory Binder Convection Oven 3 showed that NaCl maintained its stability, these findings need to be validated. This study aims to develop a protocol to evaluate the thermal stability of NaCl under real-life conditions in Qatar. Methods: Key aspects were considered to subject the research samples to the routine environmental conditions under which NaCl bags are stored in ambulances. The study bags are used for research purposes only, thus should not be used on patients (to avoid hindering the work of paramedics) and need to be tested after various exposure durations. Results: The agreed-upon study protocol is to be replicated on 5 ambulances over 12 months and includes 4 collection cycles of three 500 mL NaCl study bags and three 10 ml NaCl vials following different exposure durations (Table 1). Hence, 12 NaCl bags and 12 vials marked “for research-use-only” will be stored in a locked cabinet in the ambulance patient compartment alongside a temperature and humidity data logger taking measurements every 30 minutes (Figure 1). Control samples will be stored under manufacturer's recommended conditions. Following each collection cycle from the 5 ambulances and controls, samples will be stored at 4°C and protected from light until being visually inspected (for discoloration, turbidity, bulging), diluted, and tested using ion-exchange chromatography to measure sodium and chloride levels. Conclusion: This study performed under real-life conditions will help determine the effect of exposure to actual ambulance operational conditions on NaCl bags and may have a significant impact on how they are handled in the prehospital setting in countries with a hot/arid climate

Intravenous fluids in hot pre-hospital environments: Thermal and physical stability of normal saline after exposure to simulated stress conditions

Background: Normal saline 0.9 % (NS) is the most widespread crystalloid used as a life-saving intravenous (IV) fluid. 1 NS contains sodium and chloride in equal concentrations and is subject to thermal stress conditions while stored and transported by clinicians in the pre-hospital environment. 2 This study aimed to investigate the effect of high-temperature exposure on NS bags used by the Hamad Medical Corporation Ambulance Service in Qatar. Methods: Five-hundred mL polyolefin NS soft bags (Qatar-Pharma, BN:1929013008) were divided into 4 groups of 24 each and stored at constant temperature (22, 50, or 70°C), or subjected to a temperature of 70°C for 8 hours followed by 22°C for 16 hours repeatedly over 28 days. Inspection and chromatographic analysis of the bags was performed at 0, 12, 24, 48, and 72 hours in the 72-hour study, and at 1, 2, 3, and 4 weeks in the 28-day study. Results: NS bags slightly bulged at 50°C and significantly bulged at 70°C or in the long experiment with temperature variation (Figure 1). During the exposure period, there was no discoloration, turbidity, or leaching of plastic components observed in the NS fluid. The pH readings were 5.59 ± 0.08 (22°C-Control sample), 5.73 ± 0.04 (50°C), 5.86 ± 0.02 (70°C), and 5.79 ± 0.03 following prolonged temperature variation. The sodium and chloride levels for the short-term study ranged from 100.2 ± 0.26% to 107.9 ± 0.75% and from 99.04 ± 0.76 to 102.11 ± 1.71%, and for the long-term study they ranged from 101.93 ± 0.90% to 111.27 ± 2.61 and from 99.05 ± 0.94% to 110.95 ± 1.63%; respectively (Figure 2) in comparison to manufacturer stated concentrations. Conclusion: There was no evidence to suggest that the NS fluid inside the PO bags is physically and chemically different when exposed up to 28 days to 50°C, 70°C, and prolonged temperature variations compared to 22°C. These simulated conditions are subject to further testing under real-life pre-hospital care emergency conditions in a hot country

Understanding patient non-transport decision theories in the pre-hospital setting: a narrative review

© 2023 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background In pre-hospital emergency care, decisions regarding patient non-conveyance emerged as significant determinants of healthcare outcomes and resource utilization. These complex decisions became integral to the progress of emergency medical services, thus warranting an evolving exploration within the medical discourse. Objectives and methods This narrative review aimed to synthesize and critically evaluate various theoretical stances on patient non-conveyance in the pre-hospital emergency. The focus on studies published between January 2012 and August 2022 was intentional to capture contemporary practices and insights. PubMed and Google Scholar served as the primary databases for the investigation, while the AL-Rayyan® software facilitated a thorough screening process. Results and discussion Twenty-nine studies—encompassing articles, books, and theses—were discovered through our search, each presenting unique perspectives on patient non-transport, thus highlighting its criticality as a healthcare concern. Predominant factors influencing non-transport decisions were classified into patient-initiated refusals (PIR), clinician-initiated decisions (CID), and dispatcher-initiated decisions (DID). Conclusions The issue of patient non-conveyance to hospitals continues to pose a crucial challenge to the seamless operation of emergency healthcare systems, warranting increased attention from various healthcare entities. To comprehend and pinpoint potential areas of improvement, a comprehensive analysis of pre-hospital non-transport events is imperative. A well-informed, strategic approach could prevent resource waste while ensuring patients receive the required and definitive care.Peer reviewe

Epidemiological Determinants of Patient Non-Conveyance to the Hospital in an Emergency Medical Service Environment

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background: The increasing prevalence of comorbidities worldwide has spurred the need for time-effective pre-hospital emergency medical services (EMS). Some pre-hospital emergency calls requesting EMS result in patient non-conveyance. Decisions for non-conveyance are sometimes driven by the patient or the clinician, which may jeopardize the patients’ healthcare outcomes. This study aimed to explore the distribution and determinants of patient non-conveyance to hospitals in a Middle Eastern national Ambulance Service that promotes the transportation of all emergency call patients and does not adopt clinician-based non-conveyance decision. Methods: Using R Language, descriptive, bivariate, and binary logistic regression analyses were conducted for 334,392 multi-national patient non-conveyance emergency calls from June 2018 to July 2022, from a total of 1,030,228 calls to which a response unit was dispatched. Results: After data pre-processing, 237,862 cases of patient non-conveyance to hospital were retained, with a monthly average of 41.96% (n = 8799) of the emergency service demands and a standard deviation of 5.49% (n = 2040.63). They predominantly involved South Asians (29.36%, n = 69,849); 64.50% (n = 153,427) were of the age category from 14 to 44 years; 61.22% (n = 145,610) were male; 74.59% (n = 177,424) from the urban setting; and 71.28% (n = 169,552) had received on-scene treatment. Binary logistic regression with full variables and backward methods identified the final models of the determinants of patient non-conveyance decisions with an Akaike information criterion prediction estimator, respectively, of (250,200) and (250,169), indicating no significant difference between both models (Chi-square test; p-value = 0.63). Conclusions: Despite exercising a cautious protocol by encouraging patient transportation to hospital, patient non-conveyance seems to be a problem in the healthcare system that strains the pre-hospital medical response teams’ resources. Policies and regulations should be adopted to encourage individuals to access other primary care centers when required rather than draining emergency services for non-emergency situations.Peer reviewe

Development of a protocol to investigate the stability of drugs used by Qatar's National Ambulance Service in rapid response vehicles

Background: Paramedics need a range of medications that are stored in bags for easy transportation to the patient's side and are exposed to temperature variations, especially in a hot country like Qatar 1 . The thermal stability of some medications was examined in previous studies 2,3 . Methods: A safe and practical solution had to be found and should be approved by the Production committee to investigate the thermal stability of a range of 13 medications over different periods of time (Table 1). Results: Six medication bags have been specially prepared with the drug samples presented in Table 1. While one data logger was fixed to the metal net divider at the back of the rapid response vehicle, each bag contained a radio-frequency identification (RFID) tag for tracing, two data loggers to measure the temperature and humidity every 10 minutes over a 3 to 12-month period, and an initial total of 15 drug samples (Table 1). The bags have been labeled “For research purpose” and placed at the back of rapid response vehicles (Figure 1). At collection times, 3 samples of each medication will be removed for analysis and replaced by new samples. Similarly, data loggers will be collected and replaced with new ones. As per Qatar Ambulance Service's standard operating procedures, paramedics are required to always keep their medication bag with them when they leave their vehicle for a break or to treat a patient, but for practical and safety reasons it will not be the case with the research samples. Although this means that the research bags will have less exposure to the outdoor environment, they will still be subjected to temperature variation in case the vehicle is parked without air conditioning 1 . The collected samples will be kept at 4°C until analyzed by high-performance liquid chromatography. Conclusion: Based on the findings of this study, the results may have a significant impact on how some of the drugs are handled in the pre-hospital setting, especially, possible modification of the recommended expiration date specified by manufacturers to ensure patient safety

Exploring factors influencing time from dispatch to unit availability according to the transport decision in the pre-hospital setting: an exploratory study

© 2024 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background: Efficient resource distribution is important. Despite extensive research on response timings within ambulance services, nuances of time from unit dispatch to becoming available still need to be explored. This study aimed to identify the determinants of the duration between ambulance dispatch and readiness to respond to the next case according to the patients’ transport decisions. Methods: Time from ambulance dispatch to availability (TDA) analysis according to the patients’ transport decision (Transport versus Non-Transport) was conducted using R-Studio™ for a data set of 93,712 emergency calls managed by a Middle Eastern ambulance service from January to May 2023. Log-transformed Hazard Ratios (HR) were examined across diverse parameters. A Cox regression model was utilised to determine the influence of variables on TDA. Kaplan–Meier curves discerned potential variances in the time elapsed for both cohorts based on demographics and clinical indicators. A competing risk analysis assessed the probabilities of distinct outcomes occurring. Results: The median duration of elapsed TDA was 173 min for the transported patients and 73 min for those not transported. The HR unveiled Significant associations in various demographic variables. The Kaplan–Meier curves revealed variances in TDA across different nationalities and age categories. In the competing risk analysis, the ‘Not Transported’ group demonstrated a higher incidence of prolonged TDA than the ‘Transported’ group at specified time points. Conclusions: Exploring TDA offers a novel perspective on ambulance services’ efficiency. Though promising, the findings necessitate further exploration across diverse settings, ensuring broader applicability. Future research should consider a comprehensive range of variables to fully harness the utility of this period as a metric for healthcare excellence.Peer reviewe

Epidemiology of prehospital emergency calls according to patient transport decision in a middle eastern emergency care environment: Retrospective cohort‐based

© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background and Aim: Though emergency medical services (EMS) respond to all types of emergency calls, they do not always result in the patient being transported to the hospital. This study aimed to explore the determinants influencing emergency call‐response‐based conveyance decisions in a Middle Eastern ambulance service. Methods: This retrospective quantitative analysis of 93,712 emergency calls to the Hamad Medical Corporation Ambulance Service (HMCAS) between January 1 and May 31, 2023, obtained from the HMCAS electronic system, was analyzed to determine pertinent variables. Sociodemographic, emergency dispatch‐related, clinical, and miscellaneous predictors were analyzed. Descriptive, bivariate, ridge logistic regression, and combination analyses were evaluated. Results: 23.95% (N = 21,194) and 76.05% (N = 67,285) resulted in patient nontransport and transportation, respectively. Sociodemographic analysis revealed that males predominantly activated EMS resources, and 60% of males (n = 12,687) were not transported, whilst 65% of females (n = 44,053) were transported. South Asians represented a significant proportion of the transported patients (36%, n = 24,007). “Home” emerged as the primary emergency location (56%, n = 37,725). Bivariate analysis revealed significant associations across several variables, though multicollinearity was identified as a challenge. Ridge regression analysis underscored the role of certain predictors, such as missing provisional diagnoses, in transportation decisions. The upset plot shows that hypertension and diabetes mellitus were the most common combinations in both groups. Conclusions: This study highlights the nuanced complexities governing conveyance decisions. By unveiling patterns such as male predominance, which reflects Qatar's expatriate population, and specific temporal EMS activity peaks, this study accentuates the importance of holistic patient assessment that transcends medical histories.Peer reviewe

Introducing clinical educators to interprofessional education through scenario-based simulation. Innovations in Global Health Professions Education

Guillaume Alinier, Khalid A. Saifeldeen and Rahma Salim, ‘Introducing clinical educators to interprofessional education through scenario-based simulation’, abstract of an oral presentation at the First Middle Eastern Conference on Interprofessional Education, Doha, Qatar, 4-6 December 2015. Published by Innovations in Global Health Professions Education, available online at doi:http://dx.doi.org/10.20421/ighpe.2016.02 Copyright ©2016 The speakers and presenters of the conference.Peer reviewedFinal Published versio