Guido Francesco Villa

AREU - Agenzia Regionale Emergenza Urgenza Lombardy (Public Regional EMS) · Health Direction

Last fifty years severe pathological events history and clinical responses to critical care patient; chrono review.

AREU's update on the modalities of pain management and treatment in the emergency rescue setting (Adult and Pediatric) according Italian/International pre-hospital Emergency Guidelines. Specific references to international rating scales for helping EMS Medical Staff to evaluate the right level of pain in Emergency pre-hospital situations.

Objective. The Lombardy region was among the areas most affected by COVID-19 infection worldwide; the Lombardy Emergency Medical System (EMS) responded immediately to this emergency. We analyzed several critical aspects to understand what occurred in that region. Methods. This retrospective study compares the events managed by the dispatch center...

Aim Ventricular fibrillation amplitude spectral area (AMSA) and end-tidal carbon dioxide (ETCO2) are predictors of shock success, understood as restoration of an organized rhythm, and return of spontaneous circulation (ROSC). However, little is known about their combined use. We aimed to assess the prediction accuracy when combined, and to clarify...

Background and aim: The incidence of Out of Hospital Cardiac Arrest (OHCA) is estimated at 1/1000 persons/year. In the pre-Covid-19 era world, OHCA survival rate in Europe was 7-6%. The main objective is to analyze OHCA survival in the Lombardy region by highlighting the factors related to both the victims' characteristics and the chain of surviva...

L'arresto cardiaco extra-ospedaliero (OHCA-Out of Hospital Cardiac Arrest) è una delle principali cause di morte a livello mondiale e rappresenta la patologia tempo-dipendente maggiormente sfidante il sistema dell'emergenza sanitaria territoriale (EMS) in termini organizzativi e di interazione con la gestione ospedaliera. Purtroppo, la prognosi del...

In Italy, preparticipation screening (PPS) has been mandatory since 1982 and its main goal is to prevent sudden death (SD) in athletes through identification of cardiovascular diseases at risk of malignant ventricular arrhythmias in their pre-symptomatic phase.¹ Nevertheless, some diseases can be missed by PPS: in this case, the chances of survivin...

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerging infectious disease pandemic developed in Lombardy (northern Italy) during the last week of February 2020 with a progressive increase of patients presenting with serious clinical findings. Despite the efforts of the Central Italian Government, regional resources were rapidly a...

Obiettivo: Il trauma nel soggetto sportivo riveste grande importanza. Per comprendere in maniera più approfondita e per dimensionare il fenomeno del trauma nello sportivo abbiamo condotto un'analisi epidemiologica dei traumi sportivi gestiti dai Pronto Soccorso (PS). Disegno di studio: Studio osservazionale retrospettivo sugli accessi in PS registr...

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) during sporting events is a rare but nonetheless relevant oc- currence, that must be promptly addressed by sideline doctors and, in their absence, as well as by laymen present on site. The use of cardiopulmonary resuscitation (CPR) maneuvers and public access defibrillators (PADs) has been shown to...

Birth and development of the 118 (EMS) and 1.1.2 system in Lombardy. Key clinical results with systematic increase in efficiency and efficacy. The peculiarities of the Lombard Helicopter Emergency Medical Service (HEMS/SAR).

Indications and Recommendations to face up to a sudden overcrowding of wounded in hospital and to manage a major air incident on site. Discussion....

Rapid presentation of MEDEVAC during Covid-19 period from Lombardy to other Regions in Italy and to Germany; related back-transport of the patients. MEDEVAC of leukemia Children from Ucraina in Lombardy Hospitals. Issues and Solutions.

Cardiac arrest in sports venues is a rare event and involves mainly male athletes older than 30 years old. Comparing the periods 2011-14 and 2015-2019, we can affirm that “Balduzzi law” positively affected the outcome of cardiac arrests of presumed cardiac etiology in athletes.

Objective: The COVID-19 pandemic changed the time-dependent cardiac arrest network. This study aims to understand whether the rescue standards of CPR and out-of-hospital cardiac arrest (OHCA) were handled differently during pandemic compared to the previous year. Methods: Data for the years 2019 and 2020 were provided by the records of the Lomba...

Emergenze a bordo ring: non solo trauma cranico. Il rapido inquadramento del paziente politraumatizzato - Epidemiologia del trauma cranico - Arresto cardiocircolatorio - Protocollo ITLS - Linee guida NICE

Funding Acknowledgements Type of funding sources: None. Introduction The chances of surviving a sport-related cardiac arrest depend strictly on resuscitation efforts. Since 2015, all Italian recreational and competitive sport venues must be equipped with automated external defibrillators (AEDs), and trained staff must be present during competition...

La probabilità di sopravvivere ad un arresto cardiaco legato ad attività sportiva dipende strettamente dagli sforzi rianimatori. In seguito alla morte improvvisa di due atleti professionisti nel 2012, è stata emanata la “Legge Balduzzi” che ha sancito l’obbligo della dotazione di defibrillatori semiautomatici persocietà sportive. Durante il period...

Background during the COVID-19 pandemic a total lockdown was enforced all over Italy starting on March 9 th . This resulted in the shrinking of economic activities. In addition, all formal occupational security-training courses were halted, among them the 81/08 law lectures and Basic Life Support-Defibrillation (BLS-D) laymen training courses. The...

Introduction. Hemorrhage in major trauma is life-threatening and the activation of the Massive Transfusion Protocol (MTP) was found to reduce the time to transfusion and mortality. The purpose was i) to verify whether MTP activation identifies patients that require massive transfusions once admitted to the Emergency Department (ED), ii) to establis...

Background The Lombardy region has been one of the Italian regions most affected by the COVID-19 pandemic in 2020, with 22.7% of total Italian cases and 33.9% of total deaths. The emergency healthcare system was under deep stress throughout the period under consideration due to the admission of COVID-19 patients to the Emergency Department (ED) and...

The main objective of the research is to analyze OHCA survival in the Lombardy region by highlighting the factors related to both the victims’ characteristics and the chain of survival. Following the Utstein method, we selected witnessed OHCAs with presumed cardiac etiology. The outcome of each case was collected. Males are more predisposed to incu...

Analisi della sopravvivenza nell’Arresto Cardiocircolatorio territoriale in regione Lombardia. Durante il mese di marzo 2020, rispetto al 2019, si è registrato un incremento delle diagnosi di ACC, OR 1.51 [1.39-2.58], p<0.0001. Inoltre, la percentuale di pazienti che ha raggiunto il Rosc nel 2019 in relazione a tutti i pazienti non trovati cadave...

Covid-19 outbreak in Lombardy has upset the emergency response to Cardiac Arrest on the consolidated response of this "Network"! The "tsunami" of fatal events in short periods of time has had a devastating effect on the chances of rescue and survival of the patients. The "virtuous path" previously created to deal with the OHCA (Bystander Rescuers a...

The Coronavirus Emergency was an important test for the whole Italian nation; in particular, the Lombardy Region in 2020 suffered an unprecedented health crisis, which called all the institutions, both technical and political, to face an extraordinary situation, without being able to count on previous experiences or dedicated and updated protocols....

Background The Lombardy region has been the Italian region most affected by the coronavirus disease 2019 (COVID-19) pandemic in 2020. The emergency healthcare system was under deep stress throughout the past year due to the admission of COVID-19 patients to the emergency department (ED) and had to be thoroughly reorganized. Methods We performed a...

A "Flight" on the Out of Hospital Transport / Transfer of the Critically Critical Patient with Severe Respiratory Failure.

In the subjects with important flu-like symptoms and/or suspected Covid-19 contagion, the first health care approach in a home patient may concern: 1) people classified as a confirmed case: a person who is positive for a test for SARS Covid 2, which is classified as confirmed case regardless of the presence or absence of symptoms; 2) people classif...

The Covid-19 emergency requires a shared plan for the longrange helicopter transfer of patients affected by the virus in order to reduce the overload of intensive care units. To date, there is limited peer reviewed literature on aeromedical transport of patients with highly hazardous communicable diseases, most of it is military, and none deals spe...

Public Access Defibrillation (PAD) is the leading strategy in reducing time to first defibrillation in cases of Out-Of-Hospital Cardiac Arrest (OHCA), but PAD programs are underperforming considering their potentiality. Our aim was to develop an analysis and optimization framework, exploiting georeferenced information processed with Geographic Info...

The very important and unresolved problems for the administration of oxygen during the Covid-19 emergency highlighted both in the hospitals and at home. The need to build a virtuous collaborative model between healthcare, pharmaceutical dealers and the production industry of this invaluable gas, in order to never have a shortage during Emergencies.

The scientific collaboration agreement between AREU Lombardy and the University of Padua was born with the aim of promoting a specific research on the topic of sudden death in athletes. A first research project aims to explore the incidence, the outcome (with particular reference to the temporal trend in the period spanning the implementation of th...

The COVID-19 Emergency has engaged the system (Call Receiver Center PSAP1 and Medical Dispatch Center PSAP2) in an immediate operational reworking and redefinition, which was carried out thanks to the "new design" of the flows requested. This was fully agreed with AREU's "medical line", through a close connection and constantly synergy of objective...

Medical air transport or MEDEVAC, with the use of a fixed wing carrier (aircraft), is always a "combined" medical transport, between an air carrier and a land vehicle. This is very different from what happens with a rotary wing air carrier (copter), where the patient can be boarded and disembarked directly from the collection point to the hospital...

The flight with a fixed-wing air carrier, or flight by airplane, has always provided for the good state of health of the person who flies by airplane not only to guarantee himself, but also to assure other passengers and even more flight crew and safety assistance during all phases of the flight. In this short essay we intend to describe the epidem...

Background and aim of the work: The main objectives of our work were the regional harmonization and standardization of pharmaceutical supplies on MSA in Lombardy. Methods: The retrospective investigation was articulated in 2 phases: the first was the collection of data in every area of the Region (2012), the second was the analysis and elaborati...

Objective: Data collected via “ad hoc” AREU’s registry in large populations (Ten Million people) before COVID-19. Methods: Observational, prospective, analytical, single cohort study in Lombardy population. Data of OHCA of cardiac aetiology, according to “Utstein Style”, with resuscitation attempts started by the Emergency Medical Service (EMS), we...

Data collected in the year 2019 related to the medical rescue activity performed by the EMS of AREU in the Lombardy Region. First Hour Quintet (Sextet) Pathologies, Network Diseases, on-site arrival Time, Hub centralizations. The present and future organization of the EMS process in Lombardy.

Everything you want to know for the treatment of emergencies by EMS in pre-hospital setting

In Italy the pre-hospital management of the ACS by EMS could be strictly aligned with the standards of the Ministerial Decree n° 70 of 2015, and might follow a well-defined track, aimed at meeting the current quality goals and the performance indicators of this "heavy" pathology. This track surely needs to be improved in the most of regions through...

Italian issues: Digital technologies in rescue services can can modify and improve the difficulties of isolated communities by bringing excellent services to the citizens living in those areas

In Europe, the biological and healthcare costs of acute coronary syndrome (ACS) are extremely high. For this reason, the Emergency Medical Service of the Lombardy Region (AREU Lombardy) has defined a “mission” that can partly resolve this issue, through an accurately balanced clinical/organizational plan of territorial medical rescue. As a result o...

Global review about SCD/OHCA and cardiological causes of Cardiac Arrest. Data report about death for STEMI and organizational response in USA and in Italy. Pre-hospital organizational recommendations for fighting SCD and their declination in Lombardy.

Background: In Europe, the biological and healthcare costs of acute coronary syndrome (ACS) are extremely high. For this reason, the Emergency Medical Service of the Lombardy Region (AREU Lombardy) has defined a "mission" that can partly resolve this issue, through an accurately balanced clinical/organizational plan of territorial medical rescue....

Pain management in emergency setting. Rescue, Pain and its Treatment. Pain evaluation and the right medications for the correct medical response. Ways of drugs administration. Ethical considerations.

Background and aim of the work: The results of out-of-hospital cardiac arrests (OHCA) are usually reported through data collected collected via “ad hoc” registries, but in large populations, samples of short time periods can be used to apply the results to the entire population. We would like to describe the situation of Lombardy to provide evidenc...

To address the study of the deployment of publicly accessible Automated External Defibrillators (AED), Geomatics allows computing their limited area of effectiveness (i.e. ‘catchment area’, CA), traditionally set as circular surfaces with a 100m-radius. Exploiting open geospatial data related to roads network, also ‘realistic’ CAs, based on the eff...

Regulation draft regarding the participation of citizens of the Province of Pavia (with the "BLSD executor" certificate) to the network of lay First Responders for the improvement of the medical response to the OHCA

Preparedness, Organization and Management of all Sports Events. Lessons to be learned from the Lombardy region. Laws and their practical applications. Data and Results

Organization, Management and Solutions for fighting Trauma in the pre-hospital setting. The experience of the Lombardy region.

Data on road accidents in Lombardy and related traumas. The response of the EMS system

All You want to know about A.C.S. Rescue, managed by EMS in Lombardy for Ten Million people in 2019

The Role of AREU in Emergency Management of ten Million people. Multifaceted reality and intrinsic dynamics for a specific Health Trust (built like an Agency).

ENT Emergency Classification; what assistance can be provided to these patients by the EMS Teams. 2018 data about Emergency and Urgency managed by AREU Lombardy.

Otorhinolaryngology Emergencies in pre-Hospital Setting. A real problem For EMS Team. What Emergency Physicians, Nurses and EMS Team has to do in these difficult and heavy situations . The real solutions, the clinical and the management choices and the Data in Lombardy Region.

Discussion about the most useful Score for Stroke management by Emergency physicians and nurses of EMS during rescue on site. Choice between LAMS and LARIO.

Sudden Deaths from sepsis are often due to non-recognition of the problem from the territory and during ambulance rescue. We suggest the introduction of the qSOFA, a new score useful for EMS teams to subsequently carry out a correct and rapid hospital diagnostic and treatment path, and prompt care.

The STROKE Path in EMS pre-Hospital Phase: Stroke network management, AREU Lombardy annual data, improvement objectives and the realization of future projects.

Inclusion of the international LAMS score for Stroke rescue, in the territorial evaluation of the EMS managed by doctors and nurses. Triage and decision making for patient transfer to the right hospital.

Data collected in the year 2018 related to the medical rescue activity performed by the EMS of AREU in the Lombardy Region. Missions, Events, First Hour Quintet Pathologies, Network Diseases, on-site arrival Time. The future organization of the EMS process in Lombardy.

Sudden Cardiac Death in Sports and Boxing: Data and Prevention in Italy by FIMS (Italian Federation of Sports Medicine)

On-site Test about rapid injection of Epinephrine in the management of Out of Hospital Cardiac Arrest by Nurses.

The model of AREU for HEMS and SAR. Rescue operation missions' Data. Helicopter landing Sites. Night activity: flight to and from helipads authorized always with full crew, including HT. All about HEMS in Lombardy

Response to OHCA and Medical Rescue in The Palace of Lombardy Region. The path and the steps to guarantee the best first aid in overcrowding building!

The new stroke care EMS organization in the Lombardy region from the territory to the HUB's Emergency Department up to the final treatment in the Stroke Units. The primary role of the EMS, management and data from the last 2 years. The amplified possibilities of night-time transfer over long distances by copters "rendez-vous" at almost 400 territor...

The real and complete organization of AREU (at present and in the next future) and EMS activity in Lombardy in the Year 2018. The pre-hospital Emergency activity in Lombardy (Italy) and the relationship between EMS and the Emergency Department of the Hospitals. The Pathology networks and their 2017 data, provided by EMS of Lombardy. The Medical Eme...

Assessment and comparison of technical features of seventeen Automated External Defibrillators (AEDs) - TRAUMA EMERGENCY CARE

"Emergency Drugs Technical Datasheets of Use" in pre-hospital setting for Medical Rescue. Pharmacological Advanced Treatment by Physicians and Nurses according Italian pre-hospital Guidelines. Data Sheets for helping EMS Medical Staff to a correct and rapid drugs delivery in Emergency situations. Review and updates 2018. Featured References

Interprovincial Pavia and Lodi Project, regarding the integration of the two communities to combat Sudden Cardiac Arrest (SCA). Manufacture of a network of AREU First Responders to respond to the sudden death

Public Access Defibrillation (PAD), based on the distribution on the territory of publicly accessible Automated External Defibrillators (AED), is a key resource in increasing survival chances for victims of out-of-hospital cardiac arrest (OHCA). This study focuses on PAD in the city of Milan, assessing its current performance, identifying critical...

Constitution, organization and operations of the EMS in Lombardy. Strengths and future evolution of the system for a possible joint venture between AREU and ENI for all the needs related to the medical emergency.

Short Excursus on the issue of culture and laws useful to combat cardiac arrest (OHCA) in professional and amateur sport and in the population. Discussion and proposed solutions for Lombardy Region.

Pain is the most common reason for a patient's approach to the intra-hospital and prehospital emergency system. To alleviate, quickly and effectively, the patients' pain remains a challenge for every emergency system.... How to do by EMS.

Experiences and Result to save lives in case of OHCA. New perspectives for the future on this issue. What's better in Lombardy and the Province of Pavia

Pain is the most common reason for a patient's approach to the intra and prehospital emergency medical system. Being able to quickly and effectively alleviate the suffering of those strucking by pain, remains a challenge for every Emergency Medical System. The unjustified and common delays of analgesia in the emergency have pushed AREU (EMS Lombard...

The "Catastrophe Medicine" put numerous unresolved problems on the treatment of pain in subjects involved in a calamitous event, both for minor damage and for major injuries (physical and mental). In the incident of large proportions, the need to be able to assist and treat all victims adequately and in a short time for the injuries reported, remai...

In Italy the Emergency organizational model, based on the Clinical-Care Network, is indicated by the current legislation (in particular the Ministerial Decree 70/2015) as the most appropriate system to guarantee fairness and timeliness of access to care for the needs of citizens. The emergency clinical-care network is defined by AGENAS (National Ag...

Advanced First Aid Course for INAIL Lombardia Occupational Doctors. Use of the Emergency Trolley. The main outpatient severe emergencies and their treatment pending the arrival of the public EMS for the definitive advanced Therapy.

The recent acts of terrorism have generate a massive numbers of injured and dead, posing the real risk of possible further attacks with use of non-conventional agents, such as Biological, Chemical, Radiological, Nuclear and Explosives. Improving response to expected and unexpected crises affecting critical societal structures during man-made disast...

Figures, operators and their roles in the fight against Trauma, in a virtual E.D. location. The challenge for the present and the future for medical rescue out and in Hospital

Update on the pharmacological approach and analgesia in the "on scene" rescue of the TRAUMA. The consolidated data and drugs, the news, the medication alternatives and the challenges for the future. Which could be our pharmacological choice.

Instructions and Training for lay Rescuers to ensure a good and fast First Aid response.

The exacerbations of Asthma, with EMS call, are usually moderate or severe and require additional therapies and, almost always, hospitalization. The request for intervention of the Italian "Advanced EMS 118" takes place precisely for emergency management of the respiratory crisis, commonly arising at home or in a public place, despite the usual bas...

Operation and results of use of HEMS in the Lombardy Region. The primary support in the management of Maxi-Emergencies. The importance of the "Night Missions".

Excursus on the new stroke care organization in the Lombardy region from the territory to the Emergency Department up to the final treatment in the Stroke Units. The primary role of the EMS, data from the last 2 years. The recent possibilities of night-time transfer over long distances by copters "rendez-vous" at over 300 territorial helicopter sit...

Data collected in the year 2017 related to the medical rescue activity performed by the EMS of AREU in the Lombardy Region. Missions, Events, First Hour Quintet Pathologies, Network Diseases, on-site arrival Time. The future organization of the EMS process in Lombardy.

A new/old method to orientate health care workers for the correct therapeutic drug delivery in case of emergency. A help to EMS staff that will soon become more modern through a special digital App for the Smartphones.

The experience of the Emergency Regional EMS of Lombardy. The EMS organization for traffic accidents and related cost data.

Proposal of solutions to the problems of analgesia in Disaster and Major Incident settings.... Different treatment modes according to the two different contexts and new drug delivery systems. Choice of method for delivering medications in that situations. The Italian way.

Past, present and future of the ”Chest Pain challenge” in Lombardy Region. The organization for fighting CAS. The Role of Basic Ambulances and the advanced medical response. The methodologies to reach the best results possible in the regional settings. Real data and considerations.

Medical Rescue organization for road accidents in Lombardy region. The 1.1.2. answers to the needs of the callers after a traffic accident. The management of rescue response of 118 PSAP 2 for a correct assessment on scene and a right hospitalization within the golden hour. Areu’s Trauma medical philosophy.