Panorama of Emergency Medicine
type: channel
description: Panorama of Emergency Medicine PoEM is an international peer-reviewed independent journal dedicated to advancing knowledge and practice in emergency medicine.
publisher: New Health Concept
language: en
publication name: Panorama of Emergency Medicine
issn: 3006-0966
items: Adrenal Crisis in Internal Medicine: A Preventable Emergency Still Missed at the Bedside
items: Acute kidney injury: diuretics are effective in prevention but not in treatment
items: Rigourous audit and feedback : positive effect on healthcare professionnal practice
items: Ethical and Educational Perspectives on Involving Children and Adolescents as Simulated Patients in Pediatric Emergency Training
items: Hantavirus and the Andes Variant: A Brief Report
items: Piperacillin–Tazobactam–Associated Refractory High–Anion Gap Metabolic Acidosis in Septic Shock: A Case Report
items: Seroprevalence of the General Lebanese Population to COVID-19 Between 2023 and 2024
items: Factors Associated With Prolonged Ambulance Turnaround Time in a Large Quebec Health Network:A Two-Year Retrospective Study
items: PoEM 2026: Continuity, Resilience, and Advancement
items: Comparative Study of Medical Error Legislation in the League of Arab States (LAS). A proposal to Unify Medical error definition and its liability Legislations
items: Can a 2-Week Lockdown Control a COVID-19 Outbreak? A Cross-Sectional Analysis of the Lebanese COVID-19 Response
items: Rethinking Anticoagulation in Kidney Disease and Kidney Transplantation
items: Beyond the Checklist: A Scaffolded, Experiential Learning Framework for Medical Rescue Simulation (Part 1 of 2)
items: Emergency Staff Perceptions of Mass Casualty Management Effectiveness in Lebanese Hospitals: A Cross-Sectional Study
items: The Burden of Road Traffic Injuries: A Global Perspective
items: Knowledge and Stigma Regarding HIV and Homosexuality: An Exploratory Survey of Responding Physicians in Lebanon
items: A Near-Fatal Anaphylactic Reaction to Biliary Contrast: A Cautionary Case During Laparoscopic Cholecystectomy
items: Suggestions for the Study of Ethics of Simulation in Healthcare
items: The Assessment of Lebanese Hospital Nurses’ Qualifications in The Fight Against COVID-19: Are They Well Prepared?
items: The Digital Stethoscope: Harnessing Artificial Intelligence in Pediatric Emergency Medicine
items: Proceedings of the Qatar Paediatric Emergency Medicine 2026 Conference - Selected Abstracts
items: Literature review of the use of simulation for the training of paramedics in relation to caring for pediatric patients
items: Diagnostic accuracy of ultrasound findings for distinguishing complicated appendicitis from simple appendicitis in pediatric patients: A systematic review and meta-analysis
items: Development and Implementation of a Prehospital Paediatric Sepsis Screening Tool: Enhancing Early Recognition, Resuscitation, and Referral
items: Impact of Interprofessional Simulation-Based Training on Enhancing Non-Technical Skills and Team Readiness in Pediatric Resuscitation
items: Enhancing Paediatric & Adult Resuscitation Performance Through Flowchart Driven Targeted Training in the Critical First Five Minutes
items: Risk Factors of Peri-intubation Cardiac Arrest in Critically Ill Pediatric Patients Presenting to the Emergency Department of a Low-Middle-Income Country: A Case-Control Study
items: The Emergence of Excellence: Proposing the Paediatric Transport Reflective Improvement and Simulation-based Education (PaeTRISE) Framework for the Western Cape, South Africa
items: Reversal of Bradycardia through Nutritional Rehabilitation in Paediatric Anorexia Nervosa: A Retrospective Study from Qatar
items: Non-invasive positive pressure ventilation for acute asthma in children: Very uncertain results

Adrenal Crisis in Internal Medicine: A Preventable Emergency Still Missed at the Bedside
type: item
subject: Letter to the Editor
  topic: section
subject: Emergency Medicine
  topic: category
creator: Mohammed Alkhanafsa
rights: Copyright (c) 2026 Mohammed Alkhanafsa (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-29
publication date: 2026-07-29
doi: 10.26738/poem.v4i1.19

Acute kidney injury: diuretics are effective in prevention but not in treatment
type: item
description: CONTEXT Acute kidney injury (AKI) significantly affects patient morbidity and mortality. The prevalence of AKI ranges from 2% to 10% among hospitalised patients. Diuretics have demonstrated beneficial effects on kidney function by effectively reducing the energy demands of renal tubular cells. They may have benefits in the prevention and management of AKI. CLINICAL QUESTION What are the benefits and harms of administering diuretics compared with placebo, standard care, or no treatment for preventing AKI in patients undergoing surgery, radiological procedures, or requiring admission to an intensive care unit? What are the benefits and harms of administering diuretics in the treatment of patients with AKI? BOTTOM LINE In the prevention of AKI, diuretics may reduce the risk of AKI in at-risk patients (low-certainty evidence). They probably reduce mortality and the need for kidney replacement therapy (moderate-certainty evidence). Evidence suggests that diuretics may result in little or no difference in the need for permanent dialysis (low-certainty evidence). Regarding adverse effects, the use of diuretics may result in little or no difference in the occurrence of hypotension or hypokalaemia (low-certainty evidence). The evidence is very uncertain regarding the occurrence of arrhythmias (very low-certainty evidence). Diuretics may result in little or no difference in changes in serum creatinine at 30 days (low-certainty evidence). The evidence is very uncertain regarding the effect of diuretics on changes in urine output (very low-certainty evidence). In the treatment of AKI, evidence suggests that diuretics may result in little or no difference in mortality or the need for kidney replacement therapy (low-certainty evidence). Regarding adverse effects, the use of diuretics may increase the risk of hypotension (low-certainty evidence) and probably increases the occurrence of arrhythmias (moderate-certainty evidence). In contrast, diuretics may result in little or no hyp…
subject: Systematic review & Meta-analysis
  topic: section
subject: Critical illness & sedation
  topic: category
subject: Acute kidney injury
  topic: keywords
subject: Diuretics
  topic: keywords
creator: Tania Marx
creator: Nicolas Cazes
creator: Patricia Jabre
creator: Cochrane Pre-hospital and Emergency Care Group
rights: Copyright (c) 2026 Tania Marx, Nicolas Cazes, Patricia Jabre, Cochrane Pre-hospital and Emergency Care Group (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-16
publication date: 2026-07-16
doi: 10.26738/poem.v4i1.20

Rigourous audit and feedback : positive effect on healthcare professionnal practice
type: item
description: CONTEXT Audit and feedback (A&F) is a commonly used method in healthcare. Previous studies, particularly in the field of behavioural theories, suggest that this method encourages healthcare professionals to modify their practice. However, current evidence in healthcare does not clearly establish whether this method is associated with improvements in practice or which types of A&F are the most effective. CLINICAL QUESTION What are the effects of A&F on healthcare professional practice, and which factors may explain variations in the effectiveness of A&F ? BOTTOM LINE A&F probably improves the quality of practice, prescribing, and the ordering of additional tests (moderate-certainty evidence). Evidence suggests that A&F is more effective when the audit focuses on an individual professional’s practice or on a single behaviour rather than on the whole team or a series of actions. Feedback has greater impact when delivered by a respected peer with an existing relationship with the professional and when there is substantial room for improvement. Comparing a professional’s performance with that of higher-performing peers and focusing on issues recognised as priorities by professionals may improve the effectiveness of A&F. Several factors appear to increase the effectiveness of A&F: feedback delivered both verbally and in writing, the addition of an action plan alongside defined objectives, and feedback combined with other strategies such as training sessions, seminars, discussion groups, or regular reminders. In contrast, combining A&F with financial incentives or using it for punitive tone appears to be less effective or even counter-productive. CAVEATS The authors reported substantial heterogeneity in the effects observed. In some studies, A&F was associated with a decline in performance and difficulties in maintaining improvements over time. This highlights that A&F is not a trivial managerial intervention. Future studies are needed to better understand when and how thi…
subject: Systematic review & Meta-analysis
  topic: section
subject: Core discipline & systems
  topic: category
subject: HEALTHCARE PROFESSIONNAL
  topic: keywords
creator: Mathieu Oberlin
creator: Julie Dumouchel
creator: Patricia Jabre
creator: Cochrane Pre-hospital and Emergency Care Group
rights: Copyright (c) 2026 Mathieu Oberlin, Julie Dumouchel, Patricia Jabre, Cochrane Pre-hospital and Emergency Care Group (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-16
publication date: 2026-07-16
doi: 10.26738/poem.v4i1.21

Ethical and Educational Perspectives on Involving Children and Adolescents as Simulated Patients in Pediatric Emergency Training
type: item
description: Simulation in healthcare education encompasses a broad range of approaches, from tabletop exercises to the use of sophisticated computer-controlled manikins that mimic the physical appearance and physiological parameters of human beings. The use of simulated or standardized patients (SPs) in healthcare education is not new; however, it has evolved significantly over the past decade, particularly following the publication of the Association of Standardized Patient Educators' Standards in 2017. These standards complement a regularly updated series of best practice standards published by the International Nursing Association for Clinical Simulation and Learning, which aim to provide evidence-based guidelines to improve simulation delivery methods, ensure high-quality learner experiences, and promote the adoption of up-to-date operational procedures. Despite increasing adoption, there remains limited consolidated guidance specific to pediatric emergency contexts, which this paper aims to address. An area related to the use of SPs that remains controversial is the involvement of minors in an educational context. This narrative review synthesizes current literature and guidelines to examine the use of child and adolescent simulated patients (CASPs) in pediatric emergency medicine education, as well as their benefits and potential risks. It is recognized that the repetitive portrayal of certain medical conditions may have negative psychological or physical effects on children, and therefore, their involvement as SPs must be carefully considered. Specific measures should be implemented to protect young SPs and to prevent any adverse impact related to the roles they portray or the interactions they have with learners. The use of CASPs requires structured governance frameworks, age-appropriate role design, and formal safeguarding mechanisms to ensure ethical and effective integration. These recommendations extend beyond pediatric emergency medicine to other simulation-based e…
subject: Narrative Review
  topic: section
subject: Pediatrics & Neonates
  topic: category
subject: simulation
  topic: keywords
subject: ethics
  topic: keywords
subject: training
  topic: keywords
creator: Anan Khaled Ali Al Badawi
creator: Nandini Alinier
creator: Bahaeddin Tomeh
creator: Guillaume Alinier
rights: Copyright (c) 2026 Anan Khaled Ali Al Badawi, Nandini Alinier, Bahaeddin Tomeh, Guillaume Alinier (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-08-03
publication date: 2026-08-03
doi: 10.26738/poem.v4i1.18

Hantavirus and the Andes Variant: A Brief Report
type: item
description: N/A (Brief Report)
subject: Brief Report
  topic: section
subject: Sepsis & Infections
  topic: category
subject: Hatnavirus
  topic: keywords
subject: Andes virus
  topic: keywords
subject: transmission
  topic: keywords
subject: Risk factors
  topic: keywords
creator: Dominic Caputa
creator: Jack Ojile
creator: Hadie Islam
creator: Hilal Abdessamad
rights: Copyright (c) 2026 Dominic Caputa, Jack Ojile, Hadie Islam, Hilal Abdessamad (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-29
publication date: 2026-07-29
doi: 10.26738/poem.v4i1.22

Piperacillin–Tazobactam–Associated Refractory High–Anion Gap Metabolic Acidosis in Septic Shock: A Case Report
type: item
description: High-anion gap metabolic acidosis (HAGMA) in critically ill patients is most commonly attributed to lactic acidosis, renal failure, or toxin accumulation. Drug-induced HAGMA is uncommon and particularly difficult to establish in patients requiring renal replacement therapy. We report the case of an 86-year-old man with septic shock and severe acute kidney injury (AKI) who developed profound HAGMA requiring daily intermittent hemodialysis and continuous bicarbonate infusion. Despite normalization of lactate levels and improvement in renal function—evidenced by a decrease in serum creatinine from 8.9 to 1.8 mg/dL—persistent elevation of the anion gap and hypokalemia remained unresolved. Discontinuation of empirically initiated piperacillin–tazobactam (P/T) on day 4 resulted in resolution of the HAGMA within 48 hours, enabling cessation of dialysis. Though the improvement in the conditions of sepsis and renal function can be responsible for resolving the problem, the time factor associated with the discontinuation of piperacillin/tazobactam is suggestive of drug-related cause for the occurrence of the event. Nonetheless, the concomitant improvement in the condition of both renal dysfunction and sepsis is considered as a very important confounder in evaluating the causality for the drug.
subject: Case Report
  topic: section
subject: Shock
  topic: category
subject: case report
  topic: keywords
subject: high-anion gap metabolic acidosis
  topic: keywords
subject: piperacillin-tazobactam
  topic: keywords
subject: acute kidney injury
  topic: keywords
subject: hemodialysis
  topic: keywords
subject: septic shock
  topic: keywords
subject: drug-induced acidosis
  topic: keywords
subject: critical care nephrology
  topic: keywords
creator: Antoine Zgheib
creator: Bea Le Bon Chami
rights: Copyright (c) 2026 Antoine Zgheib, Beatrice Le Bon Chami (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-13
publication date: 2026-07-13
doi: 10.26738/poem.v4i1.17

Seroprevalence of the General Lebanese Population to COVID-19 Between 2023 and 2024
type: item
description: Background Understanding population immunity to SARS-CoV-2 is crucial for public health planning, especially Lebanon where unique healthcare challenges exist. This study aimed to assess the seroprevalence of SARS-CoV-2 antibodies and identify predictors of serostatus in a sample of the Lebanese population in 2023. Methods We conducted an observational study of 350 adult patients presenting to two emergency departments in Lebanon. Participants were tested using a ZEKMED COVID-19 IgG/IgM rapid test, a qualitative rapid SARS-CoV-2 anti-E antibody kit. A comprehensive statistical analysis including logistic regression, Bayesian modeling, and a Random Forest classifier was performed to identify predictors of IgG seropositivity. Results Our results showed high IgG seroprevalence of 95.1% (n=333), suggesting prevalent natural infection. While vaccination status and self-reported prior infection were not significant predictors of serostatus in standard analyses, both Bayesian and Random Forest models identified increased age as a potential predictor associated with a negative IgG antibody response (94% HDI: [-1.531, -0.000]; importance score: 0.61). Conclusion Our findings indicate high exposure to natural SARS-CoV-2 infection in this Lebanese cohort. However, the association of advanced age with a negative antibody response suggests that older populations may remain more vulnerable. This highlights the need for continued targeted public health surveillance and strategies despite high overall seroprevalence from past infections. Introduction Covid-19 infection is a recent pandemic, known to cause severe respiratory illness. Since the Coronavirus Infectious Disease 19 (COVID-19) pandemic hit, vaccination, infection control and immunity became a major interest for healthcare [1]. People were infected in groups, sometimes whole communities, which while overwhelming, contributed to population-level seroprevalence after resolution [2]. However, not everyone had the same COVID-19…
subject: Original Article
  topic: section
subject: Core discipline & systems
  topic: category
subject: Disaster & Crisis Management
  topic: category
subject: Public Health Emergencies
  topic: category
subject: Covid-19
  topic: keywords
subject: IgG
  topic: keywords
subject: Antibodies
  topic: keywords
subject: Anti-E
  topic: keywords
subject: Immunity
  topic: keywords
creator: Hilal Abdessamad
creator: Elsy Jabbour
creator: Danielle Abou Khater
creator: Mariana Helou
rights: Copyright (c) 2026 Hilal Abdessamad, Elsy Jabbour, Danielle Abou Khater, Mariana Helou (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-01
publication date: 2026-05-01
doi: 10.26738/poem.v4i1.7

Factors Associated With Prolonged Ambulance Turnaround Time in a Large Quebec Health Network:A Two-Year Retrospective Study
type: item
description: Background Ambulance turnaround time (TAT), defined as the interval from ambulance arrival at the emergency department (ED) to vehicle readiness for a new call, is a key performance indicator for emergency medical services (EMS). Prolonged TAT reduces ambulance availability, compromises system efficiency, and may adversely affect patient outcomes. In Quebec, performance targets require that 80% of TATs be under 35 minutes and 98% under 45 minutes. Objective This study aimed to identify factors associated with ambulance TAT exceeding 45 minutes across hospitals within the Mauricie-Centre du Quebec Integrated Health and Social Services Centre (CIUSSS MCQ) over two consecutive fiscal years. Methods A retrospective observational study was conducted using anonymized EMS operational data from the PACQSPU database. All ambulance calls recorded between April 2023 to March 2024 and April 2024 to March 2025 were analyzed. Calls with TAT >45 minutes were examined according to month, time of day, call priority, receiving hospital, and day of the week. Results Of 118 953 ambulance calls, approximately 23 to 25% exceeded the 45-minute TAT threshold in both years. Delays occurred predominantly during daytime shifts and weekdays. Priority levels P1 and P3 accounted for most delayed calls, while P0 calls showed the highest proportion of prolonged TAT. Urban hospitals, particularly the regional referral center, exhibited higher delay rates.
subject: Original Article
  topic: section
subject: Prehospital, first response & transport
  topic: category
subject: ED operations, triage & diagnostics
  topic: category
subject: Ambulance turnaround time
  topic: keywords
subject: Emergency medical services
  topic: keywords
subject: Emergency department offload delay
  topic: keywords
subject: Hospital capacity
  topic: keywords
subject: Quebec health network
  topic: keywords
creator: Laurence Larouche
creator: Christian Shooner
creator: Chady El Tawil
rights: Copyright (c) 2026 Laurence Larouche, Christian Shooner, Chady El Tawil (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-01
publication date: 2026-07-01
doi: 10.26738/poem.v4i1.16

PoEM 2026: Continuity, Resilience, and Advancement
type: item
description: In 2009, the Mediterranean Journal of Emergency Medicine (MJEM) was founded with a clear ambition: to provide emergency medicine in our region, Lebanon and the Middle East, with a credible, independent, and rigorous scientific platform. The objective was simple: to publish, to structure, and to connect. From the outset, a committed editorial board, a robust peer-review process, a firmly established open-access policy, and strict adherence to international ethical standards defined the journal’s foundations. As early as 2012, evaluations by the National Library of Medicine recognized the solidity of this framework and the high level of integrity underpinning the journal. Since then, the journal’s trajectory has unfolded within challenging environments: conflict, regional instability, a profound economic crisis, and fragile healthcare systems. Throughout these years, emergency medicine has remained on the front line. The period between 2009 and today may appear long, but it has been defined by resilience, by quiet continuity and the preservation of scientific standards despite considerable constraints. In 2023, a decisive step was taken with the launch of Panorama of Emergency Medicine (PoEM). This was not simply a change of name but a strategic transformation. PoEM emerged in continuity with MJEM, carrying forward its core values while embracing a broader identity, a clearer vision, and a more structured ambition. Not a rupture, but an evolution. By 2026, this transformation has become fully visible. A new Open Journal Systems (OJS) platform compliant with the standards required by major indexing databases has been implemented. Metadata have been harmonized, DOIs are systematically assigned, and openaccess licenses are clearly displayed. Editorial workflows are structured and traceable. The journal’s infrastructure now aligns with contemporary expectations in scholarly publishing. The editorial office has also been strengthened by a professional team overseeing the e…
subject: Editorial
  topic: section
subject: Core discipline & systems
  topic: category
subject: resilience
  topic: keywords
subject: Emergency Medicine
  topic: keywords
subject: medical education
  topic: keywords
subject: publishing
  topic: keywords
creator: Nagi Souaiby
creator: Steve Photiou
creator: Hugues Lefort
creator: Bruno Mégarbane
rights: Copyright (c) 2026 Nagi Souaiby, Steve Photiou, Hugues Lefort, Bruno Mégarbane (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-09
publication date: 2026-07-09
doi: 10.26738/poem.v4i1.15

Comparative Study of Medical Error Legislation in the League of Arab States (LAS). A proposal to Unify Medical error definition and its liability Legislations
type: item
description: Background The concept of unifying medical error legislation offers multiple potential benefits to the League of Arab States (LAS). Methods This descriptive study examined LAS medical error legislation to highlight the current state of medical error legislation principles and proposes an approach that member states of the LAS could leverage to unify their regulations governing medical error. Result Among LAS countries, only 15 out of 22 (68%) had a specific medical liability law and only 12 of them (54%) defined medical error. The Civil and Penal Code was applied in 4 countries (18%) while information could not be found for 3 countries (13.6%). Conclusion The study recommends that LAS countries undertake medical error legislation reform to unify the definition, restrict criminal liability for actions prohibited by law, and limit medical error liability to corrective disciplinary and civil penalties (award), which will reflect positively in the healthcare system and practice of medicine.
subject: Original Article
  topic: section
subject: Forensic Emergencies
  topic: category
subject: Policy Shaping
  topic: category
subject: General Public Health Education
  topic: category
subject: League of Arab States
  topic: keywords
subject: medical error
  topic: keywords
subject: medical fault
  topic: keywords
subject: medical malpractice
  topic: keywords
subject: medical liability
  topic: keywords
subject: civil versus criminal liability
  topic: keywords
subject: unified medical malpractice legislation
  topic: keywords
creator: Ayesha Almemari
creator: Abdussalam Alshehri
rights: Copyright (c) 2026 Ayesha Almemari, Abdussalam Alshehri (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-06-10
publication date: 2026-06-10
doi: 10.26738/poem.v4i1.13

Can a 2-Week Lockdown Control a COVID-19 Outbreak? A Cross-Sectional Analysis of the Lebanese COVID-19 Response
type: item
description: Introduction With the rise of the novel coronavirus cases and fatalities around the world, researchers were invested in studying not only the therapeutic measures, but also, the preventive ones. As observed in other countries, many governments resorted to the shutdown of all services and closure of all facilities thus isolating people in their homes. Due to the rapidly collapsing local currency and deteriorating Lebanese economy, the local government implemented a two-week lockdown hoping it will reduce the surge in newly diagnosed Corona Virus Disease - 19 (COVID-19) cases without worsening the economic situation. Method In this study, we aim to understand the effectiveness of such plans in Lebanon and the contribution of the Lebanese people in its accomplishment. We looked at the numbers in all Lebanese territories over 2 weeks before the lockdown, during the 2-week lockdown (from 16 till 28thNovember 2020) and 2 weeks post lockdown. After collecting the data, we analyzed the mean number of cases and death before, during and after lockdown and by followed the growth factor of cases during this period. Result It was shown that for all studied districts, there was a trend in decline of the total number of cases, but the results were not statistically significant to prove that a 2-week lockdown can impact the epidemic. Conclusion A short, partial lockdown has no benefit over the growth or reduction in the virus impact or transmission, however, it might have some positive outcomes if implemented for longer periods.
subject: Original Article
  topic: section
subject: Emergency Medicine
  topic: category
subject: Disaster & Crisis Management
  topic: category
subject: PHEOC - Public Health Emergency Operational Centers
  topic: category
subject: COVID
  topic: keywords
subject: publichealth
  topic: keywords
subject: Lockdown
  topic: keywords
subject: Cross-sectional study
  topic: keywords
creator: Mahmoud El-Hussein
creator: Malika Ait Haddou Mouloud
creator: Rachid Moudoud
creator: Faouzi Abdellaoui
creator: Brahim Houmadi
creator: Cima Hamieh
rights: Copyright (c) 2026 Mahmoud El-Hussein, Malika Ait Haddou Mouloud, Rachid Moudoud, Faouzi Abdellaoui, Brahim Houmadi, Cima Hamieh (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-07-01
publication date: 2026-07-01
doi: 10.26738/poem.v4i1.14

Rethinking Anticoagulation in Kidney Disease and Kidney Transplantation
type: item
description: Background A clinical dilemma exists in patients with CKD, ESKD, and after kidney transplantation, as they face concurrent risks of both thromboembolic and hemorrhagic complications. Objective To review the literature on anticoagulant treatments in CKD, hemodialysis, and transplantation, with particular emphasis on pharmacology, safety, and clinical implementation. Methods Narrative review of scientific articles from PubMed, EMBASE, and Cochrane databases up to July 2025 inclusive using predefined search strategy. Observational studies, randomized trials, and major guidelines (KDIGO, AHA/ACC, ESC) were included. Results Despite its widespread use, warfarin has the disadvantage of bleeding and vascular calcification. Apixaban has the best data available among DOACs for use in CKD stage 5. The use of UFH is preferred in dialysis patients due to its reversibility properties. Other new drugs like factor XI inhibitors and LAAO are also very promising. Conclusion Anticoagulant therapy in patients with renal diseases needs personal risk assessment, proper selection of medications, and good management, especially during emergencies. Introduction An intriguing hemostatic paradox exists in patients with CKD: both thrombotic and hemorrhagic complications arise from uremic changes affecting platelet function, coagulation pathways, endothelial cells, and vascular calcification [1–3]. This challenge is further magnified among ESKD patients on dialysis and in those receiving kidney transplantations, where additional variables — including extracorporeal circuits, perioperative stress, altered pharmacokinetics, and extensive drug-drug interactions attributable to immunosuppressant medications — complicate anticoagulation management [2, 3]. Within this context, this review critically analyzes the current literature on anticoagulation therapy in patients with CKD, on dialysis, and after kidney transplantation. This topic is clinically significant due to the increasing incidence of chr…
subject: Narrative Review
  topic: section
subject: Emergency Medicine
  topic: category
subject: Anticoagulants, Warfarin, Chronic Renal Insufficiency, Renal Dialysis, Kidney Transplantation
  topic: keywords
creator: Antoine Zgheib
rights: Copyright (c) 2026 Dr. Antoine J. Zgheib (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-20
publication date: 2026-05-20
doi: 10.26738/poem.v4i1.12

Beyond the Checklist: A Scaffolded, Experiential Learning Framework for Medical Rescue Simulation (Part 1 of 2)
type: item
description: The effective training of Technical Rescue Specialists (TRS) for high-stakes dynamic environments requires a sophisticated pedagogical approach. This article introduces a comprehensive framework for Simulation-based Education (SBE) designed to elevate Medical Rescue Simulation (MRS). The framework is built upon four interconnected pillars: Foundational Learning Theory, Systematic Skill Scaffolding, Integrated Physical Preparedness, and Stringent Safety Protocols. This article will concentrate specifically on Kolb's learning cycles and the principles of scaffolding. Grounded in Kolb's Experiential Learning Cycle, the framework ensures that learning moves beyond rote memorisation to foster deep understanding and adaptive expertise. The core pedagogical strategy involves scaffolding complex medical rescue procedures, by deconstructing them into isolated, manageable skills. Students’ progress through scenarios of increasing fidelity and complexity, from low-fidelity drills and Visually Enhanced Mental Rescue Simulations (VEMRS) to immersive, high-fidelity exercises, that mirror real-world pressures. This structured progression manages cognitive load, and is designed to cultivate the "emergence" of proficient practice by ensuring foundational competencies are robustly established, thereby preventing the "absence" of critical skills in high-stakes situations. Introduction The effective training of Technical Rescue Specialists (TRS) within higher education institutions, particularly in the demanding and high-stakes context of medical rescue operations, requires a pedagogically sound and integrated approach. These environments are characterised by dynamic, unpredictable scenarios that demand not only technical proficiency but also rapid decision-making, physical endurance, and cohesive teamwork [1]. In response to these challenges, Simulation-based Education (SBE) has emerged as a cornerstone methodology, offering a controlled yet realistic platform for the development of c…
subject: Original Article
  topic: section
subject: Core discipline & systems
  topic: category
subject: Emergency Medicine
  topic: category
subject: Rescue
  topic: keywords
subject: Simulation-based Education
  topic: keywords
subject: Kolb’s Cycle
  topic: keywords
subject: Experiential Learning
  topic: keywords
subject: High Angle
  topic: keywords
subject: Medical Rescue Simulation
  topic: keywords
subject: Scaffolding
  topic: keywords
subject: Technical Rescue Specialist
  topic: keywords
subject: Visually Enhanced Mental Rescue Simulation
  topic: keywords
creator: Athenkosi Sobada
creator: John Meyer
creator: Elroy Cameron
creator: Glenhael Carolus
rights: Copyright (c) 2026 Athenkosi Sobada, John Meyer, Elroy Cameron, Glenhael Carolus (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-04-19
publication date: 2026-04-19
doi: 10.26738/poem.v4i1.3

Emergency Staff Perceptions of Mass Casualty Management Effectiveness in Lebanese Hospitals: A Cross-Sectional Study
type: item
description: Introduction Mass Casualty Incidents (MCIs) present significant challenges to hospitals, often overwhelming available resources and requiring rapid, coordinated responses. Effective casualty management plans are essential to ensure optimal patient care during such crises. Key components include staff training, interdepartmental communication, resource allocation, psychological support, and post-disaster evaluation. Objective This study aimed to evaluate the perceived effectiveness of disaster management plans in Lebanese hospitals from the perspective of emergency staff responsible for implementing Mass Casualty Management (MCM) plans. Materials and Methods A cross-sectional quantitative study was conducted with 71 emergency staff members, including chiefs and personnel directly involved in MCM, from 12 public and private hospitals across Lebanon. Data were collected via a structured questionnaire covering demographics, overall plan effectiveness, specific plan components (triage, communication, coordination, resource allocation), and open-ended suggestions. Results Significant positive correlations were observed between staff training and perceived plan effectiveness (r = 0.528, p < 0.01), perceived triage efficiency and the staff’s perception of reduced mortality and morbidity (r = 0.505, p < 0.01), resource allocation and perceived plan effectiveness (r = 0.572, p < 0.01), communication and team coordination (r = 0.481, p < 0.01), and psychological support and staff satisfaction (r = 0.541, p < 0.01). Conclusion Emergency staff perceive continuous training, effective communication, optimized resource allocation, and psychological support as critical to improving the effectiveness of MCM plans. Hospitals should adopt an integrated approach that combines these elements with systematic post-disaster evaluation to strengthen preparedness, staff resilience, and patient care during mass casualty incidents. Introduction Context Lebanon has faced repeated crises in recen…
subject: Original Article
  topic: section
subject: Disaster Medicine
  topic: category
subject: Disaster & Crisis Management
  topic: category
subject: Mass Casualty Management
  topic: keywords
subject: Emergency Staff Perceptions
  topic: keywords
subject: Hospital Preparedness
  topic: keywords
subject: Psychological Support
  topic: keywords
subject: Resource Allocation
  topic: keywords
creator: Eliana Ghazal
creator: Dunya Nohra
creator: Hilda Chelala
creator: Maha Nehme
rights: Copyright (c) 2026 Eliana Ghazal, Dunya Nohra, Hilda Chelala, Maha Nehme (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-16
publication date: 2026-05-16
doi: 10.26738/poem.v4i1.10

The Burden of Road Traffic Injuries: A Global Perspective
type: item
description: Introduction Road Traffic Injury (RTI) pose a significant health challenge. It represents the eighth leading cause of death globally, prompting the UN to designate 2011-2020 as the “Decade of Action for Road Safety”. This study aims to determine the global and regional burden of RTIs, and the impact of drink-driving and seatbelt-wearing on RTIs in 2017, while also assessing the UN Action Plan outcomes and forecasting the RTI rate for 2029. Methods Data on the global and regional RTI rates (2000-2019), regional seatbelt use (2017), and regional drink-driving (2017) were compiled from the Global Health Observatory Estimates. The investigated key metrics are global and regional RTI rate per 100,000 population in 2000-2019, percentage of regional seatbelt-wearing, drink-driving RTIs, and enforced seatbelt and drink-driving laws in 2017. Results This study reveals a heterogenous regional distribution of road traffic injuries in 2017. Africa sustained the highest RTI rate (27.6/100,000 population), while Europe reported the lowest rate (10.98/100,000 population). Regional variation in seatbelt laws exists, with the highest legalization in Europe (100%), and the lowest in Western Pacific (80.95%). Eastern Mediterranean (87.43%) and South-East Asia (46.8%) reported the highest and lowest driver seatbelt-wearing rates, respectively. All countries, except the Maldives, legislated drink-driving laws. Western Pacific (29.98%) and Eastern Mediterranean (1.65%) suffer from the highest and lowest burden of drink-driving RTI, respectively. Conclusion Despite a relatively stable global RTI rate from 2011-2020 and a steady decline till 2029, the future trajectory remains uncertain in developing countries bearing the highest burden, due to slow national law enforcement, rendering the UN Action Plan insufficient in curbing the burden of RTIs. INTRODUCTION Road traffic injury (RTI) is a major global health challenge, impacting millions of individuals worldwide [1]. With approximately 20…
subject: Original Article
  topic: section
subject: Core discipline & systems
  topic: category
subject: Triage & First Response
  topic: category
subject: Trauma & injury
  topic: category
subject: Wounds and Injuries
  topic: category
subject: Multiple and Poly- Trauma
  topic: category
subject: Public Health Emergencies
  topic: category
subject: Policy Shaping
  topic: category
subject: Road Safety
  topic: category
subject: General Public Health Education
  topic: category
subject: Road Traffic Injury
  topic: keywords
subject: Health Policy
  topic: keywords
subject: Epidemiology
  topic: keywords
subject: Global Health
  topic: keywords
subject: UN Decade of Action Plan
  topic: keywords
creator: Johny El-Achkar
creator: Maya El-Gharib
creator: Nesrine Ahmad
creator: Samar Al-Hajj
rights: Copyright (c) 2026 Johny El-Achkar, Maya El-Gharib, Nesrine Ahmad, Samar Al-Hajj (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-04-06
publication date: 2026-04-06
doi: 10.26738/poem.v4i1.2

Knowledge and Stigma Regarding HIV and Homosexuality: An Exploratory Survey of Responding Physicians in Lebanon
type: item
description: Background HIV remains a major public health challenge in the Middle East and North Africa (MENA), where stigma against people with HIV (PWH) and men who have sex with men (MSM) hinders access to care. In Lebanon, little is known about physicians’ current knowledge, attitudes, and willingness to provide care for PWH. Methods We conducted an exploratory online survey of all Lebanese physicians registered with the Ministry of Public Health, distributed in four waves between 2023 and 2025. The 58-item questionnaire assessed HIV knowledge, attitudes toward PWH and homosexual colleagues, willingness to provide medical care, and practices related to sexual history and pre-exposure prophylaxis (PrEP). Out of 4,331 emails, 760 were invalid and 127 physicians responded (3.2%). Results Interpretation is limited by a low response rate, and findings should be considered for hypothesis generation rather than prevalence estimates. Respondents were mostly male (63%), with varied specialties and practice settings. Knowledge of HIV transmission was generally high, though gaps were identified: 54% did not recognize breastmilk as a transmission route, 20% were unaware of confidential testing facilities, and only 64% knew that PrEP prevents transmission. While 86% were willing to medically examine PWH and over 90% would perform minor or major procedures, 29% believed physicians have the right to refuse care due to fear of infection. Stigmatizing attitudes were also noted, where 13% would not buy food from PWH, 33% would not allow their child to play with PWH, and 39% would not accept surgery from a surgeon living with HIV. Regarding homosexuality, 10–12% opposed accepting homosexual applicants to medical training or granting them practicing privileges. Most respondents (61%) did not routinely take sexual histories, and 84% had never prescribed PrEP, while 96% agreed on the need for further education. Conclusion In this exploratory sample, respondents had adequate HIV knowledge, but sig…
subject: Original Article
  topic: section
subject: Core discipline & systems
  topic: category
subject: Emergency Medicine
  topic: category
subject: Specific Needs Patients & Elderlies
  topic: category
creator: Hilal Abdessamad
creator: Zeinab Roumieh
creator: Jacques E. Mokhbat
rights: Copyright (c) 2026 The Authors https://creativecommons.org/licenses/by/4.0
date: 2026-04-06
publication date: 2026-04-06
doi: 10.26738/poem.v4i1.6

A Near-Fatal Anaphylactic Reaction to Biliary Contrast: A Cautionary Case During Laparoscopic Cholecystectomy
type: item
description: Anaphylactic reactions to iodinated contrast agents during intraoperative cholangiography (IOC) are extremely rare, although such reactions are well documented with intravenous (IV) administration. We present the case of a 71-year-old female with a known allergy to iodinated contrast, who experienced a life threatening anaphylactic reaction immediately after intraoperative cholangiography (IOC) during laparoscopic cholecystectomy. Shortly after the administration of iodinated contrast into the biliary duct, the patient developed supraventricular tachycardia and profound hypotension. This case underscores the risk of systemic absorption and hypersensitivity reactions from biliary-administered contrast agents, even in the absence of intravenous exposure. It highlights the need for a comprehensive preoperative allergy evaluation in high-risk patients undergoing biliary procedures and the importance of considering alternative imaging methods to avoid serious complications. Introduction Cholecystitis, inflammation of the gallbladder mostly due to obstruction of the cystic duct by a gallstone, is considered one of the most frequent indications for laparoscopic cholecystectomy [1]. Intraoperative cholangiography (IOC) is performed during cholecystectomy to visualize the biliary anatomy and identify any residual obstruction [2]. The technique involves inserting a catheter into the cystic duct and injecting an iodinated contrast agent to highlight the biliary tree under fluoroscopy. While this contrast agent is generally safe and plays a crucial role in optimizing surgical outcomes, its use carries a very low risk of hypersensitivity reactions [3]. Although contrast is administered directly into the biliary tree rather than intravenously, iodinated agents can still be absorbed into the systemic circulation, potentially triggering hypersensitivity reactions, including anaphylaxis [4]. While such events are rare during intraoperative cholangiography (IOC), they are clinically …
subject: Case Report
  topic: section
subject: Emergency Medicine
  topic: category
creator: Hiba Hamdar
creator: Aktham Abdelhadi
creator: Dareen Al Ayash
creator: Yaser Harb
creator: Nadim Chaarani
creator: Abbas Al Bazzal
creator: Nazim Matta
creator: Mirna Fares
rights: Copyright (c) 2026 Hiba Hamdar, Aktham Abdelhadi, Dareen Al Ayash, Yaser Harb, Nadim Chaarani, Abbas Al Bazzal, Nazim Matta, Mirna Fares (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-12
publication date: 2026-05-12
doi: 10.26738/poem.v4i1.11

Suggestions for the Study of Ethics of Simulation in Healthcare
type: item
description: Simulation can be used in healthcare education to provide learners with the opportunity to develop the knowledge and skills needed to manage complex situations and provide patient care, however one aspect easily overlooked and which has many ramifications, is that of ethical practice. Simulation-based education is a moral and ethical imperative. “Never the first time on the patient!” is displayed at the entrance of some clinical simulation centres, but the rest of the ethical obligations, besides the professional code of ethics, are either not mentioned or only sporadically. By using an interpretive framework based upon the 4 bioethics principles used for patients (autonomy, beneficence, nonmaleficence, and distributive justice), we propose, as a conceptual framework, an analysis on the stakeholders of simulation-based education (SBE) - educators, learners, and simulated participants - to broaden and explore in depth the conventional views of ethics in simulation. This article also discusses specific features in simulation which sometimes pose an ethical dilemma such as facing simulated death, breaking bad news, research, the use of biological tissue, teaching ethics, and computer simulation. This proposal to explore ethics in healthcare simulation is intended to stimulate reflection rather than serve as a model seeking external validation. Foreword Before embarking on exploring ethics in healthcare simulation as a conceptual framework, we believe it is important to clarify the relationship between a practice, its ethical aspects, and its legal aspects. The relationship between biomedical practice, ethics, and legislation is closely tied to a society’s historical, cultural, political, and religious context [1, 2]. More specifically, the relationship between ethics and the law regarding a given action evolves according to dynamics shaped by this context. Two examples related to simulation illustrate this point: 1. In France, donating a body to science has been legal …
subject: Original Article
  topic: section
subject: Emergency Medicine
  topic: category
subject: Policy Shaping
  topic: category
creator: Denis Oriot
creator: Guillaume Alinier
creator: Zineb Messarat-Haddouche
creator: Hervé Thomazeau
creator: Laetitia May-Michelangeli
creator: Marie-Christine Moll
creator: Jean-Claude Granry
rights: Copyright (c) 2026 Denis Oriot, Guillaume Alinier, Zineb Messarat-Haddouche, Hervé Thomazeau, Laetitia May-Michelangeli, Marie-Christine Moll, Jean-Claude Granry (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-05-19
publication date: 2026-05-19
doi: 10.26738/poem.v4i1.9

The Assessment of Lebanese Hospital Nurses’ Qualifications in The Fight Against COVID-19: Are They Well Prepared?
type: item
description: Background On December 31, 2019 China reported multiple cases of a novel coronavirus, This rapid and unexpected increase in cases caused a shortage of testing kits, personal protective equipment (PPE), medical treatments, ventilators, and other medical supplies. Therefore, nurses and physicians needed to feel safe, protected and confident while treating ill patients. It is the responsibility of the healthcare system's to wisely use the skills and available resources for an effective response and ensure the safety of the personnel. Our primary objective is to assess the preparedness of nurses against the coronavirus and then to evaluate the impact of the outbreak on the nurses and their attitude towards the pandemic. Methods An anonymous online survey was conducted among nurses across Lebanon. It consisted of 24 multiple-choice, closed-ended questions related to knowledge, attitude and practice. Results A total of 370 registered nurses completed the survey. Analysis showed that age had no effect on knowledge; males were more trained than females for triage, hand hygiene and working in isolation units, while females were more trained for handling PPE. Additionally, females attended national lectures more than males, while males received information from media and brochures. The training for PPE use and working in isolation unit was better conducted in university hospitals as compared to non-university ones. 50% of nurses in both hospital types did not attend any lectures. The nurses in all Lebanese districts had training about hand hygiene and working in isolation unit before the pandemic while they had the triage training mostly after the pandemic started. Analysis also showed that the nurse-to-patient ratio was higher for older nurses and in peripheral areas. For both genders, 66.3% had never undergone an N95 fit test. Lastly, almost half of the nurses thought about quitting their job. Conclusion The study showed that there is some lack of nurses’ knowledge towards …
subject: Narrative Review
  topic: section
subject: Emergency Nursing & Midwives
  topic: category
subject: Practical Nursing
  topic: category
subject: Critical illness & sedation
  topic: category
subject: Public Health Emergencies
  topic: category
creator: Cima Hamieh
creator: Mahmoud El-Hussein
creator: Alicia Djoundourian
creator: Rachelle Riachy
creator: Ghinwa Hayek
creator: Rania Sakr
rights: Copyright (c) 2026 Cima Hamieh, Mahmoud El-Hussein, Alicia Djoundourian, Rachelle Riachy, Ghinwa Hayek, Rania Sakr (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-04-25
publication date: 2026-04-25
doi: 10.26738/poem.v4i1.8

The Digital Stethoscope: Harnessing Artificial Intelligence in Pediatric Emergency Medicine
type: item
description: Dear Editor, Artificial Intelligence (AI) is increasingly recognized as a transformative force in healthcare, with Pediatric Emergency Medicine (PEM) standing to benefit significantly from its adoption. Children often present with subtle, atypical signs, making timely recognition of critical illness challenging. AI-driven tools are being applied in triage, predictive monitoring, diagnostic imaging, and resuscitation support, while also enhancing education through simulation and personalized learning. For global health, AI offers opportunities to reduce disparities by extending decision support to resource-limited settings. However, challenges such as data bias, ethical oversight, and the need for clinician training remain critical considerations. AI should be viewed not as a replacement for pediatric emergency physicians but as an augmentation of human expertise, amplifying decision-making, enhancing safety, and expanding access to quality care. This letter to the editor reflects on the promise, pitfalls, and potential of AI in PEM, advocating for its thoughtful and equitable integration into practice and education. Why AI matters in pediatrics emergencies Children are unique individuals with dynamic physiology. Their developmental stages influence clinical presentations, and emergencies can quickly become critical. Traditional triage and diagnostic tools, primarily designed for adults, often fail to meet the specific needs of pediatric care [1]. AI offers a transformative solution by providing rapid risk stratification and pattern recognition that surpasses human intuition, all while maintaining clinician oversight. Just as pulse oximetry revolutionized patient monitoring decades ago, AI is poised to become an indispensable tool in pediatric triage. Diagnostics and resuscitation : AI as an ally Machine learning systems are already making strides in predicting sepsis, respiratory failure, and unrecognized deterioration [2, 3]. In the realm of cardiac arrest, AI-driv…
subject: Letter to the Editor
  topic: section
subject: Pediatric Emergency Medicine
  topic: keywords
subject: Artificial Intelligence
  topic: keywords
subject: Simulation
  topic: keywords
subject: Clinical Reasoning
  topic: keywords
subject: Global Health
  topic: keywords
creator: Jabeen Fayyaz
creator: Nordia Thompson-Newell
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-14
publication date: 2026-03-14
doi: 10.26738/poem.v4i1.1

Proceedings of the Qatar Paediatric Emergency Medicine 2026 Conference - Selected Abstracts
type: item
description: Welcome to this issue of Panorama of Emergency Medicine (POEM) dedicated to the 10th Qatar Paediatric Emergency Medicine (Q-PEM) International Conference which was organised and hosted by Sidra Medicine (Doha, Qatar) and held online from January 16 to 18, 2026. Since its first iteration in 2017, Q-PEM has steadily evolved into an international forum for clinicians, educators, and researchers involved in the acute care of children to exchange knowledge, reflect on clinical practice, and share emerging research in paediatric emergency medicine. In 2025, the conference welcomed 2,000 online delegates from 22 countries and the programme included over 55 speakers [1]. Adopting a similar format, with 3 parallel sessions covering different important and contemporary topics, the event proved as popular in its 2026 edition with nearly identical numbers, yet we marked an important milestone for the Q-PEM community. Building on the success of previous years, the meeting again attracted a large international audience with multidisciplinary participation from physicians, nurses, pharmacists, allied health professionals, and trainees involved in paediatric emergency care. Similar to previous editions, the scientific programme combined plenary sessions, focused tracks, and research presentations to provide practical, evidence-based updates relevant to frontline emergency care. The conference was designed to enhance recognition and management of serious illness and injury in children, promote patient safety, and facilitate the translation of evidence into everyday clinical practice. Emergency Medicine is still a relatively young specialty, yet it is important to recognise that it includes a number of subspecialisations with clinicians of different professions each with their specific skill sets and knowledge to match the needs of the distinctive patient groups they care for [2]. Emergency Medicine continues to expand into highly specialized domains requiring multidisciplinary exper…
subject: Editorial
  topic: section
subject: Emergency Medicine
  topic: keywords
subject: Paediatrics
  topic: keywords
subject: Qatar
  topic: keywords
subject: Conference
  topic: keywords
subject: Call for abstracts
  topic: keywords
creator: Guillaume Alinier
creator: Muthukumar Sakthivel
creator: Syed Haris Huda
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-14
publication date: 2026-03-14
doi: 10.26738/poem.v4i2.9

Literature review of the use of simulation for the training of paramedics in relation to caring for pediatric patients
type: item
description: Background Paramedics face unique challenges when managing paediatric emergencies due to limited clinical exposure, insufficient training, the unpredictable prehospital environment, and scarce resources [1]. These factors increase anxiety and medical error risk, especially during rare, high-stakes events [2]. Simulation-based education (SBE) provides a safe, controlled environment that bridges the gap between knowledge and practice by allowing learners to rehearse decision-making and technical skills. Aim This review assesses the current state of paediatric simulation literature, evaluates the effectiveness of SBE in paramedic training using the Kirkpatrick evaluation framework, and identifies directions for future research. Methods A comprehensive search was conducted across PubMed, PsycINFO, CINAHL, ERIC, and Scopus for studies published between 2003 and 2023, using keywords and MeSH terms related to paramedics, prehospital care, paediatrics, and simulation. The review followed PRISMA 2020 guidelines, and methodological quality was appraised using the Joanna Briggs Institute checklists. Studies were categorised according to the four Kirkpatrick levels. Findings A total of 227 articles were identified, and upon removing duplicates, 184 were screened, and 60 were assessed for eligibility, following which 46 were excluded. In the remaining 14 studies, the use of SBE was generally reported to have had a positive impact on paramedics’ confidence and competence in performing several procedures (Table 1). Several studies reported that paramedics often felt uncomfortable providing care to children, made fewer errors, and wished they had more such training opportunities. No studies reported on how the training interventions contributed to improving actual patient care to fulfil the criteria of Kirkpatrick level 4. The full details of the findings have recently been reported [3]. Conclusion Simulation shows promise in improving paramedics' readiness for paediatric emergenci…
subject: Abstract
  topic: section
subject: Simulation
  topic: keywords
subject: Paediatrics
  topic: keywords
subject: Pre-hospital
  topic: keywords
subject: Paramedic
  topic: keywords
subject: Emergency Medical Service
  topic: keywords
creator: Anan K Al Badawi
creator: Bahaeddin Tomeh
creator: Nandini Alinier
creator: Guillaume Alinier
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-14
publication date: 2026-03-14
doi: 10.26738/poem.v4i2.6

Diagnostic accuracy of ultrasound findings for distinguishing complicated appendicitis from simple appendicitis in pediatric patients: A systematic review and meta-analysis
type: item
description: Background Acute appendicitis is the most common surgical emergency in children. While up to 85% of pediatric appendicitis cases are uncomplicated, the rate of complicated appendicitis can be significant, ranging from approximately 30% overall to as high as 50–75% in certain cohorts [1]. Ultrasound (US) is a first-line imaging modality, yet its diagnostic performance in accurately identifying these complications remains uncertain [2]. Methods Following PRISMA [3], we searched PubMed, Embase, Web of Science, and Scopus from inception. Risk of bias was assessed with QUADAS-2. Bivariate random effect model pooled sensitivity and specificity; heterogeneity was summarized using I² and Q; small-study effects were evaluated using Deeks’ test. Clinical utility was illustrated using a Fagan nomogram, and overall accuracy was assessed using a summary receiver-operating characteristic (SROC) curve. Results Twenty-one studies met the inclusion criteria. Nearly all procedures were conducted by specialists or residents in radiology. The age range for the pediatric population was between 0 to 18 years old. Pooled US sensitivity for identifying complicated appendicitis was 0.52 (95% CI 0.41–0.62), and specificity was 0.90 (0.84–0.94) (Figure 1). The area under the curve was 0.80 (0.76–0.83) (Figure 2), and the summary operating point mirrored the pooled estimates. Deeks’ test suggested no significant asymmetry (p=0.08). Assuming a pre-test probability of 25%, a positive US result (LR+ = 5) increased the post-test probability to ~64%, whereas a negative result (LR–=0.54) reduced it to ~15%. Conclusion In pediatric appendicitis, US demonstrates high specificity but moderate sensitivity for discriminating complicated from simple disease. A positive scan can “rule in” complication and support expedited, targeted management; a negative scan cannot exclude complication and should be interpreted alongside clinical findings, laboratory data, and, when indicated, adjunct imaging. Future stu…
subject: Abstract
  topic: section
subject: Pediatrics
  topic: keywords
subject: Complicated appendicitis
  topic: keywords
subject: Ultrasound
  topic: keywords
subject: Diagnostic accuracy
  topic: keywords
creator: Mansoureh Fatahi
creator: Ramin Shahidi
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-14
publication date: 2026-03-14
doi: 10.26738/poem.v4i2.8

Development and Implementation of a Prehospital Paediatric Sepsis Screening Tool: Enhancing Early Recognition, Resuscitation, and Referral
type: item
description: Background Paediatric sepsis remains a leading cause of preventable morbidity and mortality, contributing to 11 million deaths annually, including 1.2 million children [1, 2]. Early recognition is critical, yet prehospital identification is hindered by subtle presentations, age-related physiological variability, and limited diagnostic capability [1, 3]. Currently, no validated prehospital paediatric sepsis screening tool exists. The aim of this project was to develop and implement an evidence-based prehospital paediatric sepsis screening tool for paramedics. Methods The development process included a targeted literature review and formal stakeholder engagement with Hamad Medical Corporation Ambulance Service (HMCAS) and Sidra Medicine. The iterative tool refinement was informed by international guidelines, aligned with Sidra Medicine pathways, and adapted to support HMCAS clinical practice guidelines. Age-specific physiological thresholds were calibrated using Advanced Paediatrc Life Support vital-sign parameters within the sepsis context. Implementation was supported by a blended educational model comprising 4 hours of online preparatory modules, 7 hours of face-to-face workshops, and simulation-enhanced active learning sessions. Results The final screening tool integrated infection-risk assessment, high-risk clinical criteria, age-specific vital-sign thresholds, and key physiological indicators, supported by an algorithm (Figure 1). A corresponding prehospital sepsis care bundle (Figure 2) was incorporated to standardise timely recognition, intervention, and escalation, aligned with the “Sepsis Golden Hour” and “Sepsis 6” principles [1, 3]. Clinical validation and alignment were provided through expert review by paediatric sepsis specialists from Sidra Medicine. Case-based learning, deliberate practice, and simulations supported the application of the tool for operational practice. Conclusion The Prehospital Paediatric Sepsis Screening Tool was successfully develo…
subject: Abstract
  topic: section
subject: Paediatric sepsis
  topic: keywords
subject: Screening tool
  topic: keywords
subject: Early Recognition
  topic: keywords
subject: Prehospital Sepsis Care
  topic: keywords
subject: Paramedic Education
  topic: keywords
creator: Vernon Naidoo
creator: Rasha Ashour
creator: Ahmed Gueddes
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-14
publication date: 2026-03-14
doi: 10.26738/poem.v4i2.7

Impact of Interprofessional Simulation-Based Training on Enhancing Non-Technical Skills and Team Readiness in Pediatric Resuscitation
type: item
description: Background Effective pediatric resuscitation relies on both technical proficiency and non-technical skills, including leadership, communication, and teamwork [1]. These skills enhance role clarity, situational awareness, and coordinated interprofessional responses under pressure [2]. Combined with technical performance, they improve outcomes, build confidence, and foster collaboration. Simulation-based training provides a structured environment to strengthen decision-making, task delegation, and closed-loop communication [3]. This study assessed the impact of interprofessional simulation-based pediatric resuscitation training on non-technical skills and team readiness. Methods A pre/post interventional study was conducted at Al Wakra Hospital over 10 months starting December 2024, included 75 participants, comprising physicians and pediatric nurses, who were randomized into 12 teams with a designated leader for each team. 2.5-3 hours program following Advanced Life Support Group (ALSG) Guidelines, included a 1-hour interactive presentation and 1.5-2 hours of simulation scenarios, with 2–3 leaders trained per session with their teams. Each leader led a 10-15-minute pediatric resuscitation scenario with structured debriefing and faculty feedback. Pre-training scores were collected immediately before, and post-training scores after completion of entire mass training. Outcomes were measured using a validated 30-item non-technical skills checklist scored by independent observers with each item rated as 1 if demonstrated and 0 if not demonstrated (maximum possible score = 30), covering leadership, teamwork, and communication. Team readiness was assessed by post-training self-reported survey. Pre–post differences were analyzed with Wilcoxon signed-rank test. Results Descriptive and inferential data analysis of normalized mean scores (0–1 scale, with 1 representing the maximum possible score: leadership = 10, teamwork = 14, communication = 6) demonstrated significant improv…
subject: Abstract
  topic: section
subject: Pediatric Resuscitation
  topic: keywords
subject: Interprofessional Simulation
  topic: keywords
subject: Simulation-based Training
  topic: keywords
subject: Non-technical Skills
  topic: keywords
subject: Teamwork and Communication
  topic: keywords
creator: Mohamed Elsayed Saad Aboudonya
creator: Fatma Serag Elayouti
creator: Aseel Abujubbeh
creator: Khaled Sayed El Shafey
creator: Ghadeer Mraweh Mohammad Mustafa
creator: Shihab M. Ameen
creator: Emad Ali Hamad Almomani
creator: Princess Mary Sebastian
creator: Lorna Cynthia Lorenzo
creator: John Tobin
creator: Nina Rachel Reyes-Arbo
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-14
publication date: 2026-03-14
doi: 10.26738/poem.v4i2.5

Enhancing Paediatric & Adult Resuscitation Performance Through Flowchart Driven Targeted Training in the Critical First Five Minutes
type: item
description: Background Early recognition of cardiac arrest and delivery of high-quality early resuscitation are critical for survival [1]. Performance during this phase remains inconsistent in healthcare settings [2]. Simulation-based multidisciplinary team (MDT) training has shown superior outcomes compared to traditional lecturing, especially when monitored by measurable key performance indicators (KPIs) [3]. Data collected by Resuscitation Officers from the Hamad International Training Centre revealed KPIs not being met (Table 1), prompting a revised training method at Hamad Medical Corporation’s (HMC) hospitals, in Qatar. This study aimed to evaluate the introduction of a MDT training program integrating response algorithms emphasizing the first five minutes on resuscitation KPIs in simulated clinical settings. Methods A pre-/post-intervention study was conducted with 80 participants randomly allocated from newly formed MDT as per the shift roster at a newly opened HMC hospital providing diverse services. Each MDT consisted of two physicians and six nurses with defined roles, all with over 5 years of post-registration experience and qualified in Immediate Life Support or Paediatric Life Support. (European Resuscitation Committee 2021 guidelines). Performance was evaluated before and after the introduction of the revised training model. The initial sessions were skills-based (90 minutes of Basic Life Support airway and defibrillation) followed by a cardiac arrest simulation (30 minutes), latter sessions of the same duration were entirely simulation-based with coaching and emphasis on rapid assessment, timely recognition, and prompt initiation of interventions within the first five minutes of collapse, reinforced by the implementation of response algorithms (Figure 1). Data collection focused on six KPIs (Table 1). Results Implementation of the MDT training program and response pathway algorithms replacing solely skills training, resulted in improvements across all KPIs (Tabl…
subject: Abstract
  topic: section
subject: Resuscitation
  topic: keywords
subject: Training
  topic: keywords
subject: Simulation
  topic: keywords
subject: Qatar
  topic: keywords
subject: First 5 minutes
  topic: keywords
creator: Peter Arrowsmith
creator: Mohamed Elsayed Saad Aboudonya
creator: Khalid Abdulnoor Saifeldeen
creator: John Tobin
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-14
publication date: 2026-03-14
doi: 10.26738/poem.v4i2.4

Risk Factors of Peri-intubation Cardiac Arrest in Critically Ill Pediatric Patients Presenting to the Emergency Department of a Low-Middle-Income Country: A Case-Control Study
type: item
description: Background Peri-intubation cardiac arrest is defined as cardiac arrest that occurs within 20 minutes of airway management [1]. Incidence in the pediatric population ranges from 0.7% to 1.7% [2, 3]. Identifying pre-intubation risk factors may improve preparedness and outcomes during emergency intubations. This study aims to identify clinical and physiological predictors associated with peri-intubation cardiac arrest in pediatric patients undergoing emergency airway management in a tertiary care emergency department. Methods A retrospective case-control study was conducted at the emergency department of a tertiary care hospital in Karachi, Pakistan, from January 2019 to June 2023. Pediatric patients (<18years) who experienced cardiac arrest within 20 minutes of intubation were included as cases. For each case, four controls were randomly selected from the same cohort who were intubated without arrest. Pre-intubation clinical data, laboratory parameters, and vital signs were analyzed. Multivariable logistic regression was used to identify independent predictors of peri-intubation cardiac arrest. Results A total of 125 pediatric patients were included, 25 cases and 100 controls. Multivariate analysis identified several independent predictors of peri-intubation cardiac arrest. Age less than one year (aOR:10.97; p=0.028), hypoxemia (SpO₂<92%) (aOR:5.48; p=0.047), elevated heart rate (aOR:2.88; p=0.029), low systolic blood pressure (aOR:6.16; p=0.043), elevated shock index (≥1.2) (aOR:5.52; p=0.046), modified shock index ≥1.3 (aOR:11.11; p=0.048), lactate ≥2 mmol/L (aOR:15.64; p=0.023), and capillary refill time >3 seconds (aOR:7.55; p=0.042), were found to be independent predictors of peri-intubation cardiac arrest (Table 1). Conclusion Pre-intubation physiological instability is strongly associated with peri-intubation cardiac arrest in pediatric patients. Early recognition of high-risk features such as hypoxemia, tachycardia, hypotension, elevated lactate levels, delaye…
subject: Abstract
  topic: section
subject: Peri-intubation
  topic: keywords
subject: Cardiac arrest
  topic: keywords
subject: Emergency Department
  topic: keywords
subject: Pediatric
  topic: keywords
subject: Risk factors
  topic: keywords
creator: Noman Ali
creator: Erum Shakeel
creator: Ahmed Raheem
creator: Hania Ather
creator: Surriya Bano
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-14
publication date: 2026-03-14
doi: 10.26738/poem.v4i2.3

The Emergence of Excellence: Proposing the Paediatric Transport Reflective Improvement and Simulation-based Education (PaeTRISE) Framework for the Western Cape, South Africa
type: item
description: Background: Inter-facility transport of critically ill children in the Western Cape, in South Africa, poses significant risks, often contributing to preventable morbidity.1 While specialised teams exist, many transfers are undertaken by non-specialist personnel. South African literature confirms this gap, noting that paediatric critical care retrieval is often absent as a formal, stand-alone course in tertiary curricula and that transfers are handled by personnel with variable baseline training.2 This lack of standardised, continuous professional development creates a gap between theoretical knowledge and clinical application. Methods: We developed the Paediatric Transport Reflective Improvement and Simulation-based Education (PaeTRISE) framework, informed by literature on simulation, reflective practice, and transport medicine. PaeTRISE is founded on two pillars: Reflective Improvement (structured debriefing to critically analyse clinical experiences) and Simulation-based Education (safe practice of high-acuity, low-occurrence events.3 The framework integrates these pillars into a continuous cycle of learning, reflection, and adaptation, tailored to the geo-historical and socio-cultural realities of the Western Cape healthcare system. Results: PaeTRISE has the potential to cultivate emergent excellence. By coupling simulation with reflective practice, it transcends procedural training to enhance adaptive decision-making, teamwork, and resilience. From a critical realist perspective, PaeTRISE functions as a causal mechanism to activate practitioners’ latent capacity. Crucially, it directly addresses the documented absence of a formalised, standardised learning structure for this high-risk activity, proposing a scalable, contextually relevant model for continuous professional development. The explicit integration of reflection and simulation represents a novel contribution to standardising paediatric transport education in South Africa. Conclusion: PaeTRISE offers a …
subject: Abstract
  topic: section
subject: Paediatric Emergency Care
  topic: keywords
subject: Simulation Based Education
  topic: keywords
subject: Reflective Improvement
  topic: keywords
subject: Paediatric Critical Care Transport
  topic: keywords
subject: Inter-facility transport
  topic: keywords
creator: Athenkosi Sobada
creator: John Thomas Meyer
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-14
publication date: 2026-03-14
doi: 10.26738/poem.v4i2.2

Reversal of Bradycardia through Nutritional Rehabilitation in Paediatric Anorexia Nervosa: A Retrospective Study from Qatar
type: item
description: Background Anorexia nervosa (AN) is a severe mental health disorder characterized by persistent energy intake restriction, intense fear of weight gain, and a distorted body image. AN affects nearly every organ system, with the cardiovascular system being affected in up to 80% of cases [1]. AN carries the highest mortality among psychiatric disorders, with sudden cardiac death as a major cause [2]. Bradycardia is the most common cardiovascular manifestation in AN.1 Nutritional rehabilitation reverses these abnormalities, but rapid weight gain can pose risks such as electrolyte imbalance and arrhythmias. Early detection and monitoring of bradycardia are therefore crucial [3]. Methods We conducted a retrospective cohort study using data from Sidra Medicine and Hamad General Hospital in Qatar. Patients admitted between December 2016 and June 2024 with AN and bradycardia (Heart Rate (HR) <60 beats per minute (bpm)) were included. Patientswith incomplete records were excluded. Ethical approval was obtained from the institutional review board of Sidra Medicine (IRB 1929504). Data were extracted and analyzed by independent reviewers. Results Of 222 screened patients (aged 10–18 years), 46 met the inclusion criteria. The majority were female (91.3%), with a mean age of onset at 14 years and a percentile of median BMI for age (%mBMI) of 9.1% (z-score -2.36) (Table 1). The average admission HR was 49.96bpm, confirming bradycardia as a frequent complication. All patients underwent nutritional rehabilitation with caloric intake starting from around 1200kCal/day and increasing by 200kCal/day/day. At 1–2 weeks follow-up, the mean HR improved significantly to 78.63bpm (Table 1). Figure 1 shows the correlation between %mBMI and the change in HR (R2=0.07, p=0.133). Conclusion This study highlights the burden of bradycardia among adolescents with AN in Qatar. Nutritional rehabilitation was effective in restoring HR, emphasizing the need for early recognition and careful monitoring. Fu…
subject: Abstract
  topic: section
subject: Anorexia Nervosa
  topic: keywords
subject: Bradycardia
  topic: keywords
subject: Nutritional Rehabilitation
  topic: keywords
subject: Eating Disorder(s)
  topic: keywords
subject: Qatar
  topic: keywords
creator: Abdulla Fahmi
creator: Sara Al-Kuwari
creator: Abdurahman Al-Ansari
creator: Sheema Hashem
creator: Madeeha Kamal
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-03-04
publication date: 2026-03-04
doi: 10.26738/poem.v4i2.1

Non-invasive positive pressure ventilation for acute asthma in children: Very uncertain results
type: item
description: Source: Korang SK, Baker M, Feinberg J et al. (2024) Non-invasive positive pressure ventilation for acute asthma in children. Cochrane Database Syst Rev. 2024 Oct 2;10(10):CD012067 http://doi.org/10.1002/14651858.CD012067.pub3 Clinical Question Asthma is the most common chronic disease in children and accounts for 2.3% of pediatric hospitalizations. This condition has a major medico-economic impact, affecting both children’s quality of life and healthcare costs. In 10–12% of cases, intensive conventional treatment based on bronchodilators and corticosteroids is insufficient, and management must be escalated to endotracheal intubation and invasive mechanical ventilation. Some observational studies suggest that non-invasive positive pressure ventilation (NPPV) could reduce the need for intubation. Bottom Line To assess the effects of NPPV combined with conventional treatments compared with conventional treatments alone in children with moderate to severe acute asthma, in terms of mortality, occurrence of serious adverse events (SAEs), length of stay in intensive care, and asthma symptom scores during the acute phase. Main Results No all-cause mortality was reported in either group. Only one randomized study assessed SAEs, namely the intubation rate. Bilevel positive airway pressure (BiPAP) may substantially reduce the intubation rate and appears to shorten the length of stay in intensive care, but these results are very uncertain (very low level of evidence). Acute asthma symptoms score was evaluated in only two studies using different outcome measures, which did not allow meta-analysis. BiPAP may have a beneficial effect on the score, but this result is also very uncertain (very low level of evidence). Caveats Current data are limited, with small sample sizes, resulting in very uncertain evidence and preventing a comprehensive evaluation of the benefits and risks of NPPV in children with acute asthma. Large, well-designed randomized controlled trials with low risk of…
subject: Editorial
  topic: section
subject: Airway & resuscitation
  topic: category
subject: asthma
  topic: keywords
creator: Yannick Auffret
creator: Tania Marx
creator: Patricia Jabre
creator: Cochrane Pre-hospital and Emergency Care Group
rights: Copyright (c) 2026 Yannick Auffret, Tania Marx, Patricia Jabre, Cochrane Pre-hospital and Emergency Care Group (Author) https://creativecommons.org/licenses/by/4.0
date: 2026-04-27
publication date: 2026-04-27
doi: 10.26738/poem.v4i1.5