bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Disaster Science: Pediatric Specific Considerations, A Global Imperative, A WADEM Opportunity
Authors: Weiner Debra , Newton Christopher , Peek Lori , Upperman Jeffery , Dixon Cinnamon
Published: June 2023

Introduction:

Pediatric disaster science is critical to provide data and discovery to guide evidence-based preparedness, response, mitigation and recovery to best serve children, families and society. With the increasing frequency, severity and global scope of disasters, there is now an unprecedented imperative and opportunity to build a sustained pediatric disaster science workforce and infrastructure. The expertise, perspective and collaboration of the international, multidisciplinary community, including WADEM members, is integral to supporting effective, efficient, ethical, high quality pediatric disaster science and its implementation.

Method:

A landmark Pediatric Disaster Science Symposium was convened in-person/virtually by the US National Academies of Science Engineering and Medicine in August 2022. Forty-eight pediatric disaster focused invited speakers, collectively representing government, non-governmental organizations, academia and community attended, and online. Attendees were polled during the two-day meeting to assign priority ratings to the topics discussed.

Results:

Symposium topics included the importance, history and scope of pediatric disaster science, and research across the disaster management cycle. Research considerations specific to children included medical and psychosocial vulnerabilities and manifestations; ethics and protections; protocol development and deployment; research tools; and data collection/integration. Scientific methodology topics addressed pediatric considerations for basic science, surveillance, clinical trials, applied sciences, community-engaged research, dissemination and implementation. Infrastructure needs described leveraging disaster centers, research networks, disaster response teams, government agencies and professional societies integratively across disciplines. Building a sustainable workforce, including training and engaging pediatric scientists with disaster-focused/disaster-relevant research, funding streams, regulation and advocacy were also discussed. Research priority ratings yielded preliminary data to inform pediatric disaster science priorities.

Conclusion:

The meeting provided insights that can further guide discussions among global disaster experts and scientists, including WADEM members, to prioritize, build and scale sustainable pediatric disaster science that yields evidence-based strategies, plans, resources, and actions that improve disaster preparedness, response, mitigation, and recovery for children, families and societies worldwide.
Pediatric Casualties in Terrorist Attacks: A Semi-Quantitative Analysis of Global Events through the Lens of Counter-Terrorism Medicine
Authors: Cahan Lea Ohana Sarna , Tin Derrick , Markovic Vesna , Ciottone Robert , Issa Fadi , Kane Ashley , Hart Alexander , Weiner Debra , Ciottone Gregory
Published: June 2023

Introduction:

Terrorism remains a major threat and concern in many countries around the world. Children represent approximately 30% of the world population and in the event of a terrorist attack can either be primary targets, to include the possibility of abduction, or unintended victims. Children are unique in their vulnerabilities and therefore, require special consideration.

Method:

This study is a semi-quantitative epidemiological analysis of all terrorism-related pediatric fatalities and injuries sustained between 1970-2019. Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). Summaries of events including search terms associated with children were individually reviewed and those describing the deaths, injuries, or abduction of children were tallied.

Results:

Of the over 200,000 terror events, 2,302 events met inclusion criteria. This represented 1.14% of total events which involved death, injury, or abduction of children. Of 2,032 events a total of 2,275 pediatric fatal injuries (FI) were recorded, as well as 2,280 pediatric non-fatal injuries (NFI). The most common weapons used in all attacks involving the pediatric population were explosives (1539[66.8%]), firearms (543 [23.5%]), other (169 [7.3%]) and melee (83 [3.6%]). 275 of the 2,032 were related to abductions, with 71 cases involving the abduction of ten children or more.

Conclusion:

Pediatric casualties in terrorist events represent a small proportion of overall victims, however, they have unique vulnerabilities, and when directly impacted by terrorism, can have long term physical and psychosocial sequelae, as well as a devastating emotional impact on the community.
“Provide Them What They Need Until the Last Minute”: Experiences of Palliative Care and Palliative Care Needs in Humanitarian Crises
Authors: Schwartz Lisa , Hunt Matthew , Nouvet Elysee , Laat Sonya de , Yantzi Rachel , Wahoush Olive , Khater Wejdan , Rwililiza Emmanuel Musoni , Abu-Siam Ibraheem , Wallace Corinne Schuster
Published: June 2023

Introduction:

Access to palliative care, and more specifically the alleviation of avoidable physical and psychosocial suffering is increasingly recognized as necessary in humanitarian response. Palliative approaches to care can meet the needs of patients for whom curative treatment may not be the aim, not just at the very end of life but also more broadly. Humanitarian organizations and sectoral initiatives have taken steps to develop guidance and policies to support integration of palliative care. However, it is still sometimes regarded as unfeasible or aspirational in crisis contexts; particularly where care for persons with life threatening conditions or injuries is logistically, legally, and ethically challenging. We present a synthesis of findings from five qualitative sub-studies within a R2HC-funded research program on palliative care provision in humanitarian crises that sought to better understand the ethical and practical dimensions of humanitarian organizations integrating palliative care into emergency responses.

Method:

A multi-disciplinary, multi-national team conducted an exploratory mixed-methods study and presented findings from semi-structured interviews with international and local health care providers, patients, and families that explored experiences of palliative care in different humanitarian responses: protracted refugee crisis (Rwanda n=17), acute refugee crises (Jordan and Bangladesh n=20), a public health emergency (Guinea n=16), and natural disasters (various countries n =17)

Results:

Four themes emerged from descriptions of the struggles and successes of applying palliative care in humanitarian settings: 1) justification and integration of palliative care into humanitarian response, 2) contextualizing palliative care approaches to crisis settings, 3) the importance of being attentive to the ‘situatedness of dying’, and 4) the need for retaining a holistic approach to care. The findings are discussed relation to the ideals embraced in palliative care and corresponding humanitarian values.

Conclusion:

Though challenging, palliative care in humanitarian response is essential for responding to avoidable pain and suffering consistent with humanitarian principles.
Challenges Introducing a Novel Health Assessment System in Disaster-prone Japan: Community-Oriented Approach for Comprehensive Healthcare in Emergency Situations (COACHES)
Authors: Kinoshita Mari , Nakai Mikiko , Shimada Ikuko
Published: June 2023

Introduction:

Collecting real-time individual health data of all disaster-affected populations is usually considered impossible. The University of Kochi's team and its partners conceived a novel health assessment system named "Community Oriented Approach for Comprehensive Healthcare in Emergency Situations (COACHES)." It collects individual health data anonymously and records such data in a cloud-based database. The system runs on any personal mobile device by scanning a personal identification code (QR code). It is expected that anyone on site with qualifications in healthcare will run this system as a volunteer to ensure data reliability. The COACHES app development is in process, and its prototype is currently available. This study aimed to assess how people react to the novel system and see the feasibility of installation in Japan.

Method:

Two focus group interviews (FGI) were conducted in a small coastal village in western Japan. The village anticipates severe damages with days of isolation once a large-scale earthquake followed by a tsunami hits the area. The first FGI was held with nine purposively recruited participants. The second FGI was held one month after and included seven of the first FGI participants with one of the absent participants providing a written response. FGI was for one-hour each, with discussion following the system demonstration. The voice data during the FGI were recorded and analyzed. The research was approved by the University of Kochi IRB.

Results:

Some showed intense interest in the system, whereas concerns such as the privacy violation for using personal devices, the availability of healthcare personnel, or a fear that anonymous data collection may delay identifying a person in need of assistance.

Conclusion:

Further studies are proposed, particularly in recruiting volunteers, data storage in case of technical damage, and how to make people with limited IT literacy comfortable using the new system.
Attitudes and Knowledge of Emergency Physicians Towards End-of-Life Care in the Emergency Department. A National Survey
Authors: Saeed Saema , Mulcaire Jeffrey , Umana Etimbuk , Foley James , Browne Leonard , Keane Owen , Chionh Wen Wei , O'Leary Mary Jane , Deasy Conor
Published: June 2023

Introduction:

With an aging population and patients on end-of-life care (EOL) pathways, emergency departments (ED) are seeing an increase in patients requiring EOL care. There is paucity of data of attitudes and knowledge of physicians providing EOL care in the ED both internationally and in Ireland. The aim of this project was to assess the attitudes and knowledge of ED physicians towards EOL care.

Method:

This was a cross-sectional electronic survey of ED physicians working in Irish Eds, facilitated through the Irish Trainee Emergency Research Network (ITERN) over six weeks from September 27, 2021, to November 8, 2021. The questionnaire covered the following domains: Demographic data, Awareness of EOL Care, Views, and attitudes towards EOL care.

Results:

A total of 311 completed questionnaires across 23 participant sites were analyzed, with a response rate of 45%. The majority of the respondents were under the age of 35 (62%), were male (58%) and at SHO level (36%). In terms of awareness 32% (98) of respondents were not aware of palliative care services in their hospitals while only 29% (91) were aware of national EOL guidance. Fifty-five percent (172) reported commencing EOL care in the ED, however 75.5% (234) respondents reported their knowledge of EOL care to be limited or non-existent. Few (30.2%) respondents felt comfortable commencing EOL care in the ED without speciality team input. There appears to be a lack of clarity on the roles and responsibilities of ED nurses and doctors in the care of the dying patients in ED with only 31.2% (95) being clear on this role. Significant differences were observed with regards to clinical experience and physician grade.

Conclusion:

This study has highlighted a lack of awareness and knowledge of EOL care, particularly among less experienced ED physicians. However, there was a willingness to commence EOL care in the ED.
“We decide according to the protocol”: Humanitarian Healthcare Workers’ Moral Experiences of Palliative Care-Related Decision-Making in Cox’s Bazar, Bangladesh
Authors: Yantzi Rachel , Hadiuzzaman Md , Gupta Pradip Sen , Lamrous Amin , Richardson Kathryn , Pringle John , Schwartz Lisa , Hossain Puspita , Kizito David , Burza Sakib
Published: June 2023

Introduction:

919,000 Rohingya refugees live in overcrowded camps in Cox’s Bazar, Bangladesh after fleeing violence in Myanmar. The Médecins Sans Frontières (MSF) Goyalmara Hospital offers the highest level of pediatric and neonatal care serving the Rohingya refugees and palliative care is gradually being integrated due to high mortality and medical complexity of patients. The purpose of this study was to understand the moral experiences of staff involved in providing palliative care to inform program implementation at Goyalmara Hospital and in other humanitarian contexts.

Method:

This focused ethnography was conducted between March-August 2021 at Goyalmara Hospital. Data collection involved participant-observation, individual interviews (22), focus group discussions (5), and analysis of protocols and other documents. Interviews and focus groups were audio-recorded, translated, and transcribed. A coding scheme was developed, and data coded using NVivo 11.

Results:

A key finding of this study was the important yet contested role of clinical guidelines and policies in palliative care related decision-making which was shaped by the authority and impermanent presence of international staff in the project. Staff saw clinical guidelines as a valuable resource that supported a consistent approach to care over time, and some locally hired staff used clinical guidelines as a tool to support their point of view during care planning discussions with international staff. Others felt that palliative care guidelines and other policies were inappropriately or rigidly applied, particularly surrounding decisions to refer (or not refer) patients to a higher level of care, or to discontinue certain medical treatments at end of life.

Conclusion:

MSF staff experienced tension between the need for clarity and consistency, and the need to tailor guidelines to the context, patient, and family. Open discussion of staff concerns may alleviate moral distress and alert teams to areas where advocacy, staff psycho-social support, training, or clinical mentoring are needed.
Investigating the Natural Disaster Preparedness of Hospital Pharmacists Across Four Hospitals in Australia
Authors: McCourt Elizabeth , Anderson Amelia , Hollingworth Samantha , Barras Michael
Published: June 2023

Introduction:

In a climate where natural disasters are becoming progressively more frequent and severe, there is a greater need for healthcare resilience. Hospital pharmacists are important healthcare responders during disasters, but little is known about how prepared pharmacists are to fill roles in disasters or how prepared pharmacy departments are to support their response. The aim of this study was to determine the disaster preparedness of pharmacists and pharmacy departments in a Metropolitan Health Service in Australia and investigate any relationship between the two.

Method:

This research utilized two surveys to determine the individual preparedness of registered pharmacists within the eligible hospitals and the preparedness of pharmacy departments (this information was obtained through the Directors of Pharmacy).

Results:

In total, 68 individual pharmacists participated in the study. It was found that individuals were moderately prepared (preparedness score 19.98). Interventions, such as education, improved individual preparedness scores, though these had poor uptake, where only 17.4% (n=12/68) of participants had received disaster education or training. Individual preparedness was unaffected by facility preparedness and provision of comprehensive resources.

The preparedness of hospital pharmacy departments was generally low, where two hospitals were rated as ‘somewhat prepared’, due to the presence of a mostly comprehensive plan and a moderate engagement in activities that contributed to preparedness. The third hospital was ‘poorly prepared’, as it did not have a disaster plan and had low engagement in preparedness activities.

Conclusion:

This study shows that a substantial improvement in pharmacy preparedness is required to achieve healthcare resilience and quality patient outcomes in disaster aftermath–further reinforcing the need for national and pharmacy-specific guidance, complemented by standardized preparedness interventions such as education and training. There is also a glaring disconnect between the preparedness of pharmacy facilities and their workforce, which demonstrates a culture of disaster preparedness.
A PhotoVoice Exploration of Pharmacists’ Lived Experiences Working During the COVID-19 Pandemic
Authors: Watson Kaitlyn , Schindel Theresa , Tsuyuki Ross , Hamarneh Yazid Al
Published: June 2023

Introduction:

Pharmacists’ pivotal role during the COVID-19 pandemic has been widely recognized, as they adapted to continue to provide an even higher level of care to their patients. We sought to gain deeper understanding of frontline pharmacists’ lived experiences of the COVID-19 pandemic and its impact on their roles and professional identity (what they do and what it means to them).

Method:

Photovoice was used, a visual research method that uses participant-generated photographs to articulate their experiences, and semi-structured interviews. This approach allowed us to explore the subjectivity of professional identity from the pharmacists’ lived experiences. Participants were asked to provide 3-5 photos that reflected on how they see themselves as a pharmacist and/or represents what they do as a pharmacist. The semi-structured interview guide asked open-ended questions about their photos, included a photo-elicitation exercise, and additional questions based on a recent scoping review. We recruited frontline community pharmacists who provided direct patient care during the COVID-19 pandemic in Alberta, Canada through social media and relevant pharmacy organizations. Data analysis incorporated content, thematic and visual analysis and was facilitated using NVivo software. Ethics approval was obtained from the University of Alberta ethics board.

Results:

Five primary themes emerged from the photographs and interviews: (1) autonomy, (2) clinical courage, (3) leadership, (4) safety, and (5) value and support. The photographs identified symbols participants associated with their lived experiences (e.g., worn shoes illustrate the relentless pace of pharmacists, a messy bed representing work-life balance out of control).

Conclusion:

This study identified that pharmacists’ felt the pandemic made them visible to the public and made them feel valued as a trusted resource and a safe-haven for ongoing healthcare. Additionally, it was highlighted how participants demonstrated clinical courage and led their communities by adapting their roles and using their autonomy to fulfil community needs.
Veterinary Behavioral Health Issues Associated with Disaster Response-Results of Global Survey
Authors: Vroegindewey Gary
Published: June 2023

Introduction:

Veterinarians have been identified as a professional group at elevated risk for behavioral health issues associated with an emergency response. Prior studies demonstrate the significant and long-lasting mental health effects experienced by veterinary responders. To examine the scale and scope of behavioral health issues exhibited by veterinary responders, an online anonymous survey was conducted.

Method:

A Qualtrics® survey was conducted to identify the scope and scale of behavioral health issues of veterinarians responding to disasters. Informed consent language and the survey included stress warnings for participants to stop the survey and seek support if needed. A link to the survey was sent to veterinarians from contact lists and the survey link was coded for reuse so it could be forwarded to others. Sending emails announcing the survey were sent and the survey was open for one month following the second notice. The results were tabulated and analyzed by the authors.

Results:

Fifty-one percent of respondents reported experiencing at least one behavioral health symptom during the disaster response and 34% reported at least one behavioral health symptom six months after the event. Milder symptoms such as loss of sleep and anxiety decreased significantly after six months, however more severe symptoms such as mood swings (24/22), depression (21/21), nightmares (18/20), and suicidal thoughts (5/5) did not significantly decrease. Sixteen percent reported support during the event and 13% reported support after.

Conclusion:

Survey analysis indicated that the scale and scope of veterinary responders’ behavioral health issues are significant, and the findings indicate that further study and action to improve health outcomes is warranted. Recommendations include developing standards and guidelines, incorporating behavioral health training into response activities, developing assessment and reporting protocols, collaborating with other professions to determine best practices, and providing funding for further research on behavioral health.
“I’ve become very introverted”: Long-term Social and Psychological Effects of the COVID-19 Pandemic
Authors: Leersum-Bekebrede Lydia van , Vetten-McMahon Marjonneke de , Haagen Joris , Tak Nannah , Dückers Michel , Marra Elske
Published: June 2023

Introduction:

Internationally, COVID-19 has impacted populations because of both infections and measures to prevent the spread of the virus. The pandemic's long-term social and psychological effects on the Dutch population were studied.

Method:

The GOR-COVID-19 health monitor1 includes quarterly measurements among youth (12- to 24-year-olds) and adult (25 and older) panels. The measurements of June and September 2022 included the open-ended question, ‘In your life at this moment, do you still feel the effects of the corona pandemic from the last 2.5 years?’ The first author qualitatively analyzed the responses (7.171 in total) through descriptive coding. A team member did a co-coder reliability check.

Results:

In the questionnaire, various people name positive effects of the pandemic, such as being able to spend time alone or feeling more confident. However, many respondents describe how the pandemic negatively affected their social life, mental health, personal development, financial situation, and perception of society. People who experienced life transitions show vulnerability to social isolation while working and learning online because they missed the opportunity to establish a new social network. Among them are young people who started secondary school, university, or their first job during the pandemic. The youth also often describe having difficulty with social interaction, feeling they have ‘unlearned’ to be in large groups or interact with strangers. Older generations, in contrast, comment on their own continued cautiousness.

Conclusion:

After years of pandemic, fear of contamination and social distancing measures have impacted society and individuals. The findings raise the question, ‘How will the experience of a pandemic continue to shape society and, in particular, what will be the lasting effects on the social networks and mental health of generation Z?’

1 See Integrated GOR-COVID-19 health monitor and The Dutch GOR-Covid-19 health monitor, both in the European Journal of Public Health (2022) 32:3.
The Evolution of an Unintended Peer Support Group
Authors: McLean Andrew
Published: June 2023

Introduction:

This presentation provides a review of a case report regarding the often unrecognized emotional support experienced among leaders during crisis management.

Method:

Members of a statewide COVID-19 advisory group were surveyed as to their level of participation and perceived emotional wellness benefit resulting from group membership.

Results:

A majority of members across all disciplines and agencies reported a benefit of emotional wellness from group membership.

Conclusion:

It is important in disaster settings, regardless of the labeled group function, to be mindful of the potential benefits to group members from not only a task standpoint but a process standpoint as well. In addition, it is important to recognize the multiple benefits of interdisciplinary interaction and inclusion.
Assessing Trends and Risk Factors of Suicidal Ideation in Young People During the COVID-19 Pandemic Through Quarterly Monitoring in The Netherlands.
Authors: Rahmon Imme , Leersum-Bekebrede Lydia van , Mahon Marjonneke de Vetten-Mc , Postema Abigail , Bosmans Mark , Meerdink Anne , Jansen Noortje , Marra Elske
Published: June 2023

Introduction:

The COVID-19 pandemic has impacted populations internationally, through infections and consequences of infections, and by the countermeasures to prevent the spread of the coronavirus. Concerns exist surrounding the impact of the COVID-19 pandemic on the mental health of youths in the Netherlands. Consequently, we studied quarterly trends and risk factors of suicidal ideation among Dutch youths from September 2021 onwards.

Method:

The Network GOR-COVID-19, a research group consisting of different organizations, monitors the effect of the COVID-19 pandemic on population health. As one element of this monitoring, quarterly data collections have been undertaken since September 2021 from a panel of youths (12 – 25 years of age) representative of the Dutch population. Online questionnaires collect data on self-reported health and wellbeing. We analyzed a selection of demographic, social activity, and mental health variables as potential risk factors for self-reported suicidal ideation in the previous three months. We assessed trends, performed longitudinal analyses, and conducted logistic and random forest regressions per quarterly round of data collection. Analyses were weighted for age, sex, educational level, and province where appropriate.

Results:

Approximately 4,500 youths participated in each quarterly questionnaire, with some participating more than once. Results showed substantial increases in self-reported suicidal ideation during and immediately after the third lockdown in the Netherlands in December 2021, rising from 9% to 17%, then slowly decreasing to 16% in May/June 2022, and to 13% in September 2022. In all multivariable analyses variables relating to mental health were indicated as risk factors. The strongest associations were seen in those experiencing mental health complaints and loneliness. Demographic variables were not strongly associated with suicidal ideation.

Conclusion:

The monitoring conducted by The Network GOR-COVID-19 enables the tracking of trends in the impact of the COVID-19 pandemic on the mental health of Dutch youths in The Netherlands.
Evidence-informed Mental Health and Psychosocial Support (MHPSS) Guidelines: Are They Any Good and Where DoThey Lead Us When Disaster Strikes?
Authors: Dückers Michel , Willems Andrea , Steen Charlie , Hoof Wera van , Te Brake Hans
Published: June 2023

Introduction:

Disasters and humanitarian crises can have a tremendous impact on the mental health and psychosocial well-being of affected populations. Reliable and practical evidence-informed mental health and psychosocial support (MHPSS) guidelines are indispensable for policy and practice to address the mental health impact. Our objective was to review the quality of available guidelines and to explore similarities and differences in content.

Method:

The review was conducted in two steps. Firstly, MHPSS guidelines, frameworks, manuals and toolkits were selected via a systematic literature review as well as a search in the grey literature. A total of 13 MHPSS guidelines were assessed independently by 3–5 raters using the Appraisal of Guidelines for Research and Evaluation–Health Systems (AGREE-HS) instrument. Secondly, we analyzed the content of the highest-ranking guidelines.

Results:

Guideline quality scores varied substantially, ranging between 21.3 and 67.6 (range 0–100, M= 45.4), with four guidelines scoring above midpoint (50). Overall, guidelines scored highest (on a 1–7 scale) on topic (M = 5.3) and recommendations (M = 4.2), while implementability (M = 2.7) is arguably the area where most of the progress is to be made. The four guidelines proved largely similar, overlapping or at least complementary in their MHPSS definitions, stated purpose of the guidelines, user and target groups, terminology, and models used. Many recommended MHPSS measures and interventions were found in all of the guidelines and could be categorized. The guidelines stress the importance of monitoring needs and problems, evaluating the effect of service delivery, deliberate implementation and preparation, and investments in proper conditions and effective coordination across professions, agencies, and sectors.

Conclusion:

The MHPSS knowledge base embedded in guidelines is rich and contains invaluable content for disaster risk reduction. Although application contexts differ geographically, available guidelines should allow policymakers and practitioners globally to plan, implement, and evaluate MHPSS actions.
Psychosocial Support Interventions for Children During Ongoing War in Ukraine: A Pilot Study
Authors: Nitza Amy , O'Meara Andrew , Leon Gloria , Vysotska Krystyna , Prokhorov Alexander , Surinon Cassandre , O'Connor Taylor
Published: June 2023

Introduction:

This presentation describes an initiative to provide psychosocial support to children in Ukraine during the ongoing war using a children’s storybook, coloring book, and activity book. The resources promote emotion identification, self-expression, coping skills, and social support–variables with empirical support in promoting children’s mental health in response to trauma.

Method:

The book: “An Unusual Situation” is a bibliotherapy intervention for children struggling with difficult situations. By identifying with the characters, children learn about their own struggles, they learn that other children share similar concerns, and learn important coping skills.

The book was translated into Ukrainian and Russian; supplementary materials including a coloring book, activity book and a guidebook were developed. Following a three-hour training, Ukrainian mental health professionals worked with children on the materials in their respective wartime settings.

Results:

Results of the following research questions will be presented:

1)

How do mental health professionals working with children in Ukraine utilize the associated book resources measured by a survey and completed by the professionals engaged in the project.

2)

What do children who use these resources report about their experiences coping with the ongoing war, measured by:

a)

Collecting children’s responses in the activity book.

b)

Surveying the mental health professionals about their observations of the children during the intervention process.

3)

Does the intervention reduce children’s distress, interpersonal functioning, or problematic behaviors, measured by pre-post scores on the Youth Outcome Questionnaire 2.0.

Conclusion:

This pilot study will provide information to guide the implementation of a broad psychosocial support intervention for children living in the setting of the ongoing war in Ukraine. Conclusions to be presented include:

1)

Tailoring the intervention to the current needs of Ukrainian children

2)

Designing a wide-scale implementation plan tailored to Ukrainian mental health professionals’ recommendations

3)

Addressing barriers to implementation.
Risk Mapping of Coastal Cities that Sinking Faster than Sea-Level Rise by 2050: The Case of Jakarta and Semarang
Authors: Pradana Atha , Yew Ying , Demetriou Christiana , Prayitno Harun , Delgado Rafael , González Pedro , Utami Ratnasari Dyah
Published: June 2023

Introduction:

Coastal area cities Jakarta and Semarang in Indonesia portray higher hazard that links to an annual sinking rate of up to 20cm. Four main factors have been determined to contribute: groundwater extraction, sea-level rise (SLR), land subsidence, and coastal floods. It accounts for people living in those high-risk regions to prevent the exacerbating situation.

Method:

This study’s main objective is to generate risk mapping in Jakarta and Semarang using Geographic Information System (GIS) from three open-source websites: Surging Seas, OpenStreetMap (OSM), and Healthsites.io. Through GIS analysis, prediction can be analyzed more accurately with precision when the sinking hits slowly to identify the risks involved.

Results:

Satellite data geographical analysis risk mapping done via Surging Seas, OpenStreetMap (OSM), and Healthsites.io showed that by 2050, North, West, part of Central Jakarta and Semarang will sink 5.6 meters below sea level with an annual sinking rate up to 20cm. Critical infrastructure will be affected in Jakarta, including Soekarno-Hatta International Airport and Tanjung Priok Port. Similarly, in Semarang, the Jenderal Ahmad Yani International Airport, Tanjung Mas Port, and Terboyo Bus Station are affected as well. Consequently, it will situate 13 million at both coastal cities as the worst impacted, categorized by the World Bank data, updated Sept 2022 as Urban Poverty, the population living at 2.15 US Dollar a day poverty line. Those living below the poverty line are also deprived of education and access to infrastructure, mainly electricity, water and sanitation hygiene indicators measured by the World Bank 2021 and 2022, Multidimensional Poverty Measure.

Conclusion:

As a conclusion, GIS mapping of Jakarta and Semarang by 2050 using Surging Seas, OpenStreetMap, and Healthsites.io showed a high risk of sinking, especially in the northern areas of both cities, with the mapping done as of April 2022.
All the Sickly People, Where Do They All Come From? An OLD Problem (Off Load Delay) Rising Ambulance Presentations to an Irish Emergency Department
Authors: Jordaan Phillip , Smit Marco , Andrews Robin , Jordaan Phillip , Kennedy Keith , Abraham Ria , Orsmond Brendan , Rensburg Rochelle Jansen van , Fayyaz Fahd , Neduchelyn Yuni , Vegte Andrea van der , Dowle Ashleigh , Vythilingam Darshini , Wickham Bryce , Kelly Thomas , Molloy Michael
Published: June 2023

Introduction:

Demand for prehospital emergency services has been increasing worldwide. Significant challenges exist in meeting response times in rural environments when faced with surges in demand related to weather events or sustained demand surge such as the pandemic environment. Significant pressure also exists in the hospital environment receiving such large volumes of patients with short duration handovers to allow prehospital assets return to their primary roles. The aim of this study is to determine trends for ambulance presentations in a rural emergency department over seven years with absolute numbers and percentage of overall attendances.

Method:

A retrospective analysis of anonymized electronic registration data on the iPMS system from initiation in 2014 to 2022 including total registration numbers, presentation by ambulance, and handover times. Excel is used to record and examine data.

Results:

ED attendances rose from 29,236 in 2014 to 43,184 in 2021 with total ambulance presentations ranging from 4,859 in 2014 (16.62% of attendances), maxing in 2019 at 10,326 out of total attendances of 42,637 (24.22% of attendances).Lowest monthly ambulance presentations occurred in April 2014 (441 or 15.82% of 2788 attendances) and maximal monthly presentations was 1,023 in May 2022 (23.38% of 4376 attendances). Lowest percentage of attendances arriving by ambulance occurred in May 2014 with 14.97% (468) out of 3,127 ED presentations. Highest percentage of attendances arriving by ambulance occurred in January 2021 with 33.67% (875) of 2,599 ED presentations which was during the lockdown phase of COVID in Ireland.

Conclusion:

Overall total numbers of patients arriving by ambulance has been steadily increasing for years but numbers (and percentages) dramatically increased during COVID and this has been sustained in the POST Lockdown pandemic phase. Strategies are required to manage demand, increase turnaround and educate the public on appropriate use of prehospital emergency services.
Emergency Medical Service Facilitated Geriatric Emergency Department Visits in Hamilton, Ontario, Canada During the COVID-19 Pandemic
Authors: Jazuli Farah , Mulla Ali , Weingarten Laura , deWit Kerstin , Franc Jeffrey
Published: June 2023

Introduction:

To determine if lockdown measures related to the COVID-19 pandemic changed the frequency and epidemiology of geriatric patient emergency medical service (EMS) facilitated visits to the emergency department (ED) in Hamilton, Ontario, Canada.

Method:

A retrospective chart review was conducted comparing ED presentations of patients over 65 years of age presenting to two academic hospitals in Hamilton, Ontario via EMS between March 17, 2020, and July 15, 2020 (the first wave of the COVID-19 pandemic) to March 17, 2019, and July 15, 2019 (pre-pandemic).

Results:

Total EMS facilitated geriatric ED number of visits decreased by 17.3% during the first wave of COVID-19 in 2020, relative to the same seasonal time frame in 2019 (March 17- July 15). Visits were more dramatically decreased in the first 8 weeks after the pandemic was declared but then recovered to pre-pandemic levels thereafter. More geriatric patients visiting the ED via EMS were admitted during the initial stages of the COVID-19 pandemic, relative to 2019. However, the acuity and epidemiology of visits remained the same during the first wave of the COVID-19 pandemic, relative to 2019.

Conclusion:

Lockdown measures during the first wave of the COVID-19 pandemic coincided with decreased geriatric EMS ED visits in the initial two months after the pandemic was declared. Visit numbers recovered as the first wave ended. The epidemiology, as well as the overall acuity, did not change.
Case Report of an Irish NGO Providing Educational Support in Establishing a Major Trauma Center in a Low-Middle-Income Country
Authors: Mulcaire Jeffrey , O'Leary Anna , Breslin Deirdre , Murphy David , O'Sullivan Jean , Eager Robert
Published: June 2023

Introduction:

St. Joseph's Mission Hospital, Nyabonda, Kenya is the site chosen for a new Trauma Response Center as part of a new national highway development scheme. This highway will significantly increase in traffic volume expected in the region. With increased traffic volume, there will be an expected increase in trauma presentations as well as medical presentations due to increased populations in the area. This center is expected to serve a population of four million people. To date, the majority of nurses, medical officers and doctors in the pre-existing facility received no formal post graduate training in medical and surgical emergencies.

Method:

Global Emergency Medical Skills (GECS) is a registered charity, with an aim to provide medical education for the management of both trauma and medical emergencies for both adults and children. GECS was invited to attend St. Joseph's Missionary Hospital to provide education to nurses, medical officers and doctors. A curriculum encompassing the management of medical and surgical emergencies through both didactic lectures, practical skills training and simulation based workshops was composed and delivered by a group of 11 faculty, crossing Emergency Medicine, Intensive Care, Anesthesia and General Medicine. This curriculum had 28 participants and was conducted over a five day period. A "train the trainer" model was employed to ensure the strongest candidates were chosen for further training on how to deliver course material and organized simulations for future colleagues in St. Josephs Trauma Center.

Results:

Questionnaires of both staff and students have highlighted the utility of GECS and its curriculum in preparing staff for the opening of this new trauma center.

Conclusion:

This program was the first of its kind undertaken in St. Joseph's Hospital and has provided valuable education to the staff of this new trauma center. This project has enabled the continuity of this knowledge through chosen trainers.
Emergency Medical Team Deployment Modalities: A Delphi Study
Authors: Yeung Tiffany
Published: June 2023

Introduction:

The COVID-19 pandemic presented obstacles to Emergency Medical Teams (EMT) deployment, including concern of exposure to COVID-19 and travel restriction in many areas of the world. Recognizing these challenges, EMTs sought alternatives to physical deployment, such as virtual deployment. However, concerns have been raised regarding access to internet in aid recipient countries, as well as patient privacy and data leakage in general due to insecure internet connections and intentional data hacking. There is limited literature, and no internationally agreed set of criteria, on the evaluation of deployment including the recipient countries’ ministries of health’s opinion on the deployments. In order to compare alternative deployment modalities, a set of criteria to evaluate an EMT deployment must be established.

Method:

The research will identify a set of criteria that can be used to evaluate a deployment; to identify the possible alternative modalities to traditional physical deployment; and to explore perceptions of acceptability and ability to meet the goals of international humanitarian assistance. A stakeholder analysis will be conducted to identify the key informants and relevant stakeholders, and the Delphi Approach will be utilized to seek experts’ opinions and reach consensus.

Results:

This research will help to establish a set of criteria for evaluating deployments, and to identify the alternative deployment modalities, the advantages, and disadvantages, and to evaluate each alternative modality, with the hopes of guiding EMTs to plan their future deployments, as well as to provide alternatives should there be further restrictions in the future.

Conclusion:

At this moment, this research is at the planning stage and ethical approval has not yet been sought. Should this abstract be accepted, ethical approval will have been obtained, and data collection will have just started in May. The presentation will include a summary of relevant literature, the methods, and any preliminary results.
The Utility of a Hospital System-Specific Emergency Medicine Residency Orientation
Authors: Katirji Linda , Cruz Angelo
Published: June 2023

Introduction:

The transition to residency is a challenging time in the medical trainee’s career. In addition to learning and implementing knowledge specific to emergency medicine, logistics and system nuances can initially impede a learner’s ability to begin the process of mastering their profession. In an attempt to ameliorate this transition to residency an orientation was created to introduce concepts of local ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits.

Method:

Interns were given a pre-workshop survey on comfort level (1-5 Likert) of ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits. They rotated through four workshop stations in small groups. The first was an ultrasound workshop showcasing our commonly used ultrasound and how we capture images and videos into our medical system for review. The next was institution specific protocols for medical and trauma resuscitation using simulation. Third was a workshop on how to navigate our electronic medical record with simple overviews of documentation and order entry. Lastly, they went through arterial and central line kits to familiarize themselves with the contents. A post-workshop survey was given.

Results:

Comfort with ultrasound documentation pre-workshop mean was 4.0 with a post-workshop mean of 4.45 (p=0.068). Comfort with resuscitation pre-workshop mean of 2.91 increased to 3.91 (p=0.008). Electronic medical record documentation comfort rose from a mean of 3.5 to 4.27 (p=0.007). Comfort navigating procedural kits increased to a mean of 4.09 from 3 (p=0.002).

Conclusion:

There was a statistically significant increase in comfort level with ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits after completion of the workshops. Only ultrasound documentation had a p value less than 0.05. It can be reasonably deduced that focusing on institutionally specific aspects of workflow can help interns expedite their education by familiarizing them with these nuances prior to their first shift.
Compliance with The National Institute for Health and Care Excellence (NICE) Guideline (NG158) Venous Thromboembolic Diseases: Diagnosis, Management, and Thrombophilia Testing; Proximal Lower Limb Venous Ultrasound Time Standards at Wexford General Hospital
Authors: Abraham Ria , Orsmond Brendan , Dowle Ashleigh , Vythilingam Darshini , Andrews Robin , Smit Marco , Kennedy Keith , Rensburg Rochelle Janse van , Vegte Andrea van der , Conradie Maria , Jordaan Philip , Wickham Bryce , Kelly T , Molloy Michael
Published: June 2023

Introduction:

The consequences of missed lower-limb deep vein thromboses (DVT) can be life-threatening. Similarly, inappropriate treatment with anticoagulation in low-risk patients carries a significant risk of harm. Early diagnosis and appropriate treatment with anticoagulation rely on timely ultrasound access. The National Institute for Health and Care Excellence (NICE) recommends timeframes for ultrasound acquisition based on Well’s score and D-dimer value.

If rapid ultrasound (Point of care Ultrasound POCUS in our context) demonstrates no features of DVT, it is safe to arrange follow-up scan within eight days without empiric anticoagulation. If, however, no bedside ultrasound is performed, anticoagulation is commenced until a formal scan excludes DVT. NG158 recommends this scan be performed within 24 hours. This audit investigated our compliance with NG158 time standards at Wexford General Hospital (WGH) emergency department (ED).

Method:

Electronic records for patients undergoing formal ultrasound for suspected DVT between 08/01/2022-10/13/2022 were reviewed using the hospital’s databases. Charts were reviewed to determine if POCUS was performed. In total, 42 records met selection criteria. Audit Committee governance review was obtained. Fisher’s exact test was used to compare compliance rates between those that underwent bedside ultrasound and those that did not.

Results:

Overall compliance with NG158 was 40.5%. Compliance rates for those offered bedside ultrasound were significantly higher than those that weren’t (58.3% vs. 16.7% p<0.0106). The mean waiting time for a radiology department ultrasound is six days, 12 hours, and 16 minutes.

Conclusion:

Overall compliance is low, and delays to obtaining formal ultrasound are long. We observed that compliance rates for those who underwent bedside ultrasound were significantly higher than for those who did not. This suggests that bedside ultrasound is under-utilized in our ED. Training more staff to perform bedside scans would alleviate current delays to ultrasound diagnosis and reduce risks associated with empiric anticoagulation.