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Background Mass chemical exposure emergencies are infrequent but can cause injury, illness, or loss of life for large numbers of victims. These emergencies can stretch and challenge the available resources of healthcare systems within the community. Political unrest in the Middle East, including chemical terrorist attacks against civilians in Syria and increasing chemical industry accidents, have highlighted the lack of hospital preparedness for chemical incidents in the region. This study aimed to evaluate the effectiveness of a course designed to empower frontline healthcare providers involved in mass casualty incidents with the basic knowledge and essential operational skills for mass chemical exposure incidents in Saudi Arabia. Methods A mixed-methods approach was used to develop a blended learning, simulation enhanced, competency-based course for major chemical incidents for front line healthcare providers. The course was designed by experts from different disciplines (disaster medicine, poisoning / toxicology, and Hazard Material Threat - HAZMAT team) in four stages. The course was piloted over five days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia). The 41 participants were from different government health discipline sectors in the country. Pre- and post-tests were used to assess learner knowledge while debriefing sessions after the decontamination triage session and simulation-enhanced exercises were used for team performance assessment. Results The overall knowledge scores were significantly higher in the post-test (69.47%) than the pre-test (46.3%). All four knowledge domains also had significant differences between pre- and post-test results. There were no differences in the pre and post-test scores for healthcare providers from the different health disciplines. A one-year post-event survey demonstrated that participants were satisfied with their knowledge retention. Interestingly, 38.3% had the opportunity to put this knowledge into practice in relation to mass chemical exposure incidents. Conclusion Delivering a foundation level competency-based blended learning course with enhanced simulation training in major chemical incidents for front line healthcare providers may improve their knowledge and skills in response to such incidents. This in turn can improve the level of national preparedness and staff availability and make a crucial difference in reducing the health impacts among victims.

Ongoing professional development constitutes an essential and necessary process for healthcare practitioners, thereby ensuring their proficiency and relevance within the field. This quantitative summative program evaluation compared the effectiveness of Virtual Reality (VR) technology versus traditional manikin-based simulation in teaching basic rescue skills to first responders in Saudi Arabia. The study, conducted through the Academy of Sciences (AOS), addressed the growing need for innovative, engaging, and efficient healthcare education methods, particularly in the context of the post-COVID-19 landscape. The research evaluated the “Mongeth” VR program against conventional manikin simulation training, focusing on key rescue skills including CPR, AED usage, stop the bleed, and choking management. Participants ( N  = 98) were divided into VR ( n  = 58) and Manikin ( n  = 40) groups. Performance was assessed using standardized checklists for various rescue skills. Results demonstrated significantly higher performance scores in the VR group for AED usage ( p  < 0.001), adult choking management ( p  = 0.009), infant choking management ( p  = 0.009), and CPR ( p  < 0.001). Only the Stop the Bleed assessment showed no significant difference between groups ( p  = 0.096). Through the lens of Social Cognitive Theory, the study revealed that VR training enhanced learner engagement and self-efficacy while reducing time investment. The findings suggest that VR technology provides a more time-efficient and engaging alternative to traditional manikin-based training, with significant improvements in skills like CPR and choking management, particularly beneficial for busy healthcare professionals and community members requiring basic rescue skills certification. This research contributes to the growing body of evidence supporting the integration of VR technology in healthcare education and has implications for improving population health through more accessible and effective training methodologies.

Background: Overcrowding in Emergency departments adversely impacts efficiency, patient outcomes, and resource allocation. Accurate triage systems are essential for prioritizing care and optimizing resources. While traditional methods provide a foundation, they often lack precision in addressing modern healthcare complexities. Artificial intelligence (AI) and machine learning (ML) offer advanced capabilities to enhance triage accuracy, improve patient prioritization, and support clinical decision-making, addressing limitations of conventional approaches and paving the way for adaptive triage solutions. Objective: This systematic review aims to assess the use of artificial intelligence (AI) and machine learning (ML) in determining the outcomes of patients presenting in Emergency department (ED) triage. Methods: A systematic search was conducted on April 21, 2023, using electronic databases including PubMed/Medline, Cochrane Library, Ovid, and Google Scholar, without year restrictions. The main outcome of this review was to assess the use of AI and ML in the ED Triage. Articles that used different models of AI and ML to predict various outcomes of patients in the ED setting were included. Results: A total of 17 studies were included in this systematic review. Fifteen studies assessed the role of machine learning methods in emergency department triage, while two studies evaluated the role of AI and machine learning in prehospital triage. The results of our systematic review favor the use of machine learning methods and artificial intelligence in emergency triage. Machine learning models were found to be superior to conventional emergency severity score methods in determining triage, diagnosis, and early management of patients. Among the machine learning methods, the boosting model was slightly more effective. Conclusion: Our study supports the notion that AI and ML are the future of Emergency departments. They aid in predicting patient outcomes and determining appropriate management strategies more efficiently, thereby enhancing decision making in the ED.

Plaques can form across different parts of the aorta, from the aortic arch to the thoracic and abdominal aorta. Aortic arch atheroma, however, is highly associated with cerebrovascular insults due to their dislodgement. Although no concise management protocol has been defined for dealing with such presentations, antiplatelet agents and anticoagulants are most frequently used. In this case, we present a 78-year-old male with a known case of diabetes mellitus type 2, hypertension, and dyslipidemia who presented to the emergency department with acute onset of slurred speech. A CT angiography was performed that revealed extensive plaque formations across the aortic arch with a 90% occlusion of the distal left common carotid artery and carotid bifurcation along with 99% stenosis of the internal carotid artery. The patient underwent aspiration thrombectomy and was started on dual antiplatelets but passed away after developing decompensated heart failure.

Whole-body computed tomography (WBCT) has been a mainstay and an integral part of the evaluation of polytrauma patients in trauma centers and emergency departments (ED) for a comprehensive evaluation of the extent of injuries. However, routine use of WBCT remains controversial since it exposes patients to radiation and exponentially increases financial expense. The primary objective was to determine the rate of negative WBCT in polytrauma patients. A retrospective cohort study was conducted at an academic hospital in the Kingdom of Saudi Arabia, which is a dedicated trauma center with a mean of 237,392 ED visits and 10,714 trauma per year. The study included all adult (≥18 years) polytrauma patients who presented to our ED, requiring trauma team activation, and underwent WBCT as part of their evaluation from January 2016 to May 2017. We excluded pediatric patients, patients transferred from another facility, and pregnant patients. The primary endpoint was to measure the rate of negative WBCT in polytraumatized patients. A total of 186 patients were included with a mean age of 28.8 ± 12.9 years. The rate of negative WBCT scans was 20.4%. The positive scans were subclassified based on the number of anatomical body regions that were affected radiologically. One body region was affected in 47 patients (31.8%), two body regions were affected in 50 patients (33.8%), and ≥3 body regions were affected in 51 patients (34.3%). In a subset analysis, we identified that oxygen saturation <94% and GCS ≤8 were associated with positive CT scans. Our study revealed a slightly higher rate of utilization of WBCT in the management of trauma patients compared to studies with similar practice. We believe that in the correct setting with incorporating high index of suspicion, a physical examination with attention to vital signs and mental status, performing E-FAST, and dedicated X-Rays is a way to potentially reduce the use of WBCT in polytrauma patients.

Background: Timely reperfusion is crucial in patients with ST-segment elevation myocardial infarction (STEMI), with door-to-balloon time often considered a key metric for assessing quality of care. However, the impact of door-to-balloon time on clinical outcomes during off-hours remains uncertain. Objective: To compare clinical outcome and door-to-balloon time of patients with STEMI in off-hours versus on-hours in King Fahad Uni-versity Hospital (KFHU). Methods: A mixed-method, qualitative and quantitative retrospective cohort study was conducted at KFUH in Al Khobar, Saudi Arabia, including adults diagnosed with STEMI and managed with primary percutaneous coronary intervention (PCI) between May 2023 to February 2024. The sample was divided into two groups based on-duty hours. The first group comprised patients presenting during duty hours, including weekdays (Sunday to Thursday, 8 a.m. - 4 p.m.), while the second group included patients presenting during off-duty hours, which consisted of weekdays (Sunday to Thursday, 4:01 pm to 7:59 am), weekends (Friday to Saturday), national holidays, and Eid holidays. Results: The study included 79 patients (57 off-hours and 22 in-hours) diagnosed with STEMI who underwent primary PCI. The mean age of the participants was 55.0 years (±10.8), 89.9% were males, 36.7% were Saudi, and 41.8% were smokers. Off-hours presentation did not significantly impact mortality rates or complications compared to on-hours presentation (p > 0.05), Similarly, no significant association was found between door-to-balloon time and 48-hour or 30-day mortality rates (p > 0.05). The mean time was statistically significant across the on- and off-duty time groups (65.2±18.0 vs 107.4±44.5, p<0.0001). Hypotension was the only complication signifi-cantly associated with mortality at 30 days (p < 0.001). Conclusion: Our results revealed that neither door-to-balloon time nor off-hours presentation significantly affected mortality rates or complications in pa-tients with STEMI undergoing Primary PCI, with the exception of hypotension being significantly associat-ed with 30-day mortality. Further research is warranted to explore other factors that may influence STEMI outcomes beyond door-to-balloon time and presentation hours. Additionally, investigating the specific rela-tionship between hypotension and 30-day mortality could lead to improved risk stratification and manage-ment strategies for STEMI patients.

Background: Anaphylaxis is known as an acute, severe hypersensitivity reaction that rapidly initiates after exposure to a triggering agent. It is a life-threatening condition, and early recognition and swift intervention are crucial to saving patients’ lives. Objective: The objective of this study is to assess the ability of certified non-critical care physicians to recognize, manage, and dispose cases of anaphylaxis. Methods: A survey consisting of 19 questions was developed by expert emergency consultants to evaluate physicians’ knowledge regarding the recognition, management, and disposition of anaphylactic episodes. Responses were collected through in-person surveys conducted with physicians from various specialties and varying clinical experience levels at a tertiary care center in the Eastern Province of Saudi Arabia. Results: In this cross-sectional study, a total of 173 physicians completed the survey, with 81.5% being consultants and 18.5% specialists. Only 5.2% correctly identified all three proposed anaphylaxis clinical scenarios, 16.8% identified two scenarios correctly, and 51.4% identified only one scenario. While 42.8% recognized the first-line management of anaphylaxis, only 24.3% and 24.9% knew the correct epinephrine dose and route, respectively. Regarding the disposition of patients experiencing an anaphylactic episode, 61.9% of responders opted to dispose the case to the emergency department. Conclusion: Our study reveals a knowledge gap among non-critical care physicians practicing in a tertiary care center concerning the identification and management of anaphylaxis. Raising awareness of this life-threatening condition is imperative to address this serious issue.

Background: COVID-19 pandemic has thrown the healthcare systems into confusion worldwide, resulting in major modifications on the practice due to fear of exposure to this virus and its fatal consequences. Objective: the study aimed to establish the prevalence of COVID-19 in cardiac arrest patients. Methods: single-centered, Retrospective, observational cohort study that included all patients who presented to ED during the period of the pandemic from January 2021 to May 2022 and documented to have either IN-hospital cardiac arrest (IHCA), specifically within the ED, or OUT-hospital cardiac arrest (OHCA). Results: This study analyzed 177 patients. Out of which, 30.5% of the patients were aged more than 70 years old. Those with associated comorbidities, the most frequently mentioned comorbidity was hypertension (40.7%). It was found that the prevalence of positive COVID-19 infection was significantly more common among non-Arab (p=0.019), patients with associated chronic kidney disease (p=0.019) and those who had an in-hospital cardiac arrest (p=0.010). No significant associations were observed between COVID-19 infection in terms of age, gender, nationality, associated comorbidities, symptoms, and trauma (all p>0.05). Conclusion: This study showed the prevalence of COVID-19 among cardiac arrest patients within ED and outside the hospital in our study population. Based on the study’s results, the major adjustments in practice were not absolutely needed. Also, this study could help in establishing a good mitigation strategy for at-risk patients.