bluuebunny/crossref_metadata_2025 huggingface dataset:
Children's Welfare Concern in a Full-scale Disaster Pediatric Drill
Authors: Ribera-Cano Anna , Houze-Cerfon Vanessa , Sangay Virginie , Viault Benoit , Bounes Vincent
Published: June 2023

Introduction:

Children are almost systematically involved in mass casualty events, especially in the context of terrorist attacks. Unfortunately, the emergency medical responder preparedness is quite often low when it comes to pediatrics, on both technical and emotional sides. Preliminary training is indispensable, and full-scale simulations are arguably the best solution to tackle the needs of the first responders. The purpose of the study was to describe a simulation-based pediatric training with pediatric psychological support set up for the drill.

Method:

A full-scale exercise involving children between five and fifteen years old was conducted in the Toulouse municipal stadium during the preparation of the 2016 UEFA (European Football Championship) in France. As children welfare was the primary concern, a psychological support team was present at each stage of the drill and assessed any mental harm that could have happened. Children were asked about their feelings at the end of the exercise with a 5-point Likert rating scale and their parents had to report any perceived changes in the following week.

Results:

Out of 16 children participating in the drill, four were in an immediate situation (P1), four were in an emergent situation (P2), and eight were in an urgent situation (P3). One hundred percent of them rated their experience as very good and expressed no stress to their parents in the week that followed, and no harm was detected by the psychological support team during the exercise.

Conclusion:

The results of the study show that involving children as victims in pediatric disaster drills is possible in these conditions without impacting the mental welfare of children.
Preparedness of Afghan Refugees for Disasters
Authors: Rizek Jamla
Published: June 2023

Introduction:

Refugees encounter many obstacles en route to the United States. Refugees face very different disasters and response resources in the US than in their home countries. On arrival to the US, refugees receive a brief introduction to disaster preparedness, but do not receive specific education based on their home country or final location of residence. This study aims to determine the preparedness levels of Afghan refugees in the United States.

Method:

This study used a modified General Disaster Preparedness Belief Scale (mGDPBS). The mGDPBS consists of 20 of the 45 questions from the GDPBS, selected from each of the six subscales most applicable to the refugee population. Ten Afghan refugee families were selected from the Afghan community in Virginia.Refugees were interviewed by a recorded one hour interview via Zoom. A list of the questions were provided, and a translator was available to ask the questions in the respective language of the refugee: Dari or Pashtu.

Results:

Data collection and analysis to be completed by January 30, 2023.

Conclusion:

Data collection and analysis to be completed by January 30, 2023.
Self-Injurious Thoughts & Behaviors of Firefighters: A Quantitative Descriptive Study
Authors: Weiss Mark
Published: June 2023

Introduction:

Little is known about Self-Injurious Thoughts & Behaviors and Non-Suicidal Self-Injury in firefighters in two East Coast United States metropolitan fire departments based on fire service tenure.

Method:

• Study comprised of two parts, a survey and a questionnaire, both conducted online. Using the Computer Adaptive Test–Suicide Scale

The only computer-based adaptive mental and behavioral health assessment clinically validated worldwide.

Validated against face-to-face structured clinician-led assessment.

Participants received a unique identifier and hyperlink allowing them access and confidentiality.

Study was completed on participants' personal electronic devices, on their own time, at their own pace.

A single-factor or One-Way ANOVA tested for a significant relationship between the variables and the four tenure groups simultaneously. Time of administration averaged 86 seconds, with a median of eleven questions.

Results:

The C-SSRS identified six participants triggering suicide alerts. One in the early-career category and five in the late-career category. The CAT-SS identified one participant as high-risk and 33 participants for suicidality. One participant in the early-career category.

Conclusion:

Early-career and late-career firefighters have more self-injurious thoughts and behaviors and mid-career firefighters have the least.
Mass Casualty Triage: What Works and Who Does it Best?
Authors: O'Sullivan Jessica Walsh , Hwang Esther , Mize Benjamin , Glassman Erik
Published: June 2023

Introduction:

There is a consensus that there lacks a standard for primary triage during mass casualty incidents. This is further compounded by a dearth of high quality research on the topic. Some studies suggest the superiority of SALT triage versus other triage systems, however, findings have not widely transitioned to clinical practice. We believe that despite specialized training including that in emergency medicine or emergency medical services (EMS), there will be significant variability amongst triage determination and use of triage methods. This study intends to analyze various provider skill levels and their accuracy of triage determination.

Method:

In a disaster exercise, a group of providers trained to use START triage were expected to triage, treat and determine transport order of the patients from a scenario of a simulated intentional radiological dispersal device (RDD) detonation with multiple casualties. Another group of providers trained to use SALT triage were expected to triage, treat, and determine transport order of patients from a scenario of a building collapse after a hurricane to assess SALT triage with the participating officers. Additional cohorts of EMS clinicians will be given the same case scenarios and asked to triage, treat when necessary, and determine transport order of the patients.

Results:

The initial data from the RDD exercise includes 102 patient case scenarios with 27 minimal (green), 40 delayed (yellow), and 35 immediate (red) patients. The providers involved in the exercise are trained at minimum to NREMT EMT level. Results showed an under-triage rate of 7.8%, an over-triage rate of 20.6% and overall accuracy of 71.6% when using START triage.

Conclusion:

The undertriage rate with START is 7.8% is higher than the generally acceptable rate of less than 5%. Our research is ongoing and we anticipate completion in 2023. We hope that our research provides future direction to improve triage in disaster scenarios.
A Qualitative Study on the Use of the Hospital Safety Index and the Formulation of Recommendations for Future Adaptations.
Authors: Lamine Hamdi , Lamberti-Castronuovo Alessandro , Singh Prinka , Chebili Naoufel , Zedini Chekib , Achour Nebil , Ragazzoni Luca , Valente Martina
Published: June 2023

Introduction:

Hospitals around the world need to be safe and prepared to face disasters, being these man-made or caused by natural hazards. The Hospital Safety Index (HSI) is a tool developed by the World Health Organization (WHO) that allows access to the level of preparedness of hospitals; it is the most widely used instrument of its kind. Although the HSI is frequently used by hospitals and healthcare facilities around the world, scientific literature on its application in real life is scarce and qualitative studies are absent. By adopting a qualitative methodology, this study aims to investigate the use of the HSI to assess disaster preparedness in hospitals and healthcare facilities, identify challenges and facilitators of the HSI use, and devise recommendations for future adaptations of the tool.

Method:

A retrospective qualitative study employing semi-structured online interviews was conducted to gather opinions and perspectives of professionals using the HSI to assess disaster preparedness. Participants were recruited by contacting via email the authors of scientific publications on the use of the HSI.

Results:

In total, nine people from three different countries (Serbia, Sri Lanka, and Indonesia) and having different professional backgrounds agreed to participate in this study. They shared the reasons for their choice of using the HSI, against other tools, as well as the steps taken before and during data collection. Strengths and weaknesses of the HSI were identified and authors reported the challenges they encountered in the preparatory phase and during data collection. Modifications of the tool and recommendations for the future were proposed targeting both researchers and hospital managers.

Conclusion:

As far as the authors know, this is the first qualitative study examining the methodological implications of using the HSI and providing practical recommendations that can advance the HSI tool and foster its use for disaster preparedness assessments worldwide.
Gallstone Ileus, A Rare Yet Deadly Cause of Small Bowel Obstruction
Authors: Yugendra Paul , Joshi Chinmaya
Published: June 2023

Introduction:

Gallstone ileus is a rare cause of intestinal obstruction. It commonly affects older patients with significant medical conditions. This disease has a high mortality rate (12-17%), hence should be an important diagnosis to consider, especially as the geriatric population grows worldwide.

Method: Case Report:

84-year old gentleman, with diabetes and ischemic heart disease, presented with diarrhea, vomiting and fever for one day. He was febrile, tachycardic and hypotensive. There was lower abdominal tenderness with guarding. Labs done revealed metabolic acidosis with a raised lactate along with raised inflammatory markers. Impression was intra-abdominal sepsis, with a need to rule out mesenteric ischemia. He underwent CTAP which revealed gallstone ileus. The gallbladder was collapsed and pneumobilia was present in keeping with fistulation. Dilated small bowel loops were present with a transition point at the distal jejunum or proximal ileum, where there are two gallstones. Patient underwent exploratory laparotomy. There was an obstructing large gallstone 100cm from the DJ flexure. After removal of gallstone and decompression, the bowel was pink with areas of bruising. Patient was hypotensive intra-operatively likely contributed by septic shower, requiring dual vasopressors. He was transferred to the ICU post-operatively and developed cardiogenic shock with type 2 respiratory failure precipitated by sepsis. He demised on Day 2 post-operatively.

Results:

Gallstone ileus is caused by intestinal impaction of a gallstone that has migrated through a cholecystoenteric fistula. The classic radiologic sign of gallstone ileus is Rigler's triad. This is only picked up 15% of the time on plain abdominal x-rays. Early CT scans can reveal Rigler triad up to 80% of the time. Surgical management remains the cornerstone of treatment.

Conclusion:

Gallstone ileus remains a diagnostic challenge as patients present with non-specific signs and symptoms. It is prudent for emergency physicians to consider this disease in elderly patients who present with small bowel obstruction.
Mixed Reality–To Better Prepare Medical First Responders for Mass-Casualty Incident Response
Authors: Gyllencreutz Lina , Schulz Fredrik , Schrom-Feiertag Helmut
Published: June 2023

Introduction:

Mass-casualty incidents (MCI) featuring a large number of injured persons caused by human-made or by natural disasters are increasing globally. During these incidents, medical first responders (MFR) need to take appropriate action that saves lives. In this context, the adage “practice makes perfect” is befitting to MCI training. However, providing large-scale MCI training is often difficult due to the significant effort required to create these types of exercises. Drawbacks include a large number of actors needed to portray victims, availability of infrastructure, and realistic treatments. Virtual Reality (VR) has been demonstrated in several domains to be a serious alternative, and in some areas also a significant improvement to conventional training. As an advanced alternative to VR, Mixed Reality (MR) have the potential to provide a dynamic simulation of an VR environment and hands-on practice on injured victims.

The aim is: 1) to present insights of a newly developed MR training system for increasing MCI preparedness and 2) discuss pedagogical aspects e.g. how the intended learning outcomes are perceived in MR training, how the participants experience the learning in MR training, and what impact MR training will have in their future work practice.

Method:

An MR training system, designed for teams of up to four MFRs to perform training in real-time, will be pilot-tested at the beginning of 2023. The system features a fully functional touch-enabled human manikin design for practicing skills in emergency situations. The pilot tests will be carried out within the Med1stMR project (https://www.med1stmr.eu/) where approximately four teams of MFR will be evaluated based on the intended learning outcome.

Results:

Preliminary results from the pilot tests will be available at the conference.

Conclusion:

Research is needed to strengthen the knowledge and impact of MR training as a pedagogical method to better support MCI training and preparedness.
Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya
Authors: Aluisio Adam , Bergam Scarlett , Sugut Janet , Guthrie Kate , Kinuthia John , Mello Michael
Published: June 2023

Introduction:

Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged in HIV Testing Services (HTS). In Kenya, these persons are often treated in emergency departments (EDs) for injuries, a healthcare interaction where HTS including HIV self-testing (HIVST) could be leveraged. There is, however, limited data from stakeholders on ED-HTS which impedes programmatic advancement.

Method:

A qualitative study was completed to understand facilitators and challenges for ED-HTS and HIVST delivery in Kenya (12/2021-03/2022). Data were collected via 28 in-depth patient interviews (14 males and 14 females) who had been treated in the Kenyatta National Hospital (KNH) ED and through seven focus-group discussions conducted with 49 ED healthcare personnel (nurses, doctors, HIV testing counselors, and administrators). Transcripts were double-coded and thematically analyzed with Dedoose™ software using a parallel inductive and deductive approach to capture both a priori and emergent themes.

Results:

Patients and providers viewed ED-HTS as a beneficial provision that was facilitated by engaged staff, education, perceived high HIV risk, and confidentiality. However, ED-HTS was limited by burdens on staff time and material resources, lacking systems integration, and patient illness severity. Facilitators of ED-HIVST delivery were perceived to have greater autonomy and confidentiality as well as lower health resource utilization. Challenges for ED-HIVST identified included patients’ concerns about HIVST accuracy and psychological stress, as well as providers’ concerns for loss to follow up and inability to complete confirmatory testing.

Conclusion:

ED stakeholders are receptive to HTS and HIVST provisions. This data provides insight into the patient, provider, and systems aspects that can be leveraged in ED-based HTS to enhance program impacts via intervention functions in the forms of education, care integration, resource scaling, and solidified post-self-testing follow-up mechanisms.
Response to Mass-Casualty Incidents and Outbreaks: A Prehospital Disaster Training Package Developed for the National Emergency Medical Service in Sierra Leone
Authors: Caviglia Marta , Silva-Moniz Josè Da , Venturini Francesco , Jambai Amara , Vandi Matthew , Wurie Abdul , Sartie Moi , Putoto Giovanni , Ragazzoni Luca
Published: June 2023

Introduction:

In 2018 Sierra Leone, a country highly prone to disasters, launched its first National Emergency Medical Service (NEMS) aiming to strengthen the provision of essential health services to the population with the long-term goal of creating a resilient health system able to effectively respond to and recover from emergencies. The Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), together with the Italian NGO Doctors with Africa (CUAMM), under the supervision of the Ministry of Health and Sanitation (MoHS), developed a prehospital Disaster Training Package (DTP) delivered to all NEMS personnel to boost the prehospital management of mass-casualty incidents (MCIs) and outbreaks.

Method:

The DTP was designed following the six-step approach to curriculum and training development with the ultimate goal of creating a workforce comprising qualified emergency responders with specific professional competencies to respond to outbreaks and MCIs. The DTP included a first phase in which NEMS local trainers underwent a training-of-trainers (ToT) course, enabling them to deliver cascade trainings to 16 district ambulance supervisors, 441 paramedics, 441 ambulance drivers, and 36 operators working in the NEMS operation center.

Results:

Starting on July 19, 2021, the ToT course was delivered to the seven national trainers. All trainers successfully passed the final examination and achieved high scores in the practical sessions, demonstrating active participation, commitment to the project, and good awareness. Following the ToT course, the series of cascade trainings started on August 2, 2021, delivered by the just-trained national trainers under the direct supervision of the two training managers.

Conclusion:

The NEMS’ DTP is the very first Disaster Medicine training course delivered to prehospital healthcare providers in Sierra Leone. The authors believe that the provision of the DTP to all NEMS personnel has the potential to improve Disaster Medicine culture among health professionals in the Country.
Creating an International Resource Center for Pandemic and Disaster Nursing Education and Training
Authors: Meyer Diane , Veenema Tener
Published: June 2023

Introduction:

Globally, nurses play pivotal roles in epidemic and emergency response. Nurses’ actions include supporting and informing surveillance and detection, dispensing live-saving medical countermeasures, implementing prevention and response interventions, providing direct care for patients, educating patients and the public, providing health systems leadership, and counseling community members. Despite these roles, there exist gaps in how countries train and prepare their nursing workforce for these health threats.

Method:

To help address this gap, the Johns Hopkins Center for Health Security has developed an International Resource Center for Pandemic and Disaster Nursing. We have established an international working group to provide input on the goals and mission of the center, website development and functionality, and advocacy efforts. This working group has met four times over the course of the last year. We have also met with several organizations involved in nursing and epidemic and disaster preparedness and response, including the World Health Organization and the International Council of Nurses (ICN), to identify ways to align our work with other ongoing efforts.

Results:

Presently, we have developed a static website that provides access to evidence-based, open-source trainings and educational resources applicable to pandemic and disaster nursing. The website also provides listings of upcoming webinars, guest blog posts, trainings, and conferences relevant to disaster and pandemic nursing. The website will be launched in early 2023.

Conclusion:

The long-term vision for this center is to expand beyond a static website and create a vibrant and fully staffed virtual center. This center would be the first of its kind dedicated to developing the resources, technical assistance, partnerships, and advocacy efforts needed to build and support a global nursing workforce that is prepared for outbreaks and disasters. It would build on the existing wealth of expertise within the working group and forge lasting connections between disaster nurse experts across the globe.
Remote Teaching in a Rwandan Emergency Medicine Residency: A Viable Option with Limited In-person Staff During a Pandemic
Authors: Beck Andrew , Diaz Maria Isabel , Odoom Enyonam , Niyigirimbabazi Claudien , Longerstaey Oriane , Ndebwanimana Vincent , Uwamahoro Doris , Karim Naz
Published: June 2023

Introduction:

Low/middle-income countries (LMIC) in Africa face unique, systemic challenges in medical education. Africa faces a shortage of medical schools; only one school serves 24 countries. 11 countries have no medical school. Residency programs are few. The effect of this shortage is far-reaching. Africa has 3.5% of the world’s health workforce and 1.7% of the world’s physicians, yet 27% of the global disease burden. COVID-19 created further resource constraints, especially in emergency medicine (EM). Non-clinical physician functions such as student and resident education suffered. In Rwanda, we implemented a pre-recorded, remote teaching model to substitute in-person instruction. This study evaluates whether remote teaching is received positively by EM learners and whether it is a viable alternative during times of limited in-person availability.

Method:

28 lectures were recorded by American EM faculty. The recordings were presented to Rwandan EM residents within their standard didactic curriculum. Lecturers were available in real time via Zoom. Topics were chosen by Rwandan faculty based on curricular needs. Program evaluation followed the Kirkpatrick framework. Attendees completed a post-lecture Likert-scale survey assessing the first Kirkpatrick level related to satisfaction, lecture and learning method quality, and suitability. Qualitative and free-response data was also collected.

Results:

Responses were analyzed with descriptive statistics using means and standard deviations. The mean response range across questions was 3.6-4.3 (1 = worst, 5 = best); the standard deviation range was 0.4-1.6, indicating an overall positive result. Qualitative feedback, which reached saturation, did not indicate significant dissatisfaction with the quality or suitability. Points for improvement included lecturer accents and rate of speech.

Conclusion:

When in-person lecturers are unavailable, pre-recorded and remote instructional methods may be a suitable substitute. Future directions may include piloting the project with a multinational cohort or in LMICs with greater technological or resource limitations, and assessing higher Kirkpatrick framework objectives.
Using Personal Learning Goals for Participants in Collaborative an International Health Partnership Project: Experiences from the Region Östergötland Model
Authors: Carlsson Henrik , Ljungwald Sara , Lidberg Henrik , Hodza-Beganovic Ruhija , Berggren Peter
Published: June 2023

Introduction:

International health partnerships have often been characterized by wealthier countries or organizations pushing resources and money into projects in countries with different needs. This can be new technologies, building facilities, and/or training personnel. Often this has been assessed in the amount of money spent. In recent years more focus has been put on synergy effects in involved organizations. Hence the change from aid to partnerships. A previous study focused on the subjective perception of the workforce regarding clinical skills, management skills, communication & teamwork, etc. (Jones et al., 2013). This paper focuses on defining learning goals and using a model by Patzauer (2022) as a complement to traditional partnership evaluation measures.

Method:

Seven team members from a health partnership participated in a project for implementing ambulance service treatment guidelines through training of the partner's ambulance personnel and instructors. The training took place during one week in the partnership country. All Swedish participants were nurses actively working as ambulance personnel or had previously worked in ambulances. Before the training week the participants answered a questionnaire with open questions about their personal learning goals and expectations for the training week. At the end of the week, after having trained ambulance personnel, they answered another questionnaire with open questions addressing what they had learned.

Results:

Analysis of the responses showed that the participants expected to acquire both personal and clinical skills. Afterwards, they had improved language skills, self-efficacy, and becoming better instructors.

Conclusion:

The model of using learning goals as an integral part of evaluating health care partnerships provides knowledge that is useful both in terms of assessing the project, and also as input to participants' managers showing clinical and organizational benefits. Including personal learning goals as a part of partnership projects' evaluation, provide useful knowledge about benefits and experiences that improves the organizations.
If We Open the Door–An Analysis of Prehospital Emergency Cases with the Need to Force the Door Open from Dresden, Germany
Authors: Frank Mark , Petrowski Katja , Haacke Wladimir , Keller Yacin
Published: June 2023

Introduction:

Germany is a highly developed country. Nevertheless, there are reports that people have supply problems or die lonely and alone in their homes. Despite a differentiated social system, there seem to be significant gaps for individuals or old people. The rescue service is often involved in situations with unclear emergency calls or calls from third parties regarding social and supply problems. In some emergency cases the rescue service is alerted to someone's home but there is no response. Depending on the available information, a timely decision must be made to have the opportunity for life-saving. The door opening procedure is executed by the fire department. Afterward, the medical emergency teams take over. The goal of the study is to analyze findings discovered after opening the door.

Method:

Data of all emergencies from the dispatch center of Dresden operated by the fire and rescue department between January 2021 and December 2021 were recorded and transferred to a central database. All cases with the need to force the door open were extracted and analyzed.

Results:

There was a total number of 157.522 cases of emergency. In 847 cases the door was opened by the fire department. After door opening there was no emergency reported in 265 cases. 100 patients were found dead, six patients had cardiac arrest and received cardiopulmonary resuscitation, and 310 patients were transported to a hospital. The causes for emergencies were social problems, downfall and injuries, hypoglycemia, convulsion, stroke, psychiatric emergencies, dementia and suicide attempt. The mean age was 71 [18-103], 54,15% of patients were female.

Conclusion:

There is a high number of emergencies with the need to open the door. The number of patients transported to a hospital is also high and justified the procedure. Since numerous patients were found dead, this underlines a gap in the German social system.
Disaster Knowledge, Skills, and Preparedness among Emergency Medical Services in Saudi Arabia.
Authors: Almukhlifi Yasir , Crowfoot Gary , Hutton Alison
Published: June 2023

Introduction:

Emergency Medical Service (EMS) workers are critical to effective disaster response in Saudi Arabia. The World Health Organization requires countries and governments to have prepared emergency health workers and disaster action plans. Therefore, it is important to understand the disaster knowledge, skills, and preparedness of Saudi Arabian EMS workers. This study investigated factors influencing EMS workers’ disaster knowledge, skills, and preparedness in the Saudi Arabian context.

Method:

A descriptive cross-sectional survey using The Disaster Preparedness Evaluation Tool was distributed to EMS workers in military and government hospitals across three Saudi Arabian cities. Responses were recorded on a 6-point Likert scale where higher scores indicated higher knowledge, skills, or preparedness. The results were analyzed using descriptive and inferential statistical analysis.

Results:

272 EMS workers participated in this study. EMS workers reported a moderate level of knowledge (3.56), skills (3.44), and preparedness (3.73) for disasters. Despite the moderate level, EMS workers reported a high level of involvement in regular disaster drills (M=4.24, SD=1.274) and a strong interest in further disaster education opportunities (M=5.43, SD=1.121). Participants also reported a high skill level with the triage principles used in their workplace during a disaster (M=4.06, SD=1.218). The study findings revealed a significant positive correlation between disaster preparedness levels and age, years of experience, education level, and the facility worked in.

Conclusion:

EMS workers have moderate disaster knowledge, skills, and preparedness levels. Knowledge, skill, and preparedness have a significant relationship with the EMS workers’ demographics. These findings demonstrate the need to invest in preparing Saudi Arabian EMS workers to effectively respond to bioterrorism disasters.
Lessons Learned from an OB / Newborn / Neonatal Intensive Care Full-Scale Exercise
Authors: Frogel Michael , Jermyn John , Foltin George , Cooper Arthur
Published: June 2023

Introduction:

Children are frequently victims of disasters. However, gaps remain in disaster planning for pediatric patients. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty incidents that involve large numbers of children.

On April 26, 2018, the NYC PDC conducted a first in NY, full-scale exercise with the NYC Fire Department (FDNY) testing evacuation, patient tracking, communications, and emergency response of the Obstetrics, Newborn and Neonatal units at a NYC based hospital. The goal of the exercise was to evaluate current Ob/Newborn/Neonatal plans and assess the hospital’s ability to evacuate patients.

Method:

The exercise planning process included a review of existing OB / Newborn / Neonatal plans, four group planning meetings, as well as, targeted specific area meetings and plan revisions. The exercise incorporated scenario-driven, operations-based activities, which challenged participants to employ the facility's existing evacuation plans during an emergency.

Results:

The Exercise assessed the following: Communication, Emergency Operation Plans, Evacuation, Patient Tracking, Supplies and Staffing. Internal and external evaluators rated exercise performance on a scale from 1-4. Evaluators completed an exercise evaluation guide based on the Master Scenario Event List.

An After Action Report was written based on the information from the exercise evaluation guides, participant feedback forms, hot-wash session, and after action review meeting. Strengths included the meaningful improvement of plans before the exercise (including the fire department) and the overall meeting of exercise objectives.

Conclusion:

Lessons learned included: addressing gaps in effective internal and external communications, adequate supplies of space, staff, equipment needed for vertical evacuations; providing staging and alternate care sites with sufficient patient care and electrical-power resources. The lessons learned are being utilized to improve existing hospital plans to prepare for future full-scale exercise and or real-time events.
Comparison of Public Health IT Reporting Capabilities Between a Large Network Hospital and Small Independent Hospital During Disaster Response
Authors: Daniel Pia , Arquilla Bonnie , Roblin Patricia , Senathirajah Yalini , Cato Kenrick , Kaufman David
Published: June 2023

Introduction:

Management of outbreaks rely on hospitals’ health information technology (IT) to electronically share data to public health systems. Studies show that half of non-federal hospitals reported a lack of capacity to exchange information with public health agencies, placing a variable burden on institutions to meet the government mandated reporting requirements. This study aims to contrast the impact of COVID-19 reporting requirements across two New York City institutions with disparate health IT capabilities.

Method:

A retrospective, qualitative study contrasting the impact of reporting requirements on a small independent hospital (SIH) with 198 staffed beds and a large, networked hospital (LNH) with eleven campuses during the COVID-19 pandemic. Researchers conducted 51 interviews with hospital leadership, clinical directors, and infection control personnel. Interviews were transcribed and coded using qualitative analysis software.

Results:

The LNH had a 50-person analytic team that handled reporting tasks, a centralized data warehouse that was automatically updated, electronically generated reports with universal access, and limited burden of clinical staff. The SIH had no dedicated analytic team. Seventeen departments were utilized to handle reporting tasks with no centralized place to share electronic data, limited capacity to create automatically updated reports, a daily manual information gathering processes, and significant need of clinical staff to collect data. Both SIH and LNH faced challenges associated with the distribution of responsibilities and resources with pressure to report in a timely fashion. However, the burden on the SIH was so onerous that it significantly impeded routine hospital work and patient care.

Conclusion:

The disparity in health IT capabilities highlights significant institutional inequities and variability in response during a pandemic. The findings have implications for how government and other regulatory bodies may adjust policies to equitably meet public health needs and not unfairly burden small hospitals.
Improving Hazardous Material Incident Preparedness for Emergency Medicine Physician Trainees: A Quality Improvement Project
Authors: Maksimenko Yevgeniy , Ryan Kevin , Dugas Julianne , Hahn Laura
Published: June 2023

Introduction:

Hazardous materials (HazMat) training is not a requirement for accreditation of US Emergency Medicine (EM) residencies, nor for EM board certification by the American Board of Emergency Medicine (ABEM). However, the US Occupational Safety and Health Administration (OSHA) requires hospitals train all personnel expected to deal with contaminated patients. This QI project aimed to develop an EM physician-specific HazMat course and evaluate the physician comfort level with HazMat personal protective equipment (PPE) donning and doffing, triage, procedural skills, and decontamination.

Method:

A four-hour “HazMat for Docs” course was designed at a large urban academic trauma center and offered to second-year EM residents. Additionally, we performed a quantitative survey of a cohort of 72 current and recently graduated EM residents (classes 2019-2024), some of whom had taken the course in person. Our primary outcome was to measure improvement in comfort level with essential HazMat tasks after completing the course. Our secondary outcome was to evaluate the current or recently graduated EM physician's overall comfort levels with managing a HazMat incident, as well as HazMat skills and knowledge retention.

Results:

A total of 53 responses (73.6%) were obtained. 45.3% of the respondents were male and 54.7% female. 37.8% of the respondents were recent EM graduates, with 20.8% PGY-4, 13.2% PGY-3, 15.1% PGY-2, 13.2% PGY-1. 16/53 (30.2%) had prior EMS experience. EM Physicians were most comfortable with donning and doffing PPE (4.92 on a 7-point scale) and least comfortable with decontamination procedures (2.98/7). After completing the HazMat course, EM physicians increased their comfort level with HazMat decontamination procedures by 8.6% and with organizing a multi-disciplinary ED HazMat response by 10.5%.

Conclusion:

EM Physician comfort levels with HazMat procedures are low. Increased training aimed at improving physician knowledge, preparedness, and comfort level for such events is necessary and can be accomplished through a short course.
“Is Resilience Useful, Usable, and Used? Outlining the Social Characteristics of a Resilient System”
Authors: Bell Olivia , Pickering Christina , Denton Neil , O'Connor Eve , Ahmed Kanza , Archer Frank , Spencer Caroline , Bracken Louise , Murray Virginia
Published: June 2023

Introduction:

The COVID-19 pandemic has underlined the international priority to systemically operationalise resilience in the face of increasing prevalence of complex and cascading hazards. This concept paper identifies the components of a resilient society, establishing the usefulness and usability of the application of ‘resilience’, and proposes the characteristics used by a resilient system.

Method:

Through the review of case-based examples and previously published concept papers, this paper underwent a concept analysis to understand and qualify the characteristics of a resilient community. Through extensive research and critical analysis of disaster risk responses both effective and not, the authors condensed the literature to identify the key components of a resilient society.

Results:

To respond to this evolving landscape of disaster risk, community and governmental responses should be collaborative in order to be successful and sustainable to increase resilience across communities, societies and networks. To unpick the complexity of how communities and governments might promote resilience effectively, we explore whether community and social capital are useful resources to create and sustain resilient approaches to disaster risk reduction and management. We consider that by exploring how social capital links, bridges and bonds actors within a system are qualitative key facets of a resilient community. A resilient system is the product of trust and collaboration between asset-based networks of bonded and bridged communities and risk and support-based networks of bonded and bridged organizations.

Conclusion:

By evaluating the usefulness and usability of the concept, we consider that a resilient system is an iterative learning process, asset based, trusting across power and resource gradients and is best built before or even if essential during a crisis. Noting that resilience is a dynamic process which requires integrated collaboration and continual adjustment to develop a sustainable framework, we consider that social characteristics of a resilient system are useful, useable and should be used.
Thai Hospitals’ Evacuation Preparedness: A Survey Among 42 Hospitals According to the Flexible Surge Capacity Concept.
Authors: Phattharapornjaroen Phatthranit , Carlström Eric , Holmqvist Lina , Sittichanbuncha Yuwares , Khorram-Manesh Amir
Published: June 2023

Introduction:

Hospitals are subject to internal and external threats which could necessitate an evacuation. Such evacuation needs deliberate surge and collaboration, particularly collaborative use of community capacities to handle affected patients, personnel, devices, and hospital structures using consensus systems. Therefore, it is crucial to identify hospital evacuation procedures’ flaws and assess the possibility of implementing measures using community resources. This study aimed to explore Thai hospitals’ current evacuation readiness and preparation regarding surge capacity and collaboration according to the Flexible Surge Capacity concept.

Method:

The previously used hospital evacuation questionnaire was adopted. It contained relevant questions about hospital evacuations’ responses and preparedness encompassing surge capacity and collaborative elements and an open-ended question to collect possible perspectives/comments.

Results:

The findings indicate glitches in evacuation protocols and triage systems and inadequacies in surge planning and multi-agency collaboration. Additionally, it was evident that hospitals had limited information about communities' capabilities and limited collaboration with other public and private organizations.

Conclusion:

Although implementing the measures for concept integration to hospital evacuation is challenging, pragmatic research exploring planning for community engagement according to the flexible surge capacity to build a concrete hospital evacuation plan would enhance hospital readiness and its generalizations. The latter needs to be tested in simulation exercises.
Use of Bedside Ultrasound at Wexford General Hospital Emergency Department: Compliance to NICE Guidelines [NG158] for Venous Thromboembolic Disease
Authors: Dowle Ashleigh , Orsmond Brendan , Vythilingam Darshini , Abraham Ria , Andrews Robin , Rensburg Rochelle Janse Van , Smit Marco , Vegte Andrea Van der , Jordaan Philip , Conradie Maria , Kennedy Keith , Wickham Bryce , Kelly Thomas , Molloy Michael
Published: June 2023

Introduction:

Ultrasound is the standard imaging technique for diagnosing lower limb deep venous thrombosis (DVT). The National Institute for Health and Care Excellence (NICE) guidance 158 recommendation 1.1.3 states that all patients with sufficient pretest probability for DVT should be offered a proximal leg vein ultrasound within four hours. However, due to high patient volumes, formal radiology department ultrasound wait times often exceed one week. Point-of-care ultrasound (POCUS) is used to bridge diagnostic delay in our emergency department (ED) .

This study aimed to quantify numbers offered POCUS for suspected proximal lower DVT in our ED and accuracy of such studies.

Method:

A retrospective review of electronic records was conducted for patients who underwent formal lower-limb ultrasound for suspected DVT at our hospital over a three-month period (August 1, 2022-October 12, 2022). Patient charts for all ED presentations were assessed to determine whether POCUS was offered and whether DVT was diagnosed.

Statistical analysis was conducted using PRISM v9.

Results:

80 formal ultrasound scans were performed at our hospital for lower limb DVT. 58 were requested for patients presenting to ED, of which 42 had complete records available meeting selection criteria.

POCUS was offered to 24 patients in ED (57.1%). Sensitivity was 66% (95% CI 12%- 98%), and specificity was 94.1% (95% CI 75%-99%). Overall accuracy was 90%, with only one false negative study identified at formal follow-up ultrasound.

Conclusion:

Although sample size was small, our results suggest that POCUS is an accurate but underused tool to diagnose lower limb DVT. Developing a standardized protocol for performing and reporting POCUS DVT scans in ED should allow for earlier diagnosis and initiation of appropriate treatment where necessary.
Enhancing Severe Weather Planning and Preparedness Across the Health Service Executive South Cork & Kerry Region
Authors: O'Brien Cian , O'Sullivan David , Fitzgerald Mary Rose , Neville Karen , Pope Andrew
Published: June 2023

Introduction:

According to the Climate Change Advisory Council, Ireland is woefully unprepared for future extreme weather events such as heatwaves, flooding, and coastal surges, which are going to be more extreme and frequent in the future. Met Éireann issued numerous red weather warnings since the inception of the severe weather forecasting system. Storms Ophelia (Ex. Hurricane) and Emma (Snow Storm) proved to be extremely challenging weather events for the Health Service across Ireland.

Method:

A comprehensive review of debriefs and lessons identified processes completed across the health system was conducted, in connection with lived experiences of emergency management staff, following Storm Ophelia and Storm Emma.

Results:

As part of the emergency management life cycle and an attempt to enhance severe weather preparations, this study lists over 50 actions (development of specific HR policies, creating 4X4 capacity, severe weather preparations sessions, development of service-specific red weather event action cards, development of severe weather care plans for community palliative care and renal dialysis patients, sharing critical health care facilities with Local Authorities for road salting and gritting etc.) that were taken across the Health Service Executive South (Cork and Kerry) to enhance the preparations for severe weather events,

Conclusion:

The frequency and intensity of severe weather events will increase in Ireland over the coming years, as a result, it is essential that healthcare facilities and services have learned from previous severe weather events to ensure that the necessary plans and procedures are in place for future events, ensuring the delivery of safe and effective patient care and staff safety.
Exploratory Laparotomy Following the Mosul Offensive, 2016-2017: Results from a Dedicated Trauma Center in Erbil, Iraqi, Kurdistan
Authors: Egelko Aron , Muhrbeck Måns , Haweizy Rawand , Schreeb Johan von , Älgå Andreas
Published: June 2023

Introduction:

The Battle of Mosul (2016-2017) involved asymmetric warfare and excess civilian causalities. Emergency Management Centre (EMC) was a designated trauma center for the battle, located 80 km from Mosul. Exploratory laparotomy outcomes in local hospitals are poorly studied compared to military hospitals. Improving response to complex emergencies requires better contextual understanding.

Method:

Prehospital and hospital data were collected from all patients undergoing exploratory laparotomy at EMC during the battle. Data were collected and validated by EMC’s chief surgeon. New Injury Severity Scores (NISS) were calculated from operative data.

Results:

Seventy-three patients were included. 22 (30.1%) were children; 40 (54.8%) were non-combatant adults. 51 (69%) were male. Bullets caused 74.0% of injuries. Children had prolonged time from injury to first laparotomy compared to adults (600 vs 208 minutes, p<0.05). Median hospital length of stay (LOS) was six days (IQR 4-10; children 16.4 days vs adults 8.6 days, p=0.05). Median NISS was 18 (IQR 12-27). NISS were significantly higher for women (28.5 vs 19.8), children (28.8 vs 20), and re-laparotomy (32.0 vs 19.0) compared to men, adults, and primary laparotomy, respectively. In univariate and multivariate analysis, NISS was associated with hospital, but not ICU, LOS (p<0.01). Twelve patients were re-laparotomies after surgery elsewhere: ten (83.3%) were for failed repairs or missed injuries. Median time to re-operation was 5.5 days (IQR 1-8). Re-operations had longer ICU (4.5 vs 2.9, p<0.01) and hospital stays (20.7 vs 7.6, p<0.01). Three (4%) patients died; two of which were re-laparotomies.

Conclusion:

During the battle, civilians and combatants had similar injury mechanisms and outcomes. Children had a long time to present and LOS. Low mortality likely reflects high prehospital mortality. Prolonged times to admission suggest the need for improved hospital transport. Re-operation was associated with increased complications and LOS. NISS demonstrated predictive value for hospitals, but not ICU, or LOS.