Objectives: This study examined the prevalence of anxiety, depression, and job burnout among frontline healthcare workers (HCWs) across six Southeast Asian countries (Indonesia, Malaysia, Philippines, Singapore, Thailand, Vietnam) during the COVID-19 pandemic in 2021. We also investigated the associated risk and protective factors. Methods: Frontline HCWs (N = 1381) from the participating countries participated between 4 January and 14 June 2021. The participants completed self-reported surveys on anxiety (GAD-7), depression (PHQ-8), and job burnout (PWLS). Multivariate logistic regressions were performed with anxiety, depression, and job burnout as outcomes and sociodemographic and job characteristics and HCW perceptions as predictors. Results: The average proportion of HCWs reporting moderate anxiety, moderately severe depression, and job burnout across all countries were 10%, 4%, and 20%, respectively. Working longer hours than usual (Odds ratio [OR] = 1.82; 3.51), perceived high job risk (1.98; 2.22), and inadequate personal protective equipment (1.89; 2.11) were associated with increased odds of anxiety and job burnout while working night shifts was associated with increased risk of depression (3.23). Perceived good teamwork was associated with lower odds of anxiety (0.46), depression (0.43), and job burnout (0.39). Conclusion: Job burnout remains a foremost issue among HCWs. Potential opportunities to improve HCW wellness are discussed.

This study aimed to explore significant pre-hospital factors affecting the survivability of Out-of-Hospital Cardiac Arrest (OHCA) patients in countries with developing EMS systems. A retrospective cohort study was conducted examining data from January 1, 2017 to December 31, 2020 from Utstein Registry databases in Thailand, collected through Pan-Asian Resuscitation Outcomes Study (PAROS). Data were collected from three centres, including regional, suburban-capital, and urban-capital hospitals. The primary endpoint of this study was 30-day survival or discharged alive after an OHCA event. The multivariable risk regression was done by modified Poisson regression with robust error variance to explore the association between 30-day survival and pre-hospital factors with potential confounders adjustments. Of 1,240 OHCA cases transferred by Emergency Medical Services (EMS), 42 patients (3.4%) were discharged alive after 30 days, including 22 (8.6%), 8 (3.0%), and 12 (1.7%) from regional, suburban-capital, and urban-capital centres, respectively. The initial arrest rhythm was 89.7% unshockable, with no significant variations across the three centres. Overall, bystander Cardiopulmonary Resuscitation (CPR) was 40.4%. However, bystander CPR with Automated External Defibrillator (AED) application was 0.8%. Bystander CPR significantly increased 30-day survival probability (aRR 1.88, 95% CI 1.01 to 3.51; p 0.049). Additionally, reducing the EMS response time by one minute significantly increased OHCA survivability (aRR 1.12, 95% CI 1.04 to 1.20; p 0.001). Response time and bystander CPR are the factors that improve the 30-day survival outcomes of OHCA patients. In contrast, scene time, transport time, and pre-hospital advanced airway management didn’t improve 30-day OHCA survival.

Emergency Medical Service (EMS) providers are essential for out-of-hospital cardiac arrest (OHCA) survival, however implementing high-performance CPR guidelines in developing EMS settings presents challenges. This study assessed the impact of Continuous Quality Improvement (CQI) initiatives on OHCA outcomes in a hospital-based EMS agency in Bangkok, Thailand. A before-and-after study design was utilized, utilizing data from a prospective OHCA registry spanning 2019 to 2023. CQI interventions included low-dose high-frequency training in advanced airway management, high-performance CPR, and post-debriefing with video recording (VDO). Data collection encompassed patient characteristics, EMS management, and survival outcomes. Quality CPR metrics were assessed using the mobile defibrillator and CPR code review software. Statistical analyses compared outcomes between the pre-intervention period in 2019 and the post-full CQI implementation period in 2023. Among enrolled OHCA patients, with 88 cases occurring in 2019 and 91 cases in 2023. The bystander CPR rate was similar between both groups (47.73% in 2023 vs 53.85%, p = 0.413). In 2023, there was a significantly higher rate of prehospital intubation (93.40% vs 70.45%, p < 0.001) compared to 2019. Prehospital return of spontaneous circulation (ROSC) improved from 30.68% to 49.45% (p = 0.012), with an adjusted odds ratio (aOR) of 2.16 (95% CI: 1.14–4.07). Survival to discharge increased significantly from 2.27% in 2019 to 7.69% in 2023 (p = 0.27), with an aOR of 3.81 (95% CI: 0.46–31.79). Tailored CQI initiatives in a developing EMS setting were significantly associated with improved prehospital ROSC but showed an insignificant increase in survival to discharge.

Introduction: Thailand has the highest mortality from road traffic injury (RTI) in the world. There are usually higher incident rates of RTI in Thailand over long holidays such as New Year and Songkran. To our knowledge, there have been no studies that describe the impact of emergency medical service (EMS) utilization by RTI patients in Thailand. We sought to determine the outcomes of EMS utilization in severe RTIs during the holidays. Methods: We conducted a retrospective review study by using a nationwide registry that collected RTI data from all hospitals in Thailand during the New Year holidays in 2008–2015 and Songkran holidays in 2008–2014. A severe RTI patient was defined as one who was admitted, transferred to another hospital, or who died at the emergency department (ED) or during referral. We excluded patients who died at the scene, those who were not transported to the ED, and those who were discharged from the ED. Outcomes associated with EMS utilization were identified by using multiple logistic regression and adjusted by using factors related to injury severity. Results: Overall we included 100,905 patients in the final analysis; 39,761 severe RTI patients (39.40%; 95% confidence interval [CI] 95% CI [39.10%–39.71%]) used EMS transportation to hospitals. Severe RTI patients transported by EMS had a significantly higher mortality rate in the ED and during referral than that those who were not (2.00% vs. 0.78%, p < 0.001). Moreover, EMSuse was significantly associated with increased mortality rate in the first 24 hours of admission to hospitals (1.38% for EMS use vs. 0.57% for no EMS use, p < 0.001). EMS utilization was a significant predictor of mortality in EDs and during referral (adjusted odds ratio [OR] 2.19; 95% CI [1.88–2.55]), and mortality in the first 24 hours of admission (adjusted OR 2.31; 95% CI [1.95–2.73]). Conclusion: In this cohort, severe RTI patients transported by EMS had a significantly higher mortality rate than those who went to hospitals using private vehicles during these holidays.