bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Access Block Is Increasing Mortality in Emergency Departments in Nepal
Authors: Maharjan Ramesh , Maharjan Rashmisha
Published: June 2023

Introduction:

Emergency patients have to stay in the Emergency Department (ED) for hours to days to get ward admission for definite care in Nepal. Access block is a major issue in the ED of University Level Teaching Hospitals (ULTH) in Nepal. This study aimed to analyze the impact of access blocks in the EDs of Nepal.

Method:

Meta-analysis of different publications on ‘duration of ED Boarding’ and ‘mortality outcome of ED’ of ULTHs of Nepal till November 15, 2022

Results:

9.7% of ED patients were admitted to the ward. The time period from ED arrival to respective ward team consultation is 5.7 hours, consultation to ward admission is 5.6 hours, and admission to ward transfer is 8 hours. The average ED boarding time is 18.1 hours. 38% of patients arrived in ED via Ambulances. The time period from ED arrival to ward team consultation for those who need transfer to another center are 6.9 hours, consultation to admission is 5.7 hours, and admission to transfer is 8.7 hours (ED Boarding time 21.3 hours). Meta-analysis of three major ULTH’s showed mortality with respect to ED boarding time to be 17% in < 1 hour, 40.4% in 1 - 6 hours, 27.4% in 6-12 hours, 9.1% in 12-24 hours, 4% in 24-28 hours and 2.1% in >48 hours. Among them, higher age, greater mortality rate. The immediate causes of mortality comparing 2018 vs 2010 are Sepsis & Septic shock 32.2% vs 18%, Cardiac Causes 21.8% vs 14.8%, Aspiration Pneumonia 19.5% vs 14.8%, Severe Lung Diseases 12.7% vs 16.4%, Hypovolumic & Haemorrhagic Shock 9.2% vs 34.4% and Poisoning 4.6% vs 1.6%.

Conclusion:

Prolonged ED boarding due to Access Block is triggering increased mortality in the ED.
Role of General Practice Led Observation Ward to Support Emergency Ward to Improve Health Outcomes at a Major Kathmandu Hospital in Nepal
Authors: Shakya Yogendra
Published: June 2023

Introduction:

Tribhuvan University Teaching Hospital (TUTH) is a tertiary care hospital in Kathmandu. The emergency department sees between 130 to 140 cases per day. These patients get initial evaluation and basic investigation for acute emergency management and treatment. Those requiring further treatment are then admitted to the department of General Practice for post emergency care which acts as an observation ward. This step allows for the patients to be observed on a short-term basis and permits patient monitoring and/or treatment for an initial 24-48 hour period and up to a maximum of five days. These steps allow for focused follow up, improved efficiency and minimizes inappropriate admissions to other hospital inpatient wards. This paper evaluates functionality, admission criteria, patient categorization and subspeciality referral to specialty patient care, discharge criteria and cost effectiveness.

Method:

A descriptive observational study was carried out of the patients admitted to the observational ward between 2020-2021.

Results:

Most articles suggest these wards improve patient satisfaction and clinical care, decrease length of stay, reduce unnecessary inpatient hospital admissions and are useful in fever under evaluations, COPD, poisoning, pneumonia, mild head injuries, high sugar, hypertension, gastroenteritis etc. Around 14% of patients were sent to the observation ward after acute emergency care. 84% were discharged from observation ward with a mean stay of three days and were followed up in community care or GP OPD. Nine percent were admitted to hospital wards, and 7% transferred to yellow/red area emergencies for derange vitals.

Conclusion:

Observation wards seem to have advantages, excluding those who will inevitably need longer treatment, reduces cost savings and unnecessary burden of hospital admission.
Decision Maker's Experiences with Rapid Evidence Summaries to Support Real-time Evidence-Informed Decision Making in Crises: A Mixed Methods Study
Authors: Khalid Ahmad Firas , Grimshaw Jeremy , Parakh Nandana , Charide Rana , Rab Faiza , Sohani Salim
Published: June 2023

Introduction:

There is a clear need for research evidence to drive policymaking and emergency responses so lives are saved and resources are not wasted. The need for evidence support for health and humanitarian crisis is pertinent because of the time and practical constraints that decision makers in these settings face. To improve the use of research evidence in policy and practice, it is important to provide evidence resources tailored to the target audience. This study aims to gain real-world insights from decision makers about how they use evidence summaries to inform real-time decision making in crisis settings, and to use the findings to improve the format of evidence summaries.

Method:

This study used an explanatory sequential mixed method study design. First, a survey was used to identify the views and experiences of those who were directly involved in crisis response in different contexts, and who may or may not have used evidence summaries. Second, the insights generated from the survey helped inform qualitative interviews with decision makers in crisis-settings to derive an in-depth understanding of how they use evidence summaries and their desired format for evidence summaries.

Results:

Twenty-six decision-makers working in health and humanitarian emergencies were interviewed. The study identified challenges decision makers face when trying to find and use research evidence in crises, including insufficient time and increased burden of responsibilities during crises. Decision makers preferred the following components in evidence summaries: title, target audience, presentation of key findings in an actionable checklist, implementation considerations, and assessment of the quality of evidence presented. The study developed an evidence summary template with accompanying training material to inform real-time decision making in crisis settings.

Conclusion:

The study provided a deeper understanding of the preferences of decision-makers working in health and humanitarian emergencies regarding the format of evidence summaries to enable real-time evidence-informed decision-making.
Keeping our Healthcare Workers Safe–Ebola and COVID-19
Authors: Turang Yanti
Published: June 2023

Introduction:

Over the past decade, the world has wrestled with two major pandemics: Ebola and COVID-19. While Ebola revealed that we needed a strategy, Covid-19 showed we still didn't have one. Apart from ensuring that we isolate and contain the virus, one of the major concerns in responding to a pandemic is limiting transmission to healthcare personnel.

Method:

This presentation describes a clinician's experience with employing the same infection control strategies used for Ebola in a makeshift Ebola Treatment Unit in a school in Sierra Leone and at a COVID-19 alternate care facility built in a convention center in the US.

Results:

Transmission control strategies used for healthcare workers during Ebola were also successful for COVID-19. Both facilities, despite grossly different access to financial resources, ensured all clinicians didn’t break protocol of safety, due to rigorous donning and doffing entrances and exits, internalized individual risk, separated spaces with tape, and zoned areas.

Conclusion:

Two facilities with access to vastly different resources to treat two distinct infectious diseases used the same infection control measures for staff with success. Highlighting the priority of internalization of risk by healthcare workers alongside critical infection control measures proves to be the most valuable resource over multi-million dollar facilities erected during COVID.
Straddling the Fields of Disaster Preparedness and Disaster Epidemiology: Lessons Learned from Planning a Study for Implementation Within Weeks of an Unpredictable Natural Disaster
Authors: DiGrande Laura , Frasier Alicia , Martin Maurice , Cummings Stirling , McMichael Joseph
Published: June 2023

Introduction:

Studies on the impact of disasters on communities often occur months to years after the event. Pre- and peri-event details collected from participants may be imprecise or even unobtainable as memory is affected by time. More so, delays in data collection can introduce recall bias when participants with adverse outcomes provide differential responses about exposure. In 2019, the US Centers for Disease Control (CDC) and RTI International designed a study to mitigate these issues by surveying within weeks of a natural disaster to examine associations of preparedness to peri-event exposures, emergency services, and health.

Method:

Given the unpredictability of natural disasters, a significant challenge for the team was to plan a rigorous study design applicable to several types of severe weather events. This presentation will review our forethought, planning, and resulting strategy, including important considerations related to IRB and OMB applications with unspecified disaster/location details. We will share decision-making on sampling, instrumentation, communication materials, and multi-mode data collection procedures. The impact of delays due to COVID-19 and waiting to select a disaster that met a prior disaster inclusion/exclusion criteria will also be presented.

Results:

Results are forthcoming. We will present details on RTI’s 2022 survey implementation in the Fort Myers area of Florida within weeks of Hurricane Ian landfall including information on our final sampling strategy, field period, and outcome rates among key community groups and exposures.

Conclusion:

Conclusions will be presented. Pragmatic lessons learned related to timeline, labor, and other resources will be used to compare our strategy to rapid needs assessment methodology as well as more typical self-report surveys with later post-disaster data collection periods. Researchers working in emergency preparedness/response and disaster epidemiology will have gained a solid understanding of the advantages and disadvantages to planning studies for the immediate aftermath of undefined disasters.
Development of an Enhanced Surveillance and Epidemiology Program to Support the Birmingham 2022 Commonwealth Games in England: Outcomes and Lessons Learned
Authors: Hughes Helen , Jarratt Reece , Harrison Melissa , Logan Sophie , MairJenkins John , Chatt Carol , Elliot Alex
Published: June 2023

Introduction:

The 2022 Commonwealth Games (B2022) was hosted by Birmingham, United Kingdom (UK) from July, 28 2022 to August 8, 2022. As a major global sporting event and mass gathering, B2022 included over 4,500 athletes (from 72 countries and territories) and attracted 1.5 million spectators. Robust public health surveillance and support for health protection incidents was required from the UK Health Security Agency (UKHSA) to protect the health of both those directly involved in B2022, and the local population.

Method:

UKHSA surveillance activities in the UK West Midlands region were enhanced, utilizing lessons learned from the response to the London 2012 Olympic and Paralympic Games and the 2021 G7 Summit (hosted in England). Enhancements included: adaptation of existing and development of new methods for the identification of increased activity of a range of pathogens/diseases/conditions of particular concern to a mass gathering; standardized daily situation reporting to inform both public health action and the B2022 organizing committee. Three streams of routine UKHSA surveillance data were assessed each day: a UKHSA health protection/clinical management system, statutory laboratory reports of infection, and syndromic surveillance. Bespoke surveillance was also implemented using B2022 health data sources.

Results:

Enhanced daily surveillance activities successfully met the need for next-day public health surveillance and reporting during B2022. No outbreaks or incidents of public health significance to the Games were identified. Syndromic surveillance reported an increased impact on local health services due to periods of extremely hot weather before and following the competition period, although these impacts were not unique to the Birmingham area.

Conclusion:

Surveillance and epidemiology reporting for B2022 provided reassurance there were no incidents/outbreaks of public health significance to the Games. The enhancements made will inform future routine surveillance and reporting activities and will be employed for similar activities during future mass gathering events.
Development of the Matrix for Regional Collaboration on Disaster Health Management in the ASEAN Region
Authors: Sutthalak Sukanya , Yanasan Alisa , Utthasit Ob-orm , Kita Taro , Ikeda Shuichi
Published: June 2023

Introduction:

The ASEAN Leaders’ Declaration on Disaster Health Management (ALD on DHM) was adopted at the 31st Summit in Manila in 2017. The Plan of Action (POA) to implement the ALD on DHM was adopted by the ASEAN Health Ministers Meeting in 2019, with Regional Collaboration Committee on Disaster Health Management (RCCDHM) established as a primary implementing mechanism under the purview of ASEAN Health Cluster two and Senior Officials Meeting on Health Development (SOMHD) to operationalize the implementation of the POA with its priority areas and targets to be realized by 2025. The first RCCDHM Meeting was organized in-person in Bangkok in 2020. The RCCDHM is composed of two representatives from each ASEAN member state (AMS), one representative from the ASEAN Secretariat and one representative from AHA Centre, and the secretariat role for the RCCDHM is carried out by the Ministry of Public Health, Thailand. The RCCDHM Meeting decided to develop the Matrix of Detailed Activities (MDA) addressing the five priority areas of the POA-ALD on DHM.

Method:

The RCCDHM Meeting organized a core group consisting of the Philippines and Thailand to develop the MDA which identifies information on activities, expected outputs, indicators, lead country, source of support, and the timeline for achieving objectives of the POA. During the COVID-19 pandemic, online communication was applied to discuss and coordinate among the AMS.

Results:

The core group developed the draft MDA in consultation with the ASEAN Secretariat/Health Division. After a series of discussions, the RCCDHM endorsed the MDA which confirms necessary activities and commitment of AMS.

Conclusion:

The review and endorsement process for the MDA will be elevated to the higher level meetings in the ASEAN Health sector for final approval. The RCCDHM also confirmed to strengthen collaboration with other ASEAN initiatives, non-health ASEAN sectors, UN, or other international partners, and the ARCH Project.
Systematically Identifying and Evaluating Strategies for Strengthening Community Resilience
Authors: Ryan Benjamin , Kako Mayumi , Brooks Bryan , Rahman Moshiur , Rahman Sohel , Hardin Mike , Swienton Raymond , Novak Jeremy , Fink Rok , Simsek Perihan
Published: June 2023

Introduction:

Vulnerable populations were the most impacted by the COVID-19 pandemic. This included those with underlying health conditions, self-employed, low-income, people with limited access to health care, and the elderly. To capture these lessons and identify resilience actions, the Health Emergency and Disaster Risk Management (Health EDRM) Framework was used to guide the application of the Public Health System Resilience Scorecard (Scorecard).

Method:

This study was conducted in Australia, Bangladesh, Japan, Slovenia, Turkey, and the United States. Participants included emergency professionals, doctors, nurses, environmental health specialists, researchers, and government officials. The Scorecard was used to rank the level of preparedness from 0-5 (5 the highest) for the public health system resilience indicators. Following the individual workshops, recommendations were collated and interpreted to develop consolidated priority actions.

Results:

The priority actions related to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. To address surge capacity issues, determining whether existing disaster structures have the capacity to provide support for hospitals during patient surges. This could include services that enable telehealth and primary health care to support hospitals during a crisis. Mental health services at the local government level should be evaluated and awareness of ecosystem risks in urban and rural areas needs to increase. Strategies for achieving reciprocal trust are required to enable uptake of public health information, and the extent at which pre-existing chronic health issues are likely to exacerbate needs to be understood and addressed.

Conclusion:

This study revealed several areas for strengthening public health system resilience. Priority actions relate to addressing needs relating to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. This serves as a framework for transforming public health systems to become more adaptive, flexible, and focused on enabling societies to function at the highest possible level when responding to a disaster or pandemics.
The UK Health Security Agency (UKHSA) Planning, Preparation, and Response to the Birmingham 2022 Commonwealth Games–Learning for Future Mass Gatherings, Including Multi-sport Events
Authors: Cox Caryn
Published: June 2023

Introduction:

The Birmingham 2022 Commonwealth Games (CWG) met the World Health Organization (WHO) definition of a mass gathering: events attended by sufficient people to strain the planning and response resources of a community, state or nation’. It was a key opportunity for the UK in terms of tourism and economy, but a major challenge in terms of the potential for adverse events e.g. infectious disease outbreaks, terrorist attacks. This increased scrutiny and threatened reputational risk. For UKHSA, as a new organization amidst a rapidly changing public health landscape–continued COVID-19 pandemic and increases in Monekypox, this was a very public test.

Method:

In 2021, a small team was established to accelerate preparation including:

assurance structures

advice to the Organizing Committee and Government departments

advice on COVID-19 including testing policy

staff/stakeholder preparation through exercising/training

increased staff numbers and skill mix able to adapt

budget

operational response structure

plans in place and tested for a health protection response in the event of an incident

other mass gatherings reviewed for transferable learning enhanced surveillance systems

Results:

Daily epidemiology reporting provided reassurance that there were no significant public health issues requiring escalation. Enhanced surveillance provided reassurance to the community that there were no population ill effects linked to the CWG. Overall, COVID-19 positivity was low. No outbreaks were detected linked to the CWG.

Conclusion:

The UKHSA successfully identified, planned and prepared for and mitigated the risks of a mass gathering of 1.5 million people. Early engagement, support, advice and cross- government collaboration has been regarded as exemplary with surveillance data indicating no outbreaks linked to the Games. Despite the breadth of risks visitors were able to attend the event in contrast to the restrictions placed at the Tokyo Olympics. This contributes to the worldwide body of knowledge for planning and delivering mass gatherings – sporting or otherwise.
Prevention and Preparedness for Mass Gathering Disasters: Our Efforts and Successes in Hyogo, Japan
Authors: Nakayama Shinichi , Ukai Takashi , Kozawa Shuichi , Kawase Tetsunori , Ishihara Satoshi , Kai Soichiro , Yoshida Takeshi
Published: June 2023

Introduction:

Both prevention and preparedness are essential to avoid casualties and deaths in mass gathering disasters (MGDs). What countermeasures should be taken?

Method:

Retrospective analysis of a MGD at Akashi City Fireworks Festival in 2001; discussion of countermeasures at Kobe Luminarie, an annual light festival to commemorate the Great Hanshin Earthquake. Retrospective analysis of mass casualty incidents (MCIs) between 2003 and 2022 in which the alert function of EMISHP (Emergency Medical Information System in Hyogo Prefecture) was activated. Duration from emergency call to activation of alert function (activation time), number of casualties, and number of destination hospitals were evaluated.

Results:

More than 200 persons were injured and eleven people died in the Akashi Fireworks crowd crush. The main cause of this MGD was lack of gateway control and one-way flow control of visitors. With such measures in place, no MGD has occurred at Kobe Luminarie. In the past nineteen years in Hyogo, the alert function has been activated for 288 MCIs, such as vehicle accidents and fires. Activation time ranged from 1 to 73 minutes (median value=12). The casualty count ranged from 0 to 662 (median value=5). The number of destination hospitals ranged from 0 to 54 (median value=2). In all cases, emergency medical coordinators at Hyogo Emergency Medical Center, a principal hub hospital for disasters, directly or indirectly contributed to the medical response, e.g. securing hospital capacity, dispatching doctor-attending cars/helicopters and other medical teams to the scene, sharing information on the MCI between fire departments and hospitals.

Conclusion:

Prevention of MGDs requires taking proactive measures, such as gateway restriction and one-way flow control without bottlenecks. Preparedness is made possible by the alert function of EMISHP; it enables smoother patient transport to hospitals and contributes much in securing sufficient time and resources for medical response in MCIs, including MDGs.
How the Deadliest Nightclub Fire in History Improved Medical Interventions and Regulations and Impacted Legal Enforcement
Authors: Williams Joyce , Williams David
Published: June 2023

Introduction:

This presentation is a continuation of a WADEM presentation from 2013 entitled: Fires in Social Settings: An Examination of Prevention Strategies.

Method:

Nightclubs should be a place of fun and frivolity, but sometimes they become a place of death and destruction. The fire at the Cocoanut Grove in Boston Massachusetts, USA, in November, 1942 was the deadliest nightclub fire worldwide with a death toll of 492 and over 130 injured. Since that tragedy, regulations that could prevent or mitigate lethal incidents at nightclubs continue to be unenforced globally. This presentation will describe not only elements leading up to the Cocoanut Grove fire, but the resulting advances that have improved the lives and safety of the public.

Results:

The discussion begins by examining the general environment within the U.S. in fall of 1942. Appointed and elected officials tasked with protecting the public to reduce occurrences for such disasters failed in their performance of their respective roles. Groundbreaking medical advances used to treat the victims include the use of penicillin, methods of treating cutaneous burns, the use of electrolyte balance to aid in determining the ongoing treatment of burn victims, as well as other medical advances improved directly as a result of the fire. Additionally, the first systematic study of grief and survivors’ guilt and the recognition of what is now called Post Traumatic Stress Disorder commenced.

Conclusion:

Finally the divergent theories of the sources of the fires, how fire codes have changed in the aftermath as well as how the parties that were directly or indirectly responsible for the fire were disciplined by the judicial system will be reviewed.
Stadium Disasters
Authors: Tin Derrick , Hata Ryan , Ciottone Gregory
Published: June 2023

Introduction:

Stadiums are an important part of the entertainment and sporting cultures of communities around the world, but the combination of outdated infrastructure with poor safety planning, large numbers of people gathering within a confined space, and the high frequency of such events have led to a number of significant disasters in the past.

This is a descriptive analysis of stadium disasters occurring between 1901-2021 which may provide useful insight for event safety personnel and disaster medicine specialists to better prevent and mitigate the effects of potential future stadium disasters.

Method:

Data was collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all stadium-related accidental disasters occurring between January 1, 1901-July 30, 2022. A disaster is defined by CRED in its glossary as “technological accidents of an industrial nature, or involving industrial buildings”. All categories and definitions are predetermined by the EM-DATS as per their glossary.

Results:

The May 24, 1964 Estadio Nacional disaster in Lima, Peru was the worst (in terms of deaths) to date with 350 deaths. This is followed by the 1982 Luzhniki Stadium disaster in Moscow, Russia (340 deaths), the 2001 Accra Sport Stadium disaster in Ghana (123 deaths), and the 1985 Hillsborough Stadium disaster in Sheffield, England (96 deaths) as well as 14 of the 40 stadium disasters occurred in Africa, 11 in Europe, 10 in the Americas, and five in Asia.

Conclusion:

A total of 40 stadium disasters were included, leading to 2,025 deaths and 6,640 injuries. This equated to an average of 50.6 deaths and 166.0 injuries per disaster. Given the potential risk of mass casualty events, stadiums should incorporate disaster medicine education, training, and expertise in their emergency medical plans.
It’s Sinking: Coastal Cities of Jakarta and Semarang, Indonesia
Authors: Pradana Atha , Yew Ying , Demetriou Christiana , Prayitno Harun , Delgado Rafael , González Pedro , Utami Ratnasari Dyah
Published: June 2023

Introduction:

Jakarta and Semarang are predicted to be engulfed by seawater by 2050, based on evidence by the Copernicus Sentinel-6 satellite. The current sinking rate is reaching almost 20 cm annually in both coastal cities, as reported at the World Economic Conference in May 2022, due to climate change, rising sea levels and excess groundwater extraction leading to land subsidence. Therefore, the objective of this study is to analyze the sinking of both coastal cities of Jakarta and Semarang, using indicators of vulnerability, exposure, and impact by 2050.

Method:

The YEW Disaster Severity Index (DSI) was used to analyze the impact, vulnerability, and exposure attributed to sinking. Data were obtained from real-time Google, Copernicus Sentinel-6 satellite, and triangulated with United Nations Office for Disaster Risk Reduction, World bank Data, Government of Indonesia Central Bureau of Statistics, as well as reputable journals.

Results:

The impact analysis on the sinking of Jakarta and Semarang, calculated in April 2022, using the YEW DSI, scored a High DSI impact of 6.03 and a Moderate DSI impact of 5.76, for each town respectively. Jakarta and Semarang also scored more than 100% baseline ability to cope on the YEW DSI indicators, which accounted for five vulnerability indicators and one exposure indicator of a total 13 million population affected. By 2050, both cities will be 5.6 meters below sea-level, with a constant current sinking of 20 cm per year.

Conclusion:

At present, vulnerability and exposure of the affected population account for a total of 13 million in both coastal cities. The analysis showed the inability to cope within local capacity, indicating a response is needed. The future of Jakarta and Semarang is in the hands of local, national, and global decisions and policymakers, in mitigating its impact through forest land conservation, adaptation, and relocation of the affected population.
Multilateralism as a Determinant of COVID-19 Outcomes in Small Island Developing States: Mitigating Disaster Impact Through Foreign Affairs Investment.
Authors: Dookeeram Darren , Borquez Sabastian , Seetharaman Hariharan , Bidaisee Satesh , Maharaj Sandeep , Dookeeram Dave
Published: June 2023

Introduction:

The United Nations (UN) recognizes Small Island Developing States (SIDS) as a heterogenous group with common geographic and socio-economic challenges. Their vulnerability to disasters was exacerbated during COVID-19 because of emerging nationalism and protectionism towards supply chains and resources. This study aimed to determine if multilateralism engagement improved COVID-19 outcomes and if Foreign Affairs investment improved short term COVID-19 outcomes.

Method:

Metrics were developed to reflect country parameters, clinical impact of COVID-19, engagement in multilateralism, health systems strength and integration in the International Political Economy. Open-source information was used to quantify proxy measures with the calculated percent spent on foreign affairs being the major proxy of multilateralism and disaster impact as lag time to vaccination, case burden and deaths in the first six months of 2020. Data was collected for each of the 38 SIDS. SPSS was used to assess possible correlations with short- and long-term clinical outcomes of the COVID-19 pandemic.

Results:

SIDS were noted to have an average lag of 4.1 months to begin vaccination rollout compared with developed nations and prolonged below global average vaccination rates. Expenditure on Foreign Affairs reduced the vaccination lag (p=0.03), decreased short-term cases (p<0.001) and deaths (p<0.001), Human Development Index improved vaccination rates (p<0.001) and lowered total cases (p=0.03). Foreign Direct Investment (FDI) inflow also decreased vaccination lag (0.02). Dependence on Foreign Aid decreased vaccination rates (p=0.01).

Conclusion:

These relationships suggest that there were multiple factors that determined short- and long-term health outcomes in SIDS. Mitigating the impact of a disaster therefore requires a multiple level investment solution that recognizes the importance of other actors in the global system. The COVID-19 experience suggests that engagement in multilateralism is important in countries that have a high vulnerability to disasters such as SIDS. This is valuable for future disasters in vulnerable states.
Innovations in Disaster Preparedness Training: An Emergency Preparedness Curriculum within a Pediatric Emergency Medicine Fellowship
Authors: Aspiotes Christine , Brumberg Elizabeth Hewett
Published: June 2023

Introduction:

Improved understanding of pediatric emergency preparedness can ensure the safety of children during disaster events, a population that is often overlooked.1 2 One method to minimize disparities is to increase the pediatric preparedness workforce by providing education to trainees about the foundations of this field.

Method:

A pediatric emergency preparedness curriculum was created as part of an elective prehospital track within a pediatric emergency medicine fellowship program at a quaternary pediatric hospital.

Results:

The curriculum focuses on three domains: education, research, and administration. The trainee is required to participate in local and regional educational opportunities. Locally, trainees create and facilitate at least one tabletop exercise about a preparedness topic of their choice. They also attend regional and state-wide preparedness drills to foster better understanding of integrated system processes. Additional educational opportunities involve the creation of asynchronous learning modules for their division and development of just-in-time resources for disaster events. For research, they have the opportunity to pursue an original project in the field and participate in other research activities with the track director. The administration domain prepares the trainee to be a leader in the field. Trainees are active participants within the emergency department’s preparedness committee and during hospital-wide preparedness meetings. These meetings develop protocols and policies as well as educational initiatives. Fellows are also encouraged to join national collaborative preparedness efforts through the American Academy of Pediatrics and the EMSC innovation and Improvement Center (EIIC).

Conclusion:

This curriculum provides an introduction to and continued education about disaster preparedness to pediatric emergency fellows early in their career. Completion of the sub-track fosters future leaders in the disaster medicine field. In the future, this curriculum can be adopted by other medical training programs to expand understanding of pediatric preparedness concepts.
The Impact of COVID-19 Patient Surges on the Burn Care System
Authors: Kearns Randy , Carter Jeffrey
Published: June 2023

Introduction:

Burn mass casualty incident (BMCI) planning efforts have been in practice and publication for 40+ years. While COVID-19 has no direct connection to burn injuries, the impact of COVID-19 on the healthcare system including burn care was and remains significant.

Method:

A retrospective analysis of data was conducted voluntarily submitted to the American Burn Association from March 2020 to June 2021 which generally coincides with the first three waves of the pandemic. We focused on the self-reported data specific to the three critical components in managing a surge of patients: staffing, space, and supplies (to include pharmaceuticals and equipment).

Results:

Staff: These data were collected over a period that coincided with the first three waves seen in the USA. Staffing shortages were noted during each of the surges but were most excessive when a regional surge paralleled surges in other parts of the country (November-December 2020).

Space: Late November and early December 2020, space was in short supply with the surge of patients for more of the region than at any other time during the 28 weeks of reporting. While single facilities reported other episodes of limited space or supplemented with temporary structures, the peak was early December.

Supplies: As the first surge began to subside, the supply shortages were abated. However, as additional surges occurred; the supply chain had not recovered. Supply shortages were reported in greater numbers than either space or staffing needs through the multiple waves of the pandemic.

Conclusion:

The COVID-19 pandemic directly led to a diminished available capacity for burn care in such a way that it compromised the ability to confront a surge of burn-injured patients. Future BMCI planning efforts must consider this aspect of the process. Crisis Standards of Care may come into play during such an event.
Which Ethical Principles Guided the Ethical Decision During the COVID-19 Pandemic in the UK, Ireland, and the US? Findings from a Qualitative Systematic Reviews
Authors: Hussein Ghaiath , Raajakesary Kesidha , Galvin Lucy , Peters Joseph , Prendiville Kate , Newport Sarah , MacAnulty Calum
Published: June 2023

Introduction:

With the Covid-19 pandemic impacting the world at such a quick rate and with many unknown variables and dangers, there was an immediate need for ethical guidance to ensure those in many different healthcare settings such as researchers and other professionals could perform ethically in this new and complex situation. This study aims to take existing research on those ethical guidance documents in the UK/Ireland and compare them with those from the United States.

Method:

This study used a qualitative systematic review methodology with thematic synthesis to analyze the included ethics-related guidance documents, as defined in this review, published in the UK and Ireland between March 2020 and March 2022. The search included a general search in Google Scholar and a targeted search on the websites of the relevant professional bodies and public health authorities in the three countries. The ethical principles in these documents were analyzed using the constant comparative method (CCM).

Results:

In the UK and ROI review, 44 guidance documents met the inclusion and exclusion criteria, and 11 main ethical principles were identified, which were then categorized under two main themes: respect and duty. The 11 main ethical principles were: fairness, honesty, minimizing harm, proportionality, responsibility, autonomy, respect, informed decision-making, community, the duty of care and reciprocity.

In the US review, 270 documents were found from searching several public health United States government bodies. Of these documents, 50 were deemed to be Covid-19 ethical guidance, each ethical principle was tallied from every document and compared with the results from the UK/Ireland study.

Conclusion:

There were remarkable similarities in some ethical principles prioritized in the Covid-19 pandemic ethical guidelines across the Atlantic Ocean. However, there were differences in the interpretations and frequencies in which these principles were used across different regions.
Resources Used by People with Hearing Disabilities to Cope with Emergency Situations
Authors: Tannenbaum-Baruchi Carolina , Aharonson-Daniel Limor , Feder-Bubis Paula
Published: June 2023

Introduction:

People with hearing disabilities (PwHDs) face many challenges in their everyday lives, as their environments were not designed to accommodate their needs. They may have a communication disability as well as a hearing disability. To cope, PwHDs rely on the assistance of others, their communities, technology, and personal resources. In emergency situations challenges become greater and resources scarcer.

Method:

This study was conducted from November 2018 through July 2020. A mixed-methods approach consisting of in-depth interviews and online quantitative surveys with PwHDs in Israel was used. The qualitative part enquired about the resources they used to cope during emergencies and the obstacles they faced. Grounded theory was used for the analysis of the findings. The quantitative part focused on their perceptions of self-efficacy, methods of communication, and accessibility of services in emergency situations. The participants were deaf or hard of hearing individuals, and those who used hearing aids and/or had a cochlear implant, as well as individuals who chose not to use them. The study excluded people over 60, because we focused on those who didn’t suffer from hearing loss caused by age. The survey was accessible in Israeli sign language using Qualtrics survey platform. The statistical analysis was conducted using SPSS ver.23.

Results:

PwHDs’ resources for coping with emergencies were identified and classified under four categories.

1. Characteristics of the PwHD: type, methods of communication (sign language, read lips, speech) and accessibility of services.

2. Personal resources: Independent communication and self-efficacy.

3. Time of event: Daytime or nighttime.

4. Characteristics of the emergency: Personal vs. collective.

Conclusion:

The study identified the resources PwHDs used to cope with emergencies. Results can help develop standards of accessibility for places providing services during both day and night that will allow PwHDs to communicate independently.
Applying a “Whole-of-Health-System” Approach in Mass Casualty Management
Authors: Alesi Andrea , Bortolin Michelangelo , Ragazzoni Luca , Lamberti-Castronuovo Alessandro
Published: June 2023

Introduction:

In 2019, the World Health Organization published the Health Emergency and Disaster Risk Management (H-EDRM) framework, detailing how all actors in the health system can contribute to reducing negative health outcomes of emergencies and disasters, including mass casualty incidents (MCI). The H-EDRM framework’s whole-of-health-system approach stresses the need for each level of healthcare systems to be involved in all phases of the disaster cycle, particularly preparedness and response. This approach highlights the critical role that lower levels of care, including primary healthcare, can play during MCI, demonstrating the need to integrate these into countries’ disaster plans. Nevertheless, countries’ disaster management plans have historically focused on hospitals and few recommendations exist for how to practically proceed with such an integration. This study explores what has been published on the topic of reverse triage (RT), namely the process used by healthcare workers (HCWs) to determine which patients can safely be discharged to lower levels of care, resulting in increased surge capacity at hospitals. The objective of this work is to collect evidence around existing criteria, tools or referral pathways used by HCWs during MCI, ultimately integrating lower levels of care in MCI management.

Method:

A systematic literature review was performed and a total of 12 studies were analyzed.

Results:

Literature focusing on RT towards lower levels of care during MCI is scant and limited to few case studies. There is no standardized tool or guidelines for how to perform RT and existing referral pathways are described in only isolated case studies.

Conclusion:

Published evidence on RT criteria is limited. The results of the current review can serve as groundwork upon which to design further research studies. It can be used to help devise strategies and policies for the integration of lower levels of care during MCI.
Current Status of the Disaster Health, Medical, and Welfare Coordination in Japan
Authors: Chishima Kayako , Akahoshi Kouki , Toyokuni Yoshiki , Kondo Hisayoshi , Koido Yuichi
Published: June 2023

Introduction:

Non-coordinated support during disasters has negative effects on affected communities and people. From the 2004 Indian Ocean Tsunami, the United Nations introduced a cluster approach to avoid gaps and duplication of aid. Japan's disaster coordination of support for health and medical care was organized after the 2017 Kumamoto earthquake. The Ministry of Health, Labour and Welfare (MHLW) announced and issued the notice that the prefectures need to establish a system related to health and medical activities in the event of a large-scale disaster. In July 2022, welfare content was added. This study investigated the current status of health sector organizational coordination among health, medical, and welfare responders during 2022 the Large-Scale Earthquake National Exercise (LSENE).

Method:

The 2022 LSENE was conducted on October 1, 2022 with participation from the Disaster Medical Assistant Team (DMAT) and responders from each prefecture's health and welfare divisions and organizations. Each responder's exercise log sheet and the exercise controller's evaluation were reviewed.

Results:

Even though there was a notice from the MHLW, organized coordination was conducted only by several medical and health teams. DMAT is the only team with a system to dispatch teams from non-affected prefectures and coordinate well to allocate teams. Some other health and welfare organizations did not have a dispatching system. They had difficulty sending teams to affected areas, especially due to a lack of a systematic response system, training, coordination headquarters, and information sharing. It was suggested that information sharing and coordination among responders is necessary, although information gathering and request judgments related to dispatch coordination are different for each organization.

Conclusion:

In order to smoothly coordinate support teams for health, medical, and welfare in the event of a disaster, it is necessary not only to improve the coordination headquarters for health, medical, and welfare but also to verify its operation through training.
Developing Contents of Practical Training for Decontamination of Radiation-contaminated Patients Using VR Training Simulator
Authors: Nam HyungWoo , Kim JungJin , Cho MinSu
Published: June 2023

Introduction:

The KIRAMS establishes radiological emergency institutions and provides training for emergency medical agents. However, because of the uniqueness of radioactive accidents, the current training program has a limitation in the realistic description. Therefore, training programs based on virtual augmented reality technology that can describe radiological emergencies are required. In this study, the contents of practical training for decontamination of radiation-contaminated patients as a part of radiation disaster prevention personnel training using VR simulator are developed.

Method:

Environments and devices required for treating patients with complex radiation damage are made visible using VR simulator to enable practical training of techniques and practices that will be required in actual radiation emergencies or training. The VR decontamination training content uses three Point tracking techniques to calculate the location of the head-mounted display device and the hand to visualize the movements. Additionally, Universal Render Pipeline technology was used to develop realistic visualizations of situations.

Results:

In this study, VR decontamination treatment practice content was developed, which allows a single trainee to go through the entire treatment process of treating radiation-contaminated patients. The radiation-exposed patient’s treatment process is composed of nine subprocesses, including wearing personal protective equipment, obtaining samples from openings, taking measurements, cleaning contaminated injuries, and so on. A checklist user interface was used to enable trainees to check their progress. The trainee can practice patient treatment with a controller while using VR decontamination treatment content. Additional functions such as narration, sound effects, animation, and so on were added to high educational effects.

Conclusion:

In this study, VR decontamination treatment content was developed using VR training simulator to practice the treatment of radiation-contaminated patients. The results of this study will contribute to fostering the workforce response to radiation through efficient education using a VR training simulator, as well as promoting the use of radiation safety regulations.
The Training Effects of Mass Casualty Triage in Radiological Events for 119 Emergency Medical Team
Authors: Hwang Kyung il , Kim Jungjin
Published: June 2023

Introduction:

Korea Institute Radiological Medical Sciences operates an emergency medical response system in case of a radiological accident or disaster. A radiation accident or disaster can affect large-scale patients and destroy medical infrastructure. However, there is currently a lack of specialized education for treating large-scale patients or high-dose exposure patients. This study aimed to evaluate the efficiency of radiological mass casualty triage education programs and present a new training method to improve the ability of 119 emergency medical teams in the event of a radiological accident or disaster.

Method:

The results of mass casualty triage for radiological events were analyzed using the audience response system and questionnaire for paramedics who participated in the radiation accident response training program. For 25 paramedics, a pre-post evaluation was conducted on two items: understanding the mass triage and understanding the radiological mass triage. The data were analyzed using the SPSS WIN 23.0 program.

Results:

Thirty simulated patient scenarios were developed with the addition of clinical symptoms of radiation exposure based on the four trauma classifications: immediate, urgent, delayed, and death. The triage results of 30 cases conducted by 119 emergency medical teams were evaluated, and the trainees were asked to respond to the level of improvement in their knowledge of triage through pre- and post-training questionnaires. As a result of the pre- and post-education questionnaire, the degree of understanding of the mass triage was 3.8 before education and 4.4 after education, showing a significant difference (p=.003/MAX=5). The pre- and post-education questionnaire results of radiological mass triage showed a difference between 2.3 before education and 4.1 after education (p=.000/MAX=5).

Conclusion:

For effective radiation medical response, 119 emergency medical teams are required to have a repetitive mass triage education program for radiological events. It is especially important to provide a radiological triage system for field application.