bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of the Six C's Psychological First Aid Model on Acute Stress Responses in a Simulated Emergency Situation
Authors: Farchi Moshe , Gidron Yori
Published: June 2023

Introduction:

Arrival to the emergency room (ER) can increase stress levels in patients and family members. Thus, there is a need for a short and effective form of PFA provided by ER staff members, to reduce acute stress responses (ASR). Past studies have shown that psychological interventions based on emotional expression do not help to regulate extreme emotional expressions nor does it prevent post-traumatic stress disorder (PTSD). Alternatively, the Six C's model adopts a neuropsychological approach that focuses on cognitive communication, challenging for efficient activation, organizing the event's chronological order and reduction in loneliness by committing to stay with them. This experimental design study examined the effectiveness of the Six C's model on reducing signs of ASR.

Method:

Sixty-three participants (mean age 41.8 years) voluntarily took part. They were randomly assigned to the Six C's intervention (experimental condition) or to supportive emotional expression (control condition). They listened to a three minute audio recording of a real emergency 911 phone call. Interventions (SIX C's or emotional) were provided before and after listening to the recording. Before, immediately after, and five minutes after the recording, participants' anxiety, heart-rate variability (HRV) and mental resilience levels were measured.

Results:

For all three outcomes, the Time x Group interactions were statistically significant. Following "simple effects", analysis revealed that The Six Cs participants showed lower anxiety and less reductions in HRV and resilience than controls immediately after the stressor. Furthermore, the Six C's participants recovered faster on all three outcomes compared to controls, five minutes after the stressor.

Conclusion:

This study showed the Six C's model moderates people's ASR. Furthermore, the Six C's method helps people to "bounce back" faster psychologically and neuro-physiologically. These findings support using the Six C's model to reduce ASR and increase resilience, which is highly relevant to ER staff.
Festina Lente: Bradycardia as a Presenting Feature of Life-Threatening Intra-Abdominal Hemorrhage
Authors: Andrews Robin , Orsmond Brendan , Abraham Ria , Bilal Muhammad , Conradie Maria , Dowle Ashleigh , Rensburg Rochelle Janse Van , Jordaan Phillip , Kelly Thomas , Kennedy Keith , Smit Marco , Taqvi Syed Yousuf Raza , Vegte Andrea Van Der , Vythilingam Darshini , Wickham Bryce , Molloy Michael
Published: June 2023

Introduction:

Trauma is one of the leading causes of death in patients under 40 years of age. The Advanced Trauma Life Support (ATLS) Guidelines are widely accepted as the standardized approach to trauma and classify hemorrhagic shock according to heart rate (HR), blood pressure (BP), urinary output, and mental status. Paradoxical bradycardia (defined as HR <60 bpm) in hemorrhagic shock is an uncommon presenting feature and presents a diagnostic challenge to the physician; its true incidence is unknown.

Method:

A case of paradoxical bradycardia was examined as a presenting feature in hemorrhagic shock.

Results:

A 17-year-old male patient presented to our Emergency Department (ED) with collapse and abdominal pain following a collision with another player during a sports match.

The patient was hypotensive (BP 92/42) and bradycardic at triage, with a heart rate of 50. He was pale and diaphoretic with a Glasgow Coma Scale of 13/15, thready pulses, and localized peritonitis in the left upper quadrant of his abdomen.

An increase in blood pressure was observed following initial fluid resuscitation; however, this was transient and preceded the onset of profound hypotension (BP 64/30). Bradycardia with a heart rate between 50-60bpm was persistent despite resuscitative efforts.

Abdominal ultrasound demonstrated intraperitoneal free-fluid, and Computerized Tomography confirmed the presence of a grade V splenic laceration. He was taken to the operating theater for emergency laparotomy and underwent splenectomy. A 2.3 liter hemoperitoneum was found intraoperatively. There were no further complications post-operatively, and he made a full recovery.

Conclusion:

Tachycardia is a potentially unreliable marker of blood loss, especially in young, healthy patients. A high index of suspicion is necessary to prevent this uncommon but life-threatening feature of hemorrhagic shock from being overlooked.
Educating the Public for the Nuclear Reality: Understanding Likely Behaviors in the Aftermath of a Nuclear Detonation
Authors: Taylor Morgan , Andino Stephanie , Zwald Zachary , Berejikian Jeffrey
Published: June 2023

Introduction:

Amid the escalating nuclear arms race in the latter half of the 20th century, civil defense preparedness drills, commonly known as “Duck-and-Cover” drills, were practiced throughout classrooms in the United States. Since then, education and preparedness measures have been largely replaced by fire evacuation and active shooter drills. This study endeavored to understand the likely actions that members of the public may take in the event of a nuclear detonation in the 21st century.

Method:

Scenarios for 5 kiloton and 100 kiloton near-surface nuclear detonations were modeled using the Hazard Prediction Assessment and Capability (HPAC) software. A video was created animating the models with a voiceover that explained the initial effects of a nuclear detonation. Using the Qualtrics platform, a survey was created in which the order of behavior-based questions and the video was randomized. Lucid distributed the survey to a representative sample of the American public.

Results:

Among 3,087 participants, only 921 (30%) indicated their confidence in knowing what to do in the event of a nuclear detonation in their city. Participants were most likely to listen to the radio, hide in an interior room, and seal windows or doors. Two thirds indicated they would “duck and cover” (n = 2034, 66%), an action that ranked below helping others (n = 2183, 71%) and wearing a mask (n = 2174, 70%). Study participants who indicated their likely behaviors after watching the video were significantly more likely to listen to the radio (p = 0.044) than those who answered such questions before watching the video.

Conclusion:

The results of this study suggest there remains a need for emergency preparedness education for members of the public in the United States. As the threat of a nuclear detonation grows, educational methods such as video explanations may increase the preparedness of the American public.
The Usefulness of a Digital Whiteboard for Communication During Disasters
Authors: Iwasaki Megumi , Shoko Tomohisa , Ogawa Mayu , Suzuki Tensei , Asakura Yuri , Mochida Yuzuru , Tanizawa Shu , Kuriyama Keiichi , Nakamoto Raira , Kojima Mitsuaki
Published: June 2023

Introduction:

Information sharing during disasters tends to be confusing. We started the trial operation of a digital whiteboard (DWB) as a communication tool during disasters in 2019 and fully introduced it in 2022. The DWB is a large tablet that allows interactive communication in close to real-time in remote locations through Wi-Fi.

Method:

To verify the usefulness of the system, DWBs were placed at triage posts in severely, moderately, and mildly damaged areas during a 2022 disaster drill responding to mass casualties to facilitate the sharing of patient information between Disaster Response Headquarters and each treatment area. In each treatment area, doctors, nurses and paramedics completed a standard form to share information about each patient. Information collected included the triage tag number, patient name, age, gender, type of injury or disease, and description of the treatment.

Results:

Six DWBs were remotely shared, with the triage post noting the number of patients passing through each severity level, and each treatment area noting the treatment status of each patient. The Disaster Response Headquarters replied with the results of adjustments such as hospitalization ward and time to start surgery. The descriptions were reflected in the remotely shared DWBs in about one second. Text conversations through the DWBs were also seen. In the post-event survey, some said that the smooth sharing of information led to quick decisions. Compared to conventional radios, DWBs have the advantage of allowing communication through text, which allows more detailed and accurate patient information to be communicated quickly. The results suggest the survival rate can be improved by assisting early medical intervention or rapid entry of patients into operating rooms. The next goal is to use DWBs for medical coordination among disaster base hospitals.

Conclusion:

DWBs are effective for the rapid and accurate sharing of patient information during disasters.
Adolescents Exposed to Cumulative Natural Disasters: A Comparison Between their Realities in Rural and Urban Areas
Authors: Pouliot Eve , Maltais Danielle , Gervais Christine , Tardif-Grenier Kristel , Simard Ann-Sophie , Gauthier Pascal , Maltais-Dufour Olivia , Hamel Ariane
Published: June 2023

Introduction:

Over the past years, the Outaouais region (Quebec, Canada) and their residents have had to endure no less than five natural disasters (floods, tornadoes). These disasters are likely to have a variety of consequences on the physical and mental health of adolescents, as well as on their personal, family, school and social lives. The experiences of teenagers are also likely to vary depending on whether they live in rural or urban areas.

Method:

Data were collected via a self-administered questionnaire in February 2022. A total of 1307 teenagers from two high schools participated in the study by completing an online survey. The questionnaire measured various aspects of the youth's mental health using validated tests, such as manifestations of post-traumatic stress, anxiety and depression, as well as the presence of suicidal thoughts and self-harm. Other aspects of the youth's experience were measured, including their level of social support, school engagement, alcohol and drug use, and coping strategies.

Results:

One third of young students (n=1307) were experiencing depressive symptoms and suicidal thoughts, as well as significant daily stress. More than 25% of the students had moderate or severe anxiety and thoughts of self-harm. These problems were significantly more prevalent among youths with prior exposure to a natural disaster. The study data also revealed that youths living in rural areas had a more worrying profile than those living in urban areas.

Conclusion:

Similar to other studies (Ran et al., 2015; Stratta et al., 2014), our research data revealed that youths living in rural areas presented a more concerning profile than those residing in urban areas. It therefore seems important, in future studies and services, to focus more specifically on these teenagers to better understand their needs and to develop adapted services more likely to meet them.
The Advancement of the Scientific Study of Prehospital MCI Response from TIIDE to NIGHTINGALE: A Scoping Review
Authors: Weinstein Eric , Cuthbertson Joseph , Herbert Teri Lynn , Bortolin Michelangelo , Magalini Sabina , Gui Daniele , Helou Mariana , Faccincani Roberto , Ragazzoni Luca , Caviglia Marta
Published: June 2023

Introduction:

The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects’ objectives, the NIGHTINGALE consortium adapted the Translational Science (TS) process. The aim of this study is to perform the first TS (T1) phase PRISMA scoping review to extract data that will be used to guide the creation of the initial evidence-based second TS phase (T2) modified Delphi statements for a subsequent study.

Method:

The consortium was divided into three work groups (WGs) MCI triage, Prehospital Life Support and Damage Control (PHLSDC) and Prehospital Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping review with a common research strategy sharing MCI related search terms and then terms specific for each WG. Final included articles went through data extraction based on identified themes and sub-themes from PH MCI response literature to be used to create the future statements.

Results:

The initial search yielded 925 total references to be considered for a title and abstract review (PH Triage 311, PHLSDC 329, PHP 285), then 483 articles for a full reference review (MCI Triage 111, PHLSDC 216, PHP 156) and 155 articles for the database extraction process (MCI Triage 27, PHLSDC 38, PHP 90).

Conclusion:

The progression of the study of prehospital MCI response enabled NIGHTINGALE partners to methodically obtain information that will contribute to each WG’s creation of initial T2 modified Delphi statements.
Test Characteristics of Stool Color for Predicting Infection with Vibrio Cholerae in Patients with Acute Diarrhea
Authors: Gainey Monique , Qu Kexin , Garbern Stephanie , Nasrin Sabiha , Alam Nur , Schmid Christopher , Nelson Eric , Levine Adam
Published: June 2023

Introduction:

Recurring outbreaks of cholera coupled with lack of laboratory diagnostic capacity in low resource settings fuels clinicians’ reliance on clinical case definitions and highlights the importance of accurate diagnostic guidelines. While “rice-water” stool color is the hallmark predictor of cholera, few have examined the diagnostic accuracy of this assessment. This study assesses the sensitivity, specificity and positive and negative predictive value (PPV; NPV) of classifying stool color as “rice”, “clear” (i.e. watery) or “rice or clear” stool by either the patient or nurse for diagnosing cholera.

Method:

From March 2019-2020, a random sample of patients presenting to the International Centre for Diarrhoeal Diseases Research, Bangladesh with acute diarrhea who had a stool sample obtained were included in this analysis (N=2135).

Results:

Of the 1198 (56.1%) of patients that had culture growth, 641 (53.5%) were positive for Vibrio cholerae. “Rice” stool was reported by 518 (23.8%) patients and 640 (29.5%) nurses, while “clear” stool was reported by 1081 (49.8%) patients and 353 (16.3%) nurses. When observed by nurses, both “rice” (76%) and “clear” (85%) stool were reasonably specific but not very sensitive for cholera (44% and 20%, respectively). The combined “rice or clear” colored stool had the best balance of sensitivity (65%) and specificity (61%) with a PPV of 42% and NPV of 80%. When reported by patients, “rice” stool had high specificity for cholera (76%) but low sensitivity (25%), while “clear” stool had both poor sensitivity (54%) and specificity (51%).

Conclusion:

Current international guidance that recommends classifying watery (clear) stool as cholera in outbreaks may still miss many patients with culture confirmed cholera even when the stool color is observed by trained health professionals and is likely not useful at all self-reported by patients. The combination of “rice or clear” diarrhea may provide somewhat more accurate assessments.
Hospital Workforce Education and Training for Emergency Management and Disaster Response in Complex Settings.
Authors: Gowing Jeremy , Mather Carey , Elmer Shandell , Cummings Elizabeth
Published: June 2023

Introduction:

Understanding how to best prepare hospital staff for disasters or emergencies is critical, as there is increasing frequency and scope of these events. Considerations include: identifying key staff, their roles, strategies to support continuity of care, delivery mode of education, and resource allocation.

Method:

Participants experienced in disasters and major emergencies or preparation at three tertiary referral teaching hospitals were purposively selected during 2016 and 2019. An interpretive paradigm and case study design enabled the exploration of perspectives concerning effective and preferred methods for preparedness. Fifty-five allied health professionals, medical practitioners, and nurses participated in semi-structured interviews; and support staff participated in focus groups.

Results:

Key findings: 1. Recognition that allied health professionals and support staff are essential and must be included in disaster or major emergency preparation and plans. 2. Factors that increase the likelihood of staff deciding to be absent from work include: perception of danger, insufficient understanding of responsibilities, and hospital preparation is perceived inadequate. Staff understanding their role has a positive influence for attendance and coping during disasters. 3. Preferred and most effective method of disaster preparedness is practical learning, combined with other preparation methods. Online learning as the major mode was unpopular. 4. Challenges of inadequate resources limits managers’ ability to facilitate staff preparation and care delivery during disasters. Resources affect method, duration and multidisciplinary inclusion in disaster preparation.

Conclusion:

This research found disaster preparedness in hospitals is critical. Site and occupation specific differences need to be addressed. To mitigate impacts of disasters or major emergencies, preparation must include identification of required resources. Disaster preparedness and management must be inclusive of multidisciplinary staff, including allied health and support staff. Facilitation of role understanding to promote continuity of care during disasters or major emergencies is imperative to promote staff participation and effectiveness in response to disasters.
Le Grand Départ 2019 - health care management during a major planned event in the heart of Brussels (Belgium)
Authors: Spaepen Kris , Hubloue Ives
Published: June 2023

Introduction:

Mass gathering events (MGE), can attract sufficient attendees to strain the planning and response resources of the host community, state, or nation, thereby delaying the response to emergencies. The organization of such a MGE can be even more problematic when the event continues across much of downtown (including hospitals) and makes some parts of the city inaccessible. The aim of this study was describing the health care management of the Grand Départ of the Tour de France, July 6-7th, 2019. On both days, the stages drew crowds of 300,000 attendees, adding a quarter of the regular number of inhabitants of Brussels (1,2 million) and closing parts of downtown Brussels.

Method:

Data were retrospectively collected from the in-event health services (coordinated by the University Hospital Brussels). Data regarding medical interventions, as well as data generated by the advanced medical posts (AMP) were recorded and handed to us after anonymization. For analysis, patients were divided into two groups: those seen by first-aid responders and paramedics (triage code green) and those seen and treated by health professionals (emergency nurses and physicians) (triage codes yellow or red).

Results:

During the event, three AMPs were established along the route of the stage as were six ambulances, three mobile medical crews (one emergency nurse and one physician), and seven mobile first aid teams. Over the two days, 84 patients were seen; 80 green codes (95,2%), 3 yellow (3,6%), and one red (1,2%) resulting in a patient presentation rate of 0.28/1,000. In total eight patients were transported to hospital for further diagnosis and treatment (ambulance transfer rate: 0.02/1,000).

Conclusion:

In-event health services for this event proved adequate according to the number of attendees and the severity of the patients. No hospital reported disruptions to their standard operational capacity.
What Has Changed? A Bibliometric Analysis and Visualization of Research in Mild Traumatic Brain Injury
Authors: Liu Tao , Li Ji , Cao Chunxia
Published: June 2023

Introduction:

People around the world are affected by traumatic experiences, ranging from collective events like natural disasters, mass violence, war, terrorism and to personal, even "everyday life" traumas such as road traffic accidents and the sudden football attack. The mTBI caused by traumatic events is a significant public health international matter. There is a greater demand for mTBI research from all cultures and societies. This paper attempts to explore the research status, focus and challenges by using a bibliometric analysis on mild traumatic brain injury (mTBI).

Method:

Publications on mTBI were retrieved from the Web of Science Core Collection by the title advanced search strategy from January 1, 2000, to October 31, 2022. Articles and reviews were included, and no language restrictions were applied. Microsoft Excel, RStudio, VOSviewer, and CiteSpace were used to extract, integrate and visualize the bibliometric information.

Results:

A total of 3,464 documents were retrieved from 2000-2022, with a general upward trend despite slight fluctuations in annual publications. The USA had an overwhelmingly dominant position in terms of both the number of publications (n = 2 028) and citations (n = 63 287). The Department of Veterans Affairs (n = 380) and Veterans Health Administration (n = 370) were the most productive institutions. Collaborations in cross-national, cross-institutional and different authors were weak. Iverson GL was the leading scholar and the Journal of Neurotrauma and Brain Injury were the most influential journals. Based on keyword co-occurrence analysis, the research focus could be divided into four clusters: epidemiology and prevention, characterization of mTBI, outcome assessment and prognosis.

Conclusion:

The mTBI research has drawn increasing attention over the years. However, the research on mTBI is still relatively limited and challenging, and collaborations that cross national, institutional, disciplinary, and sector boundaries are important to the advancement of improving mTBI worldwide.
Challenge for the Green Response: Reduction of Impact on the Environment by Emergency Medical Team
Authors: Nakade Masaharu
Published: June 2023

Introduction:

Environmental degradation and climate change can lead to humanitarian crises and undermine humanitarian operations. Therefore, Emergency Medical Teams should try to reduce environmental impacts.

Method:

Collaborative development with companies was started by trimming the weight of tents, improving lights, and introducing renewable energy to our emergency medical unit to reduce greenhouse gas emissions.

Results:

The mechanism of the medical tent, and materials was changed. The weight of tents was cut by 30%. The final goal is to develop an 8 x 6 meter tent which is set up by four women.

Light-weight and low-power tent light was created. It is 50% weight and 60% power consumption of our conventional light.

All the power of the emergency clinic was run by renewable energy. introducing a 1 x 2 m, 5,5kg solar panel that produces 350 Wh/day. If 18 panels were put on the tent roof, they produce 6,300 Wh. This is equivalent to the power consumption of a standard household in Japan, and it is estimated this can cover the power consumption of the patient department of the emergency clinic. Experimental tests will now be conducted.

Conclusion:

Nowadays, even emergency medical teams are required to reduce their impact on the environment on the field. Therefore, trying to reduce the greenhouse gas emissions from the emergency medical team. The challenge is still on the way, but marching steadily.
Introducing Advanced Paramedics into the Rural General Practice Team in Ireland – General Practitioners Attitudes
Authors: Feerick Fintan
Published: June 2023

Introduction:

As Ireland's population increases and chronic disease becomes more prevalent, demand for limited general practice services will increase. Nursing roles within a general practice are now considered to be standard, yet alternative non-medical professional roles are under-explored within an Irish context. Non-medical personnel such as Advanced Paramedics (APs) may have the capability to provide support to general practice.

Method:

A sequential explanatory mixed methodology was adopted. A questionnaire was designed and distributed to a purposeful sample of GPs attending a rural conference followed by semi-structured interviews. Data was recorded and transcribed verbatim and thematically analyzed.

Results:

In total n=27 GPs responded to the survey and n=13 GPs were interviewed. The majority of GPs were familiar with APs and were receptive to the concept of closely collaborating with APs within a variety of settings including out-of-hours services, home visits, nursing homes, and even roles within the general practice surgery.

Conclusion:

GP and AP clinical practice dovetail within many facets of primary care and emergency care. GPs believe that current models for providing rural general practice care are unsustainable, and they realize the potential of integrating APs into the general practice team to help support services into the future. These interviews provide a detailed insight into the opinions of rural general practitioners in Ireland on healthcare provision and the clear necessity for support and change.
Challenges and Complexities of Providing Emergency Medical Services During Covid-19 Pandemic in Nepal
Authors: Maharjan Ramesh , Thapaliya Sabin , Tamang Prasun , Maharjan Rashmisha
Published: June 2023

Introduction:

During the Covid-19 Pandemic, the Department of Emergency Medicine is the one of most busy in Nepal. Challenges and complexities of providing emergency medical service during the waves of the Covid-19 pandemic in Nepal were analyzed.

Method:

Three years (2020 – 2022) of data was analyzed from Covid patients registered in Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine for reference with National Data of Ministry of Health and Population, Government of Nepal.

Results:

On November 15, 2022, there were 5,969,338 Covid PCR tests and 1,452,639 Covid Antigen tests in Nepal with 1,000,826 (16.8%) PCR, 152,197 (10.5%) being positive. The cure rate was 98.7% (988,316 cases). There were 12,019 mortalities with 1.2% case fatality. In TUTH 2020 – 2022 records; 3,794 total severe Covid-19 patients were admitted; In the first year, only two patients (1M:1F); In the second year 2,056 patients 1.8M:1F and in the third year 1,736 with 1.1M:1F. The age groups with the first wave vs the second wave were 6.42% vs 5.47% of 0-20 years; 24.22% vs 26.84% of 21-40 years; 30.57% vs 30.87 of 41-60 years and 38.57% vs 36.87% of above 60 years. The hospital mortality rate was 751 (19.8%). Challenges were due to resource limitation, limited PPE, scarcity of oxygen, medication, and ventilators. In TUTH, all levels of emergency management and various definite care were provided 24/7 hours in the pandemic period. There are a lot of challenges in Pre-Hospital Emergency Care Service due to a limited number of designated Advance Ambulances during transportation of severe Covid patients. With these challenges and complexities, there were six deaths of their own hospital staff due to severe Covid-19.

Conclusion:

The challenges and complexities of providing emergency medical services during the Covid-19 pandemic in Nepal have been overcome with teamwork and activation of the emergency care system in Nepal.
Starting Points for Promoting Disaster Resilience in Home Nursing Care in Germany–A Participatory Development Process
Authors: Ewers Michael , Lessines Sanne , Kibler Angelina , Gröbe Sebastian , Köhler Michael
Published: June 2023

Introduction:

In Germany, more than 3.3 million people in need of long-term care are receiving home care. Although not all of them use professional home care providers, their services are essential especially to those who need skilled nursing care and medical-technical assistance in addition to everyday support–such as approximately 30,000 people who receive home mechanical ventilation. Little is known about the disaster resilience of home care infrastructures and ways to strengthen them. A research consortium called AUPIK, funded by the German Federal Ministry of Education and Research from 2020-2023, sought to close this gap.

Method:

A participatory process was initiated as part of the AUPIK project based on results of a multi-perspective empirical baseline analysis which resulted in a first draft text about measures to promote disaster resilience in home care. 37 representatives of home nursing care providers and community health-care services, professional boards, scientific and education institutions participated in a web-based survey on the draft text, followed by two digital group discussions. Finally, the gradually revised, condensed and consented starting points were published and distributed.

Results:

Eight starting points were defined. Among others, there is an urgent need to strengthen risk awareness and resource management among home care providers, to promote individual disaster competence and preparedness among all parties involved and, not least, to strengthen community-based networking initiatives between home care providers, emergency and disaster organizations and local authorities. Institutions or persons who should take responsibility for implementation at different levels are addressed directly.

Conclusion:

The final version of the starting points represents a consensus on urgently needed initiatives to promote disaster resilience in home nursing care in Germany. The participatory development process should support commitment on the part of all stakeholders and thus promote effective implementation of disaster resilience initiatives in home nursing care.
Lodgers, Boarders, Trolley Patients; A Growing Challenge in Emergency Departments (ED). Zero Tolerance for Trolleys or Zero Tolerance for Zero Trolleys; A Crude Examination of Progressive Capacity Issues in an Irish Emergency Department.
Authors: Conradie Maria , Smit Marco , Abraham Ria , van der Vegte Andrea , Bilal Muhammad , Orsmond Brendan , Andrews Robin , van Rensburg Rochelle Janse , Taqvi Sayed Yousuf Raza , Jordaan Phillip , Dowle Aishleigh , Vythilingam Darshini , Wickham Bryce , Kelly Thomas , Molloy Michael
Published: June 2023

Introduction:

The Health Information and Quality Authority (HIQA) Tallaght Report of 2012 found care of lodged admitted patients on ED trolleys was undermined in terms of quality and safety. HIQA advised the practice of lodging in ED adjacent hospital corridors should be discontinued entirely. This message was reiterated during the pandemic. Some lodged patients may spend the total duration of their admission on an ED trolley. ED has 15 Adult rooms, seven pediatric rooms, two minor injury rooms, one procedure room and two resus bays. The aim was to calculate the annual number of days when no admitted patients were lodged on trolleys in ED.

Method:

A descriptive study using data available from nationally issued reports on patients allocated to trolleys to the ED of Wexford General Hospital from January 2019-September 2022. Data was collected from national HSE daily SBAR reports. “Lodged patients” were those present in ED admitted but for whom no ward bed existed at 0745 daily.

Results:

Data was collected for 1,369 days, 90 days were excluded due to missing data sets, and data were included for 1,279 days. 290 days were recorded in 2019 with no lodged patients, 126 in 2020, 55 in 2021, and only 11 days in 2022 with no lodged patients. In 2022 the average number of lodged patients was six (Range 0-19). A total of 47 days had a lodged count of ten or greater.

Conclusion:

Despite a strong recommendation from HIQA to terminate the practice of ED patient lodging, this has not been implemented. During the COVID-19 pandemic, there had been a reduction in the overall number of patients visiting the ED. This contributed to the reduction in trolley-lodged patients however post-COVID pandemic there has been a surge in attendance with a clear deficit in bed capacity.
Retrospective Analysis of Patient Presentations at Belgium's Largest Multi-day Outdoor Hardstyle Dance Event
Authors: Spaepen Kris , Beens Kevin , Cardinas Robby , Hubloue Ives
Published: June 2023

Introduction:

Electronic dance music festivals (EDMF) are a unique subset of music mass gatherings. Besides the already more significant burden on in-event health services (IEHS) that comes with these festivals, EDMF are also known for their illicit drug use, with their attendees at high risk for illegal drug use.

Method:

Encounter data from all patients seen and treated by IEHS at an annual outdoor multi-day EDMF (focused on hardstyle dance music) in August 2019 were analyzed. Based on the chief complaint, and medical and nursing notes, a list was consolidated into 31 reasons for the consultation of IEHS. The most common reasons for consulting IEHS were analyzed.

Results:

This outdoor hardstyle dance event had 30,000 attendees, of which 580 visited IEHS. This resulted in a patient presentation rate of 19.3/1,000 attendees. Four were transported to the hospital (transport to hospital rate: 0.13/1,000 attendees). The most prevalent reason to consult IEHS were lacerations and abrasions (9.66%), sprains (9.48%), and headaches (7.59%). Only 4.83% of all patients (n = 12) presented with adverse effects of illicit drug use. Of interest is that twelve patients with intoxications (42.86% of all intoxicated patients) were initially triaged as life-threatening, mainly due to obstructed airways. Only one of these twelve needed endotracheal intubation and was transported to the hospital. All other intoxicated patients returned to the event. No direct relationship between gender and the chief complaint was found.

Conclusion:

Besides typical patient presentations, illicit drug use with its adverse effects can seriously impact IEHS. These results confirm the need for highly trained (Advanced life support level) IEHS at EDMF. Competent IEHS can mitigate the burden of these events on regular EMS.
A New Model for Postgraduate and Continuing Education in Disaster and Terror Medicine
Authors: Braitberg George , Smith Erin , Knott Jonathon
Published: June 2023

Introduction:

Postgraduate education is important in preparing and enhancing health professionals for the practice of disaster and terror medicine. The World Association for Disaster and Emergency Medicine (WADEM) has formulated a standardized international perspective for education and training in disaster medicine and health. Notwithstanding, there continues to be a reported gap in competency-based training in disaster and terror medicine internationally, particularly across Asia Pacific, which is a known vulnerable region. We report on a new Graduate Diploma in Disaster and Terror Medicine, to be expanded to Master level in 2024. The course is delivered mainly online to a multidisciplinary international audience. This paper summarizes the development of the course and outlines the key influences that have contributed to the design of the course.

Method:

A survey of the critical care workforce conducted by the Department of Critical Care at the University of Melbourne in early 2020 identified the need to develop education in disaster and terror medicine. A market and competitor analysis identified there was a gap in clinician focused courses offered in Australia and internationally. Based upon these results, a new course was developed to meet these needs.

Results:

Based on the results of the survey and feedback from expert stakeholders, the new postgraduate courses in disaster and terror medicine were developed. They offer both core and elective subjects, utilizing a modular approach with supervised simulation and practical training. The courses incorporate problem-based learning, the principles and practices of online education and advances in simulation-based learning, providing both a public health and clinical lens.

Conclusion:

The nested suite of postgraduate disaster and terror medicine courses at the University of Melbourne is at the forefront of learning within this field and meets the contemporary needs of health professionals who practice disaster and terror medicine
Delphi Process Recommendations for Pediatric Disaster Medicine Training Curriculum Key Competencies
Authors: Grodman Schyler , Hard Alexander , Hertelendy Attila , Woodward Christina , Voskanyan Amalia , Issa Fadi , Weiner Debra , Ciottone Greg
Published: June 2023

Introduction:

Children differ from adults, developmentally, physiologically, and psychologically. Additionally, children lack legal agency, and thus rely on adults to gain access to the healthcare system and other resources. Though children are often the face of disaster relief, the desparate needs of children can fall through the cracks during disaster response. Many training programs for disaster responders do not give pediatric concerns and issues the appropriate attention they deserve. Pediatric disaster medicine is often minimally addressed in emergency medicine residencies and prehospital provider training. Furthermore, pediatric disaster supplies and protocols are often lacking and insufficient to meet the needs of children during and after disasters.

Method:

This is a modified Delphi study. An initial set of pediatric disaster medicine competencies from a systematic review of PubMed, EMBase and the gray literature will be presented to an initial group of Subject Matter Experts (SMEs) comment, additions, and edits. This modified set of competencies will then be distributed to a large group of providers with experience in the field. Through a series of surveys, each competency in the curriculum will be rated. Those competencies which achieve a high overall rating will be reported.

Results:

Data collection and analysis expected to be completed by April 2023.

Conclusion:

This modified Delphi study will establish and prioritize a set of core competencies for pediatric disaster response based on expert recommendations. The use of such gold standard core competencies to develop discipline-role-specific pediatric disaster training can increase pediatric disaster workforce capacity and competency critically needed to improve pediatric disaster response.
Disaster Medical Responder’s Course for Training of Field Medical Teams in Singapore
Authors: Pek Jen Heng , Yeo Yi Wen Mathew , Teng Kuan Peng David , Lee Chan Yu Jimmy , Quah Li Juan Joy
Published: June 2023

Introduction:

Casualties need to be triaged, stabilized and treated before they can be evacuated to the hospital. However, when Field Medical Teams (FMTs) arrive at the First Aid Post (FAP), the staff has to perform outside of their usual settings. There are also differences in the conception of medical operations, organization of the FAP, availability of medical equipment and supply, as well as means of communication, command, and control which can affect their performance and eventually the optimal survival of casualties during a mass casualty incident.

Method:

Guided by Kern’s model for curriculum development, Disaster Medical Responder's Course (DMRC) was developed. The curriculum focused on disaster response operations and processes; roles and responsibilities; command, control and communication; as well as supplies and resources. The content was taught through interactive lectures and skill stations. Course evaluation was based on the Kirkpatrick Model. A feedback form evaluated the reaction of the participants as to whether the course was relevant, if they learnt new knowledge and skills, and if they could apply these to their roles as FMTs. A tabletop exercise evaluated learning with participants working collaboratively.

Results:

DMRC has been sustainable since 2013 with six to eight courses per year. There had been numerous revisions of the content and delivery to keep up-to-date with the latest concept of operations, best practices from the literature, as well as educational methodologies. The last update was in 2020 in response to the COVID-19 pandemic where course schedule and mode of delivery were adjusted to comply with the safe management measures.

Conclusion:

FMTs will require training so they can function to their maximum capacity and capability. In Singapore, DMRC is the course for this unique and important training of FMTs. DMRC plays a pivotal role in ensuring the preparedness and operational readiness of FMTs for mass casualty incidents.
The Impact of Hurricane Ida on Emergency Medical Services Operations in New Orleans
Authors: Rosenblatt Joy , Gruen Sean , Marino Meg , Nichols Emily
Published: June 2023

Introduction:

On August 29, 2021 Hurricane Ida struck New Orleans with Category 4 winds. While the most severe weather occurred during a 24-hr period on August 29, the city suffered significant damage to telecommunication systems, medical facilities, and infrastructure for several weeks afterward. At the height of the storm, multiple events affected routine deployment of EMS, including damage to transmission lines causing interruption of the 911 system, and suspension of ambulance travel for safety when the winds exceeded 50 mph. These factors, as well as pre-storm preparations, affected utilization of EMS by residents and thus a “peri-hurricane” period was examined to determine the overall effect of Hurricane Ida on New Orleans EMS operations.

Method:

Run sheets for calls to NOEMS between August 26-September 9, 2021 were analyzed to assess the most frequently reported medical complaint just prior to and after the hurricane. Run sheets were also evaluated to determine average time from call to arrival on scene, time to arrival at patient (“response time”), and time from leaving scene to arrival at destination (“transport time”). To account for the atypical period during which EMS response was suspended due to wind, both mean and median times were calculated. Data was compared to a control period of Aug 26-Sept 9, 2022.

Results:

During the study period, 1,971 calls were received, with trauma and respiratory the most common complaints. The mean call-to-arrival time was one hour, although the median time was 15 minutes. Response time was 34 minutes compared to 21 minutes in 2022, and median response time was comparable to the control period. Transport time mean and median were 12.3 and 11.3 minutes, also similar to 2022.

Conclusion:

Despite citywide infrastructure failures and suspension of operations for over 12 hours during landfall, multiple mitigation strategies enabled NOEMS to quickly resume operations and minimize impact on patient care times.
Patient Factors which Lead to Disagreement in Triage Decisions
Authors: Simon Stephen , Hertelendy Attila , Hart Alexander , Gregory Ciottone
Published: June 2023

Introduction:

Multiple triage algorithms have been proposed to optimize the allocation of medical resources in mass casualty incidents. Despite attempts at standardization, first responders often assign patients to triage categories that deviate from those prescribed by these algorithms. This study seeks to understand what patient level factors cause these deviations, and identify clinical factors which cause variance toward over or under triage. Rather than evaluate these decisions against a gold standard, we instead seek to identify patients that cause controversy among first responders with respect to their choices.

Method:

This will be an online survey distributed to EMT and Paramedic students in the US. They will be provided with fifty patient cards containing a clinical vignette including description of injuries and vital signs. For each vignette, they will select a triage category (Red, Yellow, Green, or Black.) We will analyze responses to identify areas of controversy, where triage classification showed a significant split between respondents. We can then evaluate these patients for clinical trends.

Results:

Data collection and analysis are planned for completion by March 30, 2023.

Conclusion:

Identifying patient-level characteristics that contribute to triage variance can allow emergency managers to anticipate under-triage and over-triage following an MCI. This can aid emergency providers as they plan to receive an influx of patients. It also addresses the sub-cognitive biases that impact first responders decision-making, which may aid EMS educators who train first responders in triage.
Logistics Educational Items Required for Hospital Paramedics to Work in Disaster Medicine Settings.
Authors: Masudome Ruki , Akahoshi Kouki , Koido Yuichi
Published: June 2023

Introduction:

In Japan, the Disaster Medical Assistance Team (DMAT) is dispatched as an Emergency Medical Team (EMT) in major disasters. DMAT consists of a physician, nurse, and operations coordinators. The operations coordinators include all occupations other than physicians and nurses, and are responsible for activities to facilitate medical treatment, gathering information, establishing communications, and ensuring transportation. Therefore, the operations coordinator must have in-depth knowledge of all aspects. Operations coordinators with this knowledge are qualified as logistics team members in addition to DMAT certification. Paramedics receive pre-graduate training in medical care, transport, and coordination with other organizations, and many of their daily duties are related to these areas. However, there are few opportunities to learn about logistics. If paramedics are effectively trained in logistics, they are likely to play an active role as operational coordinators. However, logistics covers a wide range of topics, and there are few studies on items that require focused education. Therefore, this study examines the level of understanding of each logistics item among paramedics active in the field of disaster medicine to identify items that should be emphasized.

Method:

A questionnaire survey of 36 paramedics was conducted, all of whom hold both DMAT and logistics team certifications, to determine their level of understanding and the importance of each logistics item. The logistics items used in the survey are specified in the Logistics Specialist Certification System of the Japanese Society of Disaster Medicine. The collected questionnaire results were analyzed using SPSS statistical software.

Results:

Characteristic trends were obtained in the logistics items required of paramedics. Trends were also analyzed according to the age and work history of paramedics.

Conclusion:

The logistics education for paramedics needs to be enhanced in accordance with the trends obtained from the study. Specific studies on the means and timing of education will be needed in the future.