Abstract Objectives During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators related to the epidemic and to preventative measures such as lockdown. The automatic classification of the content of calls to emergency medical communication centers could provide relevant and responsive indicators. Methods We retrieved all 796,209 free-text call reports from the emergency medical communication center of the Gironde department, France, between 2018 and 2020. We trained a natural language processing neural network model with a mixed unsupervised/supervised method to classify all reasons for calls in 2020. Validation and parameter adjustment were performed using a sample of 20,000 manually-coded free-text reports. Results The number of daily calls for flu-like symptoms began to increase from February 21, 2020 and reached an unprecedented level by February 28, 2020 and peaked on March 14, 2020, 3 days before lockdown. It was strongly correlated with daily emergency room admissions, with a delay of 14 days. Calls for chest pain, stress, but also those mentioning dyspnea, ageusia and anosmia peaked 12 days later. Calls for malaises with loss of consciousness, non-voluntary injuries and alcohol intoxications sharply decreased, starting one month before lockdown. Discussion This example of the COVID-19 crisis shows how the availability of reliable and unbiased surveillance platforms can be useful for a timely and relevant monitoring of all events with public health consequences. The use of an automatic classification system using artificial intelligence makes it possible to free itself from the context that could influence a human coder, especially in a crisis situation. Conclusion The content of calls to emergency medical communication centers is an efficient epidemiological surveillance data source that provides insights into the societal upheavals induced by a health crisis.
Abstract Importance After a traumatic event, 10–20% of injured patients will suffer for several months from various symptoms, collectively termed post-concussion-like symptoms (PCLS), which can lead to a decline in quality of life. Moreover, recent findings suggested that this condition may also apply to patients with an acute medical condition. A preliminary randomized controlled trial suggested that this condition may be prevented by a single early short Eye Movement Desensitization and Reprocessing (EMDR) psychotherapeutic session delivered at the ER. Objective The present study was designed to compare the impact of the early EMDR intervention versus usual care on 3-month PCLS in patients presenting at the ER. Design, Setting, and Participants: This study was an open-label two-center comparative randomized controlled trial with phone follow-up assessments at 3 months. Eligible participants included adults (≥18 years old) presenting at the ER who have a high risk of PCLS using a 3-item scoring scale. Interventions The randomization groups were as follows: (i) EMDR Recent Traumatic Episode Protocol (R-TEP) intervention performed during the ER stay and (ii) usual care. Main Outcomes and Measures: The primary and secondary outcomes were respectively the frequency of PCLS and PTSD at 3 months after the ER visit. Results This study included 313 patients with a high risk of PCLS who were randomized into two groups; of these patients, 219 were contacted by phone at 3 months. There was no difference in the primary outcome (EMDR: 53.8% vs. Control: 49.6%), but for the secondary outcome, the occurrence of PTSD was greater in the intervention group (9.4% vs. 2.7%, p = 0.04). In the EMDR group, a high level of self-assessed stress at admission (>6) was strongly associated with persistent PCLS (76.9% vs. 40.9%, p = 0.04). Conclusion and Relevance The present results showed that a single EMDR R-TEP session did not reduce the incidence of PCLS at 3 months in patients admitted to the ER. However, the rate of PTSD was higher in the EMDR group. These results suggest that more data should be collected to define which treatment options may be offered to patients attending the ER and the role that psychologist skill plays in this process. Trial registration ClinicalTrials.gov identifier NCT03400813 . Key points Question Does early EMDR in the emergency room reduce the incidence of PCLS at 3 months after care? Findings In patients admitted to the ER, a single EMDR R-TEP session did not reduce the incidence of PCLS at 3 months, especially among patients who reported a high level of stress at admission. Meaning The present results suggest that more data will be necessary to determine the available treatment options for patients attending the ER and the role that psychologist skill plays in this process.
Ultrasonography (US) could be used in emergency out-of-hospital settings to diagnose abdominal hemorrhage.To report the diagnosis by US of a suspected case of ruptured ectopic pregnancy despite a supposedly in utero pregnancy.A mobile intensive care unit with an emergency physician on board was sent out to a 22-year-old woman suffering from acute abdominal pain. On the previous day, an 11-week pregnancy had been diagnosed and the pelvic US images were reported to be "normal." Physical examination revealed that the patient was in shock. Point-of-care US detected an intraperitoneal effusion and suspected uterine rupture. Emergency laparotomy revealed an 11- or 12-week intra-abdominal pregnancy with uterine rupture due to myometrial implantation of the embryo.Ultrasound is a helpful tool in emergency care, particularly in out-of-hospital settings. An earlier "normal" US examination cannot definitively exclude uterine rupture.
Cardiogenic shock following myocardial infarction: beyond the mechanicsConclusion: This large multicentric and prospective registry confirmed the heterogeneity of CS in terms of etiology, presentation and prognosis with a predominance of non-ischemic CS in practice.
