Physician well-being is vital to delivering high-quality emergency care.A supported and healthy emergency medicine workforce leads to better patient outcomes,fewer medical errors,and greater job satisfaction and staff...Physician well-being is vital to delivering high-quality emergency care.A supported and healthy emergency medicine workforce leads to better patient outcomes,fewer medical errors,and greater job satisfaction and staff retention.[1,2]Emergency physicians(EPs)face unique pressures,including shift work,high patient volumes and acuities,overcrowding,and systemic inefficiencies that escalate their risk of burnout.As a result,EPs have reported the highest rates of burnout among physician specialties.展开更多
BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making ...BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making it a signifi cant public health concern.This study is to determine the prevalence and factors associated with acute pain among emergency trauma patients.METHODS:A multicenter cross-sectional study was conducted.Data were collected via interviewer-administered questionnaires and patient chart review.The data were analyzed via the statistical package for social science version 25.Bivariable and multivariable logistic regression analyses were used.Variables with a P-value<0.05 were considered statistically signifi cant.RESULTS:A total of 397 patients were included in the study,for a response rate of 96.8%.The prevalence of pain during admission was 91.9%(95%confi dence intervals[95%CIs]:88.8%-94.4%).Blunt trauma(adjusted odds ratio[aOR]=2.82;95%CI:1.23-6.45),analgesia before admission to the emergency department(aOR=2.71;95%CI:1.16-6.36),documentation of pain severity in the chart(aOR=2.71;95%CI:1.16-6.36),analgesia provided within two hours after admission(aOR=7.60;95%CI:2.79-20.68),use of non-pharmacological pain management methods(aOR=3.09;95%CI:1.35-7.08)and availability of analgesia(aOR=3.95;95%CI:1.36-11.43)were associated with acute pain experience.CONCLUSION:The prevalence of acute pain among emergency trauma patients was high in the study area.Analgesia should be administered prior to admission,and non-pharmacological pain management should be implemented.Moreover,training on pain assessment and management should be provided for healthcare providers in the emergency department.展开更多
Against the backdrop of continuous social development and growing public health demands,the efficiency and scientific nature of the emergency care system are of paramount importance.This paper focuses on researching t...Against the backdrop of continuous social development and growing public health demands,the efficiency and scientific nature of the emergency care system are of paramount importance.This paper focuses on researching the construction of an emergency care system based on the concept of“linkage”,delving into its theoretical foundations,exploring innovative construction models,and analyzing practical cases.The study indicates that an emergency care system under the“linkage”concept can effectively integrate resources and enhance efficiency,providing new insights for improving the construction of the emergency care system.It aims to promote the development of the emergency care system towards a more scientific,efficient,and collaborative direction.展开更多
BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and...BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.展开更多
BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suita...BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.展开更多
Molecular dynamics simulations were carried out to study the effect of chemical short-range order(CSRO)on the primary radiation damage in TiVTaNb high-entropy alloys(HEAs).We have performed displacement cascade simula...Molecular dynamics simulations were carried out to study the effect of chemical short-range order(CSRO)on the primary radiation damage in TiVTaNb high-entropy alloys(HEAs).We have performed displacement cascade simulations to explore the CSRO effect on the generation and evolution behaviors of irradiation defects.The results demonstrate that CSRO can suppress the formation of Frenkel pairs in TiVTaNb HEAs,with the suppression effect becoming more pronounced as the degree of CSRO increases.CSRO can change the types of interstitial defects generated during cascade collisions.Specifically,as the degree of CSRO increases,the proportion of Ti-related interstitials shows a marked enhancement,primarily evidenced by a significant rise in Ti–Ti dumbbells accompanied by a corresponding decrease in Ti–V dumbbells.CSRO exhibits negligible influence on defect clustering and the nucleation and evolution of dislocation loops.Regardless of CSRO conditions,TiVTaNb HEAs preserve exceptional radiation tolerance throughout the cascade damage process,suggesting that the intrinsic properties of this multi-principal element system dominate its radiation response.These findings provide fundamental insights into the CSRO effect on defect formation and evolution behaviors in HEAs,which may provide new design strategies for high-entropy alloys.展开更多
To address the issue that hybrid flow shop production struggles to handle order disturbance events,a dynamic scheduling model was constructed.The model takes minimizing the maximum makespan,delivery time deviation,and...To address the issue that hybrid flow shop production struggles to handle order disturbance events,a dynamic scheduling model was constructed.The model takes minimizing the maximum makespan,delivery time deviation,and scheme deviation degree as the optimization objectives.An adaptive dynamic scheduling strategy based on the degree of order disturbance is proposed.An improved multi-objective Grey Wolf(IMOGWO)optimization algorithm is designed by combining the“job-machine”two-layer encoding strategy,the timing-driven two-stage decoding strategy,the opposition-based learning initialization population strategy,the POX crossover strategy,the dualoperation dynamic mutation strategy,and the variable neighborhood search strategy for problem solving.A variety of test cases with different scales were designed,and ablation experiments were conducted to verify the effectiveness of the improved strategies.The results show that each improved strategy can effectively enhance the performance of the IMOGWO.Additionally,performance analysis was conducted by comparing the proposed algorithm with three mature and classical algorithms.The results demonstrate that the proposed algorithm exhibits superior performance in solving the hybrid flow-shop scheduling problem(HFSP).Case validations were conducted for different types of order disturbance scenarios.The results demonstrate that the proposed adaptive dynamic scheduling strategy and the IMOGWO algorithm can effectively address order disturbance events.They enable rapid response to order disturbance while ensuring the stability of the production system.展开更多
Aortic saddle embolism(ASE)is a rare but catastrophic vascular emergency characterized by acute occlusion of the aortic bifurcation,leading to bilateral lower limb ischemia and multiorgan dysfunction.Despite advances ...Aortic saddle embolism(ASE)is a rare but catastrophic vascular emergency characterized by acute occlusion of the aortic bifurcation,leading to bilateral lower limb ischemia and multiorgan dysfunction.Despite advances in imaging and surgical techniques,ASE has high morbidity and mortality rates,particularly when diagnosis or intervention is delayed.Here,we report two patients admitted to our center to increase awareness among emergency physicians.展开更多
In the present study, we aimed to analyze the irrational medical orders and evaluate the effect of pharmacy intervention on pharmacy intravenous admixture services of outpatient and emergency departments in our hospit...In the present study, we aimed to analyze the irrational medical orders and evaluate the effect of pharmacy intervention on pharmacy intravenous admixture services of outpatient and emergency departments in our hospital. The irrational medical orders of PIVAS at the outpatient and emergency departments were retrospectively analyzed in Jun. 2015. We strengthened the pharmacy intervention on irrational medical orders since July 2015. All the cases were selected by systematic sampling method. Cased studied in Jun. 2015 served as the control group, whereas those studied in Jan. 2016 served as the intervention group. The irrational rate and the irrational number of daily average were compared between the control group and intervention group. The common type of irrational outpatient and emergency intravenous orders mainly included irrational use of solvents, irrational dosing interval and inappropriate compatibility of drugs. The irrational rate was reduced from 17.4% to 3.3% （P〈0.01）, and the irrational number of daily average was decreased from 5.23 to 1.00 （P〈0.01）. Pharmacy intervention can reduce the irrational rate of medical orders in our hospital, which is of great significance to promote rational drug use and improve medical quality.展开更多
Aiming at dealing with the difficulty for traditional emergency rescue vehicle(ECV)to enter into limited rescue scenes,the electro-hydraulic steer-by-wire(SBW)system is introduced to achieve the multi-mode steering of...Aiming at dealing with the difficulty for traditional emergency rescue vehicle(ECV)to enter into limited rescue scenes,the electro-hydraulic steer-by-wire(SBW)system is introduced to achieve the multi-mode steering of the ECV.The overall structure and mathematical model of the SBW system are described at length.The fractional order proportional-integral-derivative(FOPID)controller based on fractional calculus theory is designed to control the steering cylinder’s movement in SBW system.The anti-windup problem is considered in the FOPID controller design to reduce the bad influence of saturation.Five parameters of the FOPID controller are optimized using the genetic algorithm by maximizing the fitness function which involves integral of time by absolute value error(ITAE),peak overshoot,as well as settling time.The time-domain simulations are implemented to identify the performance of the raised FOPID controller.The simulation results indicate the presented FOPID controller possesses more effective control properties than classical proportional-integral-derivative(PID)controller on the part of transient response,tracking capability and robustness.展开更多
BACKGROUND:Consenting to do-not-resuscitate(DNR)orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments(EDs).The DNR decision in EDs ...BACKGROUND:Consenting to do-not-resuscitate(DNR)orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments(EDs).The DNR decision in EDs has not been extensively studied,especially in the Chinese mainland.METHODS:This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019.The patients with out-of-hospital cardiac arrest were excluded.RESULTS:There were 214 patients’deaths in the ED in the three years.Among them,132 patients were included in this study,whereas 82 with out-of-hospital cardiac arrest were excluded.There were 99(75.0%)patients’deaths after a DNR order medical decision,64(64.6%)patients signed the orders within 24 hours of the ED admission,68(68.7%)patients died within 24 hours after signing it,and 97(98.0%)patients had DNR signed by the family surrogates.Multivariate analysis showed that four independent factors infl uenced the family surrogates’decisions to sign the DNR orders:lack of referral(odds ratio[OR]0.157,95%confi dence interval[CI]0.047–0.529,P=0.003),ED length of stay(ED LOS)≥72 hours(OR 5.889,95%CI 1.290–26.885,P=0.022),acute myocardial infarction(AMI)(OR 0.017,95%CI 0.001–0.279,P=0.004),and tracheal intubation(OR 0.028,95%CI 0.007–0.120,P<0.001).CONCLUSIONS:In the Chinese mainland,the proportion of patients consenting for DNR order is lower than that of developed countries.The decision to sign DNR orders is mainly affected by referral,ED LOS,AMI,and trachea intubation.展开更多
BACKGROUND:Paramedic and emergency personnel may encounter directly many events that threat their own wellbeing during their daily work.This study was conducted to examine the prevalence rate of post-traumatic stress ...BACKGROUND:Paramedic and emergency personnel may encounter directly many events that threat their own wellbeing during their daily work.This study was conducted to examine the prevalence rate of post-traumatic stress disorder(PTSD) among two groups of paramedic and emergency personnel in south-east Iran.METHODS:The study employed a descriptive design and was conducted in four hospital emergency wards and a pre-hospital emergency base supervised by Kerman Medical University.Using Mississippi PTSD,we assessed the prevalence rate in paramedics(n=150) and emergency personnel(n=250).RESULTS:The two groups had different levels of education,marital status,experience of traumatic events,work hours per month,and gender.Most(94%) of paramedic and hospital emergency personnel reported moderate PTSD.The two groups had significant different levels of PTSD in all subscale.CONCLUSION:The study suggests that health care managers should organize systematic and dynamic policies and procedures in dealing with PTSD to assist both groups of personnel.展开更多
BACKGROUND: The purpose of the study was to explore the association between posttraumatic stress disorder(PTSD) and work performance of emergency medical services personnel in Karachi, Pakistan.METHODS: Emergency medi...BACKGROUND: The purpose of the study was to explore the association between posttraumatic stress disorder(PTSD) and work performance of emergency medical services personnel in Karachi, Pakistan.METHODS: Emergency medical service personnel were screened for potential PTSD using Impact of Event Scale-Revised(IES-R). Work performance was assessed on the basis of fi ve variables: number of late arrivals to work, number of days absent, number of days sick, adherence to protocol, and patient satisfaction over a period of 3 months. In order to model outcomes like the number of late arrivals to work, days absent and days late, negative binomial regression was applied, whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores.RESULTS: Mean scores of PTSD were 24.0±12.2. No association was found between PTSD and work performance measures: number of late arrivals to work(RRadj 0.99; 0.98–1.00), days absent(RRadj 0.98; 0.96–0.99), days sick(RRadj 0.99; 0.98–1.00), adherence to protocol(ORadj 1.01; 0.99–1.04) and patient satisfaction(β 0.001%–0.03%) after adjusting for years of formal schooling, living status, coping mechanism, social support, working hours, years of experience and anxiety or depression.CONCLUSION: No statistically significant association was found between PTSD and work performance amongst EMS personnel in Karachi, Pakistan.展开更多
BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive...BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.展开更多
We analyze a continuous review lost sales inventory system with two types of orders—regular and emergency. The regular order has a stochastic lead time and is placed with the cheapest acceptable supplier. The emergen...We analyze a continuous review lost sales inventory system with two types of orders—regular and emergency. The regular order has a stochastic lead time and is placed with the cheapest acceptable supplier. The emergency order has a deterministic lead time is placed with a local supplier who has a higher price. The emergency order is not always filled since the supplier may not have the ability to provide the order on an emergency basis at all times. This emergency order has a higher cost per item and has a known probability of being filled. The total costs for this system are compared to a system without emergency placement of orders. This paper provides managers with a tool to assess when dual sourcing is cost optimal by comparing the single sourcing and dual sourcing models.展开更多
The purpose of our Quality Improvement (QI) project was to evaluate the effectiveness of radiology-led didactics on efficiency and ordering practices in the emergency department. Residents of the emergency medicine (E...The purpose of our Quality Improvement (QI) project was to evaluate the effectiveness of radiology-led didactics on efficiency and ordering practices in the emergency department. Residents of the emergency medicine (EM) program at Downstate Medical Center/Kings County Hospital (postgraduate years 1 - 4) participated in a didactic lecture series during the first two months of the 2013 academic year. Two fifteen-minute lectures with a question and answer session were designed to focus on radiation risk, American College of Radiology (ACR) appropriateness criteria and the department of radiology’s policies. A short survey questionnaire that included questions on ACR appropriateness criteria, radiology experiences and opinions/attitudes regarding radiology was distributed and analyzed before and after the didactic series. The average score for the knowledge-based technical questions on ACR appropriateness criteria was 60.5% initially and 76.4% post-lecture with an overall improvement of 25%, which was statistically significant (p < 0.0001). Following a short didactic lecture series, EM residents showed significant improvement of their knowledge of appropriate image utilization on the post-lecture survey. This highlights the need for dedicated radiology-led lecture series for EM residents. This type of program could be implemented yearly and expanded to other departments to promote interdepartmental commuication, increases radiology awareness, improves ordering practices and encourages appropriate imaging utilization.展开更多
BACKGROUND In the past years,only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease(ADHD),most of which were individual case reports or lac...BACKGROUND In the past years,only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease(ADHD),most of which were individual case reports or lacked detailed clinical information.Although many studies have reported patients presenting to the emergency department(ED)with recurrent abdominal symptoms for a number of disorders,there are few data involving ADHD.However,owing to a lack of awareness of the disease,misdiagnoses and mistreatments are common.Severe complications such as perforation,bleeding,malabsorption,and even death in ADHD had been reported by many studies.AIM To assist ED clinicians in having a more comprehensive understanding of this disease and making an early suspected diagnosis of ADHD more effectively.METHODS We enrolled 53 patients who visited the ED and were eventually diagnosed with ADHD over the past 11 years in our hospital.Their basic information,clinical manifestations,and imaging findings were analyzed.Blood indices were compared between the ADHD and irritable bowel syndrome(IBS)groups.RESULTS Adult patients with ADHD had a mean age of 48.8±14.3 years,and 77.4%had been treated before admission.The transverse colon was the most common dilated part(73.6%),and constipation(67.9%)was the most common symptom.ADHD patients can present with uncommon symptoms and false-negative imaging findings.Logistic regression analysis indicated that body mass index(BMI)[odds ratio(OR)=0.786,P=0.013],cholinesterase(per 1000 units;OR=0.693,P=0.008),and blood chlorine(OR=0.816,P=0.022)were determined to be independent related factors between the ADHD and IBS groups.The area under the receiver operating characteristics curve of these three indices combined was 0.812(P<0.001).CONCLUSION Emergency physicians should be vigilant regarding patients with chronic constipation,abdominal pain,or abdominal distension,and consider the possibility of ADHD despite its rarity.Abdominal computed tomography examination is recommended as a useful tool in the suspected diagnosis of ADHD.BMI,cholinesterase,and blood chlorine have good discriminative abilities between ADHD and IBS.The nutritional status of adult patients with ADHD is worthy of further attention.Surgical treatment for adult patients with ADHD is important and inevitable.展开更多
This study investigated the application and the application value of intelligent emergency in emergency management in the big data environment.It addresses the neglect of the application value(performance)measurement ...This study investigated the application and the application value of intelligent emergency in emergency management in the big data environment.It addresses the neglect of the application value(performance)measurement of intelligent emergency,further improving the effectiveness of intelligent emergency management.First,approximately 3,900 documents from the intelligent emergency field are analyzed to determine the future research trend in intelligent emergency management.The socio-technical theory concerning technical and social systems is introduced.The emergency management system concepts of“technology enabling”and“enabling value creation”are defined according to bibliometric analysis and socio-technical theory.Second,a research framework that includes technology enabling and enabling value creation for the decision-making paradigm in emergency management according to the big data environment is constructed.A detailed analysis approach from intelligent emergency technology enabling to enabling value creation in emergency management is proposed.Finally,earthquake disasters are taken as examples,and specific analyses of the intelligent emergency enabling and enabling value creation are explored;enabling value creation is discussed based on measurable indicators.The clear concept of emergency management system technology enabling and enabling value creation,as well as the detailed analysis approach from intelligent emergency technology enabling to enabling value creation,provide a theoretical bases for scholars and practitioners to evaluate the value(performance)of intelligent emergency for the first time.展开更多
BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practi...BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practice,demonstrating potential advantages in specific scenarios,including emergency settings.However,there is a lack of comprehensive reviews and practical protocols on TILP application.To address this gap,we performed a narrative review,and provided evidence-based recommendations to formulate a practice protocol,to assist clinicians to effectively apply TILP.METHODS:We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience.Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus.The practice protocols were formulated as warranted by advancements in medical knowledge,technology,and practice.RESULTS:This narrative review summarized the current evidence on TILP application,highlighting its safety,efficacy,challenges,and potential complications.In total,24 recommendations and a clinical protocol for TILP application in emergency patients were established.CONCLUSION:TILP is a valuable technique in emergency medicine.We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol.Future studies are needed to evaluate the safety and efficacy of TILP,broaden its scope of application,and explore effective training protocols.展开更多
During the rapid spread of COVID-19,first responders are at risk of being exposed to COVID-19 due to their role in providing first aid and responding to an unspecified number of people.This uncertainty can have advers...During the rapid spread of COVID-19,first responders are at risk of being exposed to COVID-19 due to their role in providing first aid and responding to an unspecified number of people.This uncertainty can have adverse mental health effects,such as increased anxiety and fear.This study aimed to investigate the degree of association between fear of COVID-19,obsession with COVID-19,and post-traumatic stress disorder(PTSD)in emergency rescue firefighters.The participants were 150 emergency rescue firefighters working in Region S,Korea.They filled out self-report questionnaires:The data obtained through the Fear of COVID-19 Scale,Obsession with COVID-19 Scale,and Impact of Event Scale-Revised Korean version were subjected to nonparametric statistical analysis using SPSS WIN 25.0.The study found a significant correlation between emergency rescue firefighters’fear of COVID-19,obsession with COVID-19,and PTSD.Fear and obsession with COVID-19 were higher among first responder firefighters who were directly involved in COVID-19-related tasks.Furthermore,a one-point increase in obsession was associated with a 2.837-point increase in PTSD.Based on the results,we found that there is a need for effective control of obsessions and fears among first responder firefighters during COVID-19,and we suggest that there is a need for mental health care for first responder firefighters during the pandemic through the development and support of programs to prevent and mitigate obsessions.展开更多
文摘Physician well-being is vital to delivering high-quality emergency care.A supported and healthy emergency medicine workforce leads to better patient outcomes,fewer medical errors,and greater job satisfaction and staff retention.[1,2]Emergency physicians(EPs)face unique pressures,including shift work,high patient volumes and acuities,overcrowding,and systemic inefficiencies that escalate their risk of burnout.As a result,EPs have reported the highest rates of burnout among physician specialties.
文摘BACKGROUND:Acute pain is a sudden experience secondary to injuries and varies in perception among individuals.In trauma patients,it can negatively aff ect respiratory function,immune response,and wound healing,making it a signifi cant public health concern.This study is to determine the prevalence and factors associated with acute pain among emergency trauma patients.METHODS:A multicenter cross-sectional study was conducted.Data were collected via interviewer-administered questionnaires and patient chart review.The data were analyzed via the statistical package for social science version 25.Bivariable and multivariable logistic regression analyses were used.Variables with a P-value<0.05 were considered statistically signifi cant.RESULTS:A total of 397 patients were included in the study,for a response rate of 96.8%.The prevalence of pain during admission was 91.9%(95%confi dence intervals[95%CIs]:88.8%-94.4%).Blunt trauma(adjusted odds ratio[aOR]=2.82;95%CI:1.23-6.45),analgesia before admission to the emergency department(aOR=2.71;95%CI:1.16-6.36),documentation of pain severity in the chart(aOR=2.71;95%CI:1.16-6.36),analgesia provided within two hours after admission(aOR=7.60;95%CI:2.79-20.68),use of non-pharmacological pain management methods(aOR=3.09;95%CI:1.35-7.08)and availability of analgesia(aOR=3.95;95%CI:1.36-11.43)were associated with acute pain experience.CONCLUSION:The prevalence of acute pain among emergency trauma patients was high in the study area.Analgesia should be administered prior to admission,and non-pharmacological pain management should be implemented.Moreover,training on pain assessment and management should be provided for healthcare providers in the emergency department.
文摘Against the backdrop of continuous social development and growing public health demands,the efficiency and scientific nature of the emergency care system are of paramount importance.This paper focuses on researching the construction of an emergency care system based on the concept of“linkage”,delving into its theoretical foundations,exploring innovative construction models,and analyzing practical cases.The study indicates that an emergency care system under the“linkage”concept can effectively integrate resources and enhance efficiency,providing new insights for improving the construction of the emergency care system.It aims to promote the development of the emergency care system towards a more scientific,efficient,and collaborative direction.
文摘BACKGROUND Appropriate care for individuals who attempt suicide and are admitted to the emergency department(ED)can prevent future suicidal behavior.It is vital to understand their sociodemographic characteristics and the effects of targeted psychological care.AIM To analyze sociodemographic characteristics of suicide attempters treated in the ED and evaluate the efficacy of psychological care.METHODS Data from 239 suicide attempters treated in the ED of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture(Hubei Province,China)between January 2021 and February 2025 were divided into 2:Control(n=108)and psychological care(n=131).The demographic characteristics and effects of the psychological care were analyzed.RESULTS The mean(±SD)age of the 239 patients[114 male(47.7%),125 female(52.3%)]was 26.25±9.3 years,of whom 122(45.2%)were single,117(48.9%)were married,and 106(44.4%)had secondary education.Thirty-eight(15.9%)patients had suicidal intent,with a mean of 1.26±0.59 suicide attempts each.Twenty-two(9.21%)patients had a family history of suicide,while 8(3.34%)had a family history of suicide attempt(s).Before intervention,mean Suicidal Intent Scale scores in the psychological nursing and control groups were 21.57±5.28 and 19.86±5.92,respectively(P>0.05).After 1 month of nursing intervention,the respective scores were 10.09±1.11 and 16.48±0.87(P<0.001);and the re-suicide rates were 11.45%(15/131)and 24.07%(26/108)(P<0.001).CONCLUSION Psychological care significantly reduces suicide risk;EDs should provide comprehensive mental health care.
基金supported by the special fund of the National Clinical Key Specialty Construction Program[(2022)301-2305].
文摘BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.
基金Project supported by the Youth Program of the National Natural Science Foundation of China(Grant No.12405324)the CNNC Science Fund for Talented Young Scholars(Grant No.24940)the CNNC Basic Science Fund(Grant No.24851)。
文摘Molecular dynamics simulations were carried out to study the effect of chemical short-range order(CSRO)on the primary radiation damage in TiVTaNb high-entropy alloys(HEAs).We have performed displacement cascade simulations to explore the CSRO effect on the generation and evolution behaviors of irradiation defects.The results demonstrate that CSRO can suppress the formation of Frenkel pairs in TiVTaNb HEAs,with the suppression effect becoming more pronounced as the degree of CSRO increases.CSRO can change the types of interstitial defects generated during cascade collisions.Specifically,as the degree of CSRO increases,the proportion of Ti-related interstitials shows a marked enhancement,primarily evidenced by a significant rise in Ti–Ti dumbbells accompanied by a corresponding decrease in Ti–V dumbbells.CSRO exhibits negligible influence on defect clustering and the nucleation and evolution of dislocation loops.Regardless of CSRO conditions,TiVTaNb HEAs preserve exceptional radiation tolerance throughout the cascade damage process,suggesting that the intrinsic properties of this multi-principal element system dominate its radiation response.These findings provide fundamental insights into the CSRO effect on defect formation and evolution behaviors in HEAs,which may provide new design strategies for high-entropy alloys.
基金funded by National Key Research and Development Program Projects of China under Grant No.2020YFB1713500.
文摘To address the issue that hybrid flow shop production struggles to handle order disturbance events,a dynamic scheduling model was constructed.The model takes minimizing the maximum makespan,delivery time deviation,and scheme deviation degree as the optimization objectives.An adaptive dynamic scheduling strategy based on the degree of order disturbance is proposed.An improved multi-objective Grey Wolf(IMOGWO)optimization algorithm is designed by combining the“job-machine”two-layer encoding strategy,the timing-driven two-stage decoding strategy,the opposition-based learning initialization population strategy,the POX crossover strategy,the dualoperation dynamic mutation strategy,and the variable neighborhood search strategy for problem solving.A variety of test cases with different scales were designed,and ablation experiments were conducted to verify the effectiveness of the improved strategies.The results show that each improved strategy can effectively enhance the performance of the IMOGWO.Additionally,performance analysis was conducted by comparing the proposed algorithm with three mature and classical algorithms.The results demonstrate that the proposed algorithm exhibits superior performance in solving the hybrid flow-shop scheduling problem(HFSP).Case validations were conducted for different types of order disturbance scenarios.The results demonstrate that the proposed adaptive dynamic scheduling strategy and the IMOGWO algorithm can effectively address order disturbance events.They enable rapid response to order disturbance while ensuring the stability of the production system.
文摘Aortic saddle embolism(ASE)is a rare but catastrophic vascular emergency characterized by acute occlusion of the aortic bifurcation,leading to bilateral lower limb ischemia and multiorgan dysfunction.Despite advances in imaging and surgical techniques,ASE has high morbidity and mortality rates,particularly when diagnosis or intervention is delayed.Here,we report two patients admitted to our center to increase awareness among emergency physicians.
文摘In the present study, we aimed to analyze the irrational medical orders and evaluate the effect of pharmacy intervention on pharmacy intravenous admixture services of outpatient and emergency departments in our hospital. The irrational medical orders of PIVAS at the outpatient and emergency departments were retrospectively analyzed in Jun. 2015. We strengthened the pharmacy intervention on irrational medical orders since July 2015. All the cases were selected by systematic sampling method. Cased studied in Jun. 2015 served as the control group, whereas those studied in Jan. 2016 served as the intervention group. The irrational rate and the irrational number of daily average were compared between the control group and intervention group. The common type of irrational outpatient and emergency intravenous orders mainly included irrational use of solvents, irrational dosing interval and inappropriate compatibility of drugs. The irrational rate was reduced from 17.4% to 3.3% （P〈0.01）, and the irrational number of daily average was decreased from 5.23 to 1.00 （P〈0.01）. Pharmacy intervention can reduce the irrational rate of medical orders in our hospital, which is of great significance to promote rational drug use and improve medical quality.
基金Project(2016YFC0802904)supported by the National Key Research and Development Program of China
文摘Aiming at dealing with the difficulty for traditional emergency rescue vehicle(ECV)to enter into limited rescue scenes,the electro-hydraulic steer-by-wire(SBW)system is introduced to achieve the multi-mode steering of the ECV.The overall structure and mathematical model of the SBW system are described at length.The fractional order proportional-integral-derivative(FOPID)controller based on fractional calculus theory is designed to control the steering cylinder’s movement in SBW system.The anti-windup problem is considered in the FOPID controller design to reduce the bad influence of saturation.Five parameters of the FOPID controller are optimized using the genetic algorithm by maximizing the fitness function which involves integral of time by absolute value error(ITAE),peak overshoot,as well as settling time.The time-domain simulations are implemented to identify the performance of the raised FOPID controller.The simulation results indicate the presented FOPID controller possesses more effective control properties than classical proportional-integral-derivative(PID)controller on the part of transient response,tracking capability and robustness.
基金The study protocol was reviewed and approved by the Institutional Review Board of the Second Affiliated Hospital of Zhejiang University School of Medicine(IRB number:IR2020001036).
文摘BACKGROUND:Consenting to do-not-resuscitate(DNR)orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments(EDs).The DNR decision in EDs has not been extensively studied,especially in the Chinese mainland.METHODS:This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019.The patients with out-of-hospital cardiac arrest were excluded.RESULTS:There were 214 patients’deaths in the ED in the three years.Among them,132 patients were included in this study,whereas 82 with out-of-hospital cardiac arrest were excluded.There were 99(75.0%)patients’deaths after a DNR order medical decision,64(64.6%)patients signed the orders within 24 hours of the ED admission,68(68.7%)patients died within 24 hours after signing it,and 97(98.0%)patients had DNR signed by the family surrogates.Multivariate analysis showed that four independent factors infl uenced the family surrogates’decisions to sign the DNR orders:lack of referral(odds ratio[OR]0.157,95%confi dence interval[CI]0.047–0.529,P=0.003),ED length of stay(ED LOS)≥72 hours(OR 5.889,95%CI 1.290–26.885,P=0.022),acute myocardial infarction(AMI)(OR 0.017,95%CI 0.001–0.279,P=0.004),and tracheal intubation(OR 0.028,95%CI 0.007–0.120,P<0.001).CONCLUSIONS:In the Chinese mainland,the proportion of patients consenting for DNR order is lower than that of developed countries.The decision to sign DNR orders is mainly affected by referral,ED LOS,AMI,and trachea intubation.
文摘BACKGROUND:Paramedic and emergency personnel may encounter directly many events that threat their own wellbeing during their daily work.This study was conducted to examine the prevalence rate of post-traumatic stress disorder(PTSD) among two groups of paramedic and emergency personnel in south-east Iran.METHODS:The study employed a descriptive design and was conducted in four hospital emergency wards and a pre-hospital emergency base supervised by Kerman Medical University.Using Mississippi PTSD,we assessed the prevalence rate in paramedics(n=150) and emergency personnel(n=250).RESULTS:The two groups had different levels of education,marital status,experience of traumatic events,work hours per month,and gender.Most(94%) of paramedic and hospital emergency personnel reported moderate PTSD.The two groups had significant different levels of PTSD in all subscale.CONCLUSION:The study suggests that health care managers should organize systematic and dynamic policies and procedures in dealing with PTSD to assist both groups of personnel.
基金partially supported through the Johns Hopkins-Pakistan International Collaborative Trauma and Injury Research Training program(grant number 2D43-TW007-292)from the Fogarty International Center of the United States,National Institutes of Healthpartially supported from department of Community Health Sciences,Aga Khan University,Karachi,Pakistan
文摘BACKGROUND: The purpose of the study was to explore the association between posttraumatic stress disorder(PTSD) and work performance of emergency medical services personnel in Karachi, Pakistan.METHODS: Emergency medical service personnel were screened for potential PTSD using Impact of Event Scale-Revised(IES-R). Work performance was assessed on the basis of fi ve variables: number of late arrivals to work, number of days absent, number of days sick, adherence to protocol, and patient satisfaction over a period of 3 months. In order to model outcomes like the number of late arrivals to work, days absent and days late, negative binomial regression was applied, whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores.RESULTS: Mean scores of PTSD were 24.0±12.2. No association was found between PTSD and work performance measures: number of late arrivals to work(RRadj 0.99; 0.98–1.00), days absent(RRadj 0.98; 0.96–0.99), days sick(RRadj 0.99; 0.98–1.00), adherence to protocol(ORadj 1.01; 0.99–1.04) and patient satisfaction(β 0.001%–0.03%) after adjusting for years of formal schooling, living status, coping mechanism, social support, working hours, years of experience and anxiety or depression.CONCLUSION: No statistically significant association was found between PTSD and work performance amongst EMS personnel in Karachi, Pakistan.
基金Science and Technology Development Plan Project of Suzhou(SKJYD2021035)Science and Technology Development Plan Project of Suzhou(SKJYD2022078)The Key Project Research Fund of the Second Affiliated Hospital of Wannan Medical College(YK2023Z04)。
文摘BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.
文摘We analyze a continuous review lost sales inventory system with two types of orders—regular and emergency. The regular order has a stochastic lead time and is placed with the cheapest acceptable supplier. The emergency order has a deterministic lead time is placed with a local supplier who has a higher price. The emergency order is not always filled since the supplier may not have the ability to provide the order on an emergency basis at all times. This emergency order has a higher cost per item and has a known probability of being filled. The total costs for this system are compared to a system without emergency placement of orders. This paper provides managers with a tool to assess when dual sourcing is cost optimal by comparing the single sourcing and dual sourcing models.
文摘The purpose of our Quality Improvement (QI) project was to evaluate the effectiveness of radiology-led didactics on efficiency and ordering practices in the emergency department. Residents of the emergency medicine (EM) program at Downstate Medical Center/Kings County Hospital (postgraduate years 1 - 4) participated in a didactic lecture series during the first two months of the 2013 academic year. Two fifteen-minute lectures with a question and answer session were designed to focus on radiation risk, American College of Radiology (ACR) appropriateness criteria and the department of radiology’s policies. A short survey questionnaire that included questions on ACR appropriateness criteria, radiology experiences and opinions/attitudes regarding radiology was distributed and analyzed before and after the didactic series. The average score for the knowledge-based technical questions on ACR appropriateness criteria was 60.5% initially and 76.4% post-lecture with an overall improvement of 25%, which was statistically significant (p < 0.0001). Following a short didactic lecture series, EM residents showed significant improvement of their knowledge of appropriate image utilization on the post-lecture survey. This highlights the need for dedicated radiology-led lecture series for EM residents. This type of program could be implemented yearly and expanded to other departments to promote interdepartmental commuication, increases radiology awareness, improves ordering practices and encourages appropriate imaging utilization.
基金the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine,No. 2017-XK-A36
文摘BACKGROUND In the past years,only a few studies with a limited number of adult patients analyzed clinical features of allied disorders of Hirschsprung’s disease(ADHD),most of which were individual case reports or lacked detailed clinical information.Although many studies have reported patients presenting to the emergency department(ED)with recurrent abdominal symptoms for a number of disorders,there are few data involving ADHD.However,owing to a lack of awareness of the disease,misdiagnoses and mistreatments are common.Severe complications such as perforation,bleeding,malabsorption,and even death in ADHD had been reported by many studies.AIM To assist ED clinicians in having a more comprehensive understanding of this disease and making an early suspected diagnosis of ADHD more effectively.METHODS We enrolled 53 patients who visited the ED and were eventually diagnosed with ADHD over the past 11 years in our hospital.Their basic information,clinical manifestations,and imaging findings were analyzed.Blood indices were compared between the ADHD and irritable bowel syndrome(IBS)groups.RESULTS Adult patients with ADHD had a mean age of 48.8±14.3 years,and 77.4%had been treated before admission.The transverse colon was the most common dilated part(73.6%),and constipation(67.9%)was the most common symptom.ADHD patients can present with uncommon symptoms and false-negative imaging findings.Logistic regression analysis indicated that body mass index(BMI)[odds ratio(OR)=0.786,P=0.013],cholinesterase(per 1000 units;OR=0.693,P=0.008),and blood chlorine(OR=0.816,P=0.022)were determined to be independent related factors between the ADHD and IBS groups.The area under the receiver operating characteristics curve of these three indices combined was 0.812(P<0.001).CONCLUSION Emergency physicians should be vigilant regarding patients with chronic constipation,abdominal pain,or abdominal distension,and consider the possibility of ADHD despite its rarity.Abdominal computed tomography examination is recommended as a useful tool in the suspected diagnosis of ADHD.BMI,cholinesterase,and blood chlorine have good discriminative abilities between ADHD and IBS.The nutritional status of adult patients with ADHD is worthy of further attention.Surgical treatment for adult patients with ADHD is important and inevitable.
基金the National Natural Science Foundation of China(Grant No.:71771061).
文摘This study investigated the application and the application value of intelligent emergency in emergency management in the big data environment.It addresses the neglect of the application value(performance)measurement of intelligent emergency,further improving the effectiveness of intelligent emergency management.First,approximately 3,900 documents from the intelligent emergency field are analyzed to determine the future research trend in intelligent emergency management.The socio-technical theory concerning technical and social systems is introduced.The emergency management system concepts of“technology enabling”and“enabling value creation”are defined according to bibliometric analysis and socio-technical theory.Second,a research framework that includes technology enabling and enabling value creation for the decision-making paradigm in emergency management according to the big data environment is constructed.A detailed analysis approach from intelligent emergency technology enabling to enabling value creation in emergency management is proposed.Finally,earthquake disasters are taken as examples,and specific analyses of the intelligent emergency enabling and enabling value creation are explored;enabling value creation is discussed based on measurable indicators.The clear concept of emergency management system technology enabling and enabling value creation,as well as the detailed analysis approach from intelligent emergency technology enabling to enabling value creation,provide a theoretical bases for scholars and practitioners to evaluate the value(performance)of intelligent emergency for the first time.
基金National Natural Science Foundation of China(U24A20714 to XMF and 82102238 to PC)。
文摘BACKGROUND:Tracheal intubation(TI)is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine.Tracheal intubation in the lateral position(TILP)has been utilized in clinical practice,demonstrating potential advantages in specific scenarios,including emergency settings.However,there is a lack of comprehensive reviews and practical protocols on TILP application.To address this gap,we performed a narrative review,and provided evidence-based recommendations to formulate a practice protocol,to assist clinicians to effectively apply TILP.METHODS:We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience.Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus.The practice protocols were formulated as warranted by advancements in medical knowledge,technology,and practice.RESULTS:This narrative review summarized the current evidence on TILP application,highlighting its safety,efficacy,challenges,and potential complications.In total,24 recommendations and a clinical protocol for TILP application in emergency patients were established.CONCLUSION:TILP is a valuable technique in emergency medicine.We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol.Future studies are needed to evaluate the safety and efficacy of TILP,broaden its scope of application,and explore effective training protocols.
基金the National Research Foundation of Korea(NRF)grant funded by the Korea government(MSIP)(No.NRF-2020R1A2B5B0100208).
文摘During the rapid spread of COVID-19,first responders are at risk of being exposed to COVID-19 due to their role in providing first aid and responding to an unspecified number of people.This uncertainty can have adverse mental health effects,such as increased anxiety and fear.This study aimed to investigate the degree of association between fear of COVID-19,obsession with COVID-19,and post-traumatic stress disorder(PTSD)in emergency rescue firefighters.The participants were 150 emergency rescue firefighters working in Region S,Korea.They filled out self-report questionnaires:The data obtained through the Fear of COVID-19 Scale,Obsession with COVID-19 Scale,and Impact of Event Scale-Revised Korean version were subjected to nonparametric statistical analysis using SPSS WIN 25.0.The study found a significant correlation between emergency rescue firefighters’fear of COVID-19,obsession with COVID-19,and PTSD.Fear and obsession with COVID-19 were higher among first responder firefighters who were directly involved in COVID-19-related tasks.Furthermore,a one-point increase in obsession was associated with a 2.837-point increase in PTSD.Based on the results,we found that there is a need for effective control of obsessions and fears among first responder firefighters during COVID-19,and we suggest that there is a need for mental health care for first responder firefighters during the pandemic through the development and support of programs to prevent and mitigate obsessions.
