bluuebunny/crossref_metadata_2025 huggingface dataset:
Train the Trainer for Implementing Treatment Guidelines
Authors: Ljungwald Sara , Carlsson Henrik , Blaku Valbona , Hasani Gylxhan , Lidberg Henrik , Hodza-Beganovic Ruhija , Berggren Peter
Published: June 2023

Introduction:

A collaborative project between Sweden and Kosovo with the aim to develop treatment guidelines for the ambulance services was undertaken. Firstly, relevant guidelines were identified, then translated, and processed to fit with the Kosovan ambulance service system. The next step was to train instructors in becoming proficient in training colleagues to use the guidelines. A train the trainer approach was chosen as it can be seen as grounded in Kolb's experiential learning theory and Crossan et al. organizational learning theory. Those theories describe how individuals learn and how organizations develop.

Method:

This implementation project supported training of local instructors to become proficient in training colleagues in 13 selected treatment guidelines for the ambulance services using scenario training. Initially, Kosovar instructors received directions from Swedish instructors then they observed the Swedish instructors. After this, they took more responsibility for the training. Seven Swedish instructors instructed eight Kosovar instructors for a week where about 100 Kosovan doctors and nurses were trained in patient assessment and treatment guidelines. The trainees were divided into four parallel groups of 4-5 participants with one Kosovar instructor supported by a Swedish instructor.

Results:

After the training week, eight instructors from two different ambulance service centers achieved proficiency in training colleagues in using treatment guidelines. Each Kosovar instructor was involved in 30 training occasions.

Conclusion:

The training resulted in the involved Kosovar ambulance service centers being able to train new colleagues in providing standardized patient assessment and treatment using treatment guidelines. In addition, the trained Kosovar instructors will be able to contribute to the development of new guidelines and revision of established guidelines.

Applying a train the trainer approach, theoretically grounded in learning theories, provides a sound basis to achieve systematic change for improving patient safety. Here, the knowledge distribution among practitioners is improved in an inexpensive manner.
Efforts at our Emergency Department as a Designated Medical Institution for the Tokyo 2020 Games: How We Prepared for it during COVID-19 Pandemic
Authors: Iwasaki Yohei , Nakatsutsumi Keita , Ohara Toshiyuki , Kato Nagisa , Ueki Yutaka , Otomo Yasuhiro
Published: June 2023

Introduction:

The Tokyo 2020 Games were held without spectators in the fifth wave of the COVID-19 pandemic after one-year postponement. From all over the world, approximately 11,000 Olympians and 4,400 Paralympians participated in the games. As one of the designated medical institutions, Tokyo Medical and Dental University Hospital provided emergency medical care for the personnel referred by medical staff at the venues or the Olympic Village clinics. On the other hand, it played a central role in treatment and care for COVID-19 patients in the Tokyo metropolitan area. The aim of this study was to review the emergency medical care system of the hospital as a designated hospital for the Tokyo 2020 Games and discuss the measures for future large-scale international events.

Method:

A retrospective analysis of persons involved in the Games who visited our emergency department by request was conducted. COVID-19 patients who were admitted were also analyzed. The study period was from July 13 to August 11 for the Olympics and from August 17 to September 11 for the Paralympics, respectively in 2021. The data was derived from electronic health records from the hospital.

Results:

The total number of ED visits was 38 during the period. One patient was hospitalized, and another patient was transferred. Twenty-one (55%) were athletes, seven (18%) were staff members, and ten (26%) were others. The reason for the visit was medical disease in 23 (61%) and surgical disease in 15 (39%). There was one COVID-19 positive patient. The number of COVID-19 inpatients was 124.

Conclusion:

Emergency medical care was provided for the persons involved in the Tokyo 2020 Games in cooperation with all the staff at the hospital. The COVID-19 pandemic ‘disaster’ may have had some impact on our hospital’s role as the designated medical institution.
Disaster Medicine Compendium and the Necessity of Preparation of Medical Techniques for Handling NBC/CBRNE Hazards, for General Surgeons
Authors: Haraguchi Yoshikura , Hoshino Masami , Tomoyasu Yozo , Tsubata Tohru
Published: June 2023

Introduction:

The risks of NBC (Nuclear, Biological and Chemical) or CBRNE (R: radiological, E: explosive) hazards are rapidly increasing even in civilian areas, as well as those of natural disasters (earthquakes, hurricanes, etc.). Therefore, one of the most important and emergent issues for medical staff, especially for general surgeons is the necessity of skills to deal with various mega- or major disasters to help people as well as, protecting themselves. This has been a point of emphasis since 2005, when the Disaster Medicine Compendium was published and continues to be updated today.

Method:

The research focuses on NBC/CBRNE hazards: Pandemics such as COVID-19, Monkeypox, influenza, the Tokyo Subway Sarin Incident, and the 2011 Tōhoku Earthquake, followed by Fukushima Plant Incident, Chernobyl, earthquakes with tsunami, such as the 2004 Indian Ocean earthquake, and the September 11 terrorist attacks in the US.

Results:

The skills that should be accustomed to are protection, prevention, diminution of toxicity, decontamination, as well as routine medical/surgical treatments. The relevant education is varied and not easily performed. For example, it was found that Japan DMAT or disaster medical assistant teams struggled with a lack of techniques to deal with the nuclear plant hazard during the above-mentioned Fukushima plant accident.

Conclusion:

In the event of hazards including NBC/CBRNE, surgical skills are necessary. However, medical teams require training in advance. Surgical methods and other skills, intensive care, and examinations performed wearing PPE or personal protection equipment is important, as well as the safety and security of the medical teams, in addition, to supporting the vulnerable/weak victims, ensured using an Incident Command System.
Focused Needs Assessment and Tailored Training Pilot for Emergency Care Providers in Rwanda
Authors: Karim Naz , Marques Catalina Gonzalez , Zhang Angela , Baird Janette , Belsky Mikaela , Uwitonze Jean Marie , Nyinawankusi Jeanne D'arc , Mugemangango Pascal , Mutabazi Zeta , Aluisio Adam
Published: June 2023

Introduction:

In lower- and middle-income countries (LMIC), 45% of deaths could be prevented by implementation of emergency care systems. Prehospital care is critical for emergency medical services (EMS) worldwide, and basic affordable training improves EMS systems. This study conducted a needs assessment in addition to a tailored prehospital training intervention. Subsequent changes in prehospital care as well as patient outcomes were measured.

Method:

Thirty providers identified through the prehospital medical command office participated. A prospective, nonrandomized interrupted time-series approach was utilized for a needs assessment and training intervention. Data collected included age, gender, training level, and a knowledge assessment, and was used to create an 18-hour training, with immediate and 11-month posttests. Prehospital process indicators evaluated on-the-ground application of skills, including airway intervention, intravenous fluid administration, and glucose administration. Linked prehospital and hospital care datasets allowed for evaluation of patient outcomes.

Results:

Of 30 providers, 60% (n=18) female and 40% (n=12) male, 19 were nurses and 11 were nurse anesthetists. Median age was 36 and median years providing care was 10 (IQR: 7,11). 24 (80%) participants completed immediate and post-test assessments, showing a 56% (95%CI: 36.2, 75.8) relative increase in mean knowledge score across 12 core skills that was maintained across post-tests. 324 of 572 total patients transported to the ED during the study were transported during the pre-training period (56.4%). Prehospital oxygen administration for patients with a saturation level of <95% increased pre- to post-intervention (66.7% to 71.7%; Δ = 5.0%; Δ95%CI: 1.9, 8.1%).

Conclusion:

This study is the first LMIC-based prehospital provider training efficacy study that includes analysis of patient outcomes and clinical process indicators. Results offer important insights on Rwanda’s prehospital care system and demonstrate that affordable, tailored educational interventions targeting process indicators have positive impacts on provider knowledge and practice.
Stress and Coping Strategies Among Those Affected by Ebola Virus Disease (EVD) Epidemic in Sierra Leone, West Africa
Authors: Smith Montray , Klein Elizabeth , Okunoren Oladoyin , Currie Charles , Crea Thomas
Published: June 2023

Introduction:

The 2014-2016 Ebola Virus Disease (EVD) outbreak in West Africa resulted in 28,000 infected and over 10,000 deaths. Sierra Leone was one of the hardest hit countries. The purpose of this study is to examine the coping strategies employed by those most affected by EVD and its related stressors in Sierra Leone.

Method:

228 EVD-infected individuals, EVD-affected individuals, and community leaders were recruited using purposive maximum variation sampling. Key-informant interviews (n=42) and focus group discussions (n=27) were conducted across five districts in Sierra Leone. Data were analyzed and coded inductively by a team of researchers, using Thematic Content Analysis using NVivo (k=0.80 or above for interrater reliability).

Results:

Participants described stressors, coping and support on four levels: individual, family, community, and society. On the individual level, theft and spoiled belongings were leading sources of stress while faith and spirituality were main sources of coping and support. On the familial level, lack of financial resources and inability to work emerged as primary stressors, while engaging with family was a main source of support. On the community level, social exclusion emerged as a prominent stressor and community reintegration as a source of support. On the societal level, participants' lack of governmental support and termination of support from NGOs emerged as stressors, and provision of formal material assistance as a source of support.

Conclusion:

In a widespread public health crisis, understanding people’s perceptions of the most salient stressors and sources of support can inform future responses. In this study, participants experienced stressors and support across multiple levels of the social ecology, such as grief and faith, household financial pressure and kinship care, and formal material resources for survivors. Results also showed the importance of community-led initiatives that addressed material needs, as well as social acceptance and social support.
Japan DAMT COVID-19 response. The Temporary Medical Facility for Hospitalization Waiting and Doctor Home Response System in Sapporo City, Hokkaido
Authors: Mimura Seiji , Toyokuni Yoshiki , Wakai Akinori , Kondo Hisayoshi , Koido Yuichi
Published: June 2023

Introduction:

In Japan, the response to COVID-19 has been a disaster response. In May 2021, the number of patients requiring hospitalization increased rapidly in Sapporo City, Hokkaido. Almost all medical institutions and clinics were overcrowded, and patients were forced to wait at home. Sapporo City requested a response from the Japan Disaster Medical Assistance Team (DMAT).

Method:

DMAT collaborated with the Sapporo City Public Health Center to set up a patient waiting station (The Temporary Medical Facility for Hospitalization Waiting) utilizing an unused hotel. DMAT placed the patient under medical care, provided oxygen therapy and other procedures, and coordinated hospitalization referrals. DMAT also organized a doctor home response system for patients who need emergency hospitalization and those who have returned home from The Hospital Waiting Stations.

Results:

64% of the patients were admitted to hospitals, 27% back to their homes, 9% were sent to residential care facilities, and 1% were sent to welfare facilities. The doctor home response system was able to redirect 52% of patients requiring emergency hospitalization.

Conclusion:

For the rapidly increasing number of patients with COVID-19, DMAT established a temporary medical facility and home visit system and was able to minimize the number of preventable deaths.
International EMT-Operational Plan–ODESA Escalation
Authors: Oba Jiro , Kubo Tatsuhiko , Toyokuni Yoshiki , Nakamori Tomoki , Habano Yukiko
Published: June 2023

Introduction:

Since February 24, 2022, at the time of writing this plan, approximately 400,000+ refugees had entered Moldova and 282,842 had exited Moldova. EMTCC will need to coordinate international medical teams assisting with the increasing refugee numbers crossing into Moldova from southern Ukraine for the MOH and international EMT’s in support of trauma management in Palanca and related borders and referral to health care facilities within Moldova.

Method:

This EMTCC operational plan sets objectives and explores trigger points that require actions in the context of International EMT’s, two service levels were trauma triage/stabilization and primary health care.

Results:

Odesa was a city located approximately 60 kilometers from the Moldova border crossing of Palanca. Trauma patients reaching the Palanca border would need to be identified in vehicular columns by roving triage teams (EMT 1 M) and expedited through the border. Survivability of severe trauma patients proceeding through the border crossing and expected to transit through to tertiary level care would be low without the intervention of trauma stabilization teams (damage control). The initial positioning of at least 2 trauma stabilization points would require the support, skills, logistics and self sustainability of classified EMT’s or similar. These would also need the additional support of specialized trauma/surgical cells at both Stefan Voda and Causeni Hospitals.

Conclusion:

Odessa escalation should have been the worst scenario, but we were able to work with MOH in Moldova to develop a plan to save more lives for trauma patients reaching the Palanca border.
Resolving the Gap: National Pediatric Disaster Coalition
Authors: Frogel Michael , Frost Patricia , Cooper Arthur
Published: June 2023

Introduction:

Children younger than 18 years constitute approximately 25% of the US population. During disasters, they are the most vulnerable population and have age-specific vulnerabilities that heighten their risks and magnify their unique needs. These include physiological vulnerability to pathogens, toxins, radioactive isotopes, and harsh conditions. Increased skin permeability, faster metabolism, more active cell division, higher respiratory rate, and higher surface area–to–mass ratio all contribute to greater susceptibility to physical threats. Behavioral/Developmental differences such as more hand-to-mouth contact, under-developed sense of self-preservation, more time spent outdoors, difficulty communicating symptoms and increased vulnerabilities. Children in disasters may develop mental health problems, including acute and post-traumatic stress disorder, and depression. Some children with disabilities are dependent on medical technology.

Method:

A US national conference in 2015 determined that significant gaps in pediatric disaster preparedness include transport, space, staffing, equipment, supplies, and training capabilities. To address these gaps the National Pediatric Disaster Coalition (NPDC) was established to advocate for enhanced pediatric disaster preparedness, and advance community healthcare preparedness, mitigation, response, and recovery for infants, children, and families in disasters.

Results:

The NPDC consists of subject matter experts, national advisory committees, commissions, agencies, and organizations. It utilizes pediatric SME knowledge to help plan for the allocation of appropriate and essential resources to address pediatric specific needs in disasters. It serves as an information clearinghouse on pediatric disaster preparedness informed by real events, research and evolving best practice. The NPDC disseminates information through organizing and participating in conferences, and web-based training.

Conclusion:

Based on the special needs of children in disasters, the NPDC assessed current gaps and has established an effective advocacy and information sharing platform to match resources to pediatric needs during disasters. The NPDC can serve as a model for addressing gaps in the special needs of children and their families during disasters.
Improving Physician Response and Recall When Activated for Mass Casualty Incidents
Authors: Yeo Mathew
Published: June 2023

Introduction:

Mass casualty incidents (MCI) overwhelm existing resources in the emergency department. The existing method to recall staff in an MCI is text notification through the hospital call center. This study aims to assess the effectiveness of a novel method to recall senior emergency physicians during an MCI.

Method:

For this method, upon notification of a MCI, the senior physician on duty will start call tree activation based on four different senior physician job grades. He/she will call the first physician for each grade, who takes over calling and activating the remaining physicians in the same grade with a maximum of two attempts. Each physician receiving the activation call then texts an acknowledgement and estimated time of arrival at the department in the group chat. An unannounced, simulated MCI event was conducted at 02:00 and 14:00 on a weekday. Effectiveness was determined by the proportion of senior physicians available within 60 minutes of activation.

Results:

For the 02:00 activation, three of the 25 senior physicians were on clinical duty in the hospital while nine were contactable within 15 minutes and thirteen after 30 minutes. Eleven were able to return to the hospital in 60 minutes or less and one beyond 60 minutes. Nine were local but unable to return and one was overseas.

For the 14:00 activation, four of the 25 senior physicians were on clinical duty in the hospital while 15 were contactable within 15 minutes and six after 30 minutes. Nine were able to return to the hospital in 60 minutes or less and four beyond 60 minutes. Three were local but unable to return and five were overseas.

Conclusion:

This method can achieve rapid manpower augmentation with more than half the staff present in the hospital within 60 minutes. Drills involving physical recall should be performed to further test this workflow.
Assessment of Disaster Preparedness Levels of Emergency Department Physicians in Kuwait
Authors: Alburaidi Abdulaziz , Hart Alexander , Hertelendy Attila , Issa Fadi , Ciottone Gregory
Published: June 2023

Introduction:

Global disasters have increased over the last century, with growing numbers of people affected. In the Middle East and North Africa, natural disasters have tripled since the 1980s. Education and training for disaster preparedness for healthcare providers can help reduce vulnerability to disasters by improving their knowledge and response effectiveness. Physicians working in the emergency department are integral members of the response to those incidents. Currently, no studies describe how much training or experience in disaster preparedness exists for physicians working in the emergency departments in Kuwait. However, comparable studies in different regions have illustrated the importance of researching this field. This paper aims to assess the disaster preparedness levels of emergency department physicians in Kuwait.

Method:

An online survey will be sent to the physicians working in the emergency departments of the seven general hospitals in Kuwait. This survey consists of four domains:

1)

Demographics: personal and professional characteristics of participants.

2)

Education and training: exploring the involvement of participants in prior formal training courses or exercises in disaster preparedness.

3)

Experience: assessing the involvement of participants in the mitigation or response to previous disasters.

4)

Knowledge and perception: participant awareness of local hospital plans and systems as well as their attitudes and opinions about disaster preparedness.

Results:

Data collection and analysis are planned for completion by March 31, 2023.

Conclusion:

The needs assessment is essential to developing educational curriculums for any discipline. In disaster medicine, tailoring the training curriculum is especially important because learners might not have experience in the field due to the high acuity and low frequency of disasters. The results can be used to develop a roadmap for Emergency Physician training in disaster preparedness in Kuwait. In addition, the approach adopted in this paper can be used to assess further disciplines for disaster preparedness.
Pediatric Disaster Medicine Literature: A Scoping Review
Authors: Jeong Yae Sul , Clark Cullen , Chung Sarita , Timm Nathan , Wright Chris , Kappy Brandon , Brumberg Elizabeth Hewitt , Goralnick Eric , Parish April , Stanley Rachel , Miller Susi , Stephens Caroline
Published: June 2023

Introduction:

Over the last 20 years disasters have increasingly involved children, and pediatric disaster medicine research is growing. However, this research is largely reactive, has not been categorized in terms of the disaster cycle, and the quality of the research is variable. To understand the gaps in current literature and highlight areas for future research, we conducted a scoping review of pediatric disaster medicine literature. This work will help create recommendations for future pediatric disaster medicine research.

Method:

Using a published framework for scoping reviews, we worked with a medical librarian and a multi-institutional team to define the research question, develop eligibility criteria, and to identify a search strategy. We conducted a comprehensive Medline search from 2001-2022, which was distributed to nine reviewers. Each article was independently screened for inclusion by two reviewers. Discrepancies were resolved by a third reviewer.

Inclusion criteria included articles published in English, related to all stages of the disaster cycle, and disaster education, focused on or included pediatric populations; published in academic, peer-reviewed journals, and policies from professional societies.

Results:

967 pediatric disaster medicine articles were imported for screening and 35 duplicates were removed. 932 articles were screened for relevance and 109 were excluded. In 2000, three articles met inclusion criteria and 66 in 2021. We noticed reactive spikes in the number of articles after major disasters. Most articles focused on preparedness and response, with only a few articles on recovery, mitigation, and prevention. Methodology used for most studies was either qualitative or retrospective. Most were single site studies and there were < 10 meta-analyses over the 20 years.

Conclusion:

This scoping review describes the trends in and quality of existing pediatric disaster medicine literature. By identifying the gaps in this body of literature, we can better prioritize future research.
Mass Gathering Events - Health Care Facility Notification Template
Authors: O'Brien Cian , O'Sullivan David , Fitzgerald Mary Rose
Published: June 2023

Introduction:

Every year many concerts, festivals, public meetings and major events take place in Ireland. Depending on the nature of the event such as: location, the number of attendees, and performers–these events present varying amounts of risk. The Health Service Executive is concerned with managing risks and advocates that event organizers put comprehensive event management plans in place. Healthcare arrangements for outdoor crowd events should be specified in the Event Medical Plan section of the event management plan by the event organizer. As part of the event notification process, event organizers engage with the HSE South Emergency Management Office which in turn liaises with the various care groups across the Cork Kerry region to inform them of events that may impact their service. Historically, event organizers have informed the Emergency Management office of events in a wide variety of formats and varying levels of information.

Method:

The HSE South Emergency Management Office engaged with Cork University Hospital (Major Trauma Center) to identify the information hospitals require from various events around the region. In addition, the Emergency Management Office liaised with a subject matter expert in Mass Gatherings from Australia to discuss key indicators/data points healthcare facilities could benefit from knowing in advance of mass gathering events.

Results:

A standardized Word document template was developed as a proof of concept that lists key data that healthcare facilities have identified as important for them to be made aware of as part of the notification process. This template now lends itself to be developed into an online editable form to enable event organizers to inform the relevant healthcare facilities of mass gathering events.

Conclusion:

Health care facilities require timely and accurate information regarding mass gathering events to ensure appropriate plans and preparations are in place. A standardized notification template would assist in the preparation phase.
Massive Influx of Victims: Staff Preparedness and Facility Readiness of Tunisian General University Hospitals.
Authors: Lamine Hamdi , Chebili Naoufel , Zedini Chekib
Published: June 2023

Introduction:

Hospital preparedness for a massive influx of victims relies, to a certain extent, on actions, programs, and systems that are created and executed ahead of time, but also on the knowledge, skills, and professional competences of the hospital's staff. This study aims to understand the factors influencing the preparedness of Tunisian University Hospital staff in facing a massive influx of victims.

Method:

This is a multi-method qualitative descriptive study, conducted in nine general University Hospitals (UH) in Tunisia; the first component was a phenomenological design via open-ended interviews; the second component was a qualitative observational non-participatory design via field observations.

Results:

17 participants were recruited, in an intentional non-probabilistic way. Participants to this study discussed issues related to the material and financial resources of their hospitals; the psychological impact of managing an influx of victims; their training, their involvement in the process, and the norm versus the circumstances in the field. Which led to the conclusion that: "For multiple reasons, the Tunisian University Hospitals are not ready to properly manage a massive influx of victims"

Conclusion:

This multi-method qualitative study discussed the factors that affected the preparedness of staff and readiness of UHs included. Factors were mainly resources (material and financial), psychological burden, lack of training, lack of involvement in the process and issues related to evidence-based practice. Data collected supports the idea that more research and more practical interventions need to be performed to increase the preparedness level of Tunisian UHs and their staff.
Simulation Model of Required Pre-deployed Auto-injectors and Stockpiled Antidotes against Chemical Terrorism
Authors: Koido Yuichi , Akaboshi Kouki , Masudome Ruki , Ichikawa Manabu , Takahashi Ayako , Wakai Akinori , Anan Hideaki
Published: June 2023

Introduction:

Chemical terrorist attacks using nerve gas require patients with immediate administration of antidote, or otherwise they will experience abnormal neurological activity, respiratory arrest, and death. When it occurs in large stadiums at mass gatherings such as the Olympics, under normal medical care systems, preventable deaths occur due to insufficient deployment of on-site auto-injectors and stockpiled antidotes in hospitals. In Japan, the government has stockpiled antidotes in confidential warehouses and deployed auto-injectors around possible terrorist sites. When a chemical attack occurs, a stockpile of antidotes go to hospitals, auto-injectors go to the site, and firefighters and police are allowed to administer auto-injectors to patients. However, few studies are conducted on pre-deployment of auto-injectors and antidotes in chemical terrorisms. Therefore, the number of pre-deployment was examined.

Method:

A single chemical attack with 750 patients was assumed. Response was divided into five steps: (1) transportation of stockpiles to hospitals, (2) transportation of auto-injectors to the site, (3) on-site use of auto-injectors, (4) transportation of patients to hospitals, and (5) patient care in hospitals. Computer estimation was used for the time required for transportation for (1), (2), and (4). Desktop exercises were conducted for on-site response time, outpatient response time, and the number of beds available at hospitals for (3) and (5). The values obtained from computer estimation and desktop exercises were imported into the simulation model to measure the number of paramedics, auto-injectors required to be deployed in advance, and the amount of stockpiles required to be delivered to hospitals.

Results:

A minimum of 80 auto-injectors and ten paramedics were required to be pre-positioned at the scene. A minimum of 100 ampules of antidote was required immediately at the nearest hospitals.

Conclusion:

The pre-deployment of auto-injectors and personnel are essential to reduce the number of deaths in the event of chemical terrorisms.
Comparison of Injury Epidemiology and Treatments by Gender Among Persons Seeking Emergent Care in Kigali, Rwanda
Authors: Aluisio Adam , Uwamahoro Chantal , Garbern Stephanie , Uwamahoro Doris , Mumporeze Lise , Marqués Catalina González
Published: June 2023

Introduction:

Variations in the incidence and patterns of injuries exist between genders which may impact treatments and outcomes. The study aimed to describe the epidemiology, treatments, and outcomes based on the gender of persons presenting with injuries to an Emergency Department (ED) in Kigali, Rwanda.

Method:

This was a secondary analysis of a prospective cross-sectional study conducted in January-June 2021 at the Centre Hospitalier Universitaire de Kigali ED. Descriptive statistics were performed and variable comparisons based on binary gender self-designation (male or female) were conducted.

Results:

A total of 601 patients were included in the analysis of whom 25.6% were female and 74.4% were male. Gender differences were found in the mechanism of injury with females more likely to be injured via falls (43.5% versus 23.0%, p=0.001), while males were more likely to be in a road traffic accident (52.6% versus 39.6%, p=0.006), have stab and/or laceration (9.0% versus 2.0%, p=0.004) or have been assaulted (6.9% versus 2.6%, p=0.047). Injury severity was not significantly different between genders based on the median Kampala Trauma Score and presence of triage hypotension. For treatments females were more likely to have been transported by prehospital services (87.7% versus 72.9%, p=0.001), but were less likely to received acute ED treatments of intubation, wound care, tourniquets, blood products, thoracostomy and point-of-care ultrasound during the first six hours of care (67.5% versus. 78.1%, p=0.009). Hospital admission was significantly greater among females as compared to males, (31.2% versus 41.8%, p=0.019) but no difference in mortality was observed (2.0% versus 1.3%, p=0.568).

Conclusion:

This study provides data on differences in epidemiologic and care characteristics between males and females presenting for emergency injury care in Rwanda. These findings can inform future research and help the development of gender-centered healthcare delivery in Rwanda and other similar contexts.
Crisis Collaboration Exercises: Are They Useful?
Authors: Sørensen Jarle
Published: June 2023

Introduction:

Crisis collaboration exercises are perceived as developing and testing cross-sectoral team integration, preparedness efforts, and response. However, the general problem is that crisis collaboration exercises may tend to produce results with limited usefulness in actual crisis work. The purpose of this quantitative, non-experimental, survey-based study was to examine to what extent there was a statistically significant relationship between participation in Norwegian maritime crisis collaboration exercises and the perceived levels of learning and usefulness in an actual crisis. The scope was limited to relevant public, military, and non-governmental exercise participants.

Method:

Surveys were electronically distributed among participants in three 2016 Norwegian maritime crisis collaboration exercises. The data collection instrument was the Collaboration, Learning, and Utility scale (Berlin & Carlström, 2015). The CLU-Scale is specially designed to measure collaboration exercise participants' perceived levels of learning and utility. The scope was limited to relevant public and non-governmental exercise participants including health, law enforcement, and military stakeholders.

The effects of collaboration, learning, and usefulness were tested in two bivariate regression analyses, where the first tested the relationship between collaboration and learning, and the second tested the relationship between learning and usefulness. To measure the linear dependence between the variables, Pearson’s r was calculated. The coefficients of determination (r2) were calculated to determine what proportions of the variance in the dependent variables could be considered predictable from the independent variables.

Results:

The joint collaborative characteristics predicted 27% (r2 = 0.27) of the learning variance, which meant that the remaining 73% of the predicted variance was unaccounted for. The perceived learning items predicted 34% (r2 = 0.34) of the usefulness variance.

Conclusion:

This study found a moderately strong statistically significant relationship between participation in Norwegian maritime crisis collaboration exercises and perceived levels of learning and usefulness. More focus on collaboration learning techniques in exercise planning and evaluation is recommended.
Hemipelvectomy following Trauma: Burden less Identified. A Ten-year Experience from the Level-1 Trauma Center
Authors: Sagar Sushma
Published: June 2023

Introduction:

Hemipelvectomy occurs seldom, yet it is a serious injury. Hemipelvectomy following trauma is associated with high incidence of morbidity and mortality. Successful management requires early recognition with a multi-speciality approach and meticulous surgical technique.

Method:

Retrospective data from hospital records of the Level-1 Trauma Center, between December 2011 through September 2022 was obtained. Clinical details including mechanism of injury, trauma scoring, associated injuries, hemodynamic status, surgical procedures, wound complications, ICU stays, hospital stay, prosthesis application, and their outcome were analyzed. Patients were followed up physically in OPD or telephonically.

Results:

Total footfall 615,274 patients with 16,786 admissions in trauma surgery, 1,299 amputations and 13 hemipelvectomy patients during the study period of ten years. Seven were in shock on presentation, of which, four were non responders and three responded to initial resuscitation. Seven patients had associated Genitourinary injuries, four had anorectal involvement, five had vascular injuries and six had associated extremity injuries. Six patients underwent hemipelvectomy in the primary surgery and seven ended up in hemipelvectomy on consecutive surgeries. Multiple surgeries were required for all the patients both for control of local sepsis and adequate soft tissue cover. Eight of thirteen patients developed wound infections, and related sepsis, one survived a covid infection and three had MODS. Four out of thirteen patients died and of the nine survivors, prosthesis is being used by three patients, two returned to work without prosthesis and two lost to follow up.

Conclusion:

With a multidisciplinary and dedicated team approach, we can expect favorable outcomes in post-trauma hemipelvectomy patients.
Evaluating the Knowledge, Readiness, and Satisfaction Level of Emergency Medical Service Personnel after an Online Chemical Mass Casualty Response Training Program
Authors: Shin Heejun , Hertelendy Attila , Hart Alexander , Issa Fadi , Tin Derrick , Woodward Christina , Ciottone Gregory
Published: June 2023

Introduction:

Compared to trauma-based injuries, chemical injuries can inflict widespread and persistent injuries to exposed victims. Emergency medical services (EMS) personnel are vulnerable to chemical injuries. Specialized training is required, including zone setup, personal protective equipment (PPE), decontamination, and antidote use, beyond simple advanced trauma life support. The purpose of this study is to evaluate the educational effectiveness of the online chemical-mass casualty incident response education module (C-MCIREM) for EMS personnel.

Method:

This study is a retrospective pre-and post-test comparison. Subjects were EMS personnel who enrolled in the C-MCIREM program at the EMS Korea online conference between August 27, 2021 and September 5, 2021. Subjects provided demographic data and completed pre-course and post-course knowledge tests and self-assessments of readiness, as well as a satisfaction survey after the course. For readiness and satisfaction surveys, an 11-point Likert scale was used. The Wilcoxon Rank Sum test was used to compare the two samples.

Results:

A total of 322 respondents were enrolled. Two-hundred (62.1%) responded that they were most motivated to take the course because of curiosity about the subject. The median pre-course knowledge score was 57/100 (47, 66) and the post-knowledge score was 80/100 (66, 91) (p<0.001). Participants stated they felt their readiness to provide triage, treatment, transport, decontamination, to select correct antidotes, and to use correct PPE (all p<0.001) increased. 90.4% stated they were satisfied with the course. Participants were overall satisfied with the use of the online format (7.71/10 SD 2.05), and were willing to recommend the training to other EMS providers (7.63/10 SD 2.1).

Conclusion:

The online C-MCIREM program showed high satisfaction with a significant increase in knowledge and self-assessed readiness to respond to a chemical mass casualty incident.
Aunty Next Door - A Qualitative Study of Community Prevention and Control for COVID-19
Authors: Nak-AI Worayuth , Suphaudomphon Thira , Khotmanee Supaporn , Wicharit Lerkiat , Sinwath Suratsawadee , Ruangrattanatrai Wilailuk , Krateth Juraporn , Kitphati Rungrueng
Published: June 2023

Introduction:

The Thai government has established public health policies to cope with COVID-19 and reduce the spread of disease by promulgating the Emergency Decree since March 26th 2019 in concept “stay at home, stop the spread of the virus for the sake of nation.” Those measures had been affected to people in all social levels whether it be urban or rural. The objective of this qualitative study was aimed to study the mechanisms and experiences of village health volunteers who work to control COVID-19 at the community level.

Method:

Forty village health volunteers in the 8th health region were included in the study. Data collection by using focus group discussion combined with audio recordings and the data were analyzed by content analysis.

Results:

The community’s context in the upper northeastern region of Thailand live in kinship. This is a factor supporting the operation of village health volunteers (VHVs) in the surveillance, prevention, and control of disease in the community. The mechanisms for disease prevention and control in the community are a virtual "Spider web" that connects people in the community, VHVs, Community Leaders, Public Health Officers, and Sub-district Administrative Organization (SAO) officers that operate together. While people in the community, especially "women", act in surveillance in the form of "watchdogs" that report abnormalities of community member movements to the VHV for coordination in surveillance, prevention, and control of disease in their community. The VHV and partners use management guidelines as prescribed by the Ministry of Public Health and adapted to the social and cultural context.

Conclusion:

The community's COVID-19 surveillance mechanism that mediates kinship begins with fear and panic from a lack of knowledge in the early stages of the outbreak. The kinship of people in the community is one of the strengths and factors of success in preventing and controlling the disease.
Lessons Learned from a Multiple Casualty Blast Incident
Authors: Juan Li , Quah Joy , Ho Shu Fang , Ng Ming Wei , Chan Wei Xin
Published: June 2023

Introduction:

On February 24, 2021, a large explosion and fire occurred in an industrial estate in Singapore. Eight casualties with major burns were conveyed to the emergency department (ED) at Singapore General Hospital, the designated regional Burns Centre. This article details the events and recommendations arising from this multiple casualty incident.

Method:

An After-Action Review (AAR) was conducted to examine the prehospital notification process, casualty triage & tagging, medical management, manpower and resource allocation, and command-and-control structure.

Results:

All eight casualties were conveyed by the national Emergency Medical Services (EMS) and arrived within a 46-minute window. The first three suffered 90% full-thickness burns and inhalational injuries and were intubated. The remaining five suffered between 37% to 64% burns, with three requiring intubations as well.

Four major areas were identified for improvement:

Firstly, there was scant information from EMS regarding total casualty count. There was also inadequate knowledge of mass burns triage protocols in the ED. Thus, resources were heavily utilized for the first three casualties - all of whom were later deemed unsalvageable, given palliative care and demised.

Secondly, casualty identities were initially unknown. They were tagged with similar-looking ten-digit serial numbers, resulting in a near-miss event involving mislabelled blood tubes.

Thirdly, there was unfamiliarity with the incident response plan for a multiple casualty incident of this scale. This contributed to lack of situational oversight and inconsistent leadership direction from various stakeholders with resulting conflicting instructions.

Fourthly, routine trauma computed tomography pan-scans for all casualties caused delayed reporting by Radiology and created a bottleneck in casualty disposition.

A multi-disciplinary workgroup comprising Emergency, Trauma, Burns and Intensive Care departments outlined several recommendations based on the AAR findings. Drills were strongly recommended to resume following a hiatus due to COVID-19.

Conclusion:

AARs help provide invaluable insights. Response plans should be refined together with relevant stakeholders.
Practical Trauma Training in Ukraine: An EMT Type 1 NGO’s Implementation of Trauma Training for Healthcare Providers and First Responders in Ukraine from March 2022-October 2022
Authors: Chartoff Stanley , Toth Robert , Young David , Nelson Erica , Bilgram Calley , Quaranta Alyssa , Callaway David
Published: June 2023

Introduction:

In March 2022, Team Rubicon deployed an EMT Type 1 mobile team to provide medical care for internally displaced people in Ukraine. Regional medical facilities and universities identified a need for training programs to prepare for the expected increase in wartime casualties.

Method:

Deployed medical teams researched and compiled initial course content. Presentations were prepared and conducted with the assistance of Ukrainian translators. The curriculum was expanded to include whole blood transfusion and point of care ultrasound. After the prioritization of needs by the MOH, Team Rubicon deployed a seven-member team to conduct training in 16 cities over two months. They provided instruction in whole blood transfusion, hemorrhage control, blast injuries, prehospital triage, shock management, point of care ultrasound, and treatment of chemical exposures. Surveys were conducted pre- and post-training to assess the usefulness of the training provided.

Results:

In two months, a total of 1549 unique individuals were trained. The participants included 769 physicians, 244 nurses, 299 paramedics, 83 hospital administrators, and 154 additional professionals. They included 614 males and 935 females. The number of participants in each course included: 477 for hemorrhage control, 564 for treatment of chemical exposures, 483 for blast injury and field trauma, 412 for pre-hospital and triage training, 135 for point-of-care ultrasound, and 154 for whole blood transfusion.

Conclusion:

With the assistance of the Ukrainian Ministry of Health, an NGO was able to conduct 64 sessions training 1549 individuals. This experience demonstrates the ability to create a robust educational platform to fulfill the medical needs of a community affected by warfare.
The Characterization of Trauma Patients Utilizing Private Vehicle Transport (PVT) to the Emergency Department (ED)
Authors: Leidlein Sabryn , Rammal Jo-Ann , Klausner Howard , Johnson Jeffrey
Published: June 2023

Introduction:

Existing studies have identified the national rate of PVT for severely injured patients to be 9-16%, our ED has displayed a PVT incidence of 35.4%, suggesting a substantial difference in ED arrival. This study aims to explore descriptive demographics and injury characteristics of patients who arrived by PVT to our ED.

Method:

A prospective, single-center observational study conducted in Detroit, Michigan. Included patients aged 15 ≥ years who arrived at the ED by PVT for blunt or penetrating trauma. The sample population consisted of 128 patients from August 2019-April 2021. Each subject completed a survey regarding their injury and prehospital care. A retrospective chart review was conducted to acquire information on their injuries.

Results:

The mean age was 44.3 ± 20.3 years old, range 15-93. 51/128 female, 77/128 male. Patients comprised 93/128 African American, 19/128 Caucasian, 4/128 Asian, 4/128 Hispanic/Latino, and 8/128 other. The most common insurance was Medicaid, comprising 63/128 patients, 25/128 of patients had Medicare and 38/128 had private coverage. Utilizing ESI indices to evaluate severity levels, 73/128 arrived at the ED with an ESI level of 3, 47/128 level of 2, 5/128 level of 4, and 3/128 level of 1, the most severe. Majority of patients 36/128, presented with trauma-related injuries due to a fall. 25/128 presented with a laceration, and 22/128 presented after a motor vehicle crash. The upper extremities were the most common location of trauma 38/128 followed by the lower extremities 23/128. The mean ED length of stay was 11.18 hours.

Conclusion:

Overall, the findings from this study allowed us to characterize our population of PVT trauma patients through their demographics and injury characteristics. We were able to establish some descriptive characteristics that delineate the population of patients at our ED in Detroit, which is the first step in identifying why trauma patients choose varying modes of transportation.