Abstract Background: All the existing frameworks of Health-Emergency Disaster Risk Management have put great emphasis on the use of educational strategies to be used as a mean of disaster risk reduction (DRR). Thus, this study was conducted to formulate experts' consensus on DRR educational strategies for Middle East/North Africa (MENA) countries. Methods: A Delphi study on expert's opinion for DRR educational strategies was carried out through surveys in two consecutive rounds through convenient sampling technique. Results: A total of 60 responses were included in this study. Most of the participants were Saudi nationals, physicians (36.7% vs. 33.3% in round 1 and round 2, respectively), and males (73.3%) with experience in disaster management (56.7%) of 5-10 years (60% vs. 53.3% in round 1 and round 2, respectively). Around 80% participants suggested that graduate health professional education should be through problem based learning (PBL) approach (36.7%) (P-value = 0.007). Universal Design for... Continue Reading

Background: The healthcare sector witnessed the occurrences and impacts of disruptions on supply chains during the coronavirus disease (COVID-19) pandemic. Consequently, it is essential to strengthen institutional medical supply chain systems by addressing the key attributes of strategic stockpile plan renewal: flexibility, traceability and transparency, perseverance and responsiveness, global independence, and equitable access. Aim and objective: To establish a resilient supply chain integrated into the emergency management cycle by proposing a sustainable 5P Strategic Medical Stockpile model. Settings: Online evidence, available literature, and lessons learned during the COVID-19 response in the Emirate of Abu Dhabi. Methods: This review employed a systematic methodology of identification, selection, assessment, synthesis, and interpretation of data from peer-reviewed articles, review reports, and response frameworks spanning the years 2012 to 2020. Additionally, media reports and announcements were analyzed to determine the implications of COVID-19 on the supply chain from 2020 to 2022. Recommendations are formulated in... Continue Reading

Background: Due to the COVID-19 pandemic, full time lockdown was applied in many countries around the world. Published literature shows that the risk of suicide and assaults has increased but the risk of motor vehicle accidents has reduced. In this research, we want to study the impact of lockdown during the COVID-19 pandemic on the trauma cases who presented to the trauma cen-ter. Method: This retrospective cross-sectional study retrieved all the trauma cases who presented to the Emergency department in Rashid hospital during April 2019 and April 2020 from the patients' electronic records system. We included all the trauma cases who fell in the Canadian Triage and Acuity Scale (CTAS) of T1-T3 only. Results: Total of 3,268 trauma cases were studied. The number of cases in April 2019 was double the cases in 2020. However, the pattern of injuries was variable in the two years. There were high-er rates of... Continue Reading

Background: Pediatric fractures constitute a significant public health concern globally, with varying implications on healthcare systems and affected individuals. While global trends have been well-documented, research in Saudi Arabia, particularly within a tertiary care setting, continues to contribute significantly to the understanding of this issue. Methods: This retrospective chart review, conducted over a four-year period from 2019 to 2023, analyzed pediatric fracture cases at a major hospital in Riyadh, Saudi Arabia. The study included 286 children aged 14 years or younger presenting with new fractures. Data on demographics, fracture types, anatomical locations, and treatment modalities were extracted from electronic health records and analyzed using IBM SPSS Statistics Version 25. Results: The study found a higher incidence of fractures in males, particularly increasing after age 8, with radial, metatarsal, and humeral fractures being the most common. Radial fractures, especially distal radial fractures, were predominant, and the majority were treated with casts... Continue Reading

Abstract Background: The learning management system (LMSs) are online platforms that are used to conduct and support teaching and training at various institutions worldwide. Therefore, this study aimed to assess the perception towards the use of Moodle and Google classrooms LMS tools in the training among the National Health Emergency Operation Center (NHEOC) staff and compare their perceptions. Methods: This was a cross-sectional study with a post-test design conducted at NHEOC in Saudi Arabia in 2023. A training program regarding crises and disaster situations was delivered via Moodle and Google classrooms. At the end of each session, participants were invited to fill a questionnaire regarding their perception towards these tools. Results: A total of 72 and 65 individuals responded to the questionnaire after the end of Moodle class and Google classrooms, respectively. There were no statistically significant differences in the mean perception scores between Moodle and Google classrooms by; the... Continue Reading

Background Healthcare medical dispatch systems play a fundamental role in the daily operations of prehospital services. This includes facilitating the interpretation of various dispatch-related systems, receiving incident calls, categorizing cases, guiding proper resources deployment, and providing proper instructions before the arrival of healthcare providers. Considering the Kingdom of Saudi Arabia's (KSA's) health sector transformation plan as part of Vision 2030, developing an Emergency Medical Dispatch (EMD) Program as part of essential prehospital services will allow rapid and competent healthcare delivery. In this study, our purpose is to describe the curriculum development of the EMD Program to improve the training of dispatchers and to share the experience in the interest of better prehospital dispatch systems. Methods A selected group of education experts and academics in emergency medical services dispatch were assigned to develop an EMD curriculum over six months. This study aims to describe the approach followed in developing an innovative... Continue Reading

Background: Burnout syndrome is a frequent challenge faced in the emergency department. There exists a dearth of clinical evidence regarding the risk and occurrence of burnout, among emergency residents in Saudi Arabia. Therefore, this study was conducted to assess the parameters of burnout in this cohort. Methods: This prospective, cross-sectional study was conducted via an online survey using Maslach Burnout Inventory for Healthcare Professionals (MBI-HSS) questionnaire. All emergency medicine residents registered under the country's residency program were invited to participate. The relative importance index (RII) analysis was used to describe the frequency of the MBI-HSS indicators. The t-test of independent groups and the one-way analysis of variance were used to assess the impact of demographic and professional factors. Results: A total of 73 residents completed the questionnaire. Low PA was reported by 53.4% while medium to high DP and EE were reported by 84.9% and 67.1% residents respectively. Female residents... Continue Reading

Background: Shoulder dislocations are common occurrences, with anterior shoulder dislocations being the most prevalent. Various reduction techniques are employed, but success rates and influencing factors remain variable. This study aims to evaluate the success rate of anterior shoulder reductions performed by emergency physicians, as well as factors contributing to reduction failure and extended emergency department (ED) stay. Methods: A retrospective cross-sectional study was conducted at King Abdulaziz Medical City from 2019 to 2022, focusing on patients presenting with closed anterior shoulder dislocation. Data were collected from medical records included patient demographics, mechanism of injury, method of reduction, and length of stay in the ED. Statistical analyses explored associations and relationships between variables. Results: A total of 179 patients were included. The mean age was 32 years. Most patients had normal BMI (34.6%), and the right shoulder was more frequently affected (56.4%). Falls (38.0%) and daily activities (33.5%) were common mechanisms... Continue Reading

Background and Objective: Point-of-care ultrasound (POCUS) has become an integral part of the curricula of various spe-cialty residency programs. POCUS education requires learners to be proficient in image acqui-sition, image interpretation, and integration into clinical practice. The assessment of POCUS skills and competency is variable. This study aimed to assess the validity and reliability of us-ing still ultrasound images as examination test items without providing clinical vignettes or anatomical locations. Methods: This is a proof-of-concept survey pilot study, residents from the Middle East who had com-pleted their training in emergency medicine were surveyed during their competency assess-ment examination. They were provided with a single ultrasound image of an abdominal aortic aneurysm in both print and PowerPoint slide format. The task was to identify the diagnosis based on this image, which was taken from a reference emergency medicine textbook. Results: The study showed that only 50% of the residents correctly identified... Continue Reading

This study sought to determine the perception of healthcare workers (HCWs) about pre-hospital airway management and their experiences. Methods: This cross-sectional study was conducted among health workers at the emergency department of King Fahad Medical City in the capital of Saudi Arabia, Riyadh City. This study targeted physicians, nurses, paramedics, and respiratory therapists. Data were collected using an online questionnaire. The questionnaire included demographic characteristics, training, and experiences in airway management and a 5-item questionnaire to measure the perception of HCWs about airway management. Results: Of the 100 HCWs, 39% were doctors, and 37% were nurses. Approximately 23% had a poor experience with intubation. Traumatic injuries were the major difficulties involving airway management (44%). The overall perception of HCWs about prehospital airway management was good (68%), 31% were moderate, and only 1% were considered poor perception levels. No significant differences were observed between perception scores in relation to the demographic... Continue Reading

Acetaminophen overdose treatment in patients admitted to two tertiary centers in Oman, variation and pitfalls Continue Reading

Background: Heat-related illnesses (HRI) are defined as elevated body core temperatures when exposed to an intense high temperature. HRIs include but are not limited to heat exhaustion (HE) and heat stroke (HS). HE and HS are among the leading causes of morbidity and mortality among pilgrims when the Hajj season occurs during the hot cycle of the year in Makkah. Methods: A retrospective cross-sectional data analysis was conducted on HRI cases during Hajj 2022/1443 Hijri. The data were extracted from the Hajj electronic health records system software immediately at the end of the Hajj period. Results: A total of 200 patients presented with HRI symptoms during the study period. Over half of the HRI patients were male (n=116, 58%). The mean age was 44 ± 14.6 years. One hundred forty-three patients (71.5%) were diagnosed with HE, while 57 (28.5%) were diagnosed with HS. A statistically significant association between age and... Continue Reading

Background: The diagnosis of meningitis in the infancy period is a challenging. Clinical evaluation and high index of suspicion with early empirical treatment guidelines continue to evolve and support physician efforts to decrease the morbidity and mortality associated with pediatric meningitis. Case report: We report a case of a previously healthy 2-month-old male who presented with excessive crying, preceded by subjective fever and watery diarrhea, for one day without any other symptoms. Parents gave multiple antipyretic doses at home for irritability which might mask his fever. The patient was tachycardic with an unremarkable physical exam. Full septic work-up done after stabilization of the patient and empirical antibiotics started. His blood culture grew Neisseria meningitides which caused meningoencephalitis and ventriculitis with bilateral extra-axial collection, the patient was in septic shock with multiple organ dysfunction. Conclusion: Meningococcal meningitis in the neonatal and infancy periods remains a serious health threat with high morbidity... Continue Reading

Background: An increased incidence of vertebral artery dissection has recently become a recognized cause of acute stroke for about 1/5 of strokes in young patients. Case Presentation: A male in his 30s presented to the emergency department with sudden onset of severe vertigo, vomiting, and dizziness while he was playing bowling. The symptoms started when he suddenly twisted his neck while throwing the ball towards pins. Initial diagnosis of central vertigo led to performing plain CT head and CT head angiogram, which demonstrated non-occlusive extradural left vertebral artery dissection. Following CT scans, an MRI head, and MRA head and neck were performed which confirmed the CT diagnosis and also showed left posterior inferior cerebellar artery territory infarcts with micro haemorrhages. The patient was started on dual antiplatelet medications which was continued for 6 months with a follow up MRI/MRA scan of head and neck. Conclusion: This appears to be a... Continue Reading

Background: Cardioversion is the treatment of choice in an unstable patient with arrhythmia. It requires analgesia and sedation, which is usually given via intravenous route. However, when there is a failure to get vascular access, alternatives routes to intravenous (IV) sedation and analgesia are needed. Case Presentation: A 59 year old male patient was presented to the emergency department (ED) complaining of chest pain and palpitation. His electrocardiogram (ECG) showed new onset rapid narrow complex atrial fibrillation, which then converted to wide complex tachycardia. Initially, the patient remained hemodynamically stable, but his blood pressure dropped, when cardioversion was indicated. In this case, intranasal (IN) and intraosseous (IO) routes were used, both of which are uncommon to be used for sedation in an unstable patient. The sedatives bioavailability and dosage via non intravenous (non-IV) routes are not commonly used, hence, literature was reviewed to find out the appropriate sedative dosage via... Continue Reading