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Article ; Online: Impact of Point-of-Care Ultrasound on Secondary Triage: A Pilot Study.

Stucchi, Riccardo / Weinstein, Eric S / Ripoll-Gallardo, Alba / Franc, Jeffrey M / Azzaretto, Massimo / Sesana, Giovanni / Della Corte, Francesco / Neri, Luca

Disaster medicine and public health preparedness

2022 Volume 17, Page(s) e194

Abstract: Objectives: In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of- ... ...

Abstract	Objectives: In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of-care ultrasound on the accuracy of secondary triage conducted at an advanced medical post to enhance the detection of patients who, despite their apparent clinically stable condition, could benefit from earlier evacuation to definitive care or immediate life-saving treatment. Methods: A mass casualty simulated event consisting of a bomb blast in a remote area was conducted with 10 simulated casualties classified as YELLOW at the primary triage scene; patients were evaluated by 4 physicians at an advanced medical post. Three patients had, respectively, hemoperitoneum, pneumothorax, and hemothorax. Only 2 physicians had sonographic information. Results: All 4 physicians were able to suspect hemoperitoneum as a possible critical condition to be managed first, but only physicians with additional sonographic information accurately detected pneumothorax and hemothorax, thus deciding to immediately evacuate or treat.
MeSH term(s)	Humans ; Triage/methods ; Emergency Medical Services/methods ; Pilot Projects ; Hemoperitoneum ; Hemothorax/diagnostic imaging ; Hemothorax/etiology ; Pneumothorax ; Point-of-Care Systems ; Mass Casualty Incidents
Language	English
Publishing date	2022-04-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2022.82
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Severe Acute Respiratory Syndrome Coronavirus 2 and Medical Evacuation in Lombardy: Lessons Learned from an Unprecedented Pandemic.

Stucchi, Riccardo / Ripoll-Gallardo, Alba / Sechi, Giuseppe Maria / Weinstein, Eric S / Villa, Guido Francesco / Frigerio, Cristina / Federighi, Federico / Grasselli, Giacomo / Zoli, Alberto / Bonora, Rodolfo / Fumagalli, Roberto

Disaster medicine and public health preparedness

2023 Volume 17, Page(s) e480

Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerging infectious disease pandemic developed in Lombardy (northern Italy) during the last week of February 2020 with a progressive increase of patients presenting with serious clinical ... ...

Abstract	The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerging infectious disease pandemic developed in Lombardy (northern Italy) during the last week of February 2020 with a progressive increase of patients presenting with serious clinical findings. Despite the efforts of the Central Italian Government, regional resources were rapidly at capacity. The solution was to plan the medical evacuation (MEDEVAC) of 119 critically ill patients (median age 61 years) to in-patient intensive care units in other Italian regions (77) and Germany (42). Once surviving patients were deemed suitable, the repatriation process concluded the assignment. The aim of this report is to underline the importance of a rapid organization and coordination process between different nodes of an effective national and international network during an emerging infectious disease outbreak and draw lessons learned from similar published reports.
MeSH term(s)	Humans ; Middle Aged ; SARS-CoV-2 ; COVID-19/epidemiology ; Pandemics ; Disease Outbreaks ; Federal Government
Language	English
Publishing date	2023-09-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2023.145
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Article ; Online: Prone Positioning in Non-Intubated Patients With COVID-19 Outside of the Intensive Care Unit: More Evidence Needed.

Ripoll-Gallardo, Alba / Grillenzoni, Luca / Bollon, Jordy / Della Corte, Francesco / Barone-Adesi, Francesco

Disaster medicine and public health preparedness

2020 Volume 14, Issue 4, Page(s) e22–e24

Abstract: The coronavirus disease (COVID-19) pandemic has brought the Italian National Health System to its knees. The abnormally high influx of patients, together with the limited resources available, has forced clinicians to make unprecedented decisions and ... ...

Abstract	The coronavirus disease (COVID-19) pandemic has brought the Italian National Health System to its knees. The abnormally high influx of patients, together with the limited resources available, has forced clinicians to make unprecedented decisions and provide compassionate treatments for which little or no evidence is yet available. This is the case for the use of noninvasive positive pressure ventilation and continuous airway pressure ventilation, combined with prone position in patients with COVID-19 and acute respiratory distress syndrome treated outside of intensive care units. In our article, we comment on the evidence available, so far, and provide a brief summary of data collected at our health institution in Piedmont, Italy.
MeSH term(s)	Adult ; Aged ; COVID-19/epidemiology ; COVID-19/physiopathology ; COVID-19/therapy ; Continuous Positive Airway Pressure/standards ; Continuous Positive Airway Pressure/statistics & numerical data ; Female ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Pandemics/statistics & numerical data ; Patient Positioning/methods ; Patient Positioning/standards ; Patient Positioning/statistics & numerical data ; Prone Position/physiology
Keywords	covid19
Language	English
Publishing date	2020-08-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2020.267
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Article ; Online: Residents working with Médecins Sans Frontières: training and pilot evaluation.

Ripoll-Gallardo, Alba / Ragazzoni, Luca / Mazzanti, Ettore / Meneghetti, Grazia / Franc, Jeffrey Michael / Costa, Alessandro / Della Corte, Francesco

Scandinavian journal of trauma, resuscitation and emergency medicine

2020 Volume 28, Issue 1, Page(s) 86

Abstract: Background: Well-prepared humanitarian workers are now more necessary than ever. Essential to the preparation process are: clearly defined learning objectives, curricula tailored to the nuances of humanitarian settings, simulation-based training, and ... ...

Abstract	Background: Well-prepared humanitarian workers are now more necessary than ever. Essential to the preparation process are: clearly defined learning objectives, curricula tailored to the nuances of humanitarian settings, simulation-based training, and evaluation. This manuscript describes a training program designed to prepare medical residents for their first field deployment with Médecins Sans Frontières and presents the results of a pilot assessment of its effectiveness. Methods: The training was jointly developed by the Research Center in Emergency and Disaster Medicine- CRIMEDIM of the Università del Piemonte Orientale, Novara, Italy, and the humanitarian aid organization Médecins Sans Frontières- Italy (MSF-Italy); the following topics were covered: disaster medicine, public health, safety and security, infectious diseases, psychological support, communication, humanitarian law, leadership, and job-specific skills. It used a blended-learning approach consisting of a 3-month distance learning module; 1-week instructor-led coaching; and a field placement with MSF. We assessed its effectiveness using the first three levels of Kirkpatrick's training evaluation model. Results: Eight residents took part in the evaluation. Four were residents in emergency medicine, 3 in anesthesia, and 1 in pediatrics; 3 of them were female and the median age was 31 years. Two residents were deployed in Pakistan, 1 in Afghanistan, 1 in the Democratic Republic of Congo, 1 in Iraq, 2 in Haiti and 1 on board of the MSF Mediterranean search & rescue ship. Mean deployment time was 3 months. The average median score for the overall course was 5 (excellent). There was a significant improvement in post-test multiple choice scores (p = 0.001) and in residents' overall performance scores (P = 0.000001). Conclusion: Residents were highly satisfied with the training program and their knowledge and skills improved as a result of participation. Trial registration: This study was approved by the Institutional Ethics Committee (date 24-02-2016, study code UPO.2015.4.10).
MeSH term(s)	Adult ; Altruism ; Clinical Competence ; Curriculum ; Female ; Health Resources/supply & distribution ; Humans ; Internship and Residency ; Italy ; Learning ; Male ; Medical Missions ; Pilot Projects ; Program Evaluation
Language	English
Publishing date	2020-08-25
Publishing country	England
Document type	Evaluation Study ; Journal Article
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-020-00778-x
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Article: Prone Positioning in Non-Intubated Patients With COVID-19 Outside of the Intensive Care Unit: More Evidence Needed

Ripoll-Gallardo, Alba / Grillenzoni, Luca / Bollon, Jordy / Della Corte, Francesco / Barone-Adesi, Francesco

Disaster Med Public Health Prep

Abstract	The coronavirus disease (COVID-19) pandemic has brought the Italian National Health System to its knees. The abnormally high influx of patients, together with the limited resources available, has forced clinicians to make unprecedented decisions and provide compassionate treatments for which little or no evidence is yet available. This is the case for the use of noninvasive positive pressure ventilation and continuous airway pressure ventilation, combined with prone position in patients with COVID-19 and acute respiratory distress syndrome treated outside of intensive care units. In our article, we comment on the evidence available, so far, and provide a brief summary of data collected at our health institution in Piedmont, Italy.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #679843
Database	COVID19

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Article ; Online: Prone Positioning in Non-Intubated Patients With COVID-19 Outside of the Intensive Care Unit

Ripoll-Gallardo, Alba / Grillenzoni, Luca / Bollon, Jordy / della Corte, Francesco / Barone-Adesi, Francesco

Disaster Medicine and Public Health Preparedness

More Evidence Needed

2020 , Page(s) 1–3

Abstract: ABSTRACT The coronavirus disease (COVID-19) pandemic has brought the Italian National Health System to its knees. The abnormally high influx of patients, together with the limited resources available, has forced clinicians to make unprecedented decisions ...

Abstract	ABSTRACT The coronavirus disease (COVID-19) pandemic has brought the Italian National Health System to its knees. The abnormally high influx of patients, together with the limited resources available, has forced clinicians to make unprecedented decisions and provide compassionate treatments for which little or no evidence is yet available. This is the case for the use of noninvasive positive pressure ventilation and continuous airway pressure ventilation, combined with prone position in patients with COVID-19 and acute respiratory distress syndrome treated outside of intensive care units. In our article, we comment on the evidence available, so far, and provide a brief summary of data collected at our health institution in Piedmont, Italy.
Keywords	Public Health, Environmental and Occupational Health ; covid19
Language	English
Publisher	Cambridge University Press (CUP)
Publishing country	uk
Document type	Article ; Online
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2020.267
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Article ; Online: Prehospital Mass Casualty Incident Response to a Fire in a Nursing Home in Milan, Italy: Actions Taken and Shortcomings.

Ripoll-Gallardo, Alba / D'Ambrosio, Annapaola / Manzoni, Paola / Grifone, Vincenzo / Pedrazzi, Catia / De Luca, Giovanni / Arghetti, Davide / Stellini, Armando / Zambelan, Alessandro / Ruggiero, Ilaria / Cusmà-Piccione, Riccardo / Bacullo, Gianluca / Lorito, Franco / Perbellini, Paolo / Giacovelli, Matteo / De Donno, Massimo / Pelà, Simone / Colzani, Giacomo / Brioschi, Elena /

Chiodini, Gianliuca / Sechi, Giuseppe / Zoli, Alberto / Fumagalli, Roberto / Stucchi, Riccardo

Disaster medicine and public health preparedness

2023 Volume 17, Page(s) e563

Abstract: On July 7, 2023, at 1:21 am, a fire was declared in a retirement home in Milan, Italy. The number of casualties (n = 87) according to the Simple Triage and Rapid Treatment (START) triage system was categorized as 65 green, 14 yellow, 2 red, and 6 black; ... ...

Abstract	On July 7, 2023, at 1:21 am, a fire was declared in a retirement home in Milan, Italy. The number of casualties (n = 87) according to the Simple Triage and Rapid Treatment (START) triage system was categorized as 65 green, 14 yellow, 2 red, and 6 black; 75% were women, and the mean age was 85.1 years (± 9). Most patients were unable to walk. A total of 30 basic life support (BLS) ambulances, 3 advanced cardiac life support (ACLS) teams on fast cars, 2 buses, and 1 coordination team were deployed. A scoop and run approach was adopted with patients being transported to 15 health care facilities. The event was terminated at 5:43 am. Though the local mass casualty incident (MCI) response plan was correctly applied, the evacuation of the building was difficult due to the age and comorbidities of the patients. START failed to correctly identify patients categorized as minor. Communication problems arose on site that led to the late evacuation of critical patients.
MeSH term(s)	Humans ; Female ; Aged, 80 and over ; Male ; Emergency Medical Services ; Triage ; Mass Casualty Incidents ; Nursing Homes ; Italy ; Disaster Planning
Language	English
Publishing date	2023-12-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2023.198
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Threat Perception and Public Preparedness for Earthquakes in Italy.

Bodas, Moran / Giuliani, Fabiana / Ripoll-Gallardo, Alba / Caviglia, Marta / Dell'Aringa, Marcelo Farah / Linty, Monica / Della Corte, Francesco / Ragazzoni, Luca

Prehospital and disaster medicine

2019 Volume 34, Issue 2, Page(s) 114–124

Abstract: ... can be used in future studies.Bodas M, Giuliani F, Ripoll-Gallardo A, Caviglia M, Dell'Aringa MF, Linty M ...

Abstract	Introduction: Italy is prone to major earthquakes and has experienced several devastating earthquakes in the far and recent past. The objectives of this study were to assess the level of Italian households' preparedness for earthquakes and to measure the public's perception of the risk and its impact on preparedness behavior. Hypothesis: Italian households' preparedness for earthquakes is insufficient and is influenced by different threat perception components that were assessed. Methods: A cross-sectional study, using an online questionnaire, was conducted in early 2018. The sample included 1,093 responders from a diverse sociodemographic background. The primary outcome was the Preparedness Index (PI), a score indicating the number of preparedness actions complied-with out of 10. Results: The PI's mean was 5.26 (SD = 2.17). The recommendation most complied-with was keeping a flashlight at home (87.7%) and the least was securing the kitchen cupboards (15.1%). The PI was positively correlated with a higher sense of preparedness (r = 0.426; P <.001). The PI was higher for responders residing in high-seismic-risk areas and those who experienced a major earthquake before. The predictors of PI were: gender, age, prior experience, sense of preparedness, searching for information, and threat intrusiveness (negatively). Conclusions: The findings demonstrate a medium-level of preparedness; however, this might be circumstantial. Italians perceive major earthquakes to be unlikely, yet severe if and when they do occur. A validated tool in Italian now exists and can be used in future studies.Bodas M, Giuliani F, Ripoll-Gallardo A, Caviglia M, Dell'Aringa MF, Linty M, Della Corte F, Ragazzoni L. Threat perception and public preparedness for earthquakes in Italy. Prehosp Disaster Med. 2019;34(2):114-124.
MeSH term(s)	Adolescent ; Adult ; Aged ; Cross-Sectional Studies ; Disaster Planning/statistics & numerical data ; Earthquakes ; Family Characteristics ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Internet ; Italy ; Male ; Middle Aged ; Socioeconomic Factors ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2019-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025975-2
ISSN	1945-1938 ; 1049-023X
ISSN (online)	1945-1938
ISSN	1049-023X
DOI	10.1017/S1049023X19000116
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Zs.A 2859: Show issues

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Article ; Online: Intra-operative low-dose ketamine does not reduce the cost of post-operative pain management after surgery: a randomized controlled trial in a low-income country.

Ragazzoni, Luca / Kwizera, Arthur / Caviglia, Marta / Bodas, Moran / Franc, Jeffrey Michael / Ssemmanda, Hannington / Ripoll-Gallardo, Alba / Della-Corte, Francesco / Alenyo-Ngabirano, Annet

African health sciences

2020 Volume 19, Issue 4, Page(s) 3127–3135

Abstract: Background: In developing countries, post-operative pain remains underestimated and undertreated due to economic constraints, lack of awareness and limited resources. In contrast, ketamine is an effective, readily available, easy to use and inexpensive ... ...

Abstract	Background: In developing countries, post-operative pain remains underestimated and undertreated due to economic constraints, lack of awareness and limited resources. In contrast, ketamine is an effective, readily available, easy to use and inexpensive drug frequently used in poor settings. Objectives: The aim of this study was to explore the overall reduction in the medication treatment cost of acute post-operative pain by adding intra-operative low-dose ketamine to traditional intravenous morphine for surgery in a low-income country. Methods: A double blind randomized controlled trial with placebo-controlled parallel group was performed in Mulago National Hospital (Uganda). Consenting adults scheduled for elective surgery were randomized into two study arms: Group K received ketamine 0.15mg/kg bolus at induction and a continuous infusion of 0.12 mg/kg/hour till start of skin closure; Group C (control) received normal saline. Both groups received Morphine 0.1 mg/kg IV at debulking. The total medication cost was registered. NRS pain scores and other measurements such vital signs and incidence of major and minor side effects were also recorded. Results: A total of 46 patients were included. Patients' baseline characteristics were comparable in both groups. No statistically significant difference was found between the groups concerning the overall medication cost of post-operative pain management. Pain scores, patients' satisfaction in the first 24 hours after surgery and hospital length of stay were similar in both groups. Conclusion: Our results do not support the utilization of intra-operative low dose ketamine as a cost-saving post-operative pain treatment strategy for all types of surgery in low-resource settings.
MeSH term(s)	Adult ; Analgesics/administration & dosage ; Analgesics/economics ; Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/economics ; Cost-Benefit Analysis ; Double-Blind Method ; Female ; Humans ; Ketamine/administration & dosage ; Ketamine/economics ; Male ; Middle Aged ; Morphine/administration & dosage ; Morphine/economics ; Pain Management/economics ; Pain Management/methods ; Pain Management/statistics & numerical data ; Pain, Postoperative/drug therapy ; Pain, Postoperative/economics ; Poverty/statistics & numerical data ; Uganda
Chemical Substances	Analgesics ; Analgesics, Opioid ; Ketamine (690G0D6V8H) ; Morphine (76I7G6D29C)
Language	English
Publishing date	2020-02-20
Publishing country	Uganda
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	2240308-5
ISSN	1729-0503 ; 1680-6905
ISSN (online)	1729-0503
ISSN	1680-6905
DOI	10.4314/ahs.v19i4.35
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Article ; Online: Gli effetti dei terremoti sulla salute a lungo termine: quali caratteristiche per un sistema di sorveglianza in Italia?

Pacelli, Barbara / Ripoll Gallardo, Alba / Faggiano, Fabrizio / Della Corte, Francesco / Allara, Elias

Recenti progressi in medicina

2019 Volume 110, Issue 5, Page(s) 209–211

Abstract: The major earthquakes occurred in Italy in the past 10 years (L'Aquila, Emilia and Amatrice) have resulted in 679 death, displacement of more than 120,000 people and economic losses for more than 20 billion euros. In a recent review, we found that ... ...

Title translation	Long-term health effects of earthquakes: outlining the features of an epidemiological surveillance system in Italy.
Abstract	The major earthquakes occurred in Italy in the past 10 years (L'Aquila, Emilia and Amatrice) have resulted in 679 death, displacement of more than 120,000 people and economic losses for more than 20 billion euros. In a recent review, we found that earthquakes are associated to multiple health conditions in the long term. Because of Italy's high seismic risk, it is likely that establishing a post-earthquake surveillance system would enable early detection of many deleterious effects and mitigation of damages. In this editorial, we outline the possible features of such a surveillance system. Firstly, it should be cost-effective, capitalising on routinely collected health data. Secondly, it should be coordinated centrally by a compact multidisciplinary team, to enable harmonised procedures and analysis. Thirdly, based on current evidence, it should be able to follow-up populations for least 7 years and capture both physical and mental health diseases. Finally, it should gather sufficient information to enable stratified analysis and identify at-risk subgroups that may need specific interventions.
MeSH term(s)	Earthquakes ; Epidemiological Monitoring ; Humans ; Italy ; Population Surveillance ; Time Factors
Language	Italian
Publishing date	2019-06-17
Publishing country	Italy
Document type	Journal Article
ZDB-ID	138266-4
ISSN	2038-1840 ; 0034-1193
ISSN (online)	2038-1840
ISSN	0034-1193
DOI	10.1701/3163.31441
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