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The novel coronavirus (COVID-19) began in China in early December 2019 and rapidly has spread to many countries around the globe, with the number of confirmed cases increasing every day. An epidemic has been recorded since February 20 in a middle province in Northern Italy (Lodi province, in the low Po Valley). The first line hospital had to redesign its logistical and departmental structure to respond to the influx of COVID-19-positive patients who needed hospitalization. Logistical and structural strategies were guided by the crisis unit, managing in 8 days from the beginning of the epidemic to prepare the hospital to be ready to welcome more than 200 COVID-19-positive patients with different ventilatory requirements, keeping clean emergency access lines, and restoring surgical interventions and deferred urgent, routine activity.

Background Airway management is a critical priority for HEMS teams, as failure to secure the airway remains a major determinant of mortality and long-term disability. The present study was designed to evaluate the variability of advanced airway management devices and medications availability across all HEMS units in Italy. In addition, crew composition and specialty training of HEMS personnel were assessed. As a whole, this survey aims at highlighting areas for improvement of airway management during HEMS operations. Methods This observational cross-sectional study was carried out between May and September 2024. A web-based questionnaire was distributed to all active HEMS bases in Italy. The questionnaire consisted of two main sections: Section A addressed the availability of basic and advanced airway management equipment and medications, whereas Section B focused on crew characteristics, including number, role, experience, and training. A composite index to capture “airway preparedness” (API) was designed based on Difficult Airway Society 2025 guidelines. Selected items were assigned a weighted value and the final score ranged 0–40. Results Of 55 active HEMS bases, 48 completed the questionnaire (response rate: 87%). Manual ventilation devices, a direct laryngoscope, a complete set of Macintosh adult blades, an end-tidal CO₂ monitoring device, and supraglottic airway devices were consistently available. A videolaryngoscope was present in most bases (39, 81%). Either surgical or Seldinger cricothyroidotomy kits were present in 94%. Medications for rapid sequence intubation were universally available, although sugammadex was stocked in only 36 bases (75%). A physician was present in all surveyed units (100%). However, specific training in airway management was not provided in 37 bases (77%), and 44% did not require a minimum number of prior endotracheal intubations for new personnel. Only 13 bases (27%) reported the adoption of airway management guidelines for prehospital care. The mean ± SD national API was 25.7 ± 7.4, ranging from a regional mean of 37 ± 1.4 to a regional mean of 11.2 ± 5.3. Conclusion The study demonstrated substantial heterogeneity in equipment, personnel background, and training across Italian HEMS bases. Although only few bases reported adherence to specific guidelines, the devices and medications recommended in the literature for the management of unexpected difficult airways were widely available.

Medical evacuation has historically been rooted in military contexts. It involves the systematic transfer of sick or injured individuals from the battlefield to designated medical facilities. Medical evacuation has found application in civilian settings: the Ebola outbreak and the COVID-19 pandemic. This paper examines the medical evacuation that occurred during the COVID-19 pandemic in Lombardy, Italy (Operation “MEDEVAC”), where overloaded hospitals required the transfer of patients to other regions and even internationally. MEDEVAC was implemented by the Regional Emergency and Urgency Agency (AREU). Data from MEDEVAC were analysed using the AREU register, detailing patient characteristics, transfer logistics, and outcomes. From March to April 2020, 121 intensive care patients were transferred via MEDEVAC, primarily by air. 65 % of patients were moved to other Italian regions. The Federal Republic of Germany received 35 % of patients, all transported by air. Outcome and mortality rates among transferred patients were comparable to those within regional intensive care units. One life-threatening event was reported during transport. The return of patient to Lombardy showed a 100 % survival rate. This study emphasises the importance of standardised protocols, improved information exchange systems, and enhanced training for medical personnel involved in medical evacuation. MEDEVAC was found to be feasible and able to cope with demands that were excessive in relation to available resources. This study proposes the development of a shared protocol for air transport of patients and a model for international cooperation among emergency response agencies to optimise future medical evacuation activities in civil context.

Background: In Italy, workplace safety regulations require the training of first-aid officers to manage medical emergencies, including acute coronary syndromes. Although clinical guidelines recommend the early use of acetylsalicylic acid in myocardial infarction, little is known about the implementation of this recommendation in practice. This study aims to assess the use of acetylsalicylic acid for ST-elevation myocardial infarction (STEMI) in workplace and non-workplace settings, with a focus on informing the evaluation and improvement of first-aid training programs and emergency response protocols. Methods: We conducted a retrospective, observational cohort study using 2019 data from the Regional Agency for Emergency Urgency. Cases were identified and stratified by event location (workplace vs non-workplace), to analyze patterns of acetylsalicylic acid administration. A logic model has been developed to program a stepwise plan of action for policies development. Results: A total of 2174 STEMI cases were identified, of which 380 (17.5%) occurred in the workplace. Workplace cases were younger and more likely to be male. Acetylsalicylic acid was administered in only 31 cases overall, with no statistically significant difference between settings. This assessment advocates for the implementation of targeted actions, which may include updates to current legislation and policies. Conclusions: These findings highlight an urgent need to systematically evaluate existing workplace first-aid training and emergency protocols. Integrating modules on acetylsalicylic acid administration into training curricula, along with performance monitoring mechanisms, may significantly enhance early STEMI management and patient outcomes. Updating safety programs to align with evidence-based practices should follow a structured approach.

The COVID-19 pandemic drastically reshaped healthcare in Lombardy, Italy, notably impacting EMS and emergency departments and altering the epidemiology of time-dependent pathologies such as STEMI and OHCA. While previous studies focused on modifications during the pandemic peak, with an increase in the number of OHCA diagnoses and a reduction in the number of STEMI, little evidence exists regarding the inter-pandemic phases. We analyzed OHCA and STEMI accesses to the ED in the regional emergency department access register (EUOL) for 2019–2021. The analysis revealed a significant difference in monthly diagnosis averages. For STEMI, the change was statistically significant (F(2, 33) = 4.45, p = 0.02), while it was not for OHCA (F(2, 33) = 0.18, p = 0.83). Despite the monthly decreases, the likelihood of receiving a STEMI diagnosis increased with total accesses, OR 1.40 [95% CI 1.25–1.58, p < 0.0001]. Additionally, there was a significant increase in March 2020 discharge diagnoses for OHCA compared to March 2019, OR 3.35 [95% CI 2.88–3.90, p < 0.0001], corresponding to the first pandemic wave. Therefore, our analysis indicates that the epidemiology of STEMI and OHCA was altered during the COVID-19 pandemic.

Background: This article examines the infectious disease surveillance system in the Lombardy region of Italy, with a focus on its response mechanisms to respiratory syndromes. This study aims to describe the alert system and the organizational procedures in place, assessing their effectiveness in managing health crises. Methods: This study is based on the analysis of Lombardy’s regional resolution No. 1125, developed by regional public health experts. Surveillance levels were categorized based on incidence thresholds and healthcare system impacts, establishing specific indicators and activation protocols. Information flows are managed through real-time data portals, enabling the real-time monitoring of COVID-19, influenza, and other infectious respiratory diseases. Results: A multi-level response system was established, with levels ranging from ordinary regimes to critical epidemic activation. Each level includes specific actions, such as resource reallocation, emergency department support, and the suspension of elective procedures. The use of technological tools, such as electronic health records, streamlined reporting processes, and real-time data flow management, has strengthened the region’s response capabilities. Conclusions: This study underscores the value of a structured, multi-level response system for infectious disease management, showing that a unified regional approach improves crisis response efficiency. It suggests that sharing activation indicators and protocols within the scientific community can help harmonize national and international responses to future pandemics. The system, while effective in its current context, may require adaptation for future health challenges.

Background/Objectives: Emergency department (ED) crowding has become a pressing global concern exacerbated by the COVID-19 pandemic. No studies have addressed this issue in Europe during the post-pandemic period so far. This study examined ED visit volumes, patient acuity, hospital admission rates, emergency vehicle arrivals, and crowding metrics before, during, and after the pandemic. Methods: We conducted a retrospective descriptive study including data on all ED visits in the Lombardy Region of Italy from January 2019 to December 2023. Furthermore, an inferential statistical analysis was performed to compare ED trends between 2019 and 2023. Results: During the analyzed period, there were 15,515,128 visits across all Lombardy EDs. ED visits dropped from 3,514,426 in 2019 to 2,380,005 in 2020, then rebounded to 3,464,756 in 2023. In 2019, triage code distribution was 9.9% white, 68.7% green, 19.0% yellow, and 1.9% red. During the pandemic, the proportion of white and green codes decreased. By 2023, these comprised 80.7% of the total. The percentage of admitted patients was 11.9% in 2019, rose to 16.2% in 2020, and returned to 11.4% in 2023. The median ED length of stay (EDLOS) for admitted patients in 2023 was 5.2 h (IQR [2.1–17.4]), compared to 3.8 h (IQR [1.6–8.6]) in 2019 (p-value < 0.01). The median EDLOS for discharged patients in 2023 was 2.7 h (IQR [1.4–4.9]), compared to 2.4 h (IQR [1.3–4.4]) in 2019 (p-value < 0.01). The rate of patients leaving before completing treatment was 5.0% in 2019 and peaked at 6.8% in 2023 (p-value < 0.01). Conclusions: In 2023, ED visits in Lombardy increased, compared to the pandemic period, but remained below 2019 levels. The proportion of high-acuity codes and hospital admissions was slightly lower than in 2019. However, ED crowding metrics worsened. The high levels of lower-acuity visits and the deterioration in crowding metrics highlight systemic challenges within the healthcare system.

Out-of-hospital cardiac arrest (OHCA) incidence rate exhibits considerable geographical variations. In Lombardy, the presence of densely populated areas alongside isolated rural municipalities makes analysing health inequalities important. Given their spatial heterogeneity, an explicitly spatial analytical approach is needed. A retrospective ecological study was conducted at the municipal level using data from the Lombardia CARe registry (2021-2024). The incidence of OHCA was calculated for 924 municipalities. Socio-demographic determinants (population density, ageing index and percentage of taxpayers with an annual income below EUR 10,000) were analysed using geographically weighted regression (GWR). Spatial analyses (Moran's I, LISA and Getis-Ord Gi*) were also applied to identify clusters and hotspots. During the study period, 22,201 OHCA events occurred (incidence rate: 126 per 100,000 inhabitants). Marked spatial heterogeneity emerged, with hotspots primarily located in mountainous and hilly areas, and cold-spots predominantly found in urban and lowland zones. GWR identified spatially non-uniform associations: incidence was inversely associated with population density in some areas, whereas it was positively associated with the ageing index and proportion of low-income taxpayers in others. The incidence of OHCA in Lombardy exhibits important spatial disparities. A spatial analytical approach can effectively identify vulnerable areas, guiding public health policies towards equity and spatial justice.

\"In the 1970s, Xerox pioneered the involvement of social science researchers in technology design and in developing better ways of working. The Xerox legacy is a hybrid methodology that combines an ethnographic interest in direct observation in settings of interest with an ethnomethodological concern to make the study of interactional work an empirical, investigatory matter. This edited volume is an overview of Xerox's social science tradition. It uses detailed case studies that show how the client engagement was conducted over time and how the findings were consequential for business impact. Case studies in retail, production, office, and home settings cover four topics: practices around documents, the customer front, learning and knowledge-sharing, and competency transfer. The impetus for this book was a 2003 Xerox initiative to transfer knowledge about how to conduct ethnographically grounded work-practice studies to its consultants so that they may generate the kinds of knowledge generated by the researchers themselves\"--

Background and Objectives: Suicidality in adults with Attention-Deficit/Hyperactivity Disorder (ADHD) is an emerging clinical concern, yet its mechanisms and risk factors are not fully understood. Specifically, little is known about the characteristics of suicide attempts (SAs), including the use of violent/nonviolent methods. This study aimed to investigate the prevalence and methods of SA in adults with ADHD and to identify associated sociodemographic and clinical factors. Materials and Methods: The sample included 211 adult outpatients with ADHD. Patients were grouped based on the presence/absence of a lifetime SA. Among attempters, those who used a violent method (e.g., hanging, shooting, or jumping from a height) were compared with those who used a nonviolent method (e.g., poisoning). Statistical analyses included χ2 tests, Kruskal–Wallis tests, and logistic regression. Results: In total, 9.9% (n = 21; 95% CI: 4.5–10.4) of participants reported a lifetime SA, with 23.8% (n = 5; 95% CI: 4.8–41.9) using violent methods. SA was significantly associated with comorbid personality disorders (p = 0.006, OR: 6.613, 95% CI: 0.537–5.812) and a higher number of hospitalizations (p = 0.008, OR: 1.980, 95% CI: 0.296–2.675). Nonviolent methods were linked to low self-esteem (p = 0.008). No significant associations with ADHD features or other psychiatric comorbidities emerged. Conclusions: Adults with ADHD are at risk for SA, showing patterns similar to other psychiatric populations. Unlike suicidal ideation, which has been directly linked to ADHD in previous studies, the transition to an SA appeared to be associated with comorbid personality disorders.