BACKGROUND

Pediatric Early Warning Scores (PEWS) help identify children at risk of clinical deterioration, but their accuracy across diverse settings, populations, interventions, and outcomes remains unexplored.

To determine the accuracy of PEWS in detecting clinical deterioration events (CDE) among pediatric patients seen at the emergency department (ED).

Retrospective cohort study.

Pediatric patients aged 1 month to 18 years seen at the ED.

Southern Philippines Medical Center Emergency Department, Davao City, Philippines from January 2021 to December 2022.

Area under the curve (AUC) of PEWS in detecting CDE; Brighton PEWS optimal cut-off and its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR).

Among the 345 patients, 56 experienced CDE and 289 did not. Patients with CDE had significantly lower median age (1.00 year vs 5.00 years; p < 0.001), oxygen saturation (93.00% vs 98.00%; p < 0.001), and pediatric Glasgow Coma Scale scores (8.00 vs 15.00; p < 0.0001) compared to those without CDE. Heart rate (135.00 vs 111.00 beats per minute; p < 0.001), and respiratory rate (32.50 vs 24.00 breaths per minute; p < 0.001) were significantly higher in patients with CDE. The two groups also differed significantly in terms of comorbidity distribution (p < 0.001) and diagnosis (p < 0.001). The AUC of Brighton PEWS was 0.9064 (95% CI 0.8716 to 0.9357), with an optimal cut-off score of ≥4.00. This threshold yielded 76.79% sensitivity, 88.58% specificity, 56.60% PPV, 95.20% NPV, 6.72 LR+, and 0.26 LR-.

The Brighton PEWS demonstrates strong diagnostic accuracy in predicting CDE among pediatric patients. A cut-off score of ≥4.00 offers a balanced combination of sensitivity, specificity, and likelihood ratios for ED application.

INTRODUCTION

The Philippines is considered a disaster-prone country, making basic pre-hospital trauma care essential in the disaster response. The Bureau of Fire Protection (BFP) is mandated by law as the lead agency in providing emergency medical services (EMS) in the country, which plays a critical role in disaster response. This study aimed to investigate the influence of the different factors (knowledge, training, experience, and logistics) on the disaster preparedness of the BFP EMS personnel and to identify the strongest predictor among the factors.

A correlational study was done among 125 EMS personnel in the Bureau of Fire ProtectionNational Capital Region (BFP-NCR) using stratified random sampling. A four-part questionnaire, which included a demographic form, a 20-item knowledge test, a logistics compliance checklist from the Department of Health licensing tool, and the Emergency Preparedness Information Questionnaire (EPIQ) was used. Statistical analysis done were Pearson correlation and logistic regression.

The findings showed that knowledge (OR = 0.299, 95% CI: 0.128–0.689), training (OR = 3.2, 95% CI: 1.8–5.6), and experience (OR = 1.9, 95% CI: 1.1–3.4) affected the level of disaster preparedness. Furthermore, logistics did not show a significant effect (p > 0.05).

The strongest predictor of disaster preparedness among the factors is knowledge. Even though logistics is an essential factor, its effectiveness still depends on the proper utilization by trained personnel. Recommendations include continuous training and retention of experienced personnel, which are essential to enhance BFP EMS readiness during disasters.

Objective:To determine the association of demographic profiles and clinical characteristics of patients with aural foreign bodies seen at the Emergency Room (ER) of the East Avenue Medical Center with clinical outcomes

Methods:
Design:Cross-Sectional Study
Setting:Tertiary Government Training Hospital
Participants:A total of 143 aural foreign body cases seen at the ER from January to December 2022 under the Department of Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) of East Avenue Medical Center were included in the study.

Results: Of the 143 patients, majority (84; 58.74%) were males. Mean age was 21.92 years old with two peak incidences noted at ages 1-12 years old and 18-65 years old. Most of the patients were right-handed (134; 93.71%). Majority of the foreign bodies were animate (76; 53.15%) and were frequently found to be lodged on the right ear (86; 60.14%) with duration from lodgment to
extraction commonly within less than 24 hours (119; 83.22%). One hundred forty two (99.30%) patients had successful foreign body extraction, 60 (41.96%) had complications, specifically involving the external auditory canal (51; 35.66%) and tympanic membrane (6; 4.20%). Significant associations were found between age and type of foreign body [χ2 (3, N =143) = 31.24, p < .01] with a higher proportion of animate foreign bodies in adults and inanimate foreign bodies in children; sex and presence of complications [χ²(1, N = 143) = 5.41, p < .05] with males experiencing more complications than females; type and duration of foreign body [, χ²(2, N = 143) = 16.33, p < .01] with animate foreign bodies generally having a shorter duration of less than 24 hours compared to inanimate foreign bodies; and the duration of foreign body and presence of TM complications [χ²(4, N = 143) = 14.21, p < .01] with shorter durations (less than 24 hours) showing fewer TM complications. Males had higher odds of developing complications compared to females (OR = 2.315, 95% CI [1.105, 4.851])

BACKGROUND AND OBJECTIVE

First responders must be physically and mentally healthy to ensure effective emergency response. However, literature showed that Filipino first responders continue to have elevated levels of stress and increased risk for post-traumatic stress and other mental health problems months after their deployment. The “Mi Salud” app was created to help Filipino first responders, their team leaders, and their agencies monitor and manage the responders’ real-time stress levels before, during, and after their deployment more effectively.

The “Mi Salud” app was pretested with Filipino first responders (n=30) to establish convergent validity using existing validated scales measuring the same construct. Participants also completed a Likert scale and questionnaire to assess user experience and app recommendations. During the rollout, first responders (n=32) tested the app and completed a survey on user experience and app recommendations. A focus group discussion (n=11; FGD) was conducted to further explore their experiences with the app. Survey data were analyzed using descriptive statistical methods, while FGD data were examined through thematic analysis.

Results from the online survey showed that the app was generally found to be helpful and that the recommendations within the app were useful. The emerging themes from the FGD corroborated many of the themes from the survey, particularly the benefits of using the app and the app’s ease of use. Positive effects were observed both on the responders and on the responders’ team leader and teammates, which further established the value of the “Mi Salud” app.

The findings show that the “Mi Salud” stress check-app may serve as a useful tool for monitoring and managing the stress levels, a critical aspect for Filipino first responders to maintain optimal functioning during deployments and daily activities.

Background: Burnout is a pressing concern among Emergency Ward (EW) nurses, stemming from the intense demands of their profession, including long hours, exposure to traumatic events, and the need for quick decision-making. This issue not only affects nurses' well-being but also has repercussions for patient care and the healthcare system. Objective: This study aimed to investigate the association between effort-reward and work-life imbalance on burnout among EW nurses in a public hospital. Methods: The study was a cross-sectional analytical study conducted from February to May 2022 involving 32 EW nurses employed at Public Hospital I.A. Moeis Hospital in Samarinda City, Indonesia. The research employed several instruments for data collection through stratified random sampling. Chi square and logistic regression analysis were performed to assess the factors contributing to burnout among EW nurses, including effort-reward imbalance, worklife balance, namely monotonous work, self-efficacy, communication among healthcare professionals, and workload. Result: There was positive correlation between effort-reward and work-life imbalance on burnout among EW nurses. The multivariate test results showed that workload, self-efficacy, communication, and monotonous work had higher risk of developing burnout in EW nurses. Conclusion In this study, we found that effort-reward and work-life imbalance were significantly associated with burnout in EW nurses in a public hospital. The development of comprehensive assessment of burnout among EW nurses and its early intervention should be warranted.
Burnout, Psychological ; Emergency Ward ; Emergency Service, Hospital ; Nurses ; Hospitals, Public

BACKGROUND

Palliative Care focuses on the needs of both the patient and their families, aiming to enhance their overall quality of life. It achieves this by anticipating, preventing, reducing, and treating suffering through comprehensive support across various aspects of life. This approach promotes patient autonomy, provides access to information, and encourages the freedom to make choices. Referring patients to Supportive and Palliative Care in a timely manner enhances their quality of life, improving symptom control, mood, and understanding of their illness. Additionally, it reduces distress for both the patient and their caregiver during the end-of-life period.

This study aimed to determine the proportion of late referrals among patients diagnosed with debilitating illnesses consulting at the Emergency Department of Batangas Medical Center from July to December 2022 and who needed Supportive and Palliative Care using the Palliative Care and Rapid Emergency Screening Tool, considering age, sex, and the specific diagnosis of the debilitating illness. Additionally, the timing of referrals for both discharged and admitted patients requiring Supportive and Palliative Care was described, with categories including those referred within one week, beyond one week, and those not referred at all.

This retrospective study was conducted via chart review of all patients with debilitating illnesses who visited the Emergency Department of Batangas Medical Center, admitted or discharged, from July 2022 to December 2022. Timing of referral to Supportive and Palliative Care was obtained from the admission charts and/or the SPC referral logbook. Frequency analysis specifically frequency tabulation was used to summarize data.

Between July and December 2022, 2,097 patients diagnosed with debilitating illnesses at the Emergency Department were identified. Only 2.52% of them received referrals to Supportive and Palliative Care, and among this group, more than half (38) were referred later than one week after diagnosis.

This study identified the need for comprehensive improvements in the referral process, emphasizing timely access to Supportive and Palliative Care for patients of all demographic facing debilitating illnesses. The call for systemic changes advocates for clear protocols and guidelines, reducing oversight and delays. The Palliative Care and Rapid Emergency Screening Tool can streamline referrals, while collaboration between healthcare providers and the palliative care team ensures a more efficient system. Strategies advocating for healthcare infrastructure improvement and awareness campaigns may be developed to facilitate timely referrals for patients across age and gender spectrums.

A crucial lesson gained through the pandemic preparedness and response to COVID-19 is that all measures for epidemic control must be law-based. The legal system is related not only to public health emergency management per se but also to all aspects of the institutional supporting system throughout the lifecycle. Based on the lifecycle emergency management model, this article analyses the problems of the current legal system and the potential solutions. It is suggested that the lifecycle emergency management model shall be followed to establish a more comprehensive public health legal system and to gather the intelligence and consensus of experts with different expertise, including epidemiologists, sociologists, economists, jurist and others, which will collaboratively promote the science-based legislation in the field of epidemic preparedness and response for the establishment of a comprehensive legal system for public health emergency management and with Chinese characteristics.
Humans ; China ; Pandemics/prevention & control* ; Public Health ; Emergencies ; Disaster Planning

In the Philippines, organ donation is regulated under the Organ Donation Act (RA7170) and promoted by the Department of Health through the Philippine Network for Organ Sharing (PHILNOS). The number of organ donors to meet the increasing demand in the country continues to lag. The emergency department (ED) was identified in several foreign studies to be a significant source of successful organ donation. This action research project investigated the attitude and perception of 125 ED healthcare workers (HCWs) from three hospitals in Metro Manila before and after an awareness event. The study reveals that ED nurses and doctors are generally supportive and hold positive perceptions and attitudes toward organ donation. Despite the positive attitude, HCWs seem to be uncomfortable or unwilling to perform tasks important to organ donation such as approaching relatives and management of the deceased organ donor. Future training on organ donation will increase the positive attitude, confidence and likelihood to participate in organ donation and transplant activities.
Tissue and Organ Procurement ; Emergency Service, Hospital

Humans ; COVID-19/epidemiology* ; Contact Tracing ; Pandemics ; SARS-CoV-2 ; Emergency Service, Hospital

Child ; Humans ; Nitrous Oxide ; Emergency Service, Hospital