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Giving a hand for Nias: a testimony of relief work during the Nias earthquake disaster

Idrose AM

J Emerg Med, 2008 Feb;34(2):209-11.
PMID: 18282539 DOI: 10.1016/j.jemermed.2007.05.029
Bam: a university for mankind

Idrose AM

Eur J Emerg Med, 2004 Oct;11(5):280-4.
PMID: 15359202
Fulltext Acute and emergency care for thyrotoxicosis and thyroid storm

Idrose AM

Acute medicine & surgery, 2015 07;2(3):147-157.
PMID: 29123713 DOI: 10.1002/ams2.104

Thyroid hormones affect all organ systems and, in excess, can cause increased metabolic rate, heart rate, ventricle contractility, and gastrointestinal motility as well as muscle and central nervous system excitability. Thyroid storm is the extreme manifestation of thyrotoxicosis with an estimated incidence of 0.20 per 100,000 per year among hospitalized patients in Japan. The mortality of thyroid storm without treatment ranges from 80% to 100%; but with treatment, the mortality rate is between 10% and 50%. The diagnostic strategy for thyroid storm may take into consideration Burch-Wartofsky scoring or Akamizu's diagnostic criteria. Multiple treatment aims need to be addressed in managing thyroid storm effectively. This paper puts together all aspects to be considered for the management of hyperthyroidism and thyroid storm during the acute and emergency phase as well as consideration of special populations.
The use of classroom training and simulation in the training of medical responders for airport disaster

Idrose AM, Adnan WA, Villa GF, Abdullah AH

Emerg Med J, 2007 Jan;24(1):7-11.
PMID: 17183034

There is a dire need to have complementary form of disaster training which is cost effective, relatively easy to conduct, comprehensive, effective and acceptable. This will complement field drills training. A classroom-based training and simulation module was built by combining multiple tools: Powerpoint lectures, simulations utilising the Kuala Lumpur International Airport (KLIA) schematic module into 'floortop' model and video show of previous disaster drill. 76 participants made up of medical responders, categorised as Level 1 (specialists and doctors), Level 2 (paramedics), Level 3 (assistant paramedics) and Level 4 (health attendants and drivers) were trained using this module. A pre-test with validated questions on current airport disaster plans was carried out before the training. At the end of training, participants answered similar questions as post-test. Participants also answered questionnaire for assessment of training's acceptance. There was a mean rise from 47.3 (18.8%) to 84.0 (18.7%) in post-test (p<0.05). For Levels 1, 2, 3 and 4 the scores were 94.8 (6.3)%, 90.1 (11)%, 80.3 (20.1)% and 65 (23.4)% respectively. Nevertheless Level 4 group gained most increase in knowledge rise from baseline pre-test score (51.4%). Feedback from the questionnaire showed that the training module was highly acceptable. A classroom-based training can be enhanced with favourable results. The use of classroom training and simulation effectively improves the knowledge of disaster plan significantly on the back of its low cost, relatively-easy to conduct, fun and holistic nature. All Levels of participants (from specialists to drivers) can be grouped together for training. Classroom training and simulation can overcome the problem of "dead-document" phenomenon or "paper-plan syndrome".
Singing Improves Oxygen Saturation in Simulated High-Altitude Environment

Idrose AM, Juliana N, Azmani S, Yazit NAA, Muslim MSA, Ismail M, et al.

J Voice, 2020 Jul 29.
PMID: 32736909 DOI: 10.1016/j.jvoice.2020.06.031

At high altitude, low oxygen partial pressure predisposes human body to hypobaric hypoxia that may lead to high-altitude illness. Currently, singing had been used for rehabilitation of patients with lung diseases but its role in high-altitude low oxygen environment is still scarce. This study aims to examine the effect of singing in improving oxygen saturation at different levels of high altitudes in a hypobaric chamber. Eight healthy volunteers were assigned to three interventions at three simulated altitudes (sea level, 3000 m and 5000 m). The oxygen saturation (SpO2) was measured via pulse oximetry under three conditions: no singing (NS), singing aloud (SA), and singing silently (SS). The "birthday song" was used as the standard song for 4 minutes. At sea level, mean NS SpO2 was 97.75% ± 1.04%. With SS, the level increased to 98.25% ± 1.04%. Mean SA SpO2 increased to 98.38% ± 0.92% (P < 0.05). At 3000 m, mean NS SpO2 was 92.75% ± 3.73% and rose to 94.50% ± 2.51% and 94.63% ± 2.00% respectively with SA and SS (P < 0.05). At 5000 m, NS level of 79.88P ± 3.60% increased to 82.13 ± 5.87 and 82.88% ± 7.12% with SA and SS respectively (P < 0.05). The repeated measure ANOVA showed significant difference for altitude (P < 0.001) and intervention (P = 0.05). In conclusion, singing both either "aloud" or "silently" significantly increased the level of SpO2 in simulated high altitude at 3000 m and above. The study suggests that singing as a potential intervention to improve oxygen saturation at high altitudes. Study with larger sample in hypobaric chamber as well as in real environment is recommended.
Fulltext Kuala Lumpur train collision during the COVID-19 pandemic

Idrose AM, Abu-Zidan FM, Roslan NL, Hashim KIM, Mohd Adibi SMA, Abd Wahab M

World J Emerg Surg, 2022 01 11;17(1):2.
PMID: 35012597 DOI: 10.1186/s13017-022-00405-3

BACKGROUND: Two city trains collided in an underground tunnel on 24 May 2021 at the height of COVID-19 pandemic near the Petronas Towers, Kuala Lumpur, Malaysia, immediately after the evening rush hours. We aim to evaluate the management of this mass casualty incident highlighting the lessons learned to be used in preparedness for similar incidents that may occur in other major cities worldwide.
METHODS: Information regarding incident site and hospital management response were analysed. Data on demography, triaging, injuries and hospital management of patients were collected according to a designed protocol. Challenges, difficulties and their solutions were reported.
RESULTS: The train's emergency response team (ERT) has shut down train movements towards the incident site. Red zone (in the tunnel), yellow zone (the station platform) and green zone (outside the station entrance) were established. The fire and rescue team arrived and assisted the ERT in the red zone. Incident command system was established at the site. Medical base station was established at the yellow zone. Two hundred and fourteen passengers were in the trains. Sixty-four of them were injured. They had a median (range) ISS of 2 (1-43), and all were sent to Hospital Kuala Lumpur (HKL). Six (9.4%) patients were clinically triaged as red (critical), 19 (29.7%) as yellow (semi-critical) and 39 (60.9%) as green (non-critical). HKL's disaster plan was activated. All patients underwent temperature and epidemiology link assessment. Seven (10.9%) patients were admitted to the hospital (3 to the ICU, 3 to the ward and 1 to a private hospital as requested by the patient), while the rest 56 (87.5%) were discharged home. Six (9.4%) needed surgery. The COVID-19 tests were conducted on seven patients (10.9%) and were negative. There were no deaths.
CONCLUSIONS: The mass casualty incident was handled properly because of a clear standard operating procedure, smooth coordination between multi-agencies and the hospitals, presence of a 'binary' system for 'COVID-risk' and 'non-COVID-risk' areas, and the modifications of the existing disaster plan. Preparedness for MCIs is essential during pandemics.
Fulltext An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study

Inoue K, Chieh JTW, Yeh LC, Chiang SJ, Phrommintikul A, Suwanasom P, et al.

Trials, 2022 Dec 07;23(1):986.
PMID: 36476401 DOI: 10.1186/s13063-022-06907-4

BACKGROUND: More than half of the world's population lives in Asia. With current life expectancies in Asian countries, the burden of cardiovascular disease is increasing exponentially. Overcrowding in the emergency departments (ED) has become a public health problem. Since 2015, the European Society of Cardiology recommends the use of a 0/1-h algorithm based on high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, these algorithms are currently not recommended by Asian guidelines due to the lack of suitable data.
METHODS: The DROP-Asian ACS is a prospective, stepped wedge, cluster-randomized trial enrolling 4260 participants presenting with chest pain to the ED of 12 acute care hospitals in five Asian countries (UMIN; 000042461). Consecutive patients presenting with suspected acute coronary syndrome between July 2022 and Apr 2024 were included. Initially, all clusters will apply "usual care" according to local standard operating procedures including hs-cTnT but not the 0/1-h algorithm. The primary outcome is the incidence of major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, unstable angina, or unplanned revascularization within 30 days. The difference in MACE (with one-sided 95% CI) was estimated to evaluate non-inferiority. The non-inferiority margin was prespecified at 1.5%. Secondary efficacy outcomes include costs for healthcare resources and duration of stay in ED.
CONCLUSIONS: This study provides important evidence concerning the safety and efficacy of the 0/1-h algorithm in Asian countries and may help to reduce congestion of the ED as well as medical costs.
Fulltext Correction: An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study

Inoue K, Chieh JTW, Yeh LC, Chiang SJ, Phrommintikul A, Suwanasom P, et al.

Trials, 2023 May 17;24(1):335.
PMID: 37198646 DOI: 10.1186/s13063-023-07342-9