bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency Healthcare Providers’ Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies
Authors: Sultan Mohammed , Sørensen Jarle Løwe , Carlström Eric , Mortelmans Luc , Khorram-Manesh Amir
Published: June 2023

Introduction:

This study evaluates the perceptions of preparedness and willingness to work during disasters and public health emergencies among 213 healthcare workers from 10 ministries of health hospitals in the southern region of Saudi Arabia, which is exposed to the risk of disasters such as flash floods in wadis, fires, sandstorms, armed conflicts at the border and ongoing waves of COVID-19 pandemic.

Method:

This study employed a quantitative research design by using a survey (Fight or Flight).

Results:

The results showed that participants' willingness to work unconditionally during disasters and emergencies varied based on the type of condition: natural disasters (61.97%), seasonal influenza pandemic (52.58%), smallpox pandemic (47.89%), SARS/COVID-19 pandemic (43.56%), special flu pandemic (36.15%), mass shooting (37.56%), chemical incident and bombing threats (31.92%), biological events (28.17%), Ebola outbreaks (27.7%), and nuclear incident (24.88%).

Conclusion:

Among several factors that determine healthcare workers’ willingness to work during disasters and public health emergencies, appropriate knowledge and skills to confidently manage an incident and the assurance of their families’ safety are two decisive factors. Although we could only find a significant correlation between education and willingness to work during emergencies, previous reports have confirmed a significant correlation between education, age, and years of experience and the perception of hazards and fear and consequently willingness to work under threatening circumstances. While unsuccessful management of disasters and emergencies may be the result of organizational shortcomings and resource scarcity, healthcare workers’ lack of knowledge, skills, and confidence and emotional distractions due to uncertainty about their own safety and that of their families may also play a significant role. Besides educational initiatives, which increase staff members’ confidence through knowledge acquisition and skill improvement, other measures, which guarantee their families’ safety and well-being during an emergency, should be established and implemented.
An Effective, Functional Approach to the Medical Operations Coordination Cell Structure
Authors: Noll Samantha , Little Charles , Ellen Steven , Nally Britta , Nielsen Brianna , Persson Caroline
Published: June 2023

Introduction:

Effectively responding to an incident across jurisdictions and coordinating with regional and jurisdictional partners is extremely challenging. The COVID-19 pandemic exemplified the need to develop an operational structure which would serve as a regional medical operations hub. Although there has been guidance for using a Medical Operations Coordination Cell (MOCC), the concept can be difficult to apply and develop for the specific needs of varying regions and jurisdictional entities.

Method:

The Mountain Plains Regional Disaster Health Response System (MPRDHRS) has developed a Medical Emergency Operations Center (MEOC) to address gaps in response coordination efforts across the six state Region VIII within the United States. This MEOC has been developed to synchronize and integrate existing systems and processes to manage the medical components of a response. This center is similar to other MOCC concepts. However, in a novel approach, the MPRDHRS organized a response framework that focuses on functional roles based on the specific needs of our region with response coordination and personnel availability. This organization is similar to the use of emergency support functions in a jurisdictional EOC.

Results:

While developing the MEOC, a local Lean team collaborated with the MPRDHRS on continuous improvement initiatives. Drills, workshops, and exercises were used to test the MEOC and offer just in time training to MPRDHRS members to staff different positions within the MEOC. The MEOC was activated for an incident response within the MPRDHRS region with many lessons learned.

Conclusion:

The MEOC is a new, developing system augmented to meet the needs of regional partners. The system was developed using feedback and ideas from partners, process improvement experts, and internal team members. Additionally, lessons learned from incidents and applications of drills, workshops, and exercises will be shared to leverage within any organization.
Catastrophes and Cultures: Differing Approaches, Differing Responses
Authors: McLean Andrew
Published: June 2023

Introduction:

The Merriam-Webster Dictionary describes culture as “the customary beliefs, social forms, and material traits of a racial, religious, or social group.” Also noted are: “the characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time.” Much has been written about the impact of culture on disaster risk and response. However, the issues are complex and multifactorial.

Method:

The author/presenter extensively reviewed current qualitative and quantitative literature regarding the impact of culture on disaster phases of mitigation, preparedness, response, and recovery.

Results:

There are over a thousand publications on the issue of culture and disaster. While it is clear culture plays a role in the phases of disaster management, there continues to be debate as to the weight which should be placed on culture, or whether it can be seen as separate from other elements which significantly impact phases of disaster, including political, economic, technologic, geophysical, etc.

Conclusion:

With subject matter expertise based on lived and academic experience, the presenter plans to utilize a tabletop format to engage small groups in discussion of the above concepts as well as their experiences relating to catastrophes and cultures. The hope is that this format will spur further translational research interest.
Effectiveness and Use of Avalanche Airbags in Mortality Reduction Among Winter Recreationists
Authors: Di Stefano Lucia Laura , Libera Bianca Della , Rodi Paolo
Published: June 2023

Introduction:

The number of backcountry skiers and snowboarder surged in the last years, especially during the COVID-19 pandemic, as ski resorts shut down. Inevitably, this led to an increase in avalanche-related injuries and death. As avalanche rescue device, avalanche airbags are increasingly becoming part of the standard winter mountaineering equipment.

Method:

This study provides a review of available data and an updated perspective on avalanche airbags, discussing their function and efficacy to reduce mortality and their limitations.

Results:

Causes of death in individuals caught by avalanches are multiple. Airbags seem to reduce mortality by decreasing chances of critical burial, the most determining risk factor. However, there is scarcity of reliable scientific research on the topic, and the way in which airbags reduce mortality and to what extent is still debated. Several elements seem to influence airbags efficacy, and their use still yields several limitations linked to manufacturing, proper use, users education, and risk compensation.

Conclusion:

Avalanche airbags seem to be an important tool in reducing mortality in backcountry expeditions. However, more research and standardized data collection is needed to fill the knowledge gap, mountain communities should promote adequate education of winter-recreationists on how to prevent and react to an avalanche, and on the correct use of airbags in combination with already available tools such as transceivers, probes and shovels, and manufacturing companies should ensure higher efficacy of the survival avalanche equipment for better prevention of burial, asphyxia, and trauma.
Prehospital Ketamine Administration for Trauma Patients Results in more ED Intubations
Authors: Aiken James
Published: June 2023

Introduction:

The use of ketamine in the prehospital setting has increased with EMS providers. Adverse effects of prehospital ketamine administration have not been well-established in the trauma population. The objective of this study was to evaluate the effects of pre-hospital ketamine on trauma patients presenting to a Level 1 trauma center. This study hypothesized that respiratory depression or oversedation from ketamine would increase the number of ED (Emergency Department) intubations.

Method:

A retrospective chart review of adult trauma patients receiving prehospital ketamine from 2016-2021 was performed. Patients with severe traumatic brain injuries were excluded. A 1:1 propensity match was performed of patients with similar demographics, injury severity, and mechanism of injury who did not receive prehospital ketamine. Univariate analyses were used to compare the groups. The primary outcome was the incidence of intubation in the Emergency Department.

Results:

Seventy-four trauma patients who received prehospital ketamine were identified. The average ketamine dose was 39 mg IV and 226.4 mg IM. 35.1% of patients received ketamine for pain while 29.7% received it for agitation. The ED intubation rate was higher in the prehospital ketamine group with 17.6% (n=13/74) requiring intubation as compared with 4.8% (n=3/63) who did not receive ketamine (p=0.03). Patients who required intubation in the ED had higher average doses of both IV/IO (37.7 +/- 4.8 mg vs. 55.0 +/- 24.2 mg) and IM ketamine (196.4 +/- 41.7 mg vs 290.0 +/- 41.3 mg).

Conclusion:

ED intubation rate was higher in the ketamine group. Patients that were intubated had received higher ketamine doses on average. Further studies are needed to understand and refine prehospital dosing and indication protocols to allow for more efficacious utilization of pre-hospital ketamine in trauma patients. A multicenter trial is ongoing.
Dedicated COVID-19 Hospitals in the State Security System of Poland
Authors: Goniewicz Krzysztof
Published: June 2023

Introduction:

The pandemic caused by the SARS-CoV-2 virus, which has been rapidly developing globally since the beginning of 2020, has forced individual states to take many restrictive decisions aimed at stopping the pandemic and controlling the crisis situation. In Poland, the strategy of fighting the pandemic in the initial phase covered the entire country and was based primarily on preventive mechanisms to identify and quell the pandemic.

Method:

A retrospective analysis was conducted incorporating media and a literature review. This retrospective analysis was performed using legal acts and press resources and other media reports to investigate every province of Poland.

Results:

This research describes one element of the state security system tasks, that of securing an appropriate number of hospital beds for COVID-19 patients. The process focused first on establishing both the purpose and tasks of dedicated hospitals followed by discussions of the potential problems related to the functioning of these specialized facilities for patients infected with SARS-COV-2 virus. Primary attention was given to ensuring both the security of the crisis situation and the diligent monitoring of the current epidemic

Conclusion:

In order to effectively use human and infrastructural resources, it was crucial to implement objective, unified methods of organization and management, as well as ongoing evaluation of the results of the conducted activity.
Medical Evacuation of Seriously Injured in Emergency Situations: Experience of EMERCOM of Russia and Directions of Development
Authors: Aleksanin Sergei , Rybnikov Viktor , Nesterenko Natalia , Yakirevich Igor
Published: June 2023

Introduction:

The steady increase in the number of natural and man-made disasters causes the need for urgent ambulance aircraft evacuation of seriously injured to the specialized federal medical institutions with appropriate equipment, advanced technologies and highly qualified personnel to provide specialized high-tech assistance to victims. The medical institutions can be located at a considerable distance from the place of emergency.

Method:

EMERCOM of Russia, staffed by highly qualified medical personnel, equipped with resuscitating medical modules in airplanes and helicopters (MMA and MMH), has been successfully carrying out medical evacuation of seriously injured in emergency situations to specialized medical institutions for many years (since 2008).

Results:

Based on the results of the use of the medical modules, it was proved that their use in mass ambulance aircraft evacuation is fully justified. During the flights, sparing transportation of the injured is provided, complete monitoring and compliance with the continuity of the treatment process. With the use of MMA and MMH, the quality of mass ambulance aircraft evacuation of seriously injured has significantly improved and the delivery time from the lesion to specialized hospitals has been reduced, as well as the lethality of victims.

The analysis of the effectiveness of the use of medical modules showed that the use of modules during the ambulance aircraft evacuation of seriously injured reduces mortality at the pre-hospital stage by 3.3 times, at the hospital stage–by two times (p<0.05).

Conclusion:

EMERCOM of Russia introduced into the practice of aviation medical evacuation the medical technology using extracorporeal membrane oxygenation (ECMO) for the rescue of seriously injured.

On the basis of NRCERM, a simulation center has been founded and equipped for the training of aviation medical teams, a training program has been developed for the medical personnel of EMERCOM of Russia participating in ambulance aircraft evacuation of victims in emergency situations.
Characteristics and Outcomes Among Patients with Acute Extremity Wounds Due to Gunshots Versus Bomb Blasts – A Prospective Cohort Analysis from Two Civilian Hospitals in Iraq and Jordan
Authors: Älgå Andreas , Haque Ghazal , Haweizy Rawand , Bashaireh Khaldoon , Malmstedt Jonas
Published: June 2023

Introduction:

Gunshots and bomb blasts are important causes of injury within conflict zones and extremities are frequently affected. There is a paucity of research on the characteristics and outcomes among civilians with conflict-related extremity injuries.

Method:

We performed a prospective cohort analysis utilizing data collected during a randomized trial at two civilian hospitals in Jordan and Iraq between 2015 and 2019. Adult patients who presented within 72 hours of sustaining an extremity injury requiring surgical care were included. We used mechanism of injury (gunshot versus bomb blast) as the exposure and wound closure by day five as the primary outcome measure.

Results:

The population was predominantly young men (n=163, 94% male, median age 29 years), injured by gunshots (61%) or bomb blasts (39%). Compared to the gunshot group, participants in the bomb blast group had more concomitant injuries (32/63 [51%] vs 11/100 [11%]; p<0.001), larger wounds (median area 100 cm2 [IQR 50–145] vs 53 cm2 [IQR 25–78]; p<0.001) and more frequent infections (16/63 [25%] vs 13/100 [13%]; p=0.04). Wound closure by day five was achieved in 25% (n=16/63) of the bomb blast group and 74% (n=74/100) of the gunshot group (p<0.001). This difference remained after controlling for confounding factors (OR 4.7; 95% CI 1.6–13.7).

Conclusion:

In this first prospective cohort analysis of civilians with acute conflict-associated injuries, those with extremity wounds caused by bomb blasts had worse outcomes than those with gunshot wounds. Our findings may prove useful to inform treatment protocols for civilians in armed conflict settings.
Measuring Patient Hazard Exposure–The Missing Middle in Disaster Mortality Prevention
Authors: Finnigan Gerard
Published: June 2023

Introduction:

Interventions that mitigate hazard exposures offer the most efficient means of reducing disaster mortality. However, such interventions require an evidence base that describes the relationship between hazard exposure dynamics and health risk. Medical practitioners have long used patient specific hazard exposure assessments to determine acute and chronic disease risk and align medical treatment and care. This study compared patient-specific hazard exposure data collected from people seeking healthcare during seven different natural hazard disaster events and compared the minimum patient data set standards recommended at the time.

Method:

Patient data collection forms used by primary and secondary health care providers during emergency health and medical responses to seven natural hazard disasters were reviewed. Data fields relating to potential exposure characteristics were recorded and compared to patient data fields used by health services prior to the disaster event. A literature review of definitions of disaster ‘exposure’ adopted by UN disaster management agencies were compared with the health and medical sector.

Results:

Only the SARS-CoV-2 disaster consistently assessed and recorded details about patient exposure characteristics. Patient hazard exposure data was typically limited to the time of onset of symptoms and duration relative to hazard impact. Little qualitative or quantitative assessment of the magnitude of exposure to any hazard was included, or patient-environmental data. While variables of hazard and vulnerability were extensively studied, and discussed in scholarly and industry literature, the concept of exposure received comparably little attention.

Conclusion:

Building an evidence base to correlate hazard and environmental exposure characteristics with patient health effects must be prioritized, especially for cohorts vulnerable from physiological or co-morbid factors. Such advances can be made through simple inclusions in minimum patient dataset recommendations. Understanding hazard-exposure dynamics are vital for advancing emergency health responses toward early intervention and health protection from future hazards that threaten functioning of whole health systems.
Can Social Media cause Needed Health Care Transformation to Occur? The STRONGERR Project
Authors: Mazurik Laurel
Published: June 2023

Introduction:

The key cripplers of health care are:

1. Fragmented Patient chart

Possible solutions:

single cloud-based chart that is owned by the patient protected by the government

information uploaded by a certified care provider (or they don't get paid)

Maintained by a patient navigator who organizes information

linked to self-care directions and

tele-support clinicians

2. Disparate and rapidly changing medical treatments of variable support with evidence

Why can't we integrate all guidance into one set of current recommendations so that when you put your information into the patient's EMR, guidance pops up and you follow that.

Not only will that lead to consistency, you are essentially entering a patient into a clinical trial of sorts as this data can be reviewed later.

3. CME

Fragmented, disparate, inconsistent.

Make it a paid part of our salary making it mandatory, and consistent

4. Telemedicine

Create a Provincial or State or Regional Virtual hospital that Offers 24/7, Full hospital e-consultant services.

a. Tier one, e-Consultants support acute care issues.They help you decide regardless of where you are working the management and connect with a regional hospital bed registry so you can move your patient from your ED to a hospital with beds.

b. Tier two, e-Consultants who support in-patient rounds virtually in rural/remote settings with hospitalists. For example, an Internist could support and monitor a regional virtual ward and do rounds with in-house hospitalists on patients across the region.

C. Tier three would be the equivalent of an outpatient clinic, done virtually.

Method:

A STRONGERR website using Social Media tools will be created to determine if social media can be used to accelerate health care transformation to create a unified delivery system.

Results:

Website will be up by Dec 2022. Results April 2023.

Conclusion:

To be determined.
Using a Multi-Agency Response Framework During COVID19 by Emergency Managers in a Healthcare Organization
Authors: Fitzgerald Mary Rose , O'Sullivan David , O'Brien Cian
Published: June 2023

Introduction:

The paper provides the perspective of emergency managers within a healthcare service, using a multi-agency framework to coordinate a regional response to COVID 19. While health services play a role in the planning, response and recovery to major emergencies they are rarely the lead in coordinating the response. The exploration of existing research through Pauchant and Mitroff Onion Theory is combined with the challenges and experiences faced by emergency managers during the COVID 19 response in Ireland. The research mirrors the experience of emergency managers that preparedness and relationship building are key to quickly establishing a response. However the experience of emergency managers was that although shared situational awareness is critical a flexible system framework is required, particularly in a prolonged pandemic situation. A hierarchical command and control system can negatively impact on strong local relationships and problem solving capability. The experience of emergency mangers concurs with research that the development of a learning organization is pivotal in information preparedness before and during the response and recovery phase. The challenges of implementing lessons learned across a national health service can be challenging especially during an extended response phase.

Method:

A deductive manifest analysis approach was adopted to carry out a qualitative thematic content analysis of exercise reports and emergency debrief reports.

Results:

Research Questions

Lessons learned in the five years prior to COVID 19 enhanced the response to the pandemic emergency–yes there are several examples of how lessons learned can improve response to seemingly unrelated emergencies.

The principals of the MEM Framework in Ireland are applicable to a pandemic emergency–yes but this is dependent on local arrangements and relationships to allow flexibility in the implementation of the framework.

Conclusion:

Regular training and exercising as well as a debriefing of exercises and real emergencies enhances preparedness for emergencies.
The Surge Capacity Applied to Migration Crises: "The Need for a Conceptual Framework for Emergency Medical Teams”
Authors: Echeverri Lina , Campoggiani Laura , Salio Flavio , Ragazzoni Luca
Published: June 2023

Introduction:

Migration and forced displacement are reshaping the globe today. More people are being displaced by conflicts and natural disasters than ever before, and climate change is playing a pivotal role as a contributing factor for migration and conflict.

While there is a growing literature regarding provision of care for migrants in hosting countries there is no evidence on the use of the surge capacity model to support preparedness, readiness, and response to migration crisis by local health services, or medical teams.

Method:

A scoping review with a narrative summary relevant to disaster medicine, looking at two major migration routes (Central/Eastern Mediterranean and South/Central America) was performed to determine if the surge capacity model has been applied by medical teams responding to migration crises, and how this has affected the adaptation of health services.

Results:

Preliminary analysis demonstrates variations on the use of the term “surge capacity”, and the imperative need to better define its application when preparing to or responding to any type of disaster, here specifically migration crisis. Thus far, there is no evidence on the use of the surge capacity model for the conformation of national/international medical teams when responding to this type of crises, and its relation to the adaptation of health services. This is particularly relevant, as the surge capacity model can support building and/or strengthening the capacity and capability of national and international medical teams.

Conclusion:

There is an imperative need to design a conceptual framework based on the surge capacity model for the conformation of fit-for-purpose medical teams, that ensures preparedness, readiness, and appropriate response to migration crises guaranteeing adaptation of health services depending on context needs, and that defines skills and competencies of the responders. Additionally, this provides a conducive platform for operational research activities to foster evidence coming from the field.
Evaluation of Inconclusive Results on the Cepheid X-Pert Xpress Platform (GXP) for the Diagnosis of Severe Acute Respiratory Syndrome-2: A Narrative Literature Review
Authors: van der Vegte Andrea , Conradie Maria , Orsmond Brendan , Smit Marco , Kleinhans Rochelle , Abraham Ria , Dowle Ashleigh , Jordaan Philip , Kennedy Keith , Molloy Michael
Published: June 2023

Introduction:

Molecular assay for diagnosing and detecting SARS-COV-2 is an essential tool in pandemic management, allowing for early informed decision-making. Worldwide, the gold standard for testing SARS-COV-2 includes real-time reverse transcription-polymerase chain reaction assay (RT-PCR). The Cepheid Xpert-Xpress was authorized for emergency diagnosis of SARS-COV-2. This platform demonstrated various advantages, including faster results, due to a decreased turnaround time, and decreased contamination risk. However, inconclusive results often leave clinicians uncertain regarding individual patient management decisions. Often leading to more confusion than answers.

The aim of this literature review includes the following:

identify the frequency and clinical implications of inconclusive results for SARS-COV-2 diagnosis utilizing GeneXpert assay

whether inconclusive results should be interpreted as negative

assessing the reliability of the GeneXpert platform to diagnose SARS-COV-2

Method:

A narrative literature review was conducted with eight critically appraised articles which met the inclusion criteria.

After the initial data collection, the SANRA Framework was implemented to aid in the sorting and filtering of data. The analysis of data was conducted with a critical appraisal tool.

Results:

The GeneXpert SARS-COV-2 assay demonstrated high sensitivity and specificity. Studies indicated that inconclusive results associated with a high cycle-threshold value (CT-value) of more than thirty-five on the Cepheid Xpert Xpress were associated with a decreased viral load and, thus, decreased infectivity. However, numerous factors influence the CT-value, such as specimen integrity. Thus, results must not be interpreted in isolation.

Conclusion:

This narrative literature review demonstrated the need for institutions to assist clinicians with decision-making regarding inconclusive results. A flow diagram grading a patient’s risk of having SARS-COV-2 with an inconclusive result could be of immense value. The flow diagram should incorporate the current epidemiology in the area, patient symptomology and risk and duration of exposure.
“This is a T.E.S.T.” (Tabletop Exercise Simulation Tool): Using Gamification to Train Public Health Staff in Community Reception Centers for a Nuclear or Radiological Incident
Authors: Schnall Amy , Finklea Lauren
Published: June 2023

Introduction:

After a nuclear or radiological (nuc/rad) incident, there is a need to screen, potentially decontaminate, and monitor the affected population. A Community Reception Center (CRC) is a site that provides these services, plus more, to those displaced by a large-scale incident. By using CRCs, federal agencies and state, tribal, local, and territorial (STLT) health departments can monitor the affected population, help prevent hospitals from becoming overburdened with persons not critically injured, compliment shelter operations, and obtain a basis for a long-term registry. However, public health staff often are not fully trained in their CRC role and the decision-making factors.

Method:

The Centers for Disease Control and Prevention (CDC) developed a unique training board game, “This is a T.E.S.T.” (Tabletop Exercise Simulation Tool), for public health staff about their CRC role and decision-making factors. We play-tested the game with several CDC and STLT staff in 2022 and received informal feedback.

Results:

Players found the game facilitated discussion and identified gaps in CRC plans, safety hazards, population needs, and staffing requirements. They also said the game improved collaboration and communication. Over 90% of players strongly agreed the game accurately simulated both bottlenecks and resource needs, individual needs and anxiety, and allowed a greater understanding of CRC operations.

Conclusion:

Games have been used for emergency response using different platforms such as virtual reality and video games. This is a T.E.S.T. facilitates collaboration by tasking players with managing resources, staff fatigue, public anxiety, and hazards. Players provided valuable feedback on its usability while learning more about CRCs. “This is a T.E.S.T” provides a unique, innovative training experience that incorporates components from typical tabletop and full-scale exercises, CRC capacity estimates through CDC’s CRC SimPLER (Simulation Program for Leveraging and Evaluating Resources), and key principles of adult learning.
Outcomes of Hemorrhage Control Training for Community Organizations in Rwanda
Authors: Longerstaey Oriane , Denison Kyle , Lee Noelle , Nzeyimana Innocent , Rutagumba Dieudonne , Hughes Ashley , Lacasse Chelsea , Krebs Elizabeth
Published: June 2023

Introduction:

Traumatic injury from road traffic accidents is a major cause of morbidity and mortality in Rwanda. Basic first aid training can help bystanders to provide prehospital care. The objective of this study was to determine the impact of Stop the Bleed (STB) hemorrhage control training on participant knowledge, attitudes, and practices regarding bleeding control.

Method:

A total of 64 participants from two community organizations (Healthy People Rwanda and the Rwandan Emergency Care Association) were provided with training in STB. The course included a didactic presentation and skills session where participants could practice skills. A KAP (Knowledge, Attitudes, Practices) survey was provided to participants before training, immediately after training, three months, and six months post-training.

Results:

Immediately after training, participant knowledge of bleeding control techniques improved across 5 of 7 questions, including correct tourniquet placement (98% vs 85%) and the correct order of steps to take when treating bleeding (63% vs 9%). There was also a significant increase in confidence across six measures: identifying life-threatening bleeding, applying a tourniquet, applying direct pressure, wound packing, treating severe active bleeding, and teaching bleeding control techniques to others (p<0.001). After three months, 100% (n = 21) of participants reported using at least one skill from the course, and 95.24% (n = 20) reported using at least one piece of equipment provided during the course. After six months, 93.33% (28 of 30) of participants reported using at least one skill from the course, and 86.67% (26 of 30) reported using at least one piece of equipment provided during the course. Notably, 17 participants reported using the tourniquet they had received by six months post-training.

Conclusion:

This study found that STB training increased participant knowledge of bleeding control techniques and confidence in performing techniques for bleeding control. All participants reported using skills learned from the course.
Reinventing Medical Hazardous Materials Response for Radiological Emergencies: Building Resiliency in Emergency Medical Response Systems Through a Novel Approach to Education and Training
Authors: Hwang Esther , Mize Benjamin , Glassman Erik
Published: June 2023

Introduction:

The past three years have included multiple Public Health Emergencies of International Concern (PHEIC) and dramatically impacted all facets of Emergency Medical Response. During this time, simultaneous crises have demonstrated the value of the non-traditional responder in mitigating complex incidents. Current geopolitical climate has proliferated nuclear power and increases the necessity for readiness and awareness for radiological incidents. These are complex incidents a responder may face and requires even the lowest skilled practitioner to be fully engaged before special operations intervention.

Limited research exists to determine whether current emergency medical services (EMS) training supplies the competency necessary to ensure safety of the prehospital provider during a radiological incident. Forthcoming research will investigate the effectiveness of this current training within the United States.

Method:

Survey data will be collected from multiple providers across the United States to evaluate their confidence level on two primary objectives during a radiological incident: competency of personal protective equipment donning and doffing, and management of contaminated patients.

Data analyses of survey responses help drive future proposed educational activities that will be compliant with best practices set forth by organizations such as the United States Department of Health and Human Services Radiation Emergency Medical Management (REMM), the National Fire Protection Agency (NFPA), and Radiation Emergency Assistance Center/ Training Site (REAC/TS).

Results:

Data will be collected by survey responses to evaluate a diverse range of EMS services. Details such as skill level, type of EMS service, catchment of communities served, and their impressions upon the training will be analyzed.

Conclusion:

This is an ongoing project that will embrace the perspectives of the diverse group of delegates of WADEM throughout and become enriched through the organization's wealth of knowledge. Gaps highlighted during roll-out of this research can also be used to address logistics, doctrine, and policy shortfalls.
The National Israeli Field Hospital in Ukraine - Innovative Adaptation to a Unique Scenario
Authors: Bar-On Elhanan , Vivante Asaf , Kreiss Yitshak
Published: June 2023

Introduction:

Following the outbreak of hostilities in Ukraine and the resultant humanitarian crisis, the State of Israel deployed a field hospital inside Ukraine. Challenges included a large refugee population, disruption of routine medical services to the local population, first-time deployment of a civilian field hospital, and deployment to a country at war.

Method:

The activity of the field hospital during a deployment in Ukraine is described along with lessons learned for future deployments.

Results:

A Rapid Assessment Team (RAT) performed needs assessment and coordination with local authorities. The main necessity encountered was delivery of primary care to both the refugee and local population. During the 6 weeks of deployment, 6,161 patients were treated in the hospital. 65 patients were hospitalized and 59 underwent surgery. The hospital was completely digitalized. 103 remote consultations were performed using telemedicine techniques. Capacity building of local teams was given high priority and 796 Ukrainian health professionals underwent training.

Conclusion:

Deployment of a national civilian field hospital in a country of war is possible through coordination with local authorities while undertaking the necessary security measures.

The change in caseload from expected war trauma to predominantly primary care necessitated agility in planning and operation with subsequent adaptation of hospital and staff structure.

The use of telemedicine enhanced capabilities, allowing access to consultation with the most experienced specialists in Israel.

Capacity building of local teams should be given a high priority. This was implemented by combining clinical training and the inclusion of a medical simulation unit in the hospital.

Dispatching a team delivering medical care and extending a helping hand in time of need, especially when done by a national entity, contributes greatly to building the people's faith, hope, and resilience during the crisis, and has a critical role in the recovery effort.
No One Should Die Alone: Preparing for the Next Pandemic
Authors: Cliff Barbara
Published: June 2023

Introduction:

As health care professionals and family members, we know that many patients died alone in healthcare settings during the first six months of the COVID-19 pandemic. An extensive literature review confirms this as well, and concludes that visiting restrictions during the pandemic had negative impacts on patients and their loved ones.

There is a right to not die alone contained in the Dying Patient’s Bill of Rights; however, it happened time and time again during the early months of this pandemic when countless people in long-term care settings and hospitals were reported to be isolated during their final hours of life. No one should die alone! What can we learn from this experience to try to minimize this from happening during the next pandemic?

Method:

This study will explore the state of the literature on the status and impact of visitor restrictions during the COVID-19 pandemic, in conjunction with a survey of a defined sample of practicing registered nurses in the United States. This study seeks to respond to the primary research question of how patients’/family members’ end-of-life needs can be met in a pandemic when hospital visitation is severely limited or non-existent? There are for (4) related sub-questions concerning effective direct and indirect methods of family presence.

Results:

The literature concludes that countless people were isolated without family presence during their final hours of life during the first six months of COVID-19. The initial survey process is currently underway, with the identification and analysis of recommendations for improvement in early 2023.

Conclusion:

The goal of this study is to develop best practices for meeting the end-of-life needs of hospitalized patients and their loved ones during a pandemic, so that to the extent possible, no one dies alone.
Review of Psychiatric Patient Transfer Times in an Emergency Department with Limited Psychiatric Services
Authors: Conradie Maria , Orsmond Brendan , Andrews Robin , Bilal Muhammad , van der Vegte Andrea , Abraham Ria , van Rensburg Rochelle Janse , Taqvi Syed , Jordaan Phillip , Smit Marco , Dowle Ashleigh , Vythilingam Darshini , Wickham Bryce , Kennedy Keith , Kelly Thomas , Molloy Michael
Published: June 2023

Introduction:

The National Ambulance Service (NAS) must transport patients with acute psychiatric needs to their nearest emergency department for assessment. Wexford General Hospital (WGH) does not have on-site medical psychiatric services after hours, in-patient psychiatric beds, or dedicated psychiatric doctors. Patients requiring formal acute psychiatric assessment and/or admission after ED review need to be transferred 60-80 km to other healthcare facilities.

Aimed to assess average ED stays of psychiatric patients and determine what degree transfer time contributed to their total time would help to determine what delay there was to providing acute psychiatric care due to the lack of after hours/on-site services.

Method:

Data was collected from the iPMS system. A total of 125 patients presented with primary psychiatric complaints between January 1, 2021 and December 31, 2021 and required onward transfer for acute psychiatric assessment or admission. Patients were excluded if less than 18 years or had been admitted to another WGH service before transfer. There are no existing guidelines in the National Clinical Program for Psychiatry or NICE guidelines for acute psychiatric patient transfer times or ED stays.

Results:

The average WGH ED attendance time was 15h 27min (range 0h08min and 19h22min). The longest interval contributing to overall time was Transfer Booked to Transfer Time (average 3h 27min). The time from Psychiatric Referral to Transfer accounted for 30% (on average) of patients’ attendance time.

Conclusion:

There are significant delays in accessing acute psychiatric care due to the absence of Ambulance Service Bypass Protocols to transport patients to the most appropriate rather than the nearest ED. Proposed Trauma bypass system changes offer unique opportunities to review such inequity of access to acute psychiatric services.
Incidence of Penetrating Trauma in an Urban Level 1–Trauma Center. A Retrospective Clinical Survey of the Years 2016-2021.
Authors: Hinrichs Katharina , Frank Mark , Gierer Philip
Published: June 2023

Introduction:

Penetrating trauma is a highly visible issue in history, social media, and politics. Crime statistics showed increasing numbers of violations of the law banning assault weapons in Germany. Although these injuries have historically been rare in Germany, we have noticed increasing numbers in our hospital. Studies focusing on these injuries of penetrating trauma are lacking, hence a distinct therapy algorithm is missing.

Method:

All penetrating injuries proximal to the wrist and ankle in the years 2016-2021 were analyzed in a retrospective survey. Isolated injuries of hand and foot were excluded. Data were gathered from the clinical information system and the protocol of the emergency medical services. For further analysis we identified three distinct groups: Patients who acquired the injury by an accident (ACCIDENT), self-inflicted (SELF-HARM) or by crime (ASSAULT). The groups were compared using MicroSoft Excel® and Sigma plot® (Jandel, San Rafael, CA).

Results:

A total of 961 cases were identified. The analysis showed an increasing number of cases with penetrating injuries from 2016 until 2019. Furthermore, major differences between the groups were revealed. The assault victims (ASSAULT n=117) were mostly male (91%) and non-German (52%). They were more likely to be accompanied by the police (13%), to be intoxicated, to require hospital admission (also to critical care) and to require surgery as compared to the cases of the ACCIDENT (n=484) and SELF-HARM (n=360) group. The SELF-HARM group cases were predominantly female, younger and had psychiatric comorbidities.

Conclusion:

The cause of penetrating trauma injury is important and can provide information crucial to the management of the patient. The emergency treatment of assault victims is challenging due to the particular circumstances of these cases. Optimal preparation and anticipation of the accident and emergency staff are necessary to deal with these patients. In summary, assault victims had more serious injuries than the other groups.
Mass Vaccination for All: Increasing Inclusivity of Point of Dispensing Plans in New Orleans.
Authors: Goldfine Shayna , Mclnturff Meredith
Published: June 2023

Introduction:

In January 2021, the State of Louisiana approved COVID-19 vaccine distribution to elderly and immunocompromised persons. From annual hurricane planning assessments, the city of New Orleans recognized medical and transportation barriers would prevent some eligible residents from accessing vaccines at public point of dispensing (POD) sites. A new vaccine distribution system was needed for homebound individuals and their caregivers. By February, the city developed and implemented a homebound vaccination plan under the direction of New Orleans Emergency Medical Services (NOEMS) and the New Orleans Health Department. This presentation will review this vaccine distribution model and the opportunities and challenges identified in maintaining this model for future medical POD interventions.

Method:

The City of New Orleans, along with news outlets and service providers, instructed homebound residents and caregivers to self-identify their need for a homebound vaccine by calling 311 and adding their name to a centralized waitlist. NOEMS/NOHD staff would schedule appointments based on resident and provider availability and geography of their home residence. Two 2-person teams were deployed simultaneously to provide ten doses within a five-hour time frame to minimize waste. Each deployment team included one city employee with an EMS certification and one volunteer, along with a cooler, ancillary supplies, registration form, and educational sheet to complete the appointment.

Results:

350 homebound residents and caregivers were vaccinated with the COVID-19 vaccine from February 2021 to January 2022. Vaccine doses were rarely wasted due to the availability of a centralized city-wide vaccine request list.

Conclusion:

The COVID-19 pandemic exposed gaps in mass dispensing plans and procedures. This local plan, created in haste to meet community need, became a model practice for other Parishes within the State of Louisiana and nationwide. This distribution modality needs to be maintained and tested, in addition to traditional POD sites, to be utilized in future dispensing events.
Border Measures Taken in Japan Against COVID-19 (Focusing on the Response to the Large Number of People Entering Japan when the Omicron Variant Emerged)
Authors: Kotani Satoshi , Koido Yuichi , Kondo Hisayoshi , Wakai Akinori , Mimura Seiji , Toyokuni Yoshiki
Published: June 2023

Introduction:

Various COVID-19 countermeasures were taken at Japan border control policy, especially, the return mission of Japanese nationals from Wuhan and the response to the Diamond Princess are considered to be cases that have stood out worldwide attention.

On the other hand, in response to the variants after December 2020, strict measures were taken, such as testing all those who entered Japan, quarantining those who tested positive, and requiring those who entered from certain regions to wait at some hotels even if they tested negative.

Method:

Report the response of quarantine in Japan.

Results:

In particular, for the Omicron variant in December 2021, the government took measures such as limiting the total number of people entering Japan, securing a maximum of over 20,000 rooms in a very short period of time, and providing domestic air transportation when necessary. The results of measures will be reported in this study.

Conclusion:

Various countermeasures taken as border control against COVID-19 in Japan were reported.