Emergency Care and Medicine

Background/Objectives: The transport of patients with high-consequence infectious diseases (HCIDs) links biosafety science and emergency medicine. The 2026 Bundibugyo virus disease epidemic and the multinational Andes virus outbreak associated with an expedition cruise ship have renewed attention on how such patients are moved safely between the community, hospitals and high-level isolation units. This narrative review synthesises the international literature on biocontainment transport and integrates it into an operational framework for emergency medical systems. Methods: A structured search of PubMed/MEDLINE and Scopus (to 10 October 2026), complemented by guidance from the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention and national authorities, was conducted, and the review was planned and written using the SANRA quality criteria. Evidence was organised across seven operational domains and combined with the operational experience of the Public Health Unit of the Italian Red Cross (CRI). Results: Of 2432 records identified, 1485 unique records were screened. The literature is dominated by aeromedical case reports, technical evaluations and expert consensus, with few comparative studies. Recurrent findings concern device integrity and air quality within transport isolators, the risk of self-contamination during doffing, heat strain and communication limits imposed by personal protective equipment, decontamination of vehicles and isolators, the maintenance of team readiness during periods of low activity, and the psychological burden on patients and staff. These findings are integrated into a framework comprising a four-link containment chain, a seven-phase operational workflow, a three-tier complexity classification and a role-based responsibility matrix. Conclusions: Biocontainment transport is better understood as an integrated emergency system than as a device-centred intervention. The proposed framework is a structured, consensus-based reference for planning, training and quality assurance; its components require prospective evaluation.

Background/Objectives: Tree stand falls have become one of the leading causes of hunting-related injuries in the United States, surpassing firearm incidents. These injuries often result in significant morbidity, particularly musculoskeletal trauma, yet detailed anatomical stratification of fractures remains underreported. The purpose of this study is to classify and analyze the anatomical distribution of musculoskeletal injuries sustained from tree stand falls during deer hunting and to describe associated demographics, injury severity, and resource utilization in a rural health system. Methods: A retrospective review was conducted on patients aged ≥18 years who presented to a Level I or II trauma center in central Pennsylvania between 2005 and 2020 following a tree stand fall. Data were extracted from electronic medical records and trauma registry, including demographics, mechanism of injury, fracture location, Injury Severity Score (ISS), Intensive Care Unit (ICU) admission, and discharge disposition. Two orthopedic surgeons independently reviewed radiographs for accuracy. Results: A total of 144 patients were included (mean age was 53.0 ± 14.6 years; 143 of 144 were male). Falls had a median height of 15 ft (range, 2–45 ft), with harness use documented in only 2 patients. The mean ISS was 11.97 (range 2–36). Twenty patients required ICU admission (mean stay 4.8 days), and seven required mechanical ventilation. Most injuries occurred between October and December. Fractures most frequently involved the spine (36.3%), followed by the thorax (ribs and sternum; 36.1%), the hip and lower extremity (9.0%), the pelvis (9.0%), the shoulder and upper extremity (6.0%), and the skull and facial bones (3.5%). No fatalities were recorded. Conclusions: Tree stand falls during deer hunting result in complex, multi-system injuries with high resource utilization but low mortality. Spine and thorax fractures predominate, underscoring the need for trauma centers serving hunting communities to maintain subspecialty capabilities in orthopedic, spine, thoracic, and multidisciplinary trauma care. Preventive strategies, including targeted safety education during peak hunting months, may be implemented to potentially reduce injury burden.

Background/Objectives: Socioeconomic deprivation is consistently associated with worse health outcomes and unequal access to healthcare in England. Less is known about how deprivation relates to ambulance service use, call acuity and recorded outcomes. Yorkshire Ambulance Service (YAS) NHS Trust introduced NHS Pathways triage into its 999 service during 2025, replacing the Advanced Medical Priority Dispatch System and aligning 999 triage with the tool already in use in NHS 111, providing an opportunity to describe call patterns across the deprivation gradient under a standardised clinical assessment framework. This evaluation aimed to quantify and describe call rates, acuity and recorded outcomes across communities with varying levels of deprivation in Yorkshire, using routine NHS 111 and 999 call data, with embedded Patient and Public Involvement and Engagement (PPIE) to contextualise the findings. Methods: Population-based retrospective observational service evaluation using routine YAS operational data on calls assigned an ambulance acuity category (Categories 1–5) from 1 May 2024 to 28 February 2026 (22 months). Of 1,793,254 calls extracted, 1,748,057 (97.5%) could be linked to an Index of Multiple Deprivation (IMD) 2019 national quintile via incident postcode and formed the analytic set. Call rates per 1000 residents per year were calculated using published population estimates aggregated to quintile. Recontact within 24, 48 and 72 h was identified by linking calls sharing an NHS number recorded at the time of the call. Analysis was descriptive and was performed in Microsoft Excel and Python 3.11.15. Two PPIE workshops (Leeds, n = 12; Bradford, n = 7) were held in March 2026 with 19 participants, after the quantitative analysis was complete. Reporting follows the STROBE statement for cross-sectional studies and the GRIPP2 short-form checklist for the reporting of patient and public involvement. Results: The most deprived quintile (Q1) accounted for 688,950 calls (39.4%) and the least deprived (Q5) for 212,803 (12.2%), a crude count ratio of 3.2:1. Q1 contains 30.5% of the catchment population and Q5 15.4%; expressed per head of population, contact was 229.0 against 139.7 calls per 1000 residents per year, a rate ratio of 1.64:1. Callers in Q1 were younger than those in Q5 (median 56 years, IQR 35–76, against 78 years, IQR 59–86). Category 1 calls formed 12.9% of Q1 calls against 9.5% in Q5. Q1 had the highest Hear-and-Treat rate (14.8% vs. 12.1%) and the lowest conveyance rate (53.0% vs. 57.3%); among lower-acuity (Category 3–5) calls, conveyance was 27.9% in Q1 against 37.7% in Q5. Recontact within 72 h was highest in Q1 (15.0%) and lowest in Q4 (13.0%). Outcome distributions were broadly similar under AMPDS and NHS Pathways triage, but the two tools were in use in different periods. Conclusions: Ambulance service contact, call acuity and recorded outcomes were patterned across the deprivation gradient in this region. The magnitude of the difference in contact depended substantially on whether population denominators were used; a crude count ratio of 3.2:1 corresponded to a rate ratio of 1.64:1 per head of population. Callers in the most deprived quintile were 22 years younger at the median than those in the least deprived, and the absence of standardised and adjusted analyses is a major limitation. PPIE participants contributed contextual perspectives on primary care access and telephone triage, and co-produced seven priority research questions to guide future work.