Coverage based empirical modelling for EMS rescue system of Karachi (Pakistan)

Hitne slučajeve uglavnom rješava služba hitne pomoći (EMS). U većini se slučajeva radi o jednom pacijentu. Osnovni sustavi nisu u stanju reagirati kod hitnih slučajeva s više unesrećenih. EMS je u zadnje dvije godine morao prilagoditi svoje planove takvim slučajevima zbog sve većeg broja nesreća i terorističkih napada. Ali takvi bi se planovi mogli osujetiti smanjenim proračunom i izvorima financiranja, a i brojem ambulantnih kola i njihovim položajem/lokacijom, te strategijom njihova slanja, što sve utječe na EMS. Dodatni faktor je promjenljivost u broju slobodnih ambulantnih kola u različito vrijeme tijekom dana. U svrhu održavanja pokrivenosti potrebno je pripaziti i da su ambulantna kola uvijek u stanju pripravnosti. U radu predlažemo model optimalizacije u EMS-u koji će pomoći kod medicinskih postupaka u regiji Karachi, Pakistan (uporabom podataka iz dvije godine, 2010. i 2011.). Također smo proveli i empirijsku analizu vremena reagiranja ambulantnih kola, njihovo vrijeme dolaska u bolnicu i vrijeme provedeno u bolnici. Korištene su Google mape kako bi se olakšalo praćenje i analiziranje mjesta nesreće uz pomoć GPSa ili nekog drugog izvora informacija. Fizikalna simulacija i rezultati su korišteni kao dio procesa planiranja što pokazuje integritet i učinkovitost vremenske granice temeljene na hitnosti pacijenta u vrijeme poziva (Spasilačka ekipa 15).Emergency Medical Services (EMS) is a major source of handling emergencies. Most of the emergencies have one patient. The routine systems are not able to respond to emergencies in which there are many casualties. The mass-casualty disaster response and EMS services plans have become more popular in case of ordinary disasters and terrorist attacks over the past decades. But it might not be possible to construct such plans due to limited resources and budget. There may be such more factors including the number of ambulances deployed, their position/location, and dispatching strategies that affect the EMS system. One more factor is the variation in number of vacant ambulances at different time of the day. In order to sustain coverage, it is necessary to locate ambulances at the station in functional states. In this paper we proposed an optimization model dealing with EMS to assist the medical treatment in the region of Karachi, Pakistan (by using two years data from the year 2010 to 2011). We also conducted and estimated an empirical analysis of ambulance response times, travel times to a hospital and the time spent at the hospital. Google maps are used to facilitate EMS’s provider to view and analyse the entire scene of the accident with the help of GPS or other sources of information. Physical simulation and results are used as part of the planning process, which shows the integrity and efficiency of the time threshold based on the acuity of the patient at the time when the 15 call is made (Rescue 15)

High flow nasal cannula therapy in children with acute respiratory insufficiency in the pediatric intensive care unit of a resource-limited country: A preliminary experience

A retrospective study was performed in children (aged one month - 16 years) receiving HFNC to determine the frequency, efficacy and adverse effects of high flow nasal cannula (HFNC) therapy in the pediatric intensive care unit (PICU), from January to December 2017. Treatment failure was defined as clinical deterioration on HFNC therapy such that mechanical ventilation (MV) was required. Clinical parameters before and after HFNC were assessed using repeated measures analysis of variance. A total of 120 patients received HFNC therapy (21% of total admissions). Primary diagnosis were respiratory disease (50%), central nervous system diseases (14.2%), sepsis (10.8%), and postoperative care (10%). Mean duration of HFNC was 27.5 ±19.7 hours and mean PICU length of stay was 6 ± 6 days. Pneumothorax developed in four patients. MV was required in 28 patients, and subsequently, 15 deaths occurred in that group. HFNC is a frequently used, safe and effective therapy for children requiring respiratory support in PICU. Key Words: Respiratory insufficiency, Non-invasive ventilation, Paediatric intensive care unit

RTA Analysis & Existing Modelling for Emergency Medical Service

Prevention of accidents is extremely difficult in absence of present situation analysis, as the aim to identify the incident locations and safety deficiency area is the key to work out the effective solution. To access the feasibility of using Geographic Information System (GIS) for mapping of incident locations with an existing data source is vital to estimate variation of RTAs (Road Traffic Accidents) pattern by interpolating. Generally, accident particulars like location, date, time, sex and suspect are included in GIS database. Here, Arc GIS (10.2.1) software is applied to identify incident locations in Karachi district. To reduce the accidents in particular area/study area and in order to sustain coverage for emergency response, there may be such more factors including the number of ambulances deployed, their position/location, and dispatching strategies that affect the EMS system, authors strictly recommended covering based probabilistic model for (Rescue-15) solving the problem of ambulance locations. GIS facilitates the respective authority to do assessment and to analyze the entire position of the accident with the help of GPS or additional sources of information while consequences are utilized as part of the preparation progression is based on the acuity of the patient in time

Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia region: A report from the pediatric oncology east and mediterranean (POEM) group

Background: Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID-19) pandemic on access to care for children with cancer is likely but has not been evaluated.Methods: A 34-item survey focusing on barriers to pediatric oncology management during the COVID-19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID-19 cases and deaths were retrieved from the World Health Organization database.Results: In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off-treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in \u3c30% of centers, reflecting the low rates of COVID-19 hospitalizations in the corresponding countries at the time of the survey.Conclusions: Mechanisms to approach childhood cancer treatment delivery during crises need to be re-evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease

HepFREEPak: protocol for a multi-centre, prospective observational study examining efficacy and impact of current therapies for the treatment of hepatitis C in Pakistan and reporting resistance to antiviral drugs: study protocol

Abstract Background Pakistan has one of the highest burdens of Hepatitis C virus (HCV) infection globally. To achieve the World Health Organization’s goals for HCV elimination, there is a need for substantial scale-up in testing, treatment, and a reduction in new infections. Data on the population impact of scaling up treatment is not available in Pakistan, nor is there reliable data on the incidence of infection/reinfection. This project will fill this gap by providing important empirical data on the incidence of infection (primary and reinfection) in Pakistan. Then, by using this data in epidemic models, the study will determine whether response rates achieved with affordable therapies (sofosbuvir plus daclatasvir) will be sufficient to eliminate HCV in Pakistan. Methods This prospective multi-centre cohort study will screen 25,000 individuals for HCV antibody (Ab) and RNA (if Ab-positive) at various centers in Pakistan- Karachi (Sindh) and Punjab, providing estimates of the disease prevalence. HCV positive patients will be treated with sofosbuvir and daclatasvir for 12-weeks, (extended to 24-weeks in those with cirrhosis) and the proportion responding to this first-line treatment estimated. Patients who test HCV Ab negative will be recalled 12 months later to test for new HCV infections, providing estimates of the incidence rate. Patients diagnosed with HCV (~ 4,000) will be treated and tested for Sustained Virological Response (SVR). Questionnaires to assess risk factors, productivity, health care usage and quality of life will be completed at both the initial screening and at 12-month follow-up, allowing mathematical modelling and economic analysis to assess the current treatment strategies. Viral resistance will be analysed and patients who have successfully completed treatment will be retested 12 months later to estimate the rate of re-infection. Conclusion The HepFREEPak study will provide evidence on the efficacy of available and widely used treatment options in Pakistan. It will also provide data on the incidence rate of primary infections and re-infections. Data on incidence risk factors will allow us to model and incorporate heterogeneity of risk and how that affects screening and treatment strategies. These data will identify any gaps in current test-and-treat programs to achieve HCV elimination in Pakistan. Study registration This study was registered on clinicaltrials.gov (NCT04943588) on June 29, 2021