Junaid Abdul Razzak

Background: Nearly half of all 4.8 million annual paediatric deaths worldwide are caused by acute illnesses, which are preventable with timely triage, emergency care and prehospital transport. We assessed the feasibility of using telemedicine to connect emergency medical technicians (EMTs) in ambulances with paediatric telemedicine physicians (TMPs) to improve patient care in a low-resource setting. Methods: We conducted a pilot cluster-randomised trial in Karachi, Pakistan, with city’s primary emergency medical transport provider and a paediatric telemedicine facility. Ten ambulances were randomised equally to intervention (real-time audiovisual telemedicine support) and control arms. The intervention was piloted using 25 simulated cases, followed by low-acuity and high-acuity patients as classified by the Medical Priority Dispatch System. Primary outcomes included rates of refusal, call completion, safety (rated by EMTs and TMPs) and completion of the Paediatric Early Warning Score (PEWS) in ambulances and hospitals. Findings: Of 166 parents approached, 151 (91%) consented; 73 patients were assigned to the intervention and 78 to the control. The mean patient age was 2.5 years (SD 43 months; range 1 day–12 years). Ambulance dispatchers categorised 35.7% as low acuity and 64.3% as high acuity. Most cases (68%) were interhospital transfers. Calls were completed in 96% of cases; 87% of calls received favourable audio/video quality scores. All interactions were rated as very safe, safe or neutral; none was deemed unsafe. 91% of EMTs and TMPs rated the system as usable (System Usability Scale). PEWS was completed for 100% of patients in ambulances and 86% in the emergency department. Interpretation: Providing real-time telemedicine support to EMTs in ambulances is feasible and safe in low-resource settings. These findings support further research into the clinical impact and scalability of prehospital telemedicine for paediatric emergencies. Trial registration number: This project is a pilot trial for the Cluster Randomised Trial NCT07027813 titled ‘Feasibility and Efficacy of Ambulance-Based m-Health for Paediatric Emergencies (FEAMER) Trial (FEAMER)’ registered on 19 June 2025. The link to the clinicaltrials.gov is attached here: https://clinicaltrials.gov/study/NCT07027813 .

Bystander intervention at the scene of illness or injury can significantly impact the outcomes of emergencies. This scoping review aims to identify the det

Background: The accelerating pace of urbanization worldwide has highlighted the improvement of disaster response in cities as a global priority. Yet, there remains a poor understanding of the emergency response to mass casualty incidents (MCI) in these environments. This study aimed to develop a conceptual framework for cities’ responses and potential policy levers. Methods: We conducted a scoping review followed by in-depth interviews (IDIs), focus group discussions (FGDs), and a modified Delphi process to develop the framework for Cities’ Assessment of Mass Casualty Emergency Response and Action (CAMERA). Results: CAMERA framework consists of six essential components of urban emergency response systems: 1) communication, 2) safety and security, 3) human resources, 4) policy and plans, 5) command control and coordination, and 6) care delivery. IDIs and FGDs also provided insight on assessment methodologies for evaluating response capacity. Using these components, we then developed a framework consisting of a diagnostic and management approach that city leadership can undertake in MCI management to ensure effective functioning at various levels of incident response. Conclusion: The CAMERA framework offers novel and simplified guidance to policymakers and other stakeholders in their attempt to improve MCI response systems across cities globally.

Low- and middle-income countries (LMICs) continue to bear the major burden of morbidity and mortality associated with out-of-hospital cardiac arrest (OHCA)

Introduction: Globally, half of all 6.2 million deaths in children are caused by acute illnesses which can be prevented if diagnosed and treated in time. We hypothesise that long elapsed travel time and delay in care can be tackled using telemedicine. The objective of this study is to determine the acceptability of linking ambulances that transport acutely ill children to a remote paediatric emergency physician using a simple audiovisual device. Methods: We conducted a qualitative study to determine the acceptability of ambulance-based teleconsultation for the emergency care of acutely ill children informed by the Theoretical Framework of Acceptability. We developed semistructured guides using this framework and conducted five interviews with telemedicine physicians (TMPs), 18 interviews with parents of children who recently needed an ambulance and four focused groups with emergency medical technicians (EMTs) who transport children. Results: All participants were supportive of using the telemedicine consultation during ambulance transport in the proposed trial as they felt that having access to a video-based physician would offer prompt intervention, particularly for critically ill children in crowded cities and remote regions with scarce resources. Parents believed that ambulance-based telemedicine would enhance their trust in EMTs and reduce their stress. The concerns related to the intervention included parental reluctance in using video cameras due to privacy issues, doubts about doctors’ treatment reliability, risk of miscommunication and inadequate parental education. To address these challenges, the groups proposed solutions such as joint training for EMTs and TMPs, educating parents about intervention processes, improving telecommunication infrastructure and promoting public awareness. Conclusion: Parents, EMTs and TMPs mutually agreed that the use of telemedicine during ambulance transport can be successfully implemented through proper training and is acceptable in our population. All participants agreed that this intervention holds great potential to improve the survival of critically ill children.

Background Low- and middle-income countries (LMICs) face a high burden of trauma-related deaths, yet lack prospective, standardized data to guide care. In Pakistan, in-hospital trauma management and outcomes remain poorly documented. Purpose The aim of this study was to examine injury epidemiology, post-emergency department care, and hospital outcomes using a pilot digital trauma registry in Pakistan. Methods This study was conducted from December 2021 to February 2023 at two leading tertiary care hospitals in Karachi, Pakistan. We included all admitted adult trauma patients (≥ 18 years). We prospectively collected data on demographics, injury details, inter-hospital case management, in-hospital care, and discharge outcomes. Results A total of 3,087 patients were enrolled, mostly male (79.82%), with 24.33% under 25 years old and 42.38% of Muhajir ethnicity. Road traffic injuries (RTIs) (56.43%), primarily amongst riders of two-wheelers (56.74%), were the leading cause, of whom only 8.66% wore helmets. Most arrived by ambulance (77.12%), and one third (33.66%) were transferred from another hospital. Extremity (55.17%) and head/neck injuries (41.72%) were most common. Severe injuries (ISS > 15) were seen in 30.26%, while 90.86% had a GCS > 12. X-rays (92.81%), CT scans (56.04%), and ultrasounds (16.55%) were common investigations. Surgery was performed in 50.28% of cases. The in-hospital mortality rate was 15.10%, and the median length of stay (LOS) was five days. Conclusion Our findings show high in-hospital trauma mortality, often among patients transferred from other facilities, emphasizing the role of timely care. This study highlights the potential of trauma registries to inform preventive policies and clinical care, particularly in low-income settings.

Background Natural disasters such as floods, earthquakes, and hurricanes pose significant threats to human lives and infrastructure, particularly in low-lying regions of Pakistan. Among the most vulnerable areas are Sanghar and Dadu in the Sindh province, which experience recurrent flooding. These disasters often overwhelm healthcare systems and underscore the urgent need for adequately trained healthcare professionals capable of providing timely and effective disaster response. Nurses play a pivotal role in emergency care, yet there remains a gap in their formal preparedness for disaster situations. Aim The purpose of this study would be to bridge the identified gap by developing and implementing a context-specific integrated disaster nursing response curriculum for healthcare providers in Sanghar and Dadu, Pakistan. Materials and Methods A sequential explanatory mixed-methods design will be employed. In Phase 1, a quasi-experimental pre-post intervention will be conducted with 310 healthcare providers (155 per district). Participants will undergo a disaster response training program, with effectiveness assessed using a self-developed tool. Quantitative data will be analyzed using SPSS 27 through paired t-tests or ANOVA after normality testing. Phase 2 will involve qualitative focus group interviews in both districts, analyzed using inductive thematic analysis to explore participant experiences and perceptions. Discussion The intervention is expected to improve healthcare providers’ competencies in disaster response and management. By incorporating co-teaching and fostering self-efficacy among participants, the program also promotes knowledge dissemination and peer training within local healthcare systems. Conclusion This study is poised to significantly enhance the preparedness of healthcare professionals in responding to disaster emergencies. Beyond building essential capacity, a key highlight of this project is its emphasis on co-teaching and fostering individual confidence, empowering participants to train others effectively. This ripple effect of knowledge transfer will ultimately strengthen the overall resilience of our healthcare system in the face of future crises.

Objectives: As the global incidence of heat-related illnesses escalates in the wake of climate change-induced heat waves, the critical necessity for reliable diagnostic tools becomes apparent. This scoping review aimed to summarize the existing body of published evidence on biomarkers that could potentially be utilized for the diagnosis of heat-related illness in the clinical setting. Methods: We conducted a thorough search of 3 databases, including Embase, MEDLINE, on Ovid, and The Cochrane Library (Wiley) databases from October 11, 2022 up until January 15, 2024. We also manually included studies by searching the reference lists of the included articles. Studies that performed statistical validation were summarized in detail. Results: 2877 citations were identified and screened, with 228 studies reviewed as full text. 56% of these studies were conducted within China or North America. The studies identified 113 biomarkers. Most common biomarkers studied were troponin I, IL-6, platelets, and ALT. The studies exhibited considerable variation, reflecting the diverse range of investigated biomarkers and the absence of standardized statistical validation for the biomarkers. Conclusions: Numerous biomarkers have been evaluated in the literature, but none have been studied to impact clinical practice. There is significant variation in the methodology and statistical validation. There is a need for further research to identify clinically relevant biomarkers for heat related illnesses.

Introduction Childhood mortality in the emergency setting is disproportionately high in low-income and middle-income countries (LMIC), with limited research dedicated to improving timely interventions, especially for critically ill children during transport. To perform essential prehospital paediatric research, there is a need for a tailored consent process, which reflects the specific needs and concerns of participants in this challenging research context. Objective The objective is to prospectively investigate stakeholder perceptions and preferences regarding consent processes for a specific paediatric ambulance-based telemedicine trial. Methods Exploratory qualitative study design using face-to-face semistructured interviews and focus group discussions. Data were analysed using thematic analysis. Participants included healthcare providers (paediatric telemedicine physicians and emergency medical technicians) and parents of children who required emergency transportation in Karachi, Pakistan. Results 47 participants, ranging from 19 to 47 years old, were involved in in-depth interviews or focus group discussions. The participants comprised 29 healthcare workers and 18 parents. Among them, 9 were women and 38 were men. Expressing diverse attitudes towards different consent methods, the majority recommended a prospective written informed consent approach to build trust and provide legal protection. Participants understood the situational incapacity that occurs in emergency settings, emphasised the importance of keeping the consent brief and recommended a subsequent contact in 2–3 days after the emergency transport to reconfirm consent and answer any questions. Conclusion Our interpretation of the findings revealed that participants preferred a staged consent process for telemedicine trials in LMIC paediatric emergency settings.