Introduction The effectiveness of cardiopulmonary resuscitation is determined by appropriate chest compression depth and rate. The American Heart Association recommended CC depth at 5–6 cm to indicate proper cardiac output during cardiac arrest. However, many studies showed the differences in the body builds between Caucasians and Asians. Therefore, this study aimed to determine heart compression fraction (HCF) in the Thai population by using contrast-enhanced computed tomography (CT) scan of the chest and a mathematical model. Materials and methods Consecutive contrast-enhanced CT scans of the chest performed at Ramathibodi Hospital were retrospectively reviewed from January to March 2018 by two independent radiologists. Patients’ characteristics, including gender, age, weight, height, and pre-existing diseases, were recorded, and the chest parameters were measured from a CT scan. The heart compression fraction (HCF) was subsequently calculated. Results Of 306 subjects, there were 139 (45.4%) males, 148 (47.4%) lung diseases and 10 (3.3%) heart diseases. Mean age and BMI were 60.4 years old and 23.8 kg/m2, respectively. Chest diameter, heart diameter, and non-cardiac soft tissue were significantly smaller in females compared to males. Mean (SD) HCF proportional with 50 mm and 60 mm depth were 38.3% (13.3%) and 50% (14.3%), respectively. There were significant differences of HCF proportional by 50 mm and 60 mm depth between men and women (33.2% vs 42.6% and 44% vs 54.9%, respectively (P<0.001)). In addition, a decrease in HCF was significantly observed among higher BMI groups. Conclusion The CT scan and mathematical model showed that 38% and 50% HCF proportions were generated by 50 mm and 60 mm CC depth. HCF proportions were significantly different between genders and among BMI groups. The recommended depth of 5–6 cm is likely to provide sufficient CC depth in the population of Thailand.

Introduction:The SARS-CoV-2 virus 2019 (COVID-19) has consumed many available resources within contingency plans, necessitating new capacity surges and novel approaches. This study aimed to explore the possibility of implementing the Flexible Surge Capacity concept in relieving hospitals by focusing on the community resources to develop “Home Isolation Centers” in Bangkok, Thailand.Method:This is a qualitative study consisting of observational and semi-structured interview data. The development and activities of Home Isolation Centers were observed, and interviews were conducted with leaders and operational workforces. Data were deductively analyzed and categorized based on the practical elements necessary in disaster and emergency management.Results:The obtained data could be categorized into the seven collaborative elements of the major incident medical management and support model. The command-and-control category demonstrated four subcategories: 1) coordination and collaboration, 2) staff engagement, 3) responsibility clarification, and 4) sustainability. Safety presented two subcategories: 1) patients’ information privacy and treatment, and 2) personnel safety and privacy. Communication showed internal and external communications subcategories. Assessment, triage, treatment, and transport followed the processes of the COVID-19 treatment protocols according to the World Health Organization guidelines and hospital operations. Several supplies and patient-related challenges were identified and managed during center development.Conclusion:The use of community resources, based on the flexible surge capacity concept, was feasible under restricted circumstances and enabled the relief of hospitals during the pandemic. Continuous education among multidisciplinary volunteer teams facilitated their full participation and engagement. The concept of flexible surge capacity may promote an alternative community-based care opportunity, irrespective of the emergencies’ etiology.

Background: Video laryngoscope (VL) has increased the success rate of intubation but the commercial VL is unaffordable for community hospitals. Therefore, Ramathibodi mobile VL (RAMA-mVL) was invented to close the gap and expected that it would be equivalent to the current device and lower price.Objective: To determine the effectiveness of intubation, compare by using RAMA-mVL and McGrath®Methods: The randomized, single-blinded study of the success intubation between RAMA-mVL and McGrath® was conducted in a manikin. Medical personnel with intubation experiences was included and trained before performing the procedure. The success rate for one best shot of intubation, time to intubation, satisfaction, and value between both VL were recorded and analyzedResults: A total of 208 persons entered the research, 104 in each group. The success rate for intubation by using both VL is 100%. The mean of time to intubation using RAMA-mVL was significantly less than that of McGrath®, which were 9.12 (±4.28) and 11.19 (±5.04) seconds, respectively (95% CI 0.001 - 0.9, P = .002). The satisfaction with innovation that is easy to build between RAMA-mVL and McGrath® was 4.88 (±0.32) and 4.23 (±0.96) points (95% CI 0.46 - 0.85, P < .001). Additionally, the cost of RAMA-mVL was cheaper than McGrath®.Conclusions: RAMA-mVL performed equivalent and even better than McGrath® compared by intubation success rate, mean intubation time, satisfaction, and cost-effectiveness.