Background: Current treatment of postdural puncture headache includes epidural blood patch (EBP), which is invasive and may result in rare but severe complications. Sphenopalatine ganglion block is suggested as a simple, minimally invasive treatment for postdural puncture headache. We aimed to investigate the analgesic effect of a transnasal sphenopalatine ganglion block with local anaesthetic vs saline. Methods: We conducted a blinded, randomised clinical trial including adults fulfilling the criteria for EBP. Participants received a sphenopalatine ganglion block bilaterally with 1 ml of either local anaesthetic (lidocaine 4% and ropivacaine 0.5%) or placebo (saline). Primary outcome was pain in upright position 30 min post-block, measured on a 0e100 mm VAS. Results: We randomised 40 patients with an upright median pain intensity of 74 and 84 mm in the local anaesthetic and placebo groups at baseline, respectively. At 30 min after sphenopalatine ganglion block, the median pain intensity in upright position was 26 mm in the local anaesthetic group vs 37 mm in the placebo group (estimated median difference: 5 mm; 95% confidence interval: e14 to 21; P¼0.53). In the local anaesthetic group, 50% required an EBP compared with 45% in the placebo group (P¼0.76). Conclusions: Administration of a sphenopalatine ganglion block with local anaesthetic had no statistically significant effect on pain intensity after 30 min compared with placebo. However, pain was reduced and EBP was avoided in half the patients of both groups, which suggests a major effect not necessarily attributable to local anaesthetics. Clinical trial registration: NCT03652714.

Background: In emergencies, such as the COVID-19 pandemic, there is an increased need for contact with emergency medical services (EMS), and call volume might surpass capacity. The Copenhagen EMS operates two telephone line the 1-1-2 emergency number and the 1813 medical helpline. A separate coronavirus support track was implemented on the 1813 medical helpline and a web-based self-triage (web triage) system was created to reduce non-emergency call volume. The aim of this paper is to present call volume and the two measures implemented to handle the increased call volume to the Copenhagen EMS. Methods: This is a cross sectional observational study. Call volume and queue time is presented in the first month of the COVID-19 pandemic (27th

BackgroundIn emergencies, such as the COVID-19 pandemic, there is an increased need for contact withemergency medical services (EMS), and call volume might surpass capacity. Thus, the Copenhagen EMS in Denmark implemented a separate coronavirus hotline followed by a web-based self-triage system to reduce nonemergency call volume. The aim of this paper is to present the two measures implemented to handle the increased call volume to the Copenhagen EMSfromthose with mild or no relevant COVID-19 symptoms.MethodsThis is a cross sectional observational study monitoring call volume in the first month of the COVID-19 pandemic in accumulated callnumbers, compared to the equivalent numbers during one month from the year before (2019). A coronavirus hotline and web-based self-triage system arepresented in absolute numbers of users.ResultsIn the first month of the COVID-19 pandemic in Copenhagen, emergency medical dispatch centers were extensively overloaded with more than 10.800 calls, resulting in significantly prolonged queue time (mean time in minutes:12:02; CI: 11:55-12:09)) compared to 2019 (mean time in minutes02:23; CI: 02:22-02:25) and thereby limiting access to emergency assistance and triage for citizens. The introduction of the coronavirus hotline showed reduced call volume and queue time to the EMS. The web-based self-triage system was used more than 107.000 times. However, no correlation between call volume and the use of a web-based self-triage systemwas observed.ConclusionsCreating a coronavirus hotlinestaffed by healthcare personnelseemed to have an impact on call volume and potentially relieved the strain in resources, while the web-based self-triage system was widely used and could be further developed to reach itsfull potential. Other EMS organizations can implement these measures to enhance capacity in a future epidemic.