bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Educational Effectiveness of Hospital Healthcare Providers after Chemical Mass Casualty Response Training Program
Authors: Shin Heejun , Hertelendy Attila , Hart Alexander , Issa Fadi , Ciottone Gregory
Published: June 2023

Introduction:

Chemical exposures can cause direct and indirect injuries to responding medical personnel. Therefore, hospital healthcare providers should be provided with disaster response training that includes identification of chemical hazards, establishment of the hazard zone, personal protective equipment use, decontamination, and chemical injury antidote use. This study evaluates the educational effectiveness of the chemical-mass casualty incident response education module (C-MCIREM) for hospital healthcare providers.

Method:

This was a retrospective quasi-experimental study. Subjects were hospital providers who enrolled in the C-MCIREM program between May 1, 2021, and July 26, 2022. Subjects were hospital providers from Bucheon, Mokpo, Iksan, Jeonju, and Dae-gu cities in South Korea. Subjects completed pre, post, and three-month knowledge retention and self-assessments of readiness tests, as well as evaluations on tabletop exercises (TTX), and a satisfaction survey (11-point Likert) after the course. The instructors scored teamwork measures via standardized evaluations on TTX throughout the course. The K-paired Sample Friedman test was used to compare samples.

Results:

127 respondents were enrolled. The median knowledge score rose from 51/100 (39, 66) to 85.5/100 (73.75, 90) with a median retention score of 74/100 (64, 88) (p<0.001). Participants felt their readiness to respond increased in all facets (all p<0.001) on the post and retention test for the MCI situation. All three hospital teams showed significant increases in teamwork between the median of the 1st and 4th TTX as 27/100 (23.5, 29) and 69/100 (66.75, 69.5) (p<0.05). Participants were overall satisfied (9.1/10 SD 1.13) and would recommend the training to others (9.15/10 SD 1.2).

Conclusion:

C-MCIREM participants had high satisfaction with a significant increase and persistence in knowledge, improved teamwork, and self-assessed readiness to respond to a chemical mass casualty incident.
“Baby Steps” for Baby Breaths–How Incremental Changes Changed Our Performance
Authors: Goswami Rahul
Published: June 2023

Introduction:

Neonatal resuscitations are challenging to any mixed ED with rotating medical staff. Covid-19 decimated nursing numbers and reduced training to a standstill. New doctors and nurses find pediatric resuscitations (simulations and in real cases) challenging as there are complex algorithms/calculations as well as preparing and operating systems such as a Drager ResuscitaireR.

Training rotating or new staff for rare complex resuscitations can be time and resource consuming with little yield.

We describe our experience of applying incremental measures after almost every simulation to improve team performance and knowledge.

Method:

This is an ongoing audit of simulations and cases for neonatal / infant resuscitations using our pediatric bay and Drager ResuscitaireR system. Our main aim was to improve:

1. Nursing preparation time / competence for:

- Pediatric / neonatal drug doses

- Drager ResuscitaireR system setup

2. Medical staff competence for:

- Neonatal resuscitation algorithms

- Drager ResuscitaireR usage (PPV/Ventilator setup)

Two ED consultants ran “in-situ” simulations and recorded gaps/errors (including feedback in debrief). Any measures deemed fixable were implemented ASAP. Improvement was made if error was not repeated in subsequent two independent simulations.

Results:

Audits of five real cases and fifteen simulations revealed gaps (e.g. dose miscalculations, equipment unfamiliarity) which were corrected by simple measures after each discovery. These include:

1. Neonatal resuscitation checklist with steps to setup the Resuscitaire

2. Weight-based resuscitation cards / pre-made packs of equipment instead of manual calculations

3. Position markers for "ideal" ResuscitaireR ventilator settings

4. Step by step ResuscitaireR numbered markers on machine

We found improvements in knowledge gaps, task accomplishment rates, staff satisfaction, appreciation of deficits and in-situ simulation uptake. More gaps are found and resolved at every simulation.

Conclusion:

A Human Factors approach with incremental adjustments and simple improvements with each simulation led to better team task accomplishment in complex preparation and resuscitation.
Developing a HazMat Decontamination Training Program for a Hospital in Singapore for National Emergency Preparedness.
Authors: Selamat Suraidah
Published: June 2023

Introduction:

Sengkang General Hospital (SKH) is a part of the national network of hospitals to respond to civil emergencies including hazardous material (Hazmat) incidents in Singapore. The HDS course aims to train our staff on basic knowledge of the effects of hazardous material exposure and the operations of the HDS.

Method:

HDS course was planned in three phases:

Phase one aimed to train all DEM personnel so as to have a critical mass of personnel equipped to operate the HDS upon immediate notice. Phase two involves hospital staff from non-emergency departments. Material and simulations for phase two was simplified to focus on the skills and prompt decontamination. Phase three aims to test out capabilities of HDS and review processes through department simulations and hospital.

Results:

155 staff have completed HDS training since 2019, amongst them, 23 as instructors. 67.7% found the demonstrations, skills and practices exceeded expectations. 69% were able to apply skills taught during simulation and overall, 71.2% were able to understand topics covered in the modules.

SKH was at the forefront of battling Covid-19 and resources were tight. We have resumed trainings to complete Phase two. We aim to train more than 35% of manpower in non-emergency departments to achieve higher recall.

Conclusion:

Training for national emergencies is challenging. HDS is located right outside the emergency department and has advantages of allowing smooth traffic to decontaminate patients and prompt treatment. However, training can get disrupted with incoming ambulances, patient influx and lack of resources.

SKH aims to be well prepared in handling pandemics and still maintain its capabilities in assisting in national emergencies. There are plans for hospital simulation exercises for all relevant stakeholders and internal and external reviews are required to improve decontamination systems and processes. It is important to continue training hospital personnel to support HDS during crises.
The JDR Method. Our 20 Years of Experience and Practice in Developing Human Resources for Disaster Medicine.
Authors: Sakamoto Taigo , Inoue Junichi , Shirokawa Masamitsu , Ooyama Futoshi , Irahara Takayuki , Ihara Noriyuki , Nakajima Yasushi , Fukushima Kenji , Sugita Manabu
Published: June 2023

Introduction:

The Japan Disaster Relief Search and Rescue Team (the JDR Rescue Team) Medical Unit consists of EMT (emergency medical team) registered doctors and nurses who provide health care and medical advice to rescue operations. The JDR Medical Unit began 20 years ago when they voluntarily participated in rescue training and is characterized by volunteers who belong to different hospitals across the country. As a result, there were problems due to varied skills, and motivation. Until 2017, all applicants were recruited and trained as provisionally registered members, but only about 30% of them became fully registered members.

Method:

Since 2018, we have fundamentally changed our personnel training methods, establishing three main pillars. The first is a screening process based on work experience, expertise, and motivation; the second is dedicated guidance through training, textbooks, online study sessions, and training; and finally, we have created abundant training opportunities and visualized the growth process through a ladder to keep them motivated and goal-oriented at all times. Specific trainers are defined as task force members and they analyze each scene of the deployment practically and reflect on training. The task force also receives training abroad and absorbs good practice from other teams.

Results:

After changing the personnel training methods, the number of participants who dropped out of the training program was significantly reduced, and approximately 90% of the participants became fully registered members. The team members are more motivated and the team's capabilities have improved, leading to IER (INSARAG External Reclassification) certification as a heavy team twice.

Conclusion:

By selecting experienced and capable members and providing them with sufficient guidance and abundant training opportunities, we succeeded in improving the efficiency and capacity of human resource development. Ideally, victims are handed over to EMTs as patients for the future goal.
Integrating Response Plans for Burn Mass Casualty Incidents
Authors: Taylor Morgan , Harris Curt
Published: June 2023

Introduction:

Across the United States (US), there are approximately 2,000 burn beds in 133 burn centers, only 72 of which are verified by the American Burn Association (ABA). As such, many areas in the US are hundreds of miles from the closest burn center. Eight states do not have a burn center, and another 11 do not have an ABA-verified center. Further, the average center has 15 beds, and, on average, there are 90 available beds across the US. Therefore, in addition to patient care complexities, the broader infrastructure for burn patients is severely limited. These constraints suggest the burn healthcare system is particularly vulnerable to disasters, where the needs will exceed the resources available.

Method:

A literature review was conducted of available burn mass casualty incident (BMCI) plans from stakeholders in each level of a response. These response partners included prehospital agencies, hospitals (those with and without trauma center designations), emergency management agencies (local, state, and federal), healthcare coalitions, public health (district, state, and federal), regional coordinating burn centers, and the ABA.

Results:

The amalgamation of the BMCI plans yields a tripartite infrastructure not unfamiliar to emergency management professionals. The burn care agencies integrate into a response, similar to the way in which public health integrates into the emergency management infrastructure. The local to state to federal escalation of assets is reflected by an escalation from the local burn center to the regional coordinating burn center to the ABA. However, gaps remain in the communication between response partners. Few plans, particularly at the local level, reflect the integration of the burn system response.

Conclusion:

The burn healthcare infrastructure in the US is constrained and therefore is particularly vulnerable to a BMCI. Emergency responders should preemptively examine their plans and systems to specifically integrate the burn care and response infrastructure.
Threat Awareness Training for Non-Governmental Organizations Deploying Humanitarian Aid Workers into Conflict Environments
Authors: Tin Derrick , Davis Terri , Hata Ryan , Court Michael , Issa Fadi , Hart Alexander , Voskanyan Amalia , Ciottone Gregory
Published: June 2023

Introduction:

The current war in Ukraine and the subsequent deployment of Non-Governmental Organizations (NGOs) from around the world has highlighted the many potential dangers faced by humanitarian aid workers operating in conflict zones. Humanitarian aid workers may face both direct and indirect threats and aggression whilst on deployment, and given the rising number of global conflicts, the authors postulate a need to incorporate threat awareness training as part of pre-deployment training.

Method:

A list of the top 22 rated NGOs providing international aid was obtained from CharityWatch. All 22 were contacted via their public email addresses or website contact pages to find out if they provide any form of security, tactical, or threat awareness training.

Results:

Seven of the 13 NGOs that responded did not deploy staff into recent conflict zones or surroundings. All six NGOs who deployed staff into Ukraine or surrounding border countries, provided either security, tactical, or threat awareness training to their staff.

Conclusion:

With the rising number of conflicts and disasters around the world, humanitarian aid workers are increasingly exposed to hostile environments and there is a compelling need for NGOs to ensure staff are adequately trained and prepared to handle any dangers and threats they may face.
Leadership Approach in a Complex Disease Outbreak Management: The Case of the Tenth Ebola Virus Disease Outbreak in the Democratic Republic of the Congo
Authors: Yao Michel
Published: June 2023

Introduction:

The world's second largest Ebola virus disease outbreak in DRC (August 2018-June 2020) caused 3,481 cases in 29 health zones, 2,299 deaths and about 250,000 contacts traced. It occurred in densely populated vast areas, with insecurity, ongoing humanitarian crisis and community reluctancy. Four hubs, sixteen sub-coordinations were set up with hundreds of experts to support local inexperienced health workers. Five health coordinators were deployed to lead more than 600 people at national and field level coordinations. This work aimed at reviewing coordinators’ leadership styles using leadership theories. Recommendations were made for future complex health operations.

Method:

The leadership styles of the five coordinators were reviewed retrospectively using different leadership theories. Three groups of theories: (1) Leader’s traits, characteristics, and skills; (2) Leader’s behaviors: behavioral, transformational, and situational; (3) Authentic and servant leadership.

Results:

Analysis with the three groups of leadership theory highlighted that leaders had mixed leadership approaches.

1) Self-confident, calm, determined, extravert (one a bit shy), conscientious, motivators; Sociable and empathic while dealing with staffs affected by incidents; Few strong characters affecting interpersonal relations; Strong negotiation skills while dealing with local stakeholders; Experienced and knowledgeable in analyzing, making judgment and decisions.

2) A participative approach when supporting nationals and partners; Using transformational leadership when coaching national counterparts and mobilizing partners, Directive when teams were to comply with rules or act quickly.

3) Compassion; building trust, confidence and capacity; empowering and coaching.

Conclusion:

The complex disease outbreak imposed a mixed leadership style. Leaders had specific traits and technical skills. Servant leadership style was often used to trigger participation and build capacity in support of national and international experts. Directive approaches were used to trigger urgent actions. Findings could help in selecting and training leaders for public health emergencies. It may require further empirical and operational research in emergency contexts.
An Organizational Perspective of a COVID-19 Outbreak at a Tertiary Hospital
Authors: Braitberg George , Kapp Suzanne , Long Karrie
Published: June 2023

Introduction:

The COVID-19 pandemic challenged healthcare systems globally disrupting access to high quality essential health services. The pandemic may be viewed as a disaster impacting on patients and staff alike. There is a paucity of research describing how large health services have maintained, scaled and innovated care during the pandemic. The study was conducted to provide insights to inform hospital disaster management responses, specifically to identify organizational learnings from the COVID-19 response, capture instances of innovation, understand the impact of COVID-19 on models of care and to identify organizational priorities to prepare for a potential future disaster or terror event.

Method:

Survey research was conducted using a qualitative research strategy. The study was conducted at a 550-bed university-affiliated tertiary hospital located in the southeast corner of Australia in the State of Victoria. The survey was purpose designed, included open-ended questions requiring text responses, and was completed in an online survey form. A thematic analysis of the data was completed.

Results:

A total of 258 staff completed the survey, with staff representing doctors, nurses, allied health, and support personnel. There were four overarching domains of learning identified; People and Care, Staff Support, Implementation of Care, and Organizational Factors. These domains were supported by 14 topic areas which highlighted specific areas of learning and opportunity in preparing for or responding to a potential future disaster or terror event

Conclusion:

There was a need during the pandemic to pivot rapidly to reorganize services and workforce to operate and deliver care in a safe manner. Attention to and action in the domains of People and Care, Staff Support, Implementation of Care, and Organizational Factors can be considered by organizations when planning health service delivery in response to and during the COVID-19 pandemic, or more generally to a potential future disaster or terror event.
Not Just a Vaccination. Provision of Public Health, Environmental, and Social Needs in an Austere Environment in Miami, Florida
Authors: Kim Deborah
Published: June 2023

Introduction:

The recently approved COVID-19 vaccine in 2021 provided a glimmer of hope to all people who had isolated, or lost loved ones to the SARS-COVID-19 virus. Clinics were rapidly established in non-traditional settings in order to meet the need in the early phases of the vaccination program. Contractor support provided rapid personnel support to meet the needs of many locations in several states. Consideration of basic infrastructure requirements such as Incident Command, security, HVAC, electricity, water and sanitation were part of a state supported vaccine clinic in an economically challenged neighborhood in downtown Miami, Florida.

Method:

Topics to be discussed include staffing mixes, language/cultural concerns, handheld EMR applications, patient flow, immunization practices, testing practices, vaccine security, adverse event management, infection control procedures and the ever present supply chain challenges. The discussion will be framed from the perspective of the Chief Nursing Officer in an ever challenging vaccine environment.

Results:

Over 20,000 vaccines were successfully provided in a little over three months, and a community-based Student Internship program was also implemented.

Conclusion:

Vaccine administration is possible in a variety of settings. Foundational principles of vaccine security, management of the environment and provision of safety and security for patients and staff will help to ensure a successful public health campaign.
Tracking Post-Disaster Chronic Disease: Protocol for the RECOVER Cohort Study
Authors: Leppold Claire , Lockery Jessica , Burns Penelope , Brady Kate , O'Donnell Meaghan , Ryan Joanne , Gibbs Lisa
Published: June 2023

Introduction:

There is growing evidence that disasters may increase the risk of developing chronic diseases, including diabetes, dyslipidemia, chronic kidney disease, and cardiovascular disease. However, how much disaster exposure specifically affects chronic disease risk is unknown. This presentation introduces the study protocol for the Risk of hEalth ConditiOn AdVerse Events after disasteRs (RECOVER) Cohort Study, which addresses this gap.

Method:

The primary aim of RECOVER is to determine the extent to which disaster exposure specifically increases the risk of developing chronic disease (Aim 1). The secondary aims of the study are to determine if the nature, duration and severity of disaster exposure are risk factors for disease (Aim 2), to map mediators of post-disaster chronic disease risk (Aim 3), and to identify potential biomarkers of post-disaster chronic disease risk (Aim 4). RECOVER will recruit over 6000 adults (1:1 disaster exposed vs unexposed) in Australia to a nationally representative cohort for longitudinal follow-up. Detailed data will be obtained annually on disaster exposure, demographic, social and health factors. The primary health outcome (Aim 1) of chronic disease will be defined as new, incident diabetes, cardiovascular or respiratory disease, and will be ascertained through data linkage with the Pharmaceutical Benefits Scheme. A biomarker sub-stream will include ~1,000 participants who provide a hair and saliva sample for cortisol and epigenetic analysis.

Results:

N/A

Conclusion:

There is an urgent need for detailed individual-level data to analyze the nature of the association between disaster exposure and chronic disease. In 2020 alone, 16.8 million Australians were exposed to disasters. The frequency and severity of disasters are only expected to grow due to climate change. As the first prospective cohort study to longitudinally track individual-level disaster exposure and chronic disease outcomes, RECOVER will fill a critical evidence gap.
Heatwaves Risk Perception and Knowledge-Empirical Evidence from Pakistan
Authors: Farman Ullah , Barone-Adesi Francesco , Hubloue Ives , Ragazzoni Luca , Valente Martina
Published: June 2023

Introduction:

Heatwaves are the leading weather-related causes of deaths globally. Since the mid 20th century, the frequency and intensity of heatwaves has increased with recent reports projecting a substantial warming in temperature extremes by the end of the 21st century.

Method:

In this cross-sectional study, we attempted to assess public perception and knowledge on heatwaves. Data was collected across Pakistan among a sample of people aged 18 years and above using an online survey questionnaire. Health Belief Model (HBM) constructs were used to assess risk perception using a total of 14 statements while knowledge was measured using 12 statements. The Unadjusted Odd Ratio (UOR) and Adjusted Odd Ratio (AOR) of 95% Confidence Intervals (CI) were employed through binary logistic regression. A total of twelve variables were included in the model (11 categorical and 1 continuous).

Results:

Out of the 686 participants, the majority of the people (57.73) showed high heatwaves risk perception and a high level of heatwave knowledge (59.91). The results of the multivariate regression model (AOR) showed that participants within the Secondary and/or higher Secondary (Grade 9th to Grade 12th) were less likely (OR=0.304) perceiving heatwaves risk compared to the reference group (Basic/Elementary Level i.e., (Grade 1st to Grade 8th)). As the number of participants who lives with others and who heard about heatwaves increases, the participants are more likely to perceive high heatwaves risk. For instance, participants who lives with others and have heard about heatwaves perceived heatwaves risk 1.982 and 1.816 times higher respectively than those who live alone and those who have not heard about heatwaves before.

Conclusion:

HBM can be useful in designing interventions aimed at increasing people’s adaptive behaviors during heat waves. This study provides useful insights to the policymakers across Pakistan in understanding the public’s perception that can lead to informed decision-making.
Data Disaster to Disaster Data: Outputs of the Inter-Agency Expert Group Disaster-related Statistics (DRS) Pilot
Authors: Ahmed Kanza , Cook Meghan , Ogunlayi Fatai , Weir Maddie , Malik Fahad
Published: June 2023

Introduction:

A Hazard Definition and Classification Review conducted by the UN Office for Disaster Risk Reduction (UNDRR) and International Science Council (ISC) resulted in publication of Hazard Information Profiles (HIPs). The HIPs provide groundwork for developing a statistical framework enabling better understanding of the true burden of hazards globally. Furthermore, standardized data is critical for effective monitoring of the Sendai Framework, Sustainable Development Goals, and Paris Agreement on Climate Change.

Following the publication of the HIPs, governments and National Statistical Offices (NSOs) have been encouraged to review their systems for classifying, monitoring and reporting on disaster risk reduction with the aim to gradually implement the HIPs in databases and reporting systems.

The aim of the pilot is to provide statistical feedback on the applicability of the reviewed hazard classification and its HIPs.

Method:

The DRS pilot utilizes mixed-qualitative methods:

Global stakeholder workshops

Literature review to understand the gaps and good practice

Utilizing snowball methodology to cascade a survey to DRS international experts.

Country-level expert focus-groups.

In-country pilots (with Low, Middle, and High-income countries).

Delphi Methodology with expert stakeholders to hone recommendations

Results:

596 responses to the survey from across 38 countries and 90 papers were identified for literature review. Survey initially sent to 120 stakeholders, and snowball methodology increased survey reach, particularly to Global South colleagues. Expert stakeholder and country-level focus groups identified a series of good practices and recommendations enabling step-change towards a standardized global statistical framework. Delphi methodology to refine recommendations is underway.

Conclusion:

The DRS pilot has raised global awareness of the importance of using the HIPs in developing a robust statistical framework with usable disaster-related statistics. This will enable greater accuracy of data contributing to Sendai Framework targets A-D. Results of the pilot being used to inform the Office of National Statistics-UKHSA-Wellcome collaboration on developing Standards for Official Statistics on Climate-Health Interactions in Africa.
Flexible Composable Health IT Platforms for Emergency Response
Authors: Senathirajah Yalini
Published: June 2023

Introduction:

Health information technology, especially electronic health records (EHRs) pose difficult design problems due to the data and workflow complexity, high-stakes stressful nature of healthcare work, variability of information and collaboration needs and stakeholders. Emergency response poses further requirements. We propose a different, novel approach in which flexible ‘building block’ platforms composable by nonprogrammers could address rapid implementation and sharing of new functionality as needed at the point of care. In order to truly meet unpredicted emergency needs a philosophy of maximal flexibility and data comprehensiveness is required.

Method:

Existing technologies were used in new ways to permit prototype design of composable health IT platforms, intended to be added to existing health information systems, allowing nonprogrammers (including clinician end users) to assemble any desired data, visualization, and new logic to permit rapid tool deployment in emergencies. An example is the rapid composition of Covid-19 screening and treatment tools (in minutes) for fast implementation of new screening and care guidelines (as happens in a new epidemic), with usable visualization and decision tools.

Results:

Prototype systems were successfully built and configured for rapid tool creation for pandemic-specific needs including setup of automated screening and decision tools using EHR data plus point of care data gathering. These will be demonstrated. A modular, composable approach is usable by nonprogrammer clinicians, permitting those most familiar with rapidly changing clinical needs and guidelines to implement new health IT functionality directly instead of incurring delays typical when IT staff must do ad hoc programming. At this time new initiatives and mandates for health IT interoperability make this more easily doable than previously.

Conclusion:

Disaster response may be facilitated by a different approach to health IT design and use, with advantages for rapid response, streamlining clinician work, and ease of use.
Effects of an Early Detection System for Barotrauma During Hyperbaric Oxygen Therapy
Authors: Wang Soon-Joo , Kang Pooreun
Published: June 2023

Introduction:

Although hyperbaric oxygen therapy is required in disasters or emergency situations, barotrauma, which is the most common complication, continues to occur. If barotrauma occurs during hyperbaric oxygen treatment, treatment is stopped, and there is no proper preventive method for this. Therefore, the authors evaluated the degree of barotrauma prevention by applying a tympanometry-based anti-barotrauma device (ABT).

Method:

The candidates of the clinical trial are adults between the ages of 18 and 65 who correspond to academic indications for hyperbaric oxygen therapy. In a prospective parallel design, the candidates were placed in the test group and control group. Simple randomization and one-sided blinding were applied. The medical staff directly observed the severity of middle ear barotrauma through a video otoscope. The number of treatment interruptions and completions along with findings from the otoscope observation (Grade 0~5) such as level of ear pain (pain scale value) were collected at three university hospitals.

Results:

When ABT was applied, it was possible to prevent barotrauma earlier than the traditional medical observation. However, since the application of ABT requires the patient's voluntary cooperation, it is difficult to prevent barotrauma if a patient has reduced consciousness or is unable to follow the instructions of the medical staff.

Conclusion:

Applying ABT is an appropriate method for early detection of barotrauma. However, in order to be applicable to patients with reduced consciousness or difficulty in cooperation, an automatic intrinsic pressure reduction system should be developed.
Machine Learning Prediction for Supplemental Oxygen Requirement in Patients with COVID-19
Authors: Igarashi Yutaka , Miyake Nodoka , Mizobuchi Taiki , Shigeta Kenta , Obinata Hirofumi , Takayama Yasuhiro , Yokobori Shoji
Published: June 2023

Introduction:

The coronavirus disease (COVID-19) poses an urgent threat to global public health and is characterized by rapid disease progression even in mild cases. In this study, we investigated whether machine learning can be used to predict which patients will have a deteriorated condition and require oxygenation in asymptomatic or mild cases of COVID-19.

Method:

This single-center, retrospective, observational study included COVID-19 patients admitted to the hospital from February 1, 2020, to May 31, 2020, and who were either asymptomatic or presented with mild symptoms and did not require oxygen support on admission. Data on patient characteristics and vital signs were collected upon admission. We used seven machine learning algorithms, assessed their capability to predict exacerbation, and analyzed important influencing features using the best algorithm.

Results:

In total, 210 patients were included in the study. Among them, 43 (19%) required oxygen therapy. Of all the models, the logistic regression model had the highest accuracy and precision. Logistic regression analysis showed that the model had an accuracy of 0.900, precision of 0.893, and recall of 0.605. The most important parameter for predictive capability was SpO2, followed by age, respiratory rate, and systolic blood pressure.

Conclusion:

In this study, we developed a machine learning model that can be used as a triage tool by clinicians to detect high-risk patients and disease progression earlier. Prospective validation studies are needed to verify the application of the tool in clinical practice.
The Future Technologies that will Define Disaster Medicine
Authors: Hart Alexander , Hertelendy Attila
Published: June 2023

Introduction:

Advances in technology can drastically improve the ability of providers to care for survivors of a disaster. Research into new applications of technology in the Disaster Medicine space, and dissemination of new technological achievements are vital to saving lives. This presentation discusses several recently proven technologies in the field of disaster medicine which deserve further dissemination, as well as promising technologies currently being studied.

Method:

An overview of the current uses and upcoming research on several technologies will be definitive in future disaster responses.

Results:

Unmanned Aerial Vehicles (UAVs) and Telemedicine have been well studied and are proven game changers in field disaster response. Artificial intelligence continues to be studied and aid real-time, strategic and tactical decision making in the field. Virtual reality simulation has now advanced to be a feasible, cost effective and effective method of training disaster responders as well as for training the lay public in disaster risk reduction. Artificial Intelligence is also being studied for uses in the hospital and in all forms of Emergency Management, and is likely to be intricately tied to the future of the field.

Conclusion:

As new technologies are developed, it is important for Disaster medicine practitioners to consider how they can be applied to the field. Advocating for applying new technologies to disaster medicine, and for dissemination of proven technologies is a vital part of advancing the field of disaster preparedness and response.
Cyberthreats and Healthcare
Authors: Tin Derrick , Hata Ryan , Staynings Richard , Granholm Fredrik , Ciottone Gregory
Published: June 2023

Introduction:

Cyberattacks against healthcare have been growing at an alarming rate globally targeting the theft of clinical research intellectual property, personally identifiable information, and personal health information. Recent studies have also shown a concerning correlation between cyberattacks and patient morbidity and mortality rates. Many top security experts consider cyberattacks a top national security concern.This paper is a descriptive analysis of healthcare-related breaches in the United States in the past decade and an analysis of cybersecurity threats that are currently facing the industry.

Method:

Breach reports of unsecured protected health information affecting 500 or more individuals in the US are publicly accessible through the U.S. Department of Health and Human Services Office for Civil Rights portal. The database was downloaded and searched for all reported breaches occurring between January 1, 2011 - December 31, 2021. Breaches were subdivided by states, dates, location, entity type, and individuals affected.

Results:

Of the 3,822 PHI breaches recorded, 1,593 (41.7%) were hacking/IT related, 1,055 (27.6%) were listed as unknown, 819 (21.4%) were theft related, 194 (5.1%) were loss related, 97 (2.5%) were related to improper disposal and 64 (1.7%) were listed as “others.”

Breaches occurred within the main categories as follows: network server (957 [25%]), email (877 [23%]), paper/films (665 [17%]), other (454 [12%]), laptop (341 [9%]), desktop (309 [8%]), and electronic medical records (220 [6%]).

Conclusion:

A total of 3,822 breaches affecting 283,335,803 people in the United States were recorded from January 1, 2011 to December 31, 2021.

The most reported breaches were from healthcare providers with 2,827 (75.1%) events, followed by health plans (500 [13.1%]), business associates (480 [12.6%]) and healthcare clearinghouses (10 [0.3%]). 4 (0.1%) breaches were from unknown sources.

This report may help healthcare providers understand the extent of the issue and mitigate some of the associated risks.
Cyber-shock and “digital withdrawal”: Organizational lLeadership and Crisis Management During a Hospital-wide Computer Shutdown Following a Ransomware Attack
Authors: Ofir Anna , Koren Rafael
Published: June 2023

Introduction:

In October 2021, Hillel Yaffe, MC, suffered a ransomware attack which shutdown most hospital computer systems, including patient EMR, pharmacy, communications, administration and backup systems. Staff were left in a state of “cyber-shock” without access to essential information for maintaining safety, quality and continuity of care. The aim of this presentation is to share the hospitals' experience and insights of this cyber-attack, outlining preparedness and response strategies.

Method:

This attack required a multifaceted emergency response strategy, including:

Immediate response activated according to specific pre-prepared emergency scenario action lists

Leadership decision making in real time under conditions of uncertainty

Identifying the extent of systems affected

Establishing alternative communication across the organization

Distributing real-time status updates and proactive guidelines, based on pre-existing emergency preparedness protocols

Finding alternative access to patient health histories

Adaptation and distribution of alternative hardcopy versions of patient evaluation and documentation normally done by EMR

Distribution of instruction materials for staff via alternative communication, ensuring quick and correct adoption of alternative protocols

Special emphasis on patient safety, risk management, quality and continuity of care

Recognition, support and resilience-building for staff facing uncertainty and unprecedented conditions

Results:

Required preparations include pre-prepared standing orders and procedures, exercises and simulations. Advanced preparation of alternative documentation and care protocols will enable uninterrupted, safe, high-quality patient care. Familiarity with pen-and-paper documentation may minimize shock and disorientation from “digital withdrawal”, especially among younger workers lacking manual documentation experience. Staff members should also be instructed in maintaining “digital hygiene”, such as using strong passwords and awareness about cyber-security threats.

Conclusion:

Hospitals must prepare for potential cyber-attacks and EMR/digital system shutdowns. Cyber-attack should be treated by organizations as an emergency event, and they should prepare incident response and contingency plans, to assure business continuity and quick disaster recovery.
Health Problems and Healthcare use During the COVID-19 Pandemic: Impact on Vulnerable Groups.
Authors: Bosmans Mark , Duinkerken Anouk van , Tak Nannah , Dückers Michel , Baliatsas Christos
Published: June 2023

Introduction:

The COVID-19 pandemic and the countermeasures taken form a threat to the physical and mental health of the population, especially for more vulnerable groups. In this study, which is part of the Integrated Health Monitor COVID-19, the impact of the COVID-19 pandemic on the healthcare use of the Dutch population and specific vulnerable groups was examined.

Method:

In this study two data-sources were combined. The first consists of electronic patient records of general practices (GP) participating in the Nivel Primary Care Database. These records are representative of the Dutch population and provide insight into acute complaints, chronic conditions, medication prescriptions and primary care use. For the current study, primary care use in pre-COVID years (2018 and 2019) was compared to that in 2021. This data was coupled with microdata from Statistics Netherlands, containing such information as socio-economic status and migration background. Analyses were conducted using longitudinal mixed-effects regression models.

Results:

Results show that risk factors play a role in the utilization of primary care. Women and those with a low household income visited the GP more often for mental complaints. Individuals with a migrant background visited the GP more often for coughing, fatigue, and social problems. Those with pre-existing chronic physical conditions were seen less often by their GP for shortness of breath. Among those with pre-existing mental problems GPs more often registered shortness of breath, yet less problems with access to care or social problems.

Conclusion:

Combining GP registry data with relevant background data has deepened our understanding of changes in health problems and healthcare use among the general population during the COVID-19 pandemic. This study provides insight into how specific vulnerable groups are affected more strongly, and emphasizes the importance of monitoring these groups during a health crisis.
Assessing the Preparedness for a Cyanide Poisoning Mass Casualty Incident in Brooklyn
Authors: Pandya Jay , Doukas Donald , Daniel Pia , Silverberg Mark
Published: June 2023

Introduction:

Urban communities are under constant threat of numerous potential disasters, including cyanide exposure events. Exposure can occur in settings such as structure fires, industrial accidents, or even intentional acts of terrorism. The typical treatment modality for cyanide toxicity employs the antidote, hydroxocobalamin. While studies regarding antidote availability have been conducted in Korea and Hong Kong, a literature search did not reveal any such studies in any part of New York City.

The borough of Brooklyn has a population of 2.57 million people. In the setting of a mass casualty incident (MCI) involving cyanide toxicity, such as a large structural fire or a chemical attack, it is uncertain of the region's capability to provide hydroxocobalamin. The objective of this study is to assess the stockpile of hydroxocobalamin across acute care hospitals in Brooklyn.

The amount of hydroxocobalamin required to treat a cyanide-related MCI was based on recommendations from the 2018 US Expert Consensus Guidelines for Stockpiling Antidotes. Ten grams of hydroxocobalamin are needed for each 100-kg patient. Theoretically, a minimum of 50 grams of hydroxocobalamin would be required for a mass casualty incident (5 patients).

Method:

Fifteen acute care hospitals within Brooklyn were identified as potential treatment sites for cyanide exposure. Each site’s emergency manager was sent a survey identifying hydroxocobalamin availability in both their pharmacy and their emergency department.

Results:

All 15 hospitals responded to the survey. Two of the 15 hospitals had at least 50g of hydroxocobalamin in their inventory, however, no hospital had 50g stored in their emergency department. The median amount of hydroxocobalamin stored was 20g or two doses.

Conclusion:

Should a mass casualty incident involving cyanide exposure occur, only two hospitals in the borough of Brooklyn would be prepared to treat five or more patients presenting to their hospital.
Worldwide Impact of COVID-19 on Frontline Pharmacists’ Roles and Services: INSPIRE International Questionnaire
Authors: Watson Kaitlyn , Lee Dillon , Nusair Mohammad , Al Hamarneh Yazid
Published: June 2023

Introduction:

Pharmacists have been recognized as essential healthcare professionals during the COVID-19 pandemic. However, evidence of the challenges that were faced by the profession and the way pharmacists adapted their roles throughout the pandemic are largely unknown. This study aimed to describe the impact of COVID-19 on pharmacy practice around the world.

Method:

A cross-sectional online questionnaire with pharmacists who provided direct patient care during the pandemic. Pharmacists were recruited through social media with assistance from national/international pharmacy organizations. The questionnaire was divided into three sections; 1) demographics, 2) pharmacists’ roles/services during the pandemic, and 3) practice challenges. The questionnaire was adapted from the established, piloted, and published INSPIRE Canadian Survey. The data were analyzed using SPSS 28. Descriptive statistics were used to report frequencies and percentages.

Results:

A total of 505 pharmacists practicing in 25 countries consented and completed the questionnaire. Only 26.4% (132/500) of participants were engaged with local disaster and public health agencies during the pandemic to coordinate pandemic response. The most common role that pharmacists undertook was responding to drug information requests (89.4%, 448/501), followed by allaying patients' fears/anxieties about COVID-19 (82.7%, 413/499), educating the public on reducing the spread of COVID-19 (81.3%, 409/503), and addressing misinformation on COVID-19 treatments/vaccinations (79.1%, 397/502). The most common services provided by pharmacists were performing medication reviews (78.5%, 391/498) and managing and/or monitoring patients’ chronic diseases (72.3%, 362/501). Almost half of the participants reported administering COVID-19 vaccines (44.9%, 225/501). The most common challenge that pharmacists encountered was increased stress level (82.2%, 415/505), followed by medication shortages (72.3%, 360/505).

Conclusion:

Despite the unprecedented nature of the COVID-19 pandemic and the various challenges associated with it, pharmacists around the world adapted their roles and services to continue to meet the needs of their patients and be their safe-haven for ongoing care.
Changing the Scene: Lessons Learned and Actioned into General Practice from Australian Flood Fire Drought & Heat through Primary Health Networks
Authors: Burns Penelope , Pettigrew Donna , Harding Joanne
Published: June 2023

Introduction:

General Practitioners (GPs) manage the majority of usual healthcare needs in a community. These healthcare needs do not cease in disasters; they increase and expand. However, inclusion of GPs in disaster healthcare systems is only just beginning. Systematic review of the health effects of disasters over days, months, and years, shows the major burden of healthcare needs associated with disasters is within the realm of usual general practice. In Australia, Primary Health Networks (PHNs) represent local GPs in each region. They offer the best option for systematic linkage of GPs to the broader DHM system.

Method:

A systematic review of the literature on the health effects of disasters and three qualitative studies reviewing the current experiences, barriers and facilitators to GP involvement in DHM systems were undertaken through a PhD at the Australian National University in 2022. A knowledge to action framework was developed and utilized to provide a systematic strategy to guide efforts to diffuse, disseminate, and implement the research as it emerged, with a focus on sustaining those changes through integration of PHNs into Australian DHM systems.

Results:

Integration of GPs, through PHNs, is evolving, through systematic inclusion in planning and policy in local health districts. Over time, evidence-based knowledge of disaster healthcare needs has been incorporated into GP disaster planning and preparedness, and resource development, and utilized by GPs during the recent 2019 Black Summer Bushfires, and East coast Floods.

Conclusion:

As our knowledge of the healthcare needs of disasters continues to reflect our increasingly challenging and complex world, the proven benefit of active involvement in holistic, comprehensive continuity of healthcare through General Practice in DHM systems through PHN linkage becomes more urgent.