Emergencies in occupational medicine: the experience of an on-site medical office

Abstract

Objective : Medical emergencies (ME) in the occupational medicine (OM) office represent an increasingly frequent challenge, because they may require treatment or an ambulance, involving monitoring the patient, halting scheduled activity. The objective of this retrospective observational study was to study ME in the on-site medical office of a local pharmaceutical company, with an emphasis on the differences between major and minor emergencies, and on the factors associated with a longer duration of consultations, in order to optimize management. Methods : ME in the on-site office of a local company, January - June 2023 (109 working days), were recorded. The presentations were divided into 2 groups (G): G1 - ME that required ambulance/hospitalization/immediate treatment (etiological and/or symptomatic) and G2 - ME without immediate intervention. Results : During the 109 working days analyzed, 173 consultations involved ME (12.5% of the total presentations), with a mean of 1.6 presentations/day, On the 62 days with ME, the average was 2.7 presentations/day. The presentations, with a mean age of 40.8 years and a female predominance (69.4%), were divided into 2 groups: G1 included 95 (54.9%) presentations with immediate intervention, G2 - 78 (45.1%). In G1, 8 (8.4%) presentations required ambulance to hospital, 39 (41.1%) received etiological treatment, and 76 (81.1%) symptomatic treatment. Presentations for infectious diseases in a pandemic context ranked first This emphasizes the role of the OM physician in assessing Covid-19 contacts/patients. An ME consultation lasted on average 16.2 minutes, with a maximum of 19.4 minutes (excluding Covid-19 rapid testing). The most frequent ME complaints/humors were of cardiovascular, neurological, digestive and musculoskeletal origin. The maximum duration was in cardiovascular disease, associated with each type of intervention (p<0.0001 in the 3 cases: ambulatory/symptomatic/etiological treatment). Conclusion : ME in the OM doctor’ activity are frequent, more so in middle-aged women, especially between 12:01-16:00. They add approximately 2-3 consultations daily, in addition to the scheduled ones (30-45 additional minutes). Most ME require medical intervention: treatment in the office/ambulance. Apart from the COVID-19 context, most ME were cardiovascular (most time-consuming), digestive, neurological, and musculoskeletal. The duration of emergency consultations, additional to appointments, could require dedicated intervals, in order not to overload the physician. A systematized analysis of ME, paralleled by a good feedback towards the employer, could favor an individualized approach and an optimized endowment of the office, allowing identification of undiagnosed chronic disease, which would enhance productivity.