bluuebunny/crossref_metadata_2025 huggingface dataset:
A Disaster Medicine Education Program for Undergraduate Medical Students in Tohoku
Authors: Kamimura Hiroki , Ogino Ryohei , Tauchi Masashi , Sugiyama Shinya , Urao Mikimasa , Fujita Motoo , Norii Tatsuya , Igarashi Yutaka , Yokobori Shoji
Published: June 2023

Introduction:

In Tohoku, the northeastern part of the main island of Japan, students entered medical school following the Great East Japan earthquake that occurred on March 11, 2011. Such students wished to volunteer at the time of disaster, however, the undergraduate medical curriculum was inadequate to enable the practice of disaster medicine. Thus, the Tohoku Disaster Medical Assistance Student (DMAS) holds workshops for undergraduate students to acquire disaster medicine knowledge.

Method:

Tohoku DMAS offers Peer Learning Education. In the DMAS course, students learned disaster medicine through lectures and simulations under the supervision of disaster medicine experts. The workshops vary in length between 3–8 hours. Tohoku DMAS’s goal is to support disaster management headquarters and shelters. Students are expected to provide logistical support that includes recounting the chronology of events at disaster management headquarters and helping with managing evacuation shelters.

Results:

According to the activity reports and roster of the course, there were only three students initially when the course was formed in 2018, however, the group continued to grow, and 165 students currently belong to the Tohoku DMAS. Those students include medical students, nursing students, and paramedics students at various universities and colleges. The DMAS has held 30 training sessions since 2018. The total number of training participants was 1,308. The DMAS has held tabletop simulation exercises and lectures on various topics such as shelter management, disaster triage, and nuclear disasters. Furthermore, some members have participated in emergency drills for each prefecture. The current challenge of the program was obtaining adequate insurance coverage for students and financial support during the activity at the disaster scene.

Conclusion:

The DMAS plays a role in disaster medicine education for undergraduate medical students in the Tohoku region. The program continues to grow and faces opportunities and challenges.
Utilization of a Delphi Study to Determine Core Concepts for a Pediatric Residency Disaster Medicine Curriculum
Authors: Jeong Yae Sul , Davis Nichole , Kaziny Brent , Lefort Roxanna
Published: June 2023

Introduction:

As disasters increase globally in both frequency and intensity, the vulnerability of children during disasters has become obvious. Pediatricians are often left to manage the resulting physical and mental repercussions. With minimal to no disaster medicine training offered at most U.S. pediatric residencies, the need for an easily accessible pediatric disaster medicine curriculum has been exacerbated. While this need has been highlighted in the literature, material to include or methods to sustainably incorporate disaster medicine into training programs has not been established.

Method:

From a thorough literature review, 19 topics were selected as potentially necessary to include in a disaster medicine curriculum for pediatric residents. Utilizing the Delphi method, subject matter experts were asked to rank these topics with an option to add others. Two independent surveys separated by time were administered with the goal of identifying ten critical core concepts for pediatric resident disaster medicine education. A virtual roundtable discussion then took place to finalize the ten core concepts, discuss objectives, and consider realistic methods of incorporating the curriculum into the residency timeline.

Results:

The ten core concepts identified were 1) introduction to disaster medicine, 2) patient triage, 3) surge capability, 4) mental health effects of a disaster, 5) preparedness for children with special healthcare needs, 6) communicating personal/family disaster preparedness, 7) hospital disaster mitigation, 8) reunification, 9) drills and training, and 10) disaster ethics and crisis standards of care.

Experts agreed upon a longitudinal multi-modal approach with inclusion of short didactics, case scenarios, questions/answers, games, and links to further educational activities and opportunities focused on individualized needs.

Conclusion:

The Delphi method was a successful approach to gathering expert consensus to establish core concepts for a pediatric resident disaster medicine curriculum.
Outcomes of Learning and Forgetting for the Undergraduate in Disaster Medicine Education by Blended Learning During the Covid-19 Pandemic: A Prospective Cohort Study
Authors: Wang Zhi-yuan
Published: June 2023

Introduction:

Blended learning has been proven to support the teaching of various concepts across disciplines. This study aims to investigate the impact of the traditional blended teaching mode (self-study online and face-to-face consultation) on the undergraduate’s learning of disaster skills, and compared with face-to-face consultation, explore the influence of new mode (tutoring manipulation online) on the acquisition and forgetting of knowledge in disaster medicine based on the blended learning.

Method:

A prospective cohort study method was used. The two semesters in a school year adopted different blended teaching models for 8 weeks. In the first term, students conducted disaster theoretical knowledge before class through an Online Course created by our team. In class, teachers guided training about response and preparedness (face-to-face consultation). Due to the outbreak of Covid-19, a new training model was adopted (tutoring manipulation online) in the second term. Three knowledge tests were conducted before class, after class, and six months after the end of the term. An accuracy rate difference was defined between the second and first as correct improvement rate (CIR), and the difference between the second and third as forgetting rate (FR).

Results:

Seventy-five students were included in the traditional group, and 64 students were included in the new group. The three results in traditional group were (0.38±0.11) %, (0.65±0.11) %, (0.56±0.13) %,and (0.49±0.15) %, (0.71±0.13) %, (0.60±0.12) % in new group. The mean scores after 6 months on both groups were lower than at the end of the term (Ptraditional <0.001, Pnew =0.010). The new group had a higher accuracy rate on all tests than the traditional group (P <0.01).

Conclusion:

Traditional blended learning models can improve students’ performance in disaster training and deepen knowledge memory. The new blended model may replace the traditional model for disaster training during the Covid-19 pandemic.
A Blended Learning Approach to Emergency Airway Training in a Low Resource Environment
Authors: Hamza Hanin , Clarke Siobhan , O'Leary Anna , Breslin Deirdre , Eager Robert , O'Sullivan Jean
Published: June 2023

Introduction:

Global Emergency Care Skills (GECS) is a charity which delivers medical training to health care professionals in low and middle income countries. Teaching airway management both didactically and through simulation training is a key component of the GECS Emergencies and Trauma Course. In 2022, a team of doctors delivered an intensive, five-day teaching course with a strong emphasis on airway management and airway emergencies at St. Joseph’s Nyabondo Mission Hospital in rural Kenya. This course was delivered to a group of doctors, nurses and clinical officers. At the conclusion of this course we collected qualitative feedback from course participants. The aim of this study was to assess airway knowledge and skills acquisition, as well as real-world application and potential for ongoing teaching of acquired airway skills.

Method:

A questionnaire was distributed to course participants to ascertain their experience of didactic airway teaching, airway skills stations, and airway simulation. Each question offered a binary response. To continue to enhance course content, we invited participants to submit qualitative feedback at the end of the questionnaire.

Results:

Questionnaires were returned by 19 of a total 24 participants. 53% were registered nurses, 21% were clinical officers, 5% were medical officers and 21% did not respond to this question. Median post graduate clinical experience was four years (2.75-5.25). 37% indicated that they had not heard of simulation training for medical education before undertaking this course. 58% had no previous airway training although 63% had prior exposure to clinical situations which required emergency airway management. 100% reported feeling more confident in their airway skills and potential for training colleagues following this course.

Conclusion:

The results indicate that participants gained knowledge, skills, and confidence when approaching airway emergencies. Furthermore, results showed increased perceived competence by participants at providing airway training to colleagues.
Development and Evaluation of Scenario-based E-Simulation for Humanitarian Health Training
Authors: Bahattab Awsan , Zain Omar , Linty Monica , Camacho Nieves Amat , Schreeb Johan von , Hubloue Ives , Corte Francesco Della , Ragazzoni Luca
Published: June 2023

Introduction:

In response to the global upward trend of humanitarian emergencies, the humanitarian health workforce has grown substantially in the last decades. Still, humanitarian education and training programs are limited in availability, geographical locations, and teaching methods, and are too expensive for local respondents. To address these gaps, an e-learning tool for humanitarian public health has been developed and evaluated.

Method:

Action research was used to develop the e-Learning tool. Rapid prototyping–a modified analysis, design, development, implementation, and evaluation (ADDIE) model, was used to identify the content and instructional design. This iterative process involved consultations and feedback from public health and disaster medicine instructors and students at different levels and training programs from within and outside CRIMEDIM. Qualitative data were analyzed using thematic analysis. Quantitative data were appropriately summarized. Pre/post-test change in knowledge score was tested with paired t-test.

Results:

Although different levels of training are needed, targeting health professionals at the entry-level in the humanitarian field is identified as a priority. Scenario-based e-Simulation covers health needs assessment, essential health services, communicable diseases standards, and the health system was developed and evaluated. Trainees were highly satisfied by the clear objectives, the realism of the simulated scenarios, quizzes, and interactivity. In the 1-7 numerical scale, the median for overall experience satisfaction was 6.3 (IQR=5.3-7, N=35). The mean of the post-test score was 7.71, which was significantly higher than the mean of the pre-test score of 5.88. The large effect size of 1.179 indicates the training effectiveness. Poor internet was identified as a potential barrier to delivering the training.

Conclusion:

This participatory study resulted in the development of effective Scenario-based e-Simulation. Offline mode of training will be adapted for trainees with poor internet connection settings. Successful factors in instructional design will be used to inform the development of advanced training in the field.
Virtual Interprofessional Education (VIPE)–The VIPE Program: VIPE Security, a Multi-sectoral Approach to Dealing with Complex Wicked Problems
Authors: Showstark Mary , Wiss Andrew , Cavezza Renee , Joosten-Hagye Dawn , Richards Julian , Brooks Patti , Wulfplimpton Julie , Acheson Ian , Kelshall Candyce , Gray Libby , Zschaebitz Elke , Embry Erin , Resnik Cheryl , An Iris , Sutherland Mark , Arcos Ruben , Kenley David , Bennett Dorine , Dobson Melina , Bergler Serge
Published: June 2023

Introduction:

The Virtual Interprofessional Education program is a multi-institutional consortium collaborative formed between five universities across the United States. As of January 2022, the collaborative includes over 60 universities in 30 countries. The consortium brings healthcare students together for a short-term immersive team experience that mimics the healthcare setting. The VIPE program has hosted over 5,000 students in healthcare training programs. The VIPE program expanded to a VIPE Security model to host students across multiple disciplines outside the field of healthcare to create a transdisciplinary approach to managing complex wicked problems.

Method:

Students receive asynchronous materials ahead of a synchronous virtual experience. VIPE uses the Interprofessional Education Competencies (IPEC) competencies (IPEC, 2016) and aligns with The Health Professions Accreditors Collaborative (HPAC) 2019 guidelines. VIPE uses an active teaching strategy, problem or case-based learning (PBL/CBL), which emphasizes creating an environment of psychological safety and its antecedents (Frazier et al., 2017 and Salas, 2019, Wiss, 2020). Following this model, VIPE Security explores whether the VIPE model can be tailored to work across multiple sectors to discuss management of complex wicked problems to include: climate change, disaster, cyber attacks, terrorism, pandemics, conflict, forced migration, food/water insecurity, human/narco trafficking etc. VIPE Security has hosted two events to include professionals in the health and security sectors to work through complex wicked problems to further understand their roles, ethical and responsible information sharing, and policy implications.

Results:

VIPE demonstrates statistically significant gains in knowledge towards interprofessional collaborative practice as a result of participation. VIPE Security results are currently being analyzed.

Conclusion:

This transdisciplinary approach to IPE allows for an all-hands-on-deck approach to security, fostering early education and communication of students across multiple sectors. The VIPE Security model has future implications to be utilized within multidisciplinary organizations for practitioners, governmental agencies, and the military.
The Quality of Hospital Disaster Plans in Belgium: Evaluation Research. Development and Content Validity of a Questionnaire to Define the Quality Key Performance Indicators Influencing Hospital Disaster Preparedness: A Modified Delphi Study
Authors: Hendrickx Christel , van Delft Brenda , Demeyer Ignace , Mortelmans Luc , Peremans Lieve , Sabbe Marc , Colombo Davide
Published: June 2023

Introduction:

Emergency and disaster situations have a major impact on hospitals, some of which are already overloaded daily. The recent COVID-19 outbreak, attacks in Brussels, floods in Wallonia and influx of Ukrainian refugees show that the risk of facing a disaster and involvement of local hospitals (and stakeholders) is real. However, how hospitals implement their own hospital disaster plan (HDP), the position of the hospital disaster coordinator (HDC) and the real efficacy of these measures remain unclear. Therefore, an evaluation tool with an expert-consensus set of Key Performance Indicators (KPIs) and an evaluation of the HDC position is needed

Method:

A semi-quantitative survey, as part of evaluation research, was designed by a research group. This questionnaire was based on the document analysis of the main topics of the national template and accompanying legislation. To establish consensus on the importance of the KPIs concerning the HDP, a three-round email-based modified Delphi study (Policy Delphi) was undertaken.

Results:

For a task group, 15 qualified multidisciplinary professionals (in-hospital) agreed to participate, 11 completed all rounds. As a pilot group, a total of 25 ‘experts on the field’, were purposively selected from Belgian hospitals, nine of them completed the questionnaire. The modified Delphi reached the agreed consensus threshold (i.e.75%), resulting in five main themes: demographic characteristics/profile HDC, hospital incident management system (HIMS), pre-incident phase, incident phase, post-incident phase. Collectively including a core set of 289 KPIs (29 indicators to assess progress concerning the HDC position).

Conclusion:

This study employed a modified Delphi approach to establish consensus, resulting in the development of an evaluation tool to measure hospital disaster preparedness and to evaluate progress of the HDC position within Belgian hospitals. All indicators were considered relevant and immediately implementable. When the implementation of KPIs is completed, the statement is that a HIMS exists within the hospitals.
Participants' Experience of Completing Trauma and Critical Skills Training in a Resource-Limited Environment
Authors: O'Leary Anna , Breslin Deirdre , Mulcaire Jeffrey , Eager Meabh , O'Sullivan Jean
Published: June 2023

Introduction:

Global Emergency Care Skills, an Irish-based NGO, provided a five-day intensive training course to 24 local healthcare professionals in Nyabondo, Kenya in November 2022, in advance of the opening of a new major trauma center which will serve the greater Kisumu region. The pre-participation knowledge, experience and skills base was surveyed. Following the completion of didactic, workshop and simulation-based training, the perceived acquired competence and applicability of skills were surveyed. The ability to provide ongoing teaching of skills acquired within local healthcare settings was evident.

Method:

Nine emergency medicine and two anesthesia doctors currently working in the Irish healthcare system traveled to Nyabondo in the Kisumu region in Kenya for one week in November 2022. A five-day course based on providing practical training addressing comprehensive trauma and acute deteriorating patient knowledge and skills was provided. This included extensive focus on the primary survey approach. A quantitative survey of 22 questions with binary answering options was used. 19 participants completed the survey, and qualitative data on the applicability of the training provided to the local healthcare resource environment was gathered.

Results:

Following surveying participants we found that the majority of participants had no previous experience or knowledge of simulation based learning. Further, a vast majority had no formal skills or educational training post completing their medical qualification.

Conclusion:

The overwhelming majority of participants felt that this training improved their confidence and competence in managing trauma and assessment of the critically unwell adult and child. 100% of participants stated they gained new skills and were confident in their ability following this training to deliver local training on an ongoing basis in their own healthcare settings.
Exploring Irish Faculty Members' Experiences of Delivering a Multi-modal Medical Education Course in a Resource-limited Environment
Authors: Breslin Deirdre , Mulcaire Jeffrey , O'Leary Anna , McKenna Roy , MacManus Bronagh , O'Sullivan Jean
Published: June 2023

Introduction:

In November 2022, a group of eleven Irish doctors traveled to St. Joseph’s Hospital, Nyabondo, Kenya with Global Emergency Care Skills (GECS), an Irish NGO. The group delivered a training course to healthcare staff in the hospital, in advance of the scheduled opening of a regional Major Trauma Center on site. This course incorporated didactic lectures, skills stations and simulated clinical scenarios and covered commonly encountered emergency presentations in low and middle income countries (LMICs).

Method:

A qualitative study was conducted using a free text questionnaire with faculty, exploring their experiences of education in a resource-limited environment. Responses were interpreted by performing thematic analysis to identify recurring themes.

Results:

All eleven faculty members completed the survey in full. An interrogation of the responses identified commonalities across the majority of faculty members. The main themes encountered were increased recognition of the lack of postgraduate training in LMICs, the challenge of devising material appropriate to a resource-limited setting, a growth in confidence and individual teaching ability, and a reaffirmation of the effectiveness of simulation teaching in medical education.

Conclusion:

This survey demonstrates the significant impact of teaching such a course on faculty members. Despite the challenges encountered, faculty members strongly felt that simulation training offered significant benefits. Survey respondents noted that moulage could be adapted to suit the needs of course participants without compromising on educational goals. In the absence of formal postgraduate education in LMICs, external agencies continue to play an important role in the delivery of structured training programs.
Novel Design of an Austere Medicine Elective
Authors: Pandit Kiran , Kingon Ashley , Todman Raleigh , Wright Melissa , Raymond Marc , Tedeschi Christopher
Published: June 2023

Introduction:

Clinicians with knowledge, skills and attitudes required in austere environments better serve their patients regardless of setting. Few opportunities traditionally exist for medical students to learn about wilderness, disaster medicine, or environmental illness. Events related to climate, disasters, and COVID-19 reinforce the need for physicians to develop tools for practice in resource-limited settings. We created a medical student elective which delivered core content related to wilderness medicine, environmental illness and disaster preparedness and response, along with overarching skills including improvisation, teamwork, and resource allocation.

Method:

Content experts partnered with educational design specialists to create a new student experience. We identified key impact areas using an analysis of courses at peer institutions, informal surveys, and published literature. Learning objectives were informed by relevant skills and content, as well as the cross-cutting goal of teaching students to perform in resource-limited settings.

A four-week curriculum was conceptualized, including lectures, workshops and skill sessions, synchronous and asynchronous online experiences, and a five-day backcountry trip focusing on in situ simulation and skills training. The course was offered in May 2021 and May 2022. Students completed post-course surveys regarding the utility of course elements, as well as teaching effectiveness.

Results:

Overall satisfaction was 3.64/4.00. Self-reported competence increased in the domains of diagnosis and pathophysiology, treatment, teamwork, and resource management and improvisation. Qualitative data suggested that students are generally under-exposed to wilderness, environmental and disaster content. Self-reported helpfulness of learning activities was greatest for small-group outdoor workshops, and least for large teleconference-based sessions.

Conclusion:

Strengths included interactive coursework reflecting teamwork, open access learning modules, and rubric-based assessment structures. Limitations include pandemic-related restrictions in group activities as well as limited objective measurements of knowledge and skills. Future goals include increasing in-person learning, dissemination of the curriculum to larger groups of learning, and development of reproducible performance measures.
Collapse of the Hard Rock Hotel in Downtown New Orleans
Authors: Maslanka Meghan , Niemeck William
Published: June 2023

Introduction:

On October 12, 2019, an 18-story building under construction collapsed in downtown New Orleans. Three construction workers were killed in the incident and their bodies were trapped in the rubble of the unstable structure.

Method:

This presentation includes public information on how and why the structure collapsed, the timeline of events for the protracted response, and feedback provided by the Urban Search and Rescue medical team about their experience and lessons learned.

Results:

The scene included a partially collapsed building still under construction, two construction cranes that were destabilized in the incident, two major roadways that required closure, several surrounding buildings impacted by debris, multiple injured workers, and three missing workers later determined to be deceased. Only two of three deceased individuals were able to be located on scene. One victim was safely recovered one day after the collapse. One victim was partially visible to the public but in an area of extreme danger to responders. His recovery required partial deconstruction of the building, which was significantly delayed due to safety, infrastructure, legal, and insurance concerns. The body of the third victim was located and recovered on day 310 of the response.

Conclusion:

The prolonged demolition of the Hard Rock collapse site resulted in emotional anguish for affected families, public anger about the perceived lack of response, and significant impacts for local businesses in the area. This event offers many lessons learned about prevention and response of urban structural collapse incidents.
You Want Me to Treat What?
Authors: Klein Kelly , Garcia Lawrence , Fogelberg Katherine
Published: June 2023

Introduction:

There are only two medical practitioners who are genuinely generalists. The confirmed generalist is the one who has been trained and credentialed to perform prenatal care, deliver babies and perform c-sections, take care of young children, perform simple surgeries, perform palliative care, and hold a patient's hand and hug the family after the death of a loved one. In the human world, that medical provider is a family practice physician. In the animal world, that provider is the veterinarian, who cares for all species that are not human and covers their medical needs, from preventive care to surgical needs, dentistry to dermatology, internal medicine to cardiology. As such, veterinarians are indeed generalist medical providers. In disasters, veterinarians are often pushed aside by their human medical counterparts. In doing so, there are a lot of learning opportunities missed on both sides.

Method:

A literature review was conducted.

Results:

n/a

Conclusion:

In learning the skills that are unique and overlapping, physicians and veterinarians will be better able to respond to disasters anywhere and will be positioned to help the displaced and injured get better so they may return to normalcy as quickly as possible. It is time that disaster teams and planning sessions stop being siloed and think about how medical generalists can team up and work together.
Medics, Mercenaries and Miscreants — A review of Canadian Medical Assistance Teams' EMT Type 1 response to the conflict in Ukraine
Authors: Fong Anthony , Rzepka Valerie , LeBlanc Jeanne , Thanh David , Scott Sarah , Kollek Daniel , Kelly Nathan
Published: June 2023

Introduction:

On February 24, 2022, Russia invaded Ukraine, resulting in Europe’s largest refugee crisis since World War II. More than six million Ukrainians fled the country—half of these to Poland—and one-third of the population was internally displaced.

Border points became bottlenecks where fatalities were reported—people risked their lives in long queues and subzero temperatures.

Method:

This presentation focuses on experiential information obtained during a 17-week deployment of EMT Type 1 both at border points (fixed) and in northwestern Ukraine (mobile). Quantitative and qualitative data were obtained after deployment by online survey with 75 medical, logistical and interpreter volunteers.

Results:

Initial teams experienced extremely fluid demands and numerous challenges with security, team adherence to COVID-19 protocols, behavioral issues with less experienced volunteers, and collaboration with novel governmental and non-governmental partners to achieve objectives.

Conclusion:

1. Deployment to a conflict setting requires adherence to the Incident Command System, with daily security briefings and structured handover between teams at the beginning of each deployment.

2. Strict adherence to well-defined protocols for the prevention and management of emerging infectious risks such as COVID-19 is necessary, along with contingency plans to isolate infected team members.

3. There is a need for standardized pre-deployment vetting, training and orientation of all volunteers—particularly team leaders.

4. Identification of international partners should start pre-deployment and remain a continuous process during deployment.
When the Tertiary Care Hospital Becomes Technologically Austere: Communication Lessons Learned from an American Health System Cyberattack
Authors: Klemann Kylie , Tackett Sierra , Seitz Daniel
Published: June 2023

Introduction:

Cyberattacks continue to plague medical systems across the world with nearly 24% of all cyber breaches impacting health systems. In Fall 2021, a large, tertiary care county hospital in Indianapolis, Indiana, USA suffered a cyberattack, causing over four weeks of downtime, forcing the system to revert to paper charting and to operate without the electronic medical record (EMR) or internet. Communication in the Emergency Department is structured through the EMR system or wireless local area network (WLAN) phones, causing communication difficulties when online systems are disrupted.

Method:

In the twelve months following the breach, a series of communications-focused interviews with stakeholders including residents, faculty, nurses, and consultants were analyzed using a thematic analysis.

Results:

Through interviews, four key themes and recommendations were identified for every internet-dependent tertiary care system to establish and maintain communication links when the primary form of communication is compromised and access to internet is limited or nonexistent:

Expect systems to fail–plan ahead

Develop multilayered communication tools that are stored and structured at different sites

Notify all affected teams immediately and initiate the downtime action plan

Reassess and adapt the downtime action plan as information becomes available

Conclusion:

While every system is going to experience different struggles during cyberattacks and downtime, all hospitals can benefit from improving communication structures when the established communication pathways are no longer available. Consider cybersecurity threats in your emergency planning meetings and designate systems to protect your communication abilities during downtime.
Patient Distribution Tool for Mass Casualty Incidents in a Large Metropolitan Setting
Authors: Booth Kathryn , Daniels Mackenzie
Published: June 2023

Introduction:

During a mass casualty incident (MCI), activating resources for response and equitable patient distribution is paramount. The Regional Hospital Coordination Center (RHCC) of a large US city lacked an objective tool readily available to manage patient distribution to area hospitals during an MCI. In a hospital-rich community, spreading the patient distribution throughout the region decreases the impact to one hospital. A tool was needed to equitably distribute patients across the healthcare system without added burden or demand to the hospitals nearest the MCI.

Method:

This tool was developed using Excel and regional hospital capability information including trauma or burn center status, pediatric designation, etc. These capabilities and geographic distances from the MCI were the driving factors of the tool development.

The city has several high-visibility, large event locations. These locations were added into the tool and can be selected as MCI origin points. From here, the tool organizes hospitals by distance from the designated point. Since the formulas were programmed into the tool, it can be easily and quickly adapted to any MCI in the area and reflect relevant resources and limitations.

Results:

Equitable patient distribution to area hospitals during an MCI is a best practice. Advance preparation is key to ensuring quick response and effective utilization of resources. Having a custom tool pre-programmed with relevant, regional hospital capabilities expedited this process and streamlined patient distribution efforts and, ultimately, improved emergency care coordination and patient outcomes.

Conclusion:

During a Mass Casualty Incident, distributing patients equitably across the healthcare system without added burden to the hospitals nearest the event is critical. Having a custom tool pre-programmed with regional hospital capabilities expedites and streamlines patient distribution efforts, ultimately improving emergency care coordination and patient outcomes.
Temporal Trends of Ambulance Times for Suspected Stroke/Transient Ischemic Attack (TIA) Before and During the COVID-19 Pandemic in Ireland: A Retrospective Cohort Study
Authors: Burton Edel , Quinn Rory , Deasy Conor , Masterson Siobhán , O'Donnell Cathal , Merwick Áine , Willis David , Kearney Patricia , McCarthy Vera , Buckley Claire
Published: June 2023

Introduction:

International reports suggest there have been prehospital delays for time-sensitive emergencies like stroke and TIA during the COVID-19 pandemic. The aim was to investigate the impact of the COVID-19 pandemic on ambulance times and emergency call volume for adults with suspected stroke and TIA in Ireland.

Method:

We conducted a retrospective cohort study of patients ≥ 18 years with suspected stroke/TIA, based on data from the National Ambulance Service. We included all cases assigned code 28 (suspected stroke/TIA) by the emergency call-taker, from 2018-2021. We compared ambulance times and emergency call volume by week, the four COVID-19 waves (defined by the Health Protection Surveillance Centre) and annually. The COVID-19 period was from March 1, 2020 - December 19, 2021 and the pre-COVID-19 period January 1, 2018 - February 29, 2020. Continuous variables were compared with t-tests and categorical variables with Pearson’s χ2 tests.

Results:

40,012 cases were included: 20,281 in the pre-COVID-19 period and 19,731 in the COVID-19 period. Mean patient age significantly decreased between the two periods, from 71 years (±16.5) to 69.8 years (±17.1); p<0.001. Mean ambulance response time increased between the two periods from 17 minutes 31 seconds to 18 minutes 59 seconds (p<0.001). The number of cases with symptom onset to emergency call time of >4 hours significantly increased from 5,581 to 6,060 during the COVID-19 period (p<0.001). Mean calls/day increased from 25.1/day to 30.1/day during the COVID-19 period.

Conclusion:

Early findings from the study suggest an increase in call volume for stroke/TIA between the COVID-19 and pre-COVID-19 periods. An increase in response times during the same periods was also found. We concluded that longer symptom-to-call times indicate a change in healthcare-seeking behavior. Sustaining high levels of compliance with stroke code protocols is crucial during healthcare crises. Future research will involve further analysis including controlling for confounders.
Developing Prehospital Care in India–A Potential Model for Low- and Middle-income Countries
Authors: Bruce David , Ramakrishnan Trichur , Patel Pankaj (Peter)
Published: June 2023

Introduction:

Road traffic accidents and natural disasters cause significant numbers of deaths and life-changing injuries in low & middle-income countries. Most of these countries have limited resources for pre-hospital care and training. In 2021, there were 155,622 deaths due to road accidents and >18,000 railway-related deaths. Natural and manmade disasters also contribute to high numbers of serious injuries and deaths in the region. India is the pilot for developing an international training course for prehospital trauma care.

Method:

A review of pre-hospital care training and ambulance services in Tamil Nadu and Kerala states of India was carried out in 2019. An international workshop on developing pre-hospital care in India was held in Chennai in October 2022. The workshop included experts from UK and India and 52 practitioners from various parts of India.

Results:

India has developed a country-wide ambulance service sub-contracted to private providers under a public-private partnership initiative and in addition, there are private and charitable providers. In-transit care and resuscitation are limited and the vehicles are primarily a transport mechanism with a scoop-and-run policy. Infrastructure, traffic congestion, rural and hard-to-reach areas, poorly equipped ambulance services and variations in training and scope of practice contribute to the challenges of providing high quality pre-hospital care.

Conclusion:

There is a need for high-quality pre-hospital care training, regulation and continuing professional development within the pre-hospital care sector. Delivery of pre-hospital care could be reinforced by wider involvement of doctors such as General Practitioners and other allied health care professionals. It was agreed by all delegates and speakers that an international course on pre-hospital care based upon an existing UK course from the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh, edited to take account of India’s current resources, should be piloted in Chennai in 2023.
Immediate Medical Care Rendered by U.S. Law Enforcement Officers After Officer-Involved Shootings – An Open-Access Public Domain Video Analysis
Authors: Keim Audrey , McGuire Sarayna , Blakeney Craig , Brand Shari , Klassen Aaron , Luke Anuradha , Maher Steven , Wood Jeffrey , Sztajnkrycer Matthew
Published: June 2023

Introduction:

After officer-involved shootings, rapid delivery of emergency medical care is critical but may be delayed due to scene safety concerns. The purpose of this study was to describe medical care rendered by law enforcement officers (LEO) after lethal force incidents.

Method:

Retrospective analysis of open-source video footage of officer-involved shootings (OIS) occurring between 2/15/2013 and 12/31/2020. Frequency and nature of care provided, time until LEO and emergency medical services (EMS) care, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board.

Results:

342 videos were included in the final analysis. LEOs rendered care in 172 (50.3%) incidents. The average elapsed time from the time of injury to LEO-provided care was 155.8 + 198.8 seconds. Hemorrhage control was the most common intervention performed. An average of 214.2 seconds elapsed between LEO care and EMS arrival. No mortality difference was identified between LEO vs EMS care (p = 0.1631). Subjects with truncal wounds were more likely to die than those with extremity wounds (p < 0.00001).

Conclusion:

LEO rendered medical care in half of all OIS incidents, initiating care on average 3.5 minutes prior to EMS arrival. Although no significant mortality difference was noted for LEO versus EMS care, this finding must be interpreted cautiously, as specific interventions, such as extremity hemorrhage control, may have impacted select patients. Future studies are needed to determine optimal LEO care for these patients.
Developing Prepositioned Burn Care-Specific Disaster Resources for a BMCI
Authors: Kearns Randy , Flores Carl , Hargrove Paige , Arledge Frances , Prats Rosanne , Kanter Joseph , Hector Chris , Woods Jason , Sittig Kevin , Carter Jeffrey
Published: June 2023

Introduction:

Disaster planning and preparedness for a burn mass casualty incident (BMCI) must consider the needs of those who will be directly involved and support the response to such an event. An aspect of developing a more comprehensive statewide burn disaster program included meeting (regionally) with healthcare coalitions (HCC) to identify gaps in care and deficiencies.

Method:

Regularly scheduled (quarterly) HCC meetings are held around the state linking stakeholders representing local hospitals, health departments, emergency medical services (EMS) agencies, and other interested parties. We were able to use the HCCs regional meetings to serve as a platform for conducting focus group research to identify gaps specific to a BMCI and to inform strategy development for a statewide approach. Additionally, we held engagement meetings with state emergency response network (a state agency that coordinates the movement of ambulances to appropriate destinations) and the Burn Medical Directors findings were vetted from the focus groups.

Results:

One of the deficiencies identified, included a lack of burn-specific wound care dressings that could support the initial response. Relying on this same process, a consensus was attained for equipment types and quantities, including a kit for storage. Furthermore, a maintenance, supply replacement, and delivery to the scene processes were developed for these kits of supplies that could augment a BMCI response.

Conclusion:

Focus group feedback reminded us that outside of the world of burn care, many report an infrequent opportunity to provide care for patients with burn injuries. Several types of burn-specific dressings can be expensive, and with the occurrence being infrequent. EMS agencies and rural hospitals alike reported that it was unlikely their agency/hospital would have more than a minimal stock of burn injury supplies. Developing supply caches that can be quickly mobilized and deployed to the impacted area was one of the deficiencies we addressed.
Emergencies as Catalysts to Invest in the Health Workforce
Authors: Nitzan Dorit , Benin-Goren Odeda
Published: June 2023

Introduction:

Emergencies provide opportunities for deep systemic intra-action and after-action reviews, followed by changes and adaptations that are aimed at enhancing resilience against future health emergencies. One of the most prevalent lessons learned from the COVID-19 pandemic is the need to intensify the investment in the health workforce. Diverse groups of health workers have brought their expertise from the benches to patients’ beds, and the desks of the decision-makers.

Method:

Match skill mix of health staff with the needed level of care: those with mild diseases can be cared for by basic nursing staff. Critical patients require advanced skilled nursing that is familiarized with advanced technologies such as ECMO, and use “out-of-the-box” thinking.

Developing the capabilities of the communities and civil society organizations to respond to emergencies. Cooperation agreements with partners that are not involved in medical care during “regular days” should be set before emergencies strike.

Formulate civil-military-police cooperation as well as the Good Samaritan Law is an important legal instrument to allow for humanitarian aid from within and outside the country.

Results:

Matching the skill mix of the health staff with the needed level of care for basic nursing for minor patients as well as advanced nursing for critical patients, while using “out of the box “ thinking to develop a high level of knowledge is important to maintain quality care during emergencies.

Conclusion:

The COVID-19 pandemic and other emergencies provide us with the opportunity to switch from bouncing back to bouncing forward, and from just coping to anticipating and transforming. Investing in the health workforce would enhance preparedness and readiness so that emergencies will not turn into disasters and crises. The presentation will highlight some of the new approaches and methods applied during the COVID-19 outbreak, as well as those applied in countries that are faced with wars and military conflicts.
Use of Postmortem Computed Tomography in Disaster Victim Identification: Current Japanese Methods and Challenges
Authors: Yoshida Maiko , Motomura Ayumi , Makino Yohsuke , Saito Hisako , Iwase Hirotaro
Published: June 2023

Introduction:

In Japan, victims of large-scale disasters are usually identified by non-objective means. In the case of the 2011 Great East Japan Earthquake, ~90% of the bodies were identified based on nonobjective means such as facial features or belongings, which resulted in misidentification. At present, the situation remains the same. However, according to global standards, a method referred to as “disaster victim identification” (DVI; individual identification of disaster victims) is recommended by the International Criminal Police Organization; in this method, a multidisciplinary investigation team integrates objective information such as dental charts and DNA. Furthermore, recently, there has been a movement to employ postmortem computed tomography (CT) for personal identification, and radiologists are expected to be included in the DVI team.

Method:

In the Department of Legal Medicine of Chiba University in Japan, individual identification via CT or magnetic resonance imaging was conducted in forensic autopsy cases of unknown identities when there was an assumed person for the body and the antemortem image of the person could be acquired. Two certified radiologists interpreted and compared the antemortem CT with the postmortem CT taken prior to autopsy and assessed whether the two images were compatible to indicate the same person.

Results:

A total of 20 cases were judged. In all cases, two images were compatible, indicating the same person. Image-based identification was particularly useful when dental findings or fingerprints were unavailable for comparison and there were no family members available for DNA testing.

Conclusion:

In the future, this method will be applied to large-scale disasters.
Clinician Consensus on “Inappropriate” Presentations to the Emergency Department in the Better Data, Better Planning (BDBP) Census: A Cross-sectional Multi-center Study of Emergency Department Utilization in Ireland
Authors: Cummins Niamh , Barry Louise , Garavan Carrie , Devlin Collette , Corey Gillian , Cummins Fergal , Ryan Damien , Deasy Conor , McCarthy Gerald , Galvin Rose
Published: June 2023

Introduction:

Utilization of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing avoidable attendance is an important area for intervention in the prevention of ED crowding. This study aims to develop a consensus among clinicians across care settings about the “appropriateness” of attendance at the ED in Ireland.

Method:

The Better Data, Better Planning study was a multi-center, cross-sectional study investigating factors influencing ED utilization in Ireland. Following ethical approval, data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels.

Results:

The National Panel determined that 11% (GP) to 38% (EMC) of n=306 lower acuity presentations could be treated by a GP within 24-48h (k=0.259; p<0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered “inappropriate” (k=0.341; p<0.001). For attendances deemed “appropriate” the admission rate was 47% compared to 0% for “inappropriate” attendees. There was no consensus on 45% of charts (n=136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0-59% and for inappropriate attendances ranged from 0-29%. For the Local Panel review (n=306) consensus on appropriateness ranged from 40-76% across sites.

Conclusion:

Multidisciplinary clinicians agree that “inappropriate” use of Irish EDs is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogeneous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.