bluuebunny/crossref_metadata_2025 huggingface dataset:
EMS Calls for Service at Adult Detention Centers–A Descriptive Study
Authors: Wood Jeffrey , Klassen Aaron , Rogerson M , Sztajnkrycer Matthew
Published: June 2023

Introduction:

Incarcerated individuals represent a particularly vulnerable sector of society, with a disproportionate burden of drug use, mental health problems, and chronic illness. The purpose of this study was to perform a descriptive analysis of EMS response to detention facilities.

Method:

Retrospective review of EMS calls to detention facilities between 1/1/2002 and 12/31/2021 within our EMS system. Data were analyzed using descriptive statistics and Student’s t-test. This study was deemed exempt by the Institutional Review Board.

Results:

3,126 requests for service occurred during the study period. Average patient age was 40.2 ± 13.3 years, compared with 54.0 ± 25.9 years for non-detention center calls (p < 0.001). The majority (80.8%) of patients were male. Mean scene time was 14:13 ± 7:49 minutes, compared with 12:04 ± 12:27 minutes (p < 0.01) for non-detention center calls. The most common complaints were chest pain (15.6%), trauma (13.6%), seizure (11.7%), behavioral (9.2%), and overdose (4.7%); OB requests accounted for 5.8% of calls for female patients. Most calls (86.0%) to detention centers involved incarcerated individuals. Four percent of patients refused treatment; 27.8% of these patients were still transported. One hundred and eight patients were identified by EMS as not needing transport. Consent for treatment/transport by the patient was documented in 5.2% of charts.

Conclusion:

Within our 911 service area, calls to detention facilities are not uncommon, predominantly involve incarcerated individuals, and are primarily due to chest pain, trauma, or seizures. Consent for treatment/transport was not documented in most EMS encounters. Further study is needed to better understand the health care needs of these patients, including ability to consent and access to chronic medications.
Our Trial of Disaster Victim Identification Training in Chiba, Japan
Authors: Motomura Ayumi , Ishii Namiko , Saito Hisako , Yoshida Maiko , Iwase Hirotaro , Yajima Daisuke
Published: June 2023

Introduction:

Internationally, Disaster Victim Identification (DVI) activities are conducted under the International Criminal Police Organization system for handling a large number of bodies during disasters. However, the police have taken the initiative and commissioned clinicians and dentists to estimate the cause of death and identify the deceased, under a unique system in Japan. In this presentation, we examine the problems in the current DVI activities in Japan through DVI training.

Method:

We held DVI training sessions three times in preparation for the occurrence of a large-scale disaster in Chiba Prefecture with Chiba Prefectural Police, Chiba Medical Association, Chiba Dental Association, local government staff in Chiba, and forensic staff in other institutions. We conducted desktop trainings using paper dolls, under a simulation of an aircraft disaster, and a natural disaster such as flooding and landslides caused by typhoon damage in the third session. After the training, participants reflected on their activities through a questionnaire.

Results:

In accordance with the conventional method, the police officers numbered the bodies, photographed and checked their personal belongings, followed by the estimation of the cause of death with a doctor, the preparation of documents. Subsequently, dentists collected postmortem findings and matched with antemortem data. On the other hand, police officers and local government staff interviewed the bereaved family members under simulations. In the post-survey, participants were generally satisfied with the training, but some said that it was difficult to understand the activities of other professions.

Conclusion:

In Japan, where there are no DVI teams, this training was a good opportunity for all the job categories involved in DVI activities to meet each other. While the activities conducted by each profession helped to improve skills, the collaboration among professions was poor. We would like to improve the quality of DVI activities by introducing a team system for collaboration among multiple professions.
Not Everyone Can be a Chief
Authors: Desai Sameer , Katirji Linda
Published: June 2023

Introduction:

In 2014, the residency program adopted a new chief resident model. Multiple other programs had adopted a similar style of having all final-year residents have a “chief” role. Chief residents are meant to be leaders in the residency, have a direct influence on the program, and serve as liaisons with other department chiefs.

Method:

Prior to 2014, the program had three chief residents a year: one Admin, one Academic, and one Recruitment. They were chosen using a vote amongst residents/faculty, with the ultimate decision made by the residency leadership. Many other residents were interested, and often qualified, but were ultimately not chosen. In 2014, the all-chief model was adopted. Each PGY-3 would have a responsibility. The goal was to give each a leadership opportunity, and a tangible product as they transition to fellowships or new jobs. The residents were allowed to pick their position, with some influence by residency leadership. Residents were encouraged to create new roles which aligned with their personal interests or career goals. Examples included Medical Director Chief, U/S chief, PEM chief and Wellness Chief.

Results:

Some residents thrived when given responsibility, while others did not. Some could not manage more responsibility: there was a clear disparity in the effort. At the start of this, all residents’ total shifts/month decreased equally. This created some controversy when the workload was not equal. The alteration of details, requirements, and expectations occurred every year in an attempt to correct the failures.

Conclusion:

Ultimately, the all-chief model was a failure. The program reverted to a traditional chief model, allowing only those the residency leadership felt could manage chief responsibilities to have a role. Those not doing a chief role were given additional shifts and those with less added work were given only a partial shift reduction.
Evidence Mapping Survey on Professional Development Programs and Courses in Health Emergency and Disaster Risk Management
Authors: Hung Kei Ching Kevin , MacDermot Makiko , Kayano Ryoma , Abrahams Jonathan , Huda Qudsia , Chan Emily , Graham Colin
Published: June 2023

Introduction:

A prepared and well-trained workforce is essential to reducing the loss of lives from health emergencies. However, it is uncertain what should be included in the common set of core competencies for the health emergency and disaster risk management (Health EDRM) workforce. The objective of the study is to provide evidence mapping for the competencies in existing professional development programs and courses in Health EDRM.

Method:

A survey conducted using an online platform (Survey Monkey) was conducted from October to November 2021. Experts in the Health EDRM Research Network including experts identified for the Delphi studies were invited to join the study. Participants should be ≥ 18 years of age, and had relevant experience in Health EDRM and in disaster education and training programs. A self designed questionnaire containing 28 questions in four domains including competencies; curriculum; evidence gaps; work and personal details were used.

Results:

There were 65 respondents from 20 countries participating in the survey. Most of the respondents worked in academic institutions (60%), followed by government employees (19%), and non-governmental organizations (7%). These organizations have roles throughout the disaster cycle with 95% in the preparedness phase. For management skills, EDRM managers should be competent in planning, organizing, applying management processes, establishing effective communication systems and providing effective leadership. For technical competencies, emergency communications, hazard specific knowledge, communicable diseases were essential for frontline workers. In terms of designing the competency matrix, WHO resources were frequently used for the competencies and the curriculum design.

Conclusion:

Health EDRM managers are expected to master a large number of managerial and technical skills, including the increasingly recognized leadership and decision-making skills for effective planning and implementation. These competencies need to be established for the development of a Health EDRM workforce.
MCI (Mass Casualty Incident) Response Support for Palestine Refugee Hospitals in Lebanon
Authors: Masuda Mitsuru
Published: June 2023

Introduction:

The Japanese Red Cross Society has been supporting MCI response support for Palestine hospitals in Lebanon since 2018.

Method:

It was started from a hospital as a single topic in a one-year ER trauma course, which was combined with an ER triage course. In the next hospital it was revised into not only a theological lecture course but also a field triage training course with pre-hospital volunteers. As a result, when the Beirut explosion happened in 2020, the first hospital could accept more than 50 green patients at once, and the second one sent a pre-hospital team to do triage at the scene showing that training courses were useful in a real MCI case .

Results:

At this time, support is being provided in a new hospital by making use of these experiences. A current report will be available when this association is held.

Conclusion:

MCI response support for refugee camps is improving through trial and error, which would have much in common with other MCI responses in many countries and areas.
Emergency Health Care Workers’ Preparedness for Disaster Management: An Integrative Review
Authors: Almukhlifi Yasir , Crowfoot Gary , Hutton Alison
Published: June 2023

Introduction:

Around two billion people globally were affected by natural disasters between 2008 and 2018. Countries are required to effectively prepare their healthcare workers for disaster response. A greater level of preparedness is associated with a more effective response to disasters. The World Health Organization requires countries and governments to have disaster plans and emergency health workers ready and prepared at all times. This integrative review aims to understand emergency healthcare workers’ perceived preparedness for disaster management.

Method:

An integrative literature review using the PRISMA checklist guidelines was conducted to explore physicians, nurses, emergency medical services, and allied medical professionals’ preparedness for disasters. Literature was searched from 2005, published in the English language and from MEDLINE (PubMed), Google Scholar, EMBASE, PsycINFO, SCOPUS, ProQuest and CINAHL databases. Reviews, case reports, clinical audits, editorials and short communications were excluded. Studies were critically appraised using the Mixed Methods Appraisal Tool.

Results:

The initial search yielded 9,589 articles. Twenty-seven articles were included following the application of the eligibility criteria. Included studies were geographically diverse including North America, the Middle East, and the Asia Pacific. Most studies (n=24) assessed the knowledge of healthcare workers in general disasters. Studies using the Disaster Preparedness Evaluation Tool reported moderate disaster preparedness and knowledge, while studies using other instruments largely reported inadequate disaster preparedness and knowledge. Regional variations were recorded, with high-income countries’ reporting a higher perceived preparedness for disasters than low-income countries.

Conclusion:

The majority of emergency healthcare workers appear to have inadequate disaster preparedness. Previous disaster experience and training improved disaster preparedness. Future research should focus on interventions to improve emergency healthcare workers' preparedness for disasters.
Under Pressure–TrolleyGar, a Metric Reflecting a Hospital System at Crisis-Capacity
Authors: Conradie Maria , Smit Marco , Rensburg Rochelle Janse van , Taqvi Sayed , Orsmond Brendan , Andrews Robin , Vegte Andrea van der , Dowle Aishleigh , Wickham Bryce , Vythilingam Darshini , Fayyaz Fahd , Kennedy Keith , Jordaan Phillip , Abraham Ria , Neduchelyn Yuni , Kelly Thomas , Molloy Michael
Published: June 2023

Introduction:

Health service capacity has been an issue in Ireland since the 1980s swinging cuts. Government reports from 2003 have consistently identified a requirement for 3,000-5,000 extra beds on top of the current approximately 10,500 capacity. Acute hospital bed capacity issues have escalated, the formal system of recording “over capacity” patients or “patients on trolleys” has developed. A “Trolleygar” reports issues from the Health Service Executive (HSE) three times daily. This count is an underestimate as patients temporarily housed in day care units, surgical, or medical assessment units, discharge lounges and other clinical areas which have a bed space are not counted in this overcapacity measure. This study's aim is to calculate the annual number of days on which no patients were lodged on trolleys in Wexford General Hospital.

Method:

Descriptive study using anonymized freely available data from the national HSE Trolley GAR reports on trolley patients in Wexford General Hospital from January 2019 until September 2022. A Golden Zero trolley day was stated as a day on which there were no reported trolley-patients at the three time points, Silver Zero trolley day when two of the time periods recorded no trolleys and a Bronze Zero Trolley day when one period recorded a zero trolley count.

Results:

Data was collected on 1,369 days, with 90 days excluded due to missing data sets. There were 162 Golden days recorded (12.67% of total days). The year 2020 recorded the highest number of Golden days at 28.69% (105 days), followed by 2021 with 11.23% (41 days). During 2019 there were 3.84% (14 days) Golden days and 2022 had the lowest number (January-September) with 0.73% (2 days).

Conclusion:

Despite a zero-tolerance policy, Golden days are disappearing rapidly, capacity is urgently required with post-pandemic ED attendance surges worldwide. True recording of overcapacity patients is required for appropriate capacity modeling.
Improving PET and Reducing Coagulation Sample Requests in ED
Authors: Bilal Muhammad , Yousuf Syed , Nedujchelyn Yunitra , Kelly T Paul , Wickham Bryce , Molloy Michael S.
Published: June 2023

Introduction:

Front loading tests reduce Patient Experience Time (PET) in Emergency Departments (ED). “Blanket” or “scattergun” approach to test requests results in prolonged PET, increase in laboratory workload with wastage of resources. Coagulation studies are one of the most commonly ordered investigations. Previous to the 2020 audit, it was suggested that 70% of ED coagulation requests were unnecessary not changing management. By establishing local guidelines, we worked to reduce coagulation test requests.

Method:

The aim of this study was to assess reduction in coagulation tests following implementation of local guidelines in ED. The coagulation indicator checklist was introduced to ED areas storing coagulation bottles. Presentations, small group education, reminders about clinical indications for appropriate coagulation requests were given to nurses, doctors, and advising about audits of practice. From February 1-14, 2022, nurses and doctors were instructed to send coagulation samples after filling out audit forms for the laboratory indicating the purpose of the request.

Results:

Prospective data in February demonstrates a 20% decline in coagulation requests. Only 47% of requests had accompanying coagulation forms filled and the remaining 53%was not filled. In 57% of cases, coagulation samples were requested appropriately, and in 43% there were no indications.

Conclusion:

Through microsystem interventions and awareness campaigns, unnecessary coagulation requests can be reduced. By introducing local guidelines, regular training of new doctors and nurses at induction and intervals, clinical practice changes can be embedded. Consideration should be given to specific coagulation request forms stating the indication for the request. The cost of each sample is 2.87 euro. Obtaining 90% compliance with coagulation requests can save approximately 100,000 euros annually.
What do you Need to Know to Respond to a Disaster? A Review of Competencies and Skills Needed Among Health Professionals
Authors: Westman Anja , Hugelius Karin , Kurland Lisa
Published: June 2023

Introduction:

There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes that add value in a medical disaster situation. Some studies suggest that not only technical skills are needed, but also non-technical skills. However, little is known about the actual demands and skills needed to manage a medical disaster situation. Therefore, this scoping review aimed to identify core competencies required for the disaster medicine response.

Method:

A scoping review using the Arksey & O´Malley framework (1) was used. Structured searchers in the databases PuBMed, CINAHL full plus, Web of Science, PsychInfo and Scopus was conducted. Thereafter, data was structured and analyzed. Inclusion criteria were (1) original papers published in English during the last ten years, (2) covering any aspect of competence or skills needed to respond to a disaster situation. (3) Both qualitative and quantitative studies were included. Exclusion criteria were (1) reviews, editorial texts or similar, (2) papers focusing on the care of single patients.

(1) Arksey H, O’Malley L. Scoping Studies: Towards a methodological framework. Int. J. Social Research Methodology. 2005;8(1):19-32.

Results:

To be presented at the congress.

Conclusion:

To be presented at the congress.
Community Advanced First Aid Training for Day-to-Day Emergency and Disaster Response in Nepal
Authors: Maharjan Rashmisha , Maharjan Ramesh
Published: June 2023

Introduction:

Nepal is a country with geographical difficulties in tackling day-to-day emergency healthcare and disaster preparedness. The aim is to develop community preparedness by training for day-to-day emergency and disaster response in Nepal to generate preventive and first aid awareness of consequences and complications of simple to severe emergency conditions during day-to-day emergencies and disasters.

Method:

It is an analysis of five years of advanced first-aid training at the Nepal Disaster and Emergency Medicine Center from July 2015 to March 2020. In April 2015, the earthquake affected 15 districts of Nepal.

Results:

During July 2015 to March 2020, NADEM has been training 3,995 Community First Aiders for Male Leaders and Active Community people: 1,315 special mothers’ group–Adolescent Maternity & Child Health First Aiders; 794 Ambulance Drivers–Advanced First Aid Trained of remote districts of Mountain and hilly region’s ambulance’s Drivers and Assistants ; 637 ToT First Aiders for Community School Teachers (Training of Trainers); Total AFAT Trained by NADEM = 6,741 (Province 1 to 5); Total Population AFAT Trained = 52,610 (Province 1 to 5); Total Population Benefit by AFAT = 902,100 and its ongoing. NADEM Study Reports of Nepali community with ‘Incident Rate of First Aid Required’ is 9% per day with First Aid Services for 87.4% minor causes, 5.4% major causes, 0.5% gynecological causes, 1.7% AMCH causes, 4.5% trauma causes, 0.5% Prehospital Cardiac Arrest. With NADEM advanced first-aid training, now we are preventing 70% of deaths in remote parts of those districts before reaching the health care centers.

Conclusion:

It is a great challenge to train community laypersons to be Community First Aiders who can tackle day-to-day emergencies and disasters in their community with knowledge, skills practice, and attitude to prepare and prevent the increased tendencies of disability, deformity, morbidity, and mortality in Nepal.
Determinant of Severe Road Traffic Injury Cases Managed by Fatmawati Jakarta Hospital Emergency Department
Authors: Yogadhita Gde
Published: June 2023

Introduction:

A traffic accident injury is one type of unintentional injury that contributes to the third leading cause of death in Indonesia, according to the WHO 2013 Global Road Safety Report based on Indonesian Police, estimated 37,000-47,000 fatalities annually and 46,000 experiencing severe injuries. The injury surveillance pilot project by the Ministry of the Health Republic of Indonesia in the Fatmawati Hospital Emergency Department is trying to describe the magnitude of injury along with its components and risk factors.

Method:

This study aims to determine the risk factors of severe road traffic injury documented by injury surveillance forms in the Fatmawati Hospital Emergency Department from March to July 2016. The research design used was cross-sectional with a number of samples of 600 road traffic injury cases.

Results:

The results show risk factors that contributed as predictors for severe road traffic injury are being male, OR 2.03 (95% CI 1.37-3.02); age greater than 30 years old, OR 1.57 (95% CI 1.11 - 2.22); low education (not attending school until high school graduate) with OR 1.59 (95% CI 1.12-2.25); during working days with OR 1.53 (95% CI 1.08 – 2.17), and cyclists with OR 4.84 (95% CI 0.87-29.0).

Conclusion:

Based on this research, the Ministry of Health of the Republic of Indonesia needs to continue advocating the use of injury surveillance forms at hospital emergency departments to provide a complete picture of injury characteristics and risk factors and to educate and develop road traffic injury prevention and risk communication for the community.
Creating a Health Emergency and Disaster Risk Management (EDRM) Learning Community
Authors: Donahue Donald , Barach Paul , Swienton Raymond , Hansen Jan-Cedric , Harris Curt
Published: June 2023

Introduction:

Disaster research is primarily posthoc analysis, locally focused or within response organizations, overlooking the wellness and safety of first and second responders or the broad multi- and interdisciplinary activities necessary to foster and sustain recovery. A broad framework to span locality, institutional, and professional boundaries supports the development of a true learning community–a health EDRM sector that supports society in recognizing lessons, refining findings, and free and fluid global sharing.

Method:

Several organizations joined to create a robust disaster health learning community: CREDO, GloHSA, ICDM, and ECDM, a multi-national, multi-disciplinary collaborative network of patients, universities, societies, regulators, publishing, healthcare, and technology partners designed to foster expert level education and training with shared educational design concepts, milestones, and core curricula that embrace the strength of a standardized base upon which to link unique pillars of excellence of separate functions, institutions, nations, and regions.

Results:

The Emergency Disaster Global Health Sciences (EDGHS) model developed by University of Texas Southwestern Medical Center is interactive, open, and responsive. EDGHS addresses critical gaps in applied research by convening leaders across the healthcare and public health continuum to map the way forward, designing and implementing high-quality, evidence-based practical and policy research.

This defines essential public health functions for national contexts, including a focus on emergency preparedness and response, strengthening competency-based education on essential public health functions, and mapping and measurement of occupations delivering EDRM functions, offering an exportable model of global relevance.

Conclusion:

Putting disaster prevention into recovery processes is a strategic opportunity to improve the well-being of future generations. The survivability and well-being needs of present and future generations are contingent on knowledge-based, lived experiences of recoverable disaster loss and damage, and the capacity to thrive sustainably. This presentation serves as an invitation to join the growing momentum of creating a learning health EDRM community.
Hospital Preparedness in Facing the COVID-19 Pandemic Based on the Command System: A Study in Jakarta and Yogyakarta, Indonesia
Authors: Ariani Madelina , Donna Bella , Pangaribuan Happy , Yogadhita Gde , Wartatmo Hendro
Published: June 2023

Introduction:

Hospitals have had Hospital Disaster Plans (HDP), however, when the COVID-19 pandemic attacked, several hospitals neglected the HDP. They seem to find it difficult to operationalize HDP. The hospital’s problems were also increasingly complex because they must also think about how to break the internal transmission chain and how to deal with the surge in COVID-19 patients besides building a clear incident command system (ICS). This study aimed to carry out documentation and analyze hospital preparedness in dealing with COVID-19 based on the ICS.

Method:

This study was documentation research using a qualitative approach. All hospital preparations in "high case" areas in Jakarta and Yogyakarta from April to June 2020 were documented, followed by interviews and document observations. Furthermore, data were analyzed according to the ICS management functions; commander, secretary, operational, logistics, planning, and financial administration.

Results:

Since the COVID-19 pandemic, hospitals had developed a separate COVID-19 handling system from the existing HDP documents. The analysis showed the division of tasks and functions of each field in the COVID-19 Task Force already existed, but it had not been described in detail. The communication and procedure flow within the internal and external COVID-19 task force were generally only verbal. In conclusion, related to the readiness to face the surge in COVID-19 patients, the hospitals have not made any plans or supervision for handling COVID-19.

Conclusion:

Hospital preparedness in the face of the COVID-19 pandemic based on the Command System has not been maximized. The existing HDP only includes planning for natural disaster management. Furthermore, every health facility established the COVID-19 Task Force. However, the principle of division of tasks, communication, and planning flow in the Task Force still needs to be improved.
Kiwi Ingenuity – How New Zealand Healthcare Adapted for the Whakaari/White Island Disaster
Authors: Toy Nicole , Simpson Catherine , Taylor Matthew
Published: June 2023

Introduction:

New Zealand is widely known across the globe as an adventure tourism destination. On December 9, 2019, the natural wonders of the country became a major disaster that impacted the lives of many and stretched the resources of the New Zealand healthcare system.

Whakaari/White Island is an uninhabited, privately owned island 50 km off the North Island of New Zealand. It contains two strato-volcanoes, which were and remain a popular tourist destination. While an international tourist group were enjoying their guided tour of the crater, one of the volcanoes erupted, sending superheated debris and gas into the air. Of the 47 individuals on the island at the time, 39 were rescued. Overall, 25 people survived. The mortality of this event was significantly lower than historic volcanic eruptions involving ballistic and pyroclastic injuries. We are fortunate to present information specifically on the chemical and physiological changes noted from exposure to volcanic ash.

Located in New Zealand’s largest city is Middlemore Hospital, home of the National Burns Center. This center is supported by three regional burn centers throughout the country. Prior to Whakaari, mass-casualty plans were in place, however, system-wide adaptations were required on many levels to ensure delivery of healthcare. This included changes in pre-hospital triage, support for regional burns centers and repatriation to home countries.

This poster presentation takes you on the journey of adaptation experienced within the National Burns Service, focusing on operating theater, intensive care and acute burns management.

Method:

Case Study

Results:

.

Conclusion:

.
The Utilization of Hospital-Based Decontamination Facility for Chemical Incidents
Authors: Ponampalam R
Published: June 2023

Introduction:

The constraints of performing prehospital decontamination in mass casualty incidents involving the release of chemical agents at disaster sites in modern cities are notable. Compounding this are highly built-up urban areas with significantly high population density and traffic congestion. This places the burden of performing such decontamination on nearby healthcare facilities. Based on this need, public hospitals in Singapore have been equipped with decontamination facilities. We present a review of the utilization of this facility at our institution.

Method:

A retrospective review of the utilization of the hospital decontamination station (HDS) was carried out, noting its frequency, purpose, and outcomes.

Results:

Since its construction, the HDS has been deployed successfully many times a year for both routine training and disaster preparedness exercises. Despite the lockdown measures due to Covid-19, with concomitant reduction in social and economic activity, the HDS was activated five times for decontamination of chemical contaminated casualties. It is fortunate that, although HDS training activities were curtailed during this period, emergency department (ED) staff were still able to function effectively using prior experience, donning chemical protective suits, and performing decontamination. The semi-automated HDS facilitated rapid deployment which contributed to ease of use of this resource for timely decontamination of casualties with good outcomes.

Conclusion:

Chemical incidents resulting in contaminated casualties are uncommon events. Nonetheless hospitals must be prepared to deal with this situation in a timely manner. The rapidly deployable HDS has become an important resource and an operationally ready solution for dealing with chemical contaminated casualties presenting at short notice to the ED. Regular training and deployment exercises utilizing the HDS provide staff familiarity critical to overall readiness for chemical incidents. This strategy provides a reliable countermeasure in an all-hazards approach to disaster preparedness at the hospital.
The Effect of Weather and Heat-Related Variation on Patient Presentation and Transport Rates
Authors: DiCesare Danielle , Duan Peter , Fitzpatrick Desmond , Paynter Stan , Zuver Christian
Published: June 2023

Introduction:

Mass gatherings are becoming increasingly more common and require adequate preparedness in order to ensure the safety of participants. Standardized planning tools for optimal resource utilization during these events are lacking. We analyzed prehospital data from a high census US theme park to determine whether heat index and wet bulb index are predictive of patient presentation and transport rates.

Method:

This was a retrospective analysis of prehospital data from a high census US theme park. Daily EMS data including call and transport volume as well as corresponding local weather information were gathered between May 2021 to September 2022. The relationship between patient presentation rate and transport rate and weather information was analyzed using Analysis of Variance Testing. Patient presentation rates were calculated based on average daily attendance according to unofficial attendance tracking sources. Seasonal attendance variation was accounted for by comparing variations in patient presentation and transports to the average call and transportations rates for that respective month.

Results:

A total of 515 days of data were included. We found that higher wet bulb temperature readings correlated with both higher patient presentation rates per 10,000 attendees (>80F 4.09, 70-79F 3.39, <69F 2.84 patients; P<0.05) and increased hospital transport rates per 10,000 attendees (>80F 1.38, 70-79F 1.29, <69F 1.09 patients; P<0.05). Adjusted for seasonal variation of attendance, higher wet bulb temperatures were likewise correlated with increased presentation (>80F 102%, 70-79F 98%, <69F 93% of average patients per day; P<0.05) and transports (>80F 101%, 70-79F 100%, <69F 93% of average transports per day; P<0.05). Additional analysis noted similarly increased patient presentation and transport rates on days with higher maximum heat indices.

Conclusion:

In the setting of a high census US theme park, higher wet bulb and heat indices were strongly associated with increased patient presentation rates and patient transport rates.
Establishment of a Medical System for Emergency Radiation Exposure (One local city in Japan)
Authors: Yoshioka Hayato , Okawara Yusuke , Ogoshi Tomofumi , Ueda Takahiro , Homma Masato
Published: June 2023

Introduction:

Japan is the only country to have experienced the atomic bombings and still has many nuclear power plants. In 2011, a nuclear power plant accident occurred during a major magnitude 9.0 earthquake, and there was a great deal of concern about radiation exposure medicine for the public. It is necessary to provide appropriate radiation exposure medicine.

Method:

The facility is located within the IAEA's UPZ, and in the event of an emergency, it is necessary to provide medical care for a large number of people exposed to radiation, so an advanced radiation exposure medical facility was built in 2015 (the surrounding population is approximately 300,000).

Results:

The basics of radiation exposure medicine are: 1) medical priority, 2) prevention of the spread of radioactive materials, and 3) protection of our responders from radiation exposure. Everything from whole body assessments, contamination examinations due to exposure, medical procedures (including advanced medical procedures), and decontamination were able to be performed. The facility is also equipped with WBC (whole body counter) that can assess internal exposure. A support system for other medical facilities was being developed in the region by forming a team that can respond to radiation exposure.

Conclusion:

With the current system, not only radiation exposure medicine will be handled, but also CBRNE and other such services in the future. For this reason, repeated training and human resource development are very important.
Issues in Psychiatric Hospitals that were Revealed Through COVID-19 Infection Countermeasures
Authors: Usuda Daisuke , Tsuge Shiho , Sugita Manabu , Kawauchi Takeshi , Hori Toru
Published: June 2023

Introduction:

Infection countermeasures that consider patient characteristics are needed at psychiatric hospitals.

Method:

Based on the experience of implementing countermeasures against infection by COVID-19, which has become a pandemic disaster over the past few years. This report is on the current situation and issues of infection countermeasures in psychiatric hospitals.

Results:

Reasons for why it is difficult to take COVID-19 countermeasures in psychiatric hospitals included the following: for patient predispositions–it is difficult to promote understanding and practice of infection countermeasures such as proper wearing of masks, hand hygiene enforcement, zoning, etc. For environmental predispositions–it is difficult to ventilate because windows and doors cannot be opened, and it is difficult to isolate infected individuals as there are few private rooms. Countermeasures included the following: recreation should be limited to that which does not involve speaking and having everybody face the same direction, ensuring sufficient space between people during meals, installing ventilation equipment in hospital wards, handle care in private rooms until the hospitalized patient is judged to be not infectious, and conducting zoning and isolation on a hospital ward level. Results showed that although COVID-19 outbreaks occasionally occurred in hospital wards, this did not result in spread throughout the hospital.

Conclusion:

Future challenges include improving the quality of infection countermeasures in hospitals through thoroughly educating hospital personnel who are unaccustomed to taking infection countermeasures.
Research on Supports for Those Who Require Special Care to Prevent Disuse Syndrome in Disasters and Disaster-related Death Using Telemedicine
Authors: Gomi Tomoki , Gomi Shizuko , Nomura Shoko , Hashizume Yumi , Maki Naoki , Yanagi Hisako
Published: June 2023

Introduction:

In Japan, natural disasters such as earthquakes and typhoons are extremely frequent. It is predicted that Tokyo Inland earthquakes will occur within the next 30 years. Disuse syndrome and Disaster-related deaths have increased in disasters. It has been reported that Disuse syndrome and Disaster-related deaths are particularly prevalent among those who require special care. Therefore, it is necessary to consider support for them in the future disaster. Telemedicine has become increasingly popular in recent years. Previous researches using telemedicine have reported that it is useful for rehabilitation and management of chronic diseases. This study aimed telemedicine would be useful to prevent Disuse syndrome and Disaster-related deaths.

Method:

The subjects were physicians, nurses, physical therapists, occupational therapists, and speech therapists. Semi-structured interviews were conducted with the subjects on how telemedicine could be used to assist them. The data were analyzed using Krippendorff's content analysis.

Results:

The research interviewed medical staff including physical therapists and occupational therapists with knowledge about disaster medicine. Thirteen categories of problems with telemedicine were identified, including problems with infrastructure and operation by the elderly. Eight categories of support that could be provided were generated that were common to all rehabilitation professionals, two categories for physical therapists, two categories for occupational therapists, and five categories for speech therapists.

Conclusion:

This study examined what kind of support can be provided using telemedicine to prevent Disuse syndrome and Disaster-related deaths. Common support by rehabilitation professionals included instruction in exercises and prevention of economy class syndrome. It was suggested that speech therapists could provide oral swallowing exercises and support for those with dysphagia. However, the handling of communication devices by the elderly, and the interaction of medical personnel were cited as problems. In response to these issues, there was a possibility to support the victims by collaborating with remote and local medical professionals.
A Crisis is an Opportunity for Human Resource Development
Authors: Shimada Jiro , Hakozaki Takahiro , Waragai Mitsuru , Kohayagawa Yoshitaka , KKobari Takehiro
Published: June 2023

Introduction:

The COVID-19 pandemic also raged in Fukushima Prefecture, Japan. Moreover, it forced a response to the medical crisis just as much as the disaster. After the Great East Japan Earthquake, disaster response system development progressed in Fukushima Prefecture. The relationship between the DMAT and the Prefectural Medical Health and Welfare Department was becoming more assertive.

Method:

However, as the disaster response members became fixed, there was an urgent need to develop new young human resources.

Results:

Meanwhile, flood damage caused by Typhoon No. 24 occurred in September 2018. It was the first time since the Great East Japan Earthquake that a disaster countermeasures headquarters was set up within the prefectural office. In that response, we discovered young talents. Furthermore, they nurtured in response to the medical crisis caused by the COVID-19 pandemic.

Conclusion:

In recent years, the main elements of disaster response required support for continuing medical care and securing public health. Unfortunately, however, these things are insufficient both as medical education and as postgraduate education. Therefore, few human resources are interested in disaster medicine and taking action. In addition, it is also a fact that, like surgical operations, if disasters are not responded to, they will not come to fruition. The response to this pandemic is genuinely an opportunity for human resource development. Taking advantage of this crisis to develop new human resources can be a blessing.
Psychological Emergency Cell and Prehospital Emergency Medical Service Integration into the Care Pathway for Victims
Authors: Cayre Anais , Sangay Virginie , Dionnet Pascal , Viault Benoit , Bounes Vincent , Schmitt Laurent
Published: June 2023

Introduction:

The Medical-Psychological Emergency Cells (CUMP) are integrated in France into the pre-hospital Medical Emergency Services (SAMU). The objective of this study aims to show an integrated course of care and the major interest of the inclusion of the Psychological Cells in the structures of the SAMU.

Method:

The CUMP of the Toulouse Area is made up of Psychologists, Nurses, Psychiatrists, professionals or volunteers sent or put on alert. Interventions take place immediately under the aegis of the prehospital medical care department or in a deferred manner within the first 48 hours. All subjects having at the time signs of acute stress, peritraumatic dissociation, behavioral disorders, are invited to follow-up consultations within 48 to 72 hours. The objective of this work is to show the continuity of care and the pathway of patients coordinated from an emergency call to several months beyond.

Results:

During 2021, 222 situations were handled, either individually or collectively. 94 were assaults (physical, psychological, or sexual), 55 were accidents (traffic accident, fire, explosion, etc.), 50 were confrontations with death (attending a suicide, death, etc.), 13 were traumatic bereavements, and 10 a context of a health disaster. Overall, 1,109 patients were seen immediately on site, 192 post-immediate in less than 48 hours and 197 had repeated individual consultations.

Conclusion:

1) The participation of the same professionals in immediate and post-immediate care makes the prevention of chronic post-traumatic stress more effective.

2) The articulation with the care structures for lasting psycho-trauma establishes consistency in the course of care: sensitivity to signs of distress, dissociation or stupefaction.

3) The links with the pre-hospital emergency medical aid service make emergency specialists aware of the psychological component of traumatic events.
Readiness of Emergency Medical Teams of Sri Lanka Army Medical Corps for Response to Natural Disasters in Sri Lanka
Authors: Kumara Saminda
Published: June 2023

Introduction:

Sri Lanka has been divided into 26 districts. These 26 districts are Colombo, Gampaha, Kalutara, Galle, Matara, Hambanthota, Trincomalee, Batticaloa, Ampara, Jaffna, Mullaitivu, Kilinochchi, Mannar, Vavuniya, Kandy, Matale, Nuwara Eliya, Anuradhapura, Polonnaruwa, Rathnapura, Kegalle, Badulla, Monaragala, Puttalam and Kurunegala. Ten key natural disasters have been identified in Sri Lanka as important to develop response capacity. These natural disasters are coastal erosion, cyclones, droughts, earthquakes, epidemics, floods, forest fires, landslides, lightning and tsunamis. Five battalions of the Sri Lanka Army Medical Corps (SLAMC) have been established in various parts of Sri Lanka. These battalions are named 1 SLAMC, 2(V) SLAMC, 3 SLAMC, 4 SLAMC and 5 SLAMC. The Army Hospital, Army Base Hospitals (ABH), and Medical Reception Stations have been located in various parts of Sri Lanka

Method:

Each battalion and hospital have Emergency Medical Teams (EMTs) for response to disasters. An EMT consists of: one medical officer, two nurses, two nursing assistants and one ambulance with a driver. There are two EMTs in each battalion and each ABH. The Army hospital has three EMTs.

Results:

1 SLAMC is responsible for responding to disasters in Colombo, Gampaha, Kalutara, Galle, Matara, Rathnapura, Kegalle, Kurunegala and Puttalam. 2(V) SLAMC is responsible for responding to disasters in Hambanthota, Kandy, Matale, Nuwara Eliya, Badulla and Monaragala. 3 SLAMC will respond to disasters in Anuradhapura, Vavuniya, Mannar and Mullaitivu. 4 SLAMC will respond to disasters in Jaffna and Kilinochchi dis. 5 SLAMC is responsible for disasters arising in Polonnaruwa, Trincomalee, Batticaloa and Ampara. When disasters happen in adjacent districts, hospitals will respond to those disasters.

Conclusion:

EMTs will be deployed to the disaster site as soon as possible and do treatments for casualties by staying seven days. The number of EMTs depends on the magnitude of the disaster.
The Results of a Foresight Exercise: Future Threats and Trends in Crisis Management
Authors: Voicescu George , Linty Monica , Ler Lian Guey , Kaufmann Stefan , Corte Francesco Della
Published: June 2023

Introduction:

The challenges that the health systems face in the last years increased exponentially. No matter if we are talking about the impact of the COVID-19 pandemic or the Russian military action in Ukraine, the European health ecosystem is facing new problems. In the light of these uncertainties, we assessed which could be the next trends that can impact the healthcare systems, in order to better prepare and adapt to the new contexts.

Method:

Using two foresights exercises (FSE), one in 2018 and the second one in 2022, we identified the most important trends in the political, economic, social, technological, security, environmental and medical sectors that could have an impact on health.

Results:

53 people participated in the first FSE and 40 in the second one. The respondents identified cyber security, an increased reliance on digital technologies for communications, CBRNE management of the patients, centrally coordinated attacks, demographic aging, reduced economic resources, violence against emergency medical staff and the increased need and demand for psychosocial support as the most important trends. Moreover, they considered that wars, hybrid threats, the fake news, pandemics and the influence of artificial intelligence could impact the healthcare systems.

Conclusion:

Many of the trends identified in 2018 as having a possible impact on the health system proved to be relevant four years later. Therefore, we consider the FSE a relevant tool in foreseeing the main areas that could have an impact on health and its results could guide the preparedness for the future.