Opiophobia contributes to oligoanalgesia in the emergency department (ED), but its definition varies, and its association to healthcare providers’ personality traits has been scantly explored. Our purpose was to study the different definitions of opiophobia and their association with two personality traits of doctors and nurses working in EDs, namely the stress from uncertainty and risk-taking. We used three online questionnaires: the ‘Attitude Towards Morphine Use’ Score (ATMS), the Stress From Uncertainty Scale (SUS) and the Risk-Taking Scale (RTS). Doctors and nurses from nine hospital EDs in francophone Switzerland were invited to participate. The ATMS score was analyzed according to demographic characteristics, SUS, and RTS. The response rate was 56%, with 57% of respondents being nurses and 63% women. Doctors, less experienced and non-indigenous participants had a significantly higher ATMS (all p ≤ 0.01). The main contributors of the ATMS were the fear of side effects and of addiction. In multivariate analysis, being a doctor, less experience and non-indigenous status were predictive of the ATMS; each point of the SUS increased the ATMS by 0.24 point. The fear of side effects and of addiction were the major contributors of opiophobia among ED healthcare providers; opiophobia was also associated with their personality traits.

This paper describes how the profession of paramedics has evolved in Switzerland and takes the perspective of public health. Ambulance drivers play an important role in the health system, not only as a response to emergencies, but also by working in an interprofessional and interdisciplinary manner in response to other public health needs, such as home care, triage, telemedicine and interhospital transfers. This pre-hospital system is rapidly evolving and relies on the work of paramedics.

AIMS OF THE STUDY: As emergency department consultations rise across Europe, patients must be guided to obtain appropriate care at the right time and place.In Switzerland, the absence of a unique health number that would enable the avoidance of emergency services through telephone medical advice, and the shortage of general practitioners, redirecting low-severity patients from the emergency department before medical consultation to other healthcare facilities could help reduce emergency department overload. This study assessed the safety of a newly implemented redirection process by examining the rate of unexpected returns to any healthcare facility. METHODS: This monocentric cohort study included patients aged 18 or older who presented to the emergency department of a regional hospital in Switzerland between 1 January and 31 May 2023 and who accepted redirection before medical consultation. Patients were identified from our electronic medical registry and retrospectively enrolled after telephone interviews. The primary outcome was the rate of unexpected returns to any healthcare facility within 2 days of redirection. The secondary outcomes were the rate of returns within 7 days, hospital admissions, and patient satisfaction. RESULTS: Among 16,362 patients who came to the emergency department during the study period, 688 (4%) were redirected. A total of 321 patients were included in the final analysis after telephone interviews. The rate of unexpected returns to any healthcare facility after redirection was 4% within 2 days and 16% within 7 days. The rate of returns to any hospital was 1.2% within 2 days and 4.7% within 7 days after redirection. Six patients (2%) required hospitalisation, and no fatalities were reported. The mean satisfaction score was 3.9/5 (standard deviation [SD] = 1.1) for triage experience, 4.4/5 (SD = 1) for care received in partner clinics, and 3.7/5 (SD = 1) for the redirection process. CONCLUSION: The rate of unexpected returns to any healthcare facility after redirection was 4% within 2 days and 16% within 7 days. The implementation of this protocol appeared to provide safe redirection to nearby clinics for redirected low-acuity patients. Satisfaction with care received in partner clinics was high, although it was lower for the redirection process and triage experience.

This study aims to assess the impact of the Volunteer Community Responders (VCR) Network on the outcomes of Out-of-hospital Cardiac Arrest (OHCA) patients in the Swiss Canton Fribourg from 2018 to 2022. We collected data from the SWISSRECA registry of all OHCA occurring in the Swiss Canton of Fribourg between January 1, 2018 and December 31, 2022. The patients were divided in two groups according to whether a VCR intervened and were compared using descriptive statistics. We constructed exact multivariable logistic regression models to analyse the association of a VCR intervention with Return of Spontaneous Circulation (ROSC) rate, survival to hospital admission and survival to hospital discharge, adjusting for age, sex, emergency services arrival time, witness status, initial rhythm and location of the OHCA. We included 559 patients, 319 in the VCR intervention group and 240 in the other group. The key differences were more home located OHCA (80% vs 63%; p-value = < 0.001), longer EMS arrival times (13 [11, 17] vs 11 [8, 14] minutes; p-value = < 0.001) and more pre-EMS CPR performed (95% vs 63%; p < 0.001) and pre-EMS AED usage (48% vs 13%; p < 0.001) in the VCR intervention group. In the adjusted model, the odds ratios with VCR Cardiopulmonary Resuscitation (CPR) were 0.82 (95% CI: 0.39–1.74; p = 0.61) for ROSC, 0.65 (95% CI: 0.27–1.53; p = 0.32) for survival to hospital admission and 1.22 (95% CI: 0.26–5.74; p = 0.80) for survival to hospital discharge. In the sub-cohort of home-located OHCA, consisting of 192 patients the VCR intervention group and 202 in the other group, the adjusted odds ratios of VCR CPR were 0.78 (95% CI: 0.34–1.81; p = 0.57) for ROSC, 0.75 (95% CI: 0.27–2.08; p = 0.58) for survival to hospital admission and 1.34 (95% CI: 0.23–7.79; p = 0.75) for survival to hospital discharge. The rates of CPR performed and AED usage before EMS arrival were higher in the VCR intervention group. However, the VCR intervention was not independently associated with ROSC rate, survival to hospital admission and survival to hospital discharge. Potential key explanations are the sequential manual activation of the VCR network, leading firstly to potential delays in VCR deployment and secondly to potentially more VCR deployment on home-located OHCAs or on OHCA with longer expected EMS travel time. Updating the deployment system of the emergency medical communication centre could be a key improvement measure to address this. Further studies are needed to explore these issues and to improve the chain of survival including the VCR Network.

Background: In the emergency department (ED), medical procedures, such as arterial blood gas (ABG) testing, can cause pain and high stress levels. However, ABG testing is a routine procedure assessing the severity of the patient's condition. To reduce the pain of ABG, several methods have been investigated without significant difference in pain perception. Communication, a key element of care, has shown a significant effect on pain perception. A positive communication strategy, including positive, kind, or reassuring words, can reduce pain perception, while negative words can raise this perception, causing discomfort, known as the “nocebo effect.” Although some studies have compared the impact of verbal attitudes, particularly in anesthesia and mainly with staff already trained in hypnosis, to the best of our knowledge, none have investigated the effect of communication in the emergency setting, where patients may be more suggestible to the words used. Objective: In this study, we will investigate the effect of positive therapeutic communication on pain, anxiety, discomfort, and global satisfaction in patients requiring ABG compared to nocebo and neutral communication. Methods: A single-center, double-blind randomized controlled trial (RCT) with 3 parallel arms will be conducted with 249 patients requiring ABG during their ED visit. Patients will be randomly assigned to 1 of 3 groups before receiving ABG: positive communication group, negative communication (nocebo) group, or neutral communication (neutral) group. The communication and the words used by the physicians during hygiene preparation, artery location, and puncture will be imposed in each group. The study will be proposed to each patient corresponding to the inclusion criteria. The physicians will not be trained in hypnosis or in positive therapeutic communication. The procedure will be recorded with audio recorders to test its quality. Intention-to-treat analysis will be performed. The primary endpoint is the onset of pain. The secondary outcomes are patient comfort, patient anxiety, and global satisfaction of the patient with the communication strategy used. Results: On average, 2000 ABG procedures are performed each year in the EDs of hospitals. In this study, 249 patients are expected to be included. With a projected positive response rate of 80%, we intend to include 25 (10%) patients per month. The inclusion period began in April 2023 and will run until July 2024. We hope to publish the results of the study during the fall of 2024. Conclusions: To the best of our knowledge, this study is the first RCT assessing the use of positive communication on pain and anxiety in patients undergoing the ABG procedure in the ED. A reduction in pain, discomfort, and anxiety is expected when using positive communication. If the results are positive, this could be useful to the medical community and encourage clinicians to monitor their communication during care. Trial Registration: ClinicalTrials.gov NCT05434169; https://clinicaltrials.gov/ct2/show/NCT05434169 International Registered Report Identifier (IRRID): PRR1-10.2196/42043