Pubblicazioni Scientifiche
In questa sezione sono disponibili gli articoli redatti negli anni dalle strutture dell'Agenzia Regionale Emergenza Urgenza della Lombardia e pubblicati sulle principali riviste scientifiche di settore.
2025_07 Implementation of Telemedicine for Patients Referred to Emergency Medical Services
Implementazione della Telemedicina per i Pazienti che si rivolgono al Sistema di Emergenza.
Francesca Cortellaro, Lucia Taurino, Marzia Delorenzo, Paolo Pausilli, Valeria Ilardo, Andrea Duca, Giuseppe Stirparo, Giorgio Costantino, Filippo Galbiati, Ernesto Contro, Guido Bertolini, Lorenzo Fenech, and Giuseppe Maria Sechi
Abstract
Background
The surge in the use of Pre-hospital Emergency Medical Systems (EMS) and Emergency Departments (ED) has become a pressing issue worldwide after the COVID-19 pandemic. To address this challenge, we developed an experimental and innovative care pathway supported by telemedicine. The aim of this study is to describe the activity of the Integrated Medical Center (CMI): a new telemedicine-based care model for patients referring to the Emergency Medical System.
Methods
A prospective observational study was conducted from January 2022 to December 2022. The CMI was established to manage patients referring to the Emergency Medical System.
Results
From January to December 2022, a total of 8680 calls were managed by CMI, with an average of 24 calls per day. 6243 patients (71.9%) were managed without ED access, of whom 4884 patients (78.2%) were managed through telemedicine evaluation only, and 1359 (21.8%) with telemedicine evaluation and dispatch of the Home Rapid Response Team (HRRT). The population treated by the HRRT exhibited a higher age. The mean satisfaction score was 9.1/10.
Conclusions
Telemedicine evaluation allowed for remote assessments, treatment prescriptions, and teleconsultation for HRRT and was associated with high patient satisfaction. This model could be useful in future pandemics for managing patients with non-urgent illnesses at home, preventing hospital admissions for potentially infectious patients, and thereby reducing in-hospital transmission.
2025_07 Prehospital management of supraventricular tachycardia: a multicentre study of current practices with a subgroup propensity score-based comparison of adenosine and electrical cardioversion in unstable patients
Gestione preospedaliera della tachicardia sopraventricolare: studio multicentrico sulle pratiche correnti con un confronto, basato sul propensity score, tra adenosina e cardioversione elettrica nei pazienti instabili
Lorenzo Gamberini, Valeria Carinci, Paolo Pallavicini, Matteo Rovera, Marco Tartaglione, Roberto Gioachin, Annapaola D’ambrosio, Riccardo Fiameni, Simone Baroncini, Davide Allegri, Carlo Coniglio, Federico Semeraro, Giuseppe Ristagno
Abstract
Background
Supraventricular tachycardia (SVT) is a common prehospital arrhythmia that can cause life-threatening instability. Adenosine is the first-line treatment for stable SVT, but guidelines differ for unstable cases with hypotension, syncope, myocardial ischaemia, or severe heart failure. The European Resuscitation Council recommends electrical cardioversion (ECV), while the American Heart Association allows for an adenosine trial. This multicentre observational retrospective study evaluated global prehospital management strategies for SVT, subsequently focusing on adenosine vs ECV in unstable patients.
Methods
Data from 2019 to 2024 were collected from three Italian physician-staffed Emergency Medical Services. Primary outcome was the rate of successful cardioversion; secondary outcomes included the presence of life-threatening complications following cardioversion. Finally, the diagnostic accuracy of available ECG traces was evaluated. Propensity score-weighted analysis was employed to control for potential cofounding variables.
Results
Among 1234 SVT events, 819 (66.3 %) underwent prehospital cardioversion. Of these, 763 (93.2 %) received adenosine and 56 (6.8 %) underwent ECV. Unweighted cardioversion success rates were 80.1 % for adenosine and 83.9 % for ECV. In unstable patients, ECV had a weighted odds ratio of 2.41 (95 % CI: 1.01–7.14) for successful conversion. ECV was associated with more frequent sedative use compared to adenosine. No complications were observed in either groups. ECG diagnostic accuracy was 90.7 %, with dangerous misdiagnosis, such as ventricular tachycardia, occurring in fewer than 2 % of available ECG readings.
Conclusions
In patients with prehospital SVT, adenosine is the preferred cardioversion strategy. In unstable cases, adenosine may be a safe first-line attempt before ECV, potentially reducing sedation-related risks.
2025_06 A Case Report of Prehospital Point-Of-Care Ultrasound in Acute Aortic Dissection: Reinforcing the Out-of-Hospital Chain of Survival
Descrizione dell’utilizzo di ecografia preospedaliera in un caso di dissezione aortica acuta: un rinforzo della catena di sopravvivenza preospedaliera.
Alba Ripoll-Gallardo, Maddalena Cabrini, Matteo Cairo, Alessandro Mori, Valeria Diana, Pietro Boschiroli, Annibale Navoni, Giacomo Balladore, Daniele Sozzani, Antonella De Pirro, Riccardo Stucchi
Abstract
This case report highlights the importance of prehospital point-of-care ultrasound (POCUS) when acute aortic dissection is suspected. At 2:09 pm the local emergency medical services (EMS) received a call from a small town in Lombardy, Italy, reporting that a 54-years-old man had collapsed while lifting weights in a fitness club. Response teams found him lying on the floor, fully responsive and very pale; he was a lean man, with no allergies, no home therapy and no significant past medical history. He had had a transient facial paralysis and complained of dizziness and mild chest discomfort. During physical examination he became suddenly hypotensive (60/30 mmHg). The electrocardiogram showed a sinus rhythm, 80 beats per minute (bpm) and unaltered T wave and ST segment. The POCUS showed a dilated aortic root with intimal flap and small pericardial effusion. A diagnosis of Type A acute aortic dissection was made on the spot. The EMS dispatch center identified the closest hospital with available cardiothoracic surgery and provided a full report of the patient’s condition, diagnosis and initial treatment. At 3:10 pm, the patient entered the emergency room and a rapid transthoracic ultrasound confirming the diagnosis was performed in the presence of the cardiac anesthetist and cardiothoracic surgeon. The patient was agitated, tachycardic (110 bpm) and hypotensive (50/30 mmHg). Upon stabilization with intravenous norepinephrine and fluids, a computed tomographic angiogram was performed demonstrating a Stanford Type A aortic dissection with intimal flap starting from the bulb/valvular plane and extending to the origin of supra-aortic trunks down to the left common iliac artery. At 4.00 pm the patient was ready for surgery; he underwent successful ascending aorta replacement with a regular postoperative course and no signs of neurological damage. On post-operative day eight he was referred to an inpatient cardiac rehabilitation facility and later discharged home. At prehospital level, POCUS is feasible and may provide key diagnostic findings in some threatening medical (non-trauma-related) conditions that are normally diagnosticated only once the patient has reached the hospital. In addition, this report highlights a perfect interaction between out-of-hospital medical personnel, dispatch center and in-hospital multidisciplinary health staff.
2024_11 Management Of Psychiatric Emergencies and Associated Comfort Among EMS Physicians in Lombardy, Italy: A Cross-Sectional Study
Valutazione delle competenze e del livello di comfort relativi alla gestione delle emergenze psichiatriche da parte dei medici in servizio di emergenza preospedaliera: uno studio trasversale.
Alba Ripoll-Gallardo, Elisa Scarpolini, Giacomo Colzani, Roberto Biella, Ilaria Offredi, Roberto Di Silvestre, Claudia Giannotti, Giuseppe Maria Sechi, Roberto Fumagalli, Rita E Fioravanzo, Riccardo Stucchi
Abstract
Objectives
The aims of this study were to explore the knowledge of EMS physicians (EMSPs) on the legal aspects related to the management of prehospital psychiatric emergencies, assess their degree of comfort, and measure their perceived communication skills.
Methods
A survey was distributed to the 376 EMSPs working in the prehospital setting in Lombardy, Italy. Knowledge of medico-legal aspects was measured through multiple-choice questions; the Comfort Score (CS) and perceived Communication Skills Score (CSS) were calculated using Likert Scale questions. CS ranged from 11 points (lowest) to 44 (highest); CSS ranged from 8 points (lowest) to 32 (highest).
Results
A total of 272 EMSPs answered the survey (RR= 72.3%); 45.2% were women. Mean age was 45.76 years (SD 8.8). Mean percentage of correct knowledge test answers was 52.4 (SD 12.3); 81.3% believed to have little knowledge of the Italian legislation regarding this topic. Mean CS was 29.3 (SD 5.5); mean CSS was 19.1 (SD 3.9). A higher percentage of correct answers in the knowledge test was associated with lower CS (P = 0.019). Higher self-appraised knowledge of the Italian legislation was associated with higher CS (P < 0.001) and higher CSS (P < 0.001).
Conclusions
These findings should prompt policy makers to ensure proper training and support for EMSPs in the matter of prehospital psychiatric emergency management.
2024_05 What If Nice Terrorist Attack Would Have Happened in Milan? Drawing a Disaster Plan for Mass Casualty Incidents Involving the Pediatric Population
Cosa sarebbe successo se l’attentato terroristico di Nizza fosse accaduto a Milano? Disegno di un piano d’emergenza per eventi di massa che coinvolgono la popolazione pediatrica
Margherita Difino, Riccardo Stucchi, Eric S. Weinstein, Maurizio De Pellegrin, Alberto Zoli, Giuseppe Maria Sechi, Roberto Faccincani
Abstract
Terrorist attacks involving children raised concern regarding the preparedness to treat pediatric trauma patients during mass casualty incidents (MCIs). The purpose of this project was to assess the resources available in Milan to respond to MCIs as the 2016 Bastille Day attack in Nice. Literature and guidelines were reviewed and minimal standard requirements of care of pediatric trauma patients in MCIs were identified. The hospitals that took part in the study were asked to answer a survey regarding their resource availability. An overall surge capability of 40-44 pediatric trauma patients was identified, distributed based on age and severity, hospital resources, and expertise. The findings showed that adult and pediatric hospitals should work in synergy with pediatric trauma centers, or offer an alternative if there is none, and should be included in disaster plans for MCIs. Simulations exercises need to be carried out to evaluate and validate the results.
2023_12 Development and Validation of a New Tool to Improve the Accuracy of the Hospital Mass-Casualty Incident Response Plan Activation: The PEMAAF Score
Sviluppo e validazione di un nuovo strumento per migliorare l’accuratezza dell’attivazione del piano di risposta ospedaliera agli eventi di massa: il PEMAAF score
Claudia Ruffini, Monica Trentin, Alberto Corona, Marta Caviglia, Giuseppe Maria Sechi, Maurizio Migliari, Riccardo Stucchi, Luca Ragazzoni, Roberto Fumagalli
Abstract
Introduction
Effective response to a mass-casualty incident (MCI) entails the activation of hospital MCI plans. Unfortunately, there are no tools available in the literature to support hospital responders in predicting the proper level of MCI plan activation. This manuscript describes the scientific-based approach used to develop, test, and validate the PEMAAF score (Proximity, Event, Multitude, Overcrowding, Temporary Ward Reduction Capacity, Time Shift Slot [Prossimità, Evento, Moltitudine, Affollamento, Accorpamento, Fascia Oraria], a tool able to predict the required level of hospital MCI plan activation and to facilitate a coordinated activation of a multi-hospital network.
Methods
Three study phases were performed within the Metropolitan City of Milan, Italy: (1) retrospective analysis of past MCI after action reports (AARs); (2) PEMAAF score development; and (3) PEMAAF score validation. The validation phase entailed a multi-step process including two retrospective analyses of past MCIs using the score, a focus group discussion (FGD), and a prospective simulation-based study. Sensitivity and specificity of the score were analyzed using a regression model, Spearman’s Rho test, and receiver operating characteristic/ROC analysis curves.
Results
Results of the retrospective analysis and FGD were used to refine the PEMAAF score, which included six items–Proximity, Event, Multitude, Emergency Department (ED) Overcrowding, Temporary Ward Reduction Capacity, and Time Shift Slot–allowing for the identification of three priority levels (score of 5-6: green alert; score of 7-9: yellow alert; and score of 10-12: red alert). When prospectively analyzed, the PEMAAF score determined most frequent hospital MCI plan activation (>10) during night and holiday shifts, with a score of 11 being associated with a higher sensitivity system and a score of 12 with higher specificity.
Conclusions
The PEMAAF score allowed for a balanced and adequately distributed response in case of MCI, prompting hospital MCI plan activation according to real needs, taking into consideration the whole hospital response network.
2023_12 Prehospital Mass Casualty Incident Response to a Fire in a Nursing Home in Milan, Italy: Actions Taken and Shortcomings
Risposta preospedaliera ad un evento di massa in seguito ad un incendio in una casa di riposo a Milano, Italia: azioni intraprese e criticità
Alba Ripoll-Gallardo, Annapaola D’Ambrosio, Paola Manzoni, Vincenzo Grifone, Catia Pedrazzi, Giovanni De Luca, Davide Arghetti, Armando Stellini, Alessandro Zambelan, Ilaria Ruggiero, Riccardo Cusmà-Piccione, Gianluca Bacullo, Franco Lorito, Paolo Perbellini, Matteo Giacovelli, Massimo De Donno, Simone Pelà, Giacomo Colzani, Elena Brioschi, Gianluca Chiodini, Giuseppe Sechi, Alberto Zoli, Roberto Fumagalli, Riccardo Stucchi
Abstract
On July 7, 2023, at 1:21 am, a fire was declared in a retirement home in Milan, Italy. The number of casualties (n = 87) according to the Simple Triage and Rapid Treatment (START) triage system was categorized as 65 green, 14 yellow, 2 red, and 6 black; 75% were women, and the mean age was 85.1 years (± 9). Most patients were unable to walk. A total of 30 basic life support (BLS) ambulances, 3 advanced cardiac life support (ACLS) teams on fast cars, 2 buses, and 1 coordination team were deployed. A scoop and run approach was adopted with patients being transported to 15 health care facilities. The event was terminated at 5:43 am. Though the local mass casualty incident (MCI) response plan was correctly applied, the evacuation of the building was difficult due to the age and comorbidities of the patients. START failed to correctly identify patients categorized as minor. Communication problems arose on site that led to the late evacuation of critical patients.
2023_09 Severe Acute Respiratory Syndrome Coronavirus 2 and Medical Evacuation in Lombardy: Lessons Learned from an Unprecedented Pandemic
Sindrome respiratoria acuta severa da coronavirus di tipo 2 ed evacuazione sanitaria in Lombardia: insegnamenti acquisiti da una pandemia senza precedenti
Riccardo Stucchi, Alba Ripoll-Gallardo, Giuseppe Maria Sechi, Eric S. Weinstein, Guido Francesco Villa, Cristina Frigerio, Federico Federighi, Giacomo Grasselli, Alberto Zoli, Rodolfo Bonora, Roberto Fumagalli, AREU Crisis Unit
Abstract
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 at capacity. The solution was to plan the medical evacuation (MEDEVAC) of 119 critically ill patients (median age 61 years) to in-patient intensive care units in other Italian regions (77) and Germany (42). Once surviving patients were deemed suitable, the repatriation process concluded the assignment. The aim of this report is to underline the importance of a rapid organization and coordination process between different nodes of an effective national and international network during an emerging infectious disease outbreak and draw lessons learned from similar published reports.
2023_07 How the Italian Formula 1 Grand Prix 2022 Mass Gathering Event Compares to the Arbon Model: A Descriptive Study
Il Gran Premio Italiano di Formula 1 2022 come raduno di massa a confronto con il modello di Arbon: uno studio descrittivo
Andrea Paleari, Stefano Spina, Francesco Marrazzo, Alba Ripoll, Fabio Volontè, Gianluca Greco, Alberto Zoli, Giuseppe Maria Sechi, Diego Saggiante, Gianluca Chiodini, Riccardo Stucchi, Roberto Fumagalli
Abstract
Objective
To describe the health-care resources implemented during the Italian Formula 1 Grand Prix (F1GP) and to calculate the patient presentation rate (PPR) based on both real data and a prediction model.
Methods
Observational and descriptive study conducted from September 9 to September 11, 2022, during the Italian F1GP hosted in Monza (Italy). Maurer’s formula was applied to decide the number and type of health resources to be allocated. Patient presentation rate (PPR) was computed based on real data (PPR_real) and based on the Arbon formula (PPR_est).
Results
Of 336,000 attendees, n = 263 requested medical assistance with most of them receiving treatment at the advanced medical post, and n = 16 needing transport to the hospital. The PPR_real was 51 for Friday, 78 for Saturday, 134 for Sunday, and 263 when considering the whole event as a single event. The PPR_est resulted in 85 for Friday, 93 for Saturday, 97 for Sunday, and 221 for the total population.
Conclusions
A careful organization of health-care resources could mitigate the impact of the Italian F1GP on local hospital facilities. The Arbon formula is an acceptable model to predict and estimate the number of patients requesting medical assistance, but further investigation needs to be conducted to implement the model and tailor it to broader categories of MGE.
2022_04 Evaluation of Interaction Between Emergency Medical System and Hospital Network During a Train Derailment in Milano
Valutazione dell’interazione tra il sistema di emergenza medica e la rete ospedaliera durante il deragliamento di un treno a Milano
Roberto Faccincani, Riccardo Stucchi, Michele Carlucci, Riccardo Sannicandro, George Formenti-Ujlaki, Federico Pascucci, Carl Montan, Alberto Zoli, Carlo Picco, Roberto Fumagalli
Abstract
On January 25, 2018 a 5-car train derailed in Pioltello, 10 kilometers North-East of Milano City. A standardized post-hoc form was distributed to the hospitals involved in the management of the victims and allowed for an evaluation of the response to the incident.
The management of the incident by EMS (Emergency Medical System) was effective in terms of organization of the scene and distribution of the patients, although the time for the first severe patient to reach the closest appropriate hospital was very long (2 hours). This can be partially explained by the extrication time.
None of the alerted hospitals exceeded their capacity, as patients were distributed carefully among the hospitals. The overall outcome was quite satisfactory; no deaths were reported except for those on scene. Some responding hospitals reported that there was an over-activation based on the services ultimately needed. However this is common in MCIs, as an over-activation is preferable to an under-estimation. To address this concern, as more data are available, activation should be scaled down based on a plan established prior to it; this mechanism of scaling down seems to have failed in this event.
It is of note that the highest performing hospitals underwent recently to an educational program on MCI management.
2022_04 Impact of Point-of-Care Ultrasound on Secondary Triage: A Pilot Study
L’impatto dell’ecografia sul campo sul triage secondario: uno studio pilota
Riccardo Stucchi, Eric S. Weinstein, Alba Ripoll-Gallardo, Jeffrey M. Franc, Massimo Azzaretto, Giovanni Sesana, Francesco Della Corte, Luca Neri
Abstract
Objectives
In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of-care ultrasound on the accuracy of secondary triage conducted at an advanced medical post to enhance the detection of patients who, despite their apparent clinically stable condition, could benefit from earlier evacuation to definitive care or immediate life-saving treatment.
Methods
A mass casualty simulated event consisting of a bomb blast in a remote area was conducted with 10 simulated casualties classified as YELLOW at the primary triage scene; patients were evaluated by 4 physicians at an advanced medical post. Three patients had, respectively, hemoperitoneum, pneumothorax, and hemothorax. Only 2 physicians had sonographic information.
Results
All 4 physicians were able to suspect hemoperitoneum as a possible critical condition to be managed first, but only physicians with additional sonographic information accurately detected pneumothorax and hemothorax, thus deciding to immediately evacuate or treat.
2020_09 Rapid reorganization of the Milan metropolitan public safety answering point operations during the initial phase of the COVID‐19 outbreak in Italy
Riorganizzazione rapida delle operazioni del punto unico di risposta alle emergenze della Città metropolitana di Milano nella fase iniziale dell’epidemia di COVID-19 in Italia
Francesco Marrazzo, Stefano Spina, Paul E Pepe, Annapaola D'Ambrosio, Filippo Bernasconi, Paola Manzoni, Carmela Graci, Cristina Frigerio, Marco Sacchi, Riccardo Stucchi, Mario Teruzzi, Sara Baraldi, Federica Lovisari, Thomas Langer, Alessandra Sforza, Maurizio Migliari, Giuseppe Sechi, Fabio Sangalli, Roberto Fumagalli
Abstract
Objective
To quantify how the first public announcement of confirmed coronavirus disease 2019 (COVID‐19) in Italy affected a metropolitan region's emergency medical services (EMS) call volume and how rapid introduction of alternative procedures at the public safety answering point (PSAP) managed system resources.
Methods
PSAP processes were modified over several days including (1) referral of non‐ill callers to public health information call centers; (2) algorithms for detection, isolation, or hospitalization of suspected COVID‐19 patients; and (3) specialized medical teams sent to the PSAP for triage and case management, including ambulance dispatches or alternative dispositions. Call volumes, ambulance dispatches, and response intervals for the 2 weeks after announcement were compared to 2017–2019 data and the week before.
Results
For 2 weeks following outbreak announcement, the primary‐level PSAP (police/fire/EMS) averaged 56% more daily calls compared to prior years and recorded 9281 (106% increase) on Day 4, averaging ∼400/hour. The secondary‐level (EMS) PSAP recorded an analogous 63% increase with 3863 calls (∼161/hour; 264% increase) on Day 3. The COVID‐19 response team processed the more complex cases (n = 5361), averaging 432 ± 110 daily (∼one‐fifth of EMS calls). Although community COVID‐19 cases increased exponentially, ambulance response intervals and dispatches (averaging 1120 ± 46 daily) were successfully contained, particularly compared with the week before (1174 ± 40; P = 0.02).
Conclusion
With sudden escalating EMS call volumes, rapid reorganization of dispatch operations using tailored algorithms and specially assigned personnel can protect EMS system resources by optimizing patient dispositions, controlling ambulance allocations and mitigating hospital impact. Prudent population‐based disaster planning should strongly consider pre‐establishing similar highly coordinated medical taskforce contingencies.
2020_03 The response of Milan's Emergency Medical System to the COVID-19 outbreak in Italy
La risposta del servizio sanitario d’emergenza di Milano alla pandemia da COVID-19 in Italia
Stefano Spina, Francesco Marrazzo, Maurizio Migliari, Riccardo Stucchia, Alessandra Sforza, Roberto Fumagalli
The number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), is dramatically increasing worldwide.1 The first person-to-person transmission in Italy was reported on Feb 21, 2020, and led to an infection chain that represents the largest COVID-19 outbreak outside Asia to date. Here we document the response of the Emergency Medical System (EMS) of the metropolitan area of Milan, Italy, to the COVID-19 outbreak.
On Jan 30, 2020, WHO declared the COVID-19 outbreak a public health emergency of international concern.2 Since then, the Italian Government has implemented extraordinary measures to restrict viral spread, including interruptions of air traffic from China, organised repatriation flights and quarantines for Italian travellers in China, and strict controls at international airports' arrival terminals. Local medical authorities adopted specific WHO recommendations to identify and isolate suspected cases of COVID-19.3,4 Such recommendations were addressed to patients presenting with respiratory symptoms and who had travelled to an endemic area in the previous 14 days or who had worked in the health-care sector, having been in close contact with patients with severe respiratory disease with unknown aetiology. Suspected cases were transferred to preselected hospital facilities where the SARS-CoV-2 test was available and infectious disease units were ready for isolation of confirmed cases.
Since the first case of SARS-CoV-2 local transmission was confirmed, the EMS in the Lombardy region (reached by dialling 112, the European emergency number) represented the first response to handling suspected symptomatic patients, to adopting containment measures, and to addressing population concerns. The EMS of the metropolitan area of Milan instituted a COVID-19 Response Team of dedicated and highly qualified personnel, with the ultimate goal of tackling the viral outbreak without burdening ordinary EMS activity. The team is active at all times and consists of ten health-care professionals supported by two technicians.
The COVID-19 Response Team collaborated with regional medical authorities to design a procedural algorithm for the detection of suspected cases of COVID-19 (figure). Patients were screened for: (1) domicile or prolonged stay in the hot zone (ie, where COVID-19 cases first appeared), or both; (2) close contact with suspected or confirmed cases of COVID-19; and (3) close contact with patients with respiratory symptoms from the hot zone or China. The COVID-19 Response Team assessed the clinical condition of screened individuals to determine the need for hospital admission or for home testing for SARS-CoV-2 and subsequent isolation. Finally, recommendations to limit viral spread were provided to the other family members, especially when isolation was indicated.4
The COVID-19 Response Team handles patient flow to local hospitals and addresses specific issues about bed resources, emergency department overcrowding, and the need for patient transfer to other specialised facilities. The algorithm is constantly updated to meet regional directives about hot zone extension and modalities for SARS-CoV-2 testing.
Recent literature suggests that viral spread is still expected to grow, and the preparedness of public health systems will be challenged worldwide.5 In this context, the EMS is inevitably involved in facing the consequences of the SARS-CoV-2 outbreak. Specific algorithms, detailed protocols, and specialised teams must be fostered within each EMS department to allocate the right resources to the right individuals when cases of COVID-19 present. The Italian EMS, along with public health authorities, has just started to fight a battle that must be won.