bluuebunny/crossref_metadata_2025 huggingface dataset:
IBERO Protocol: A Multi-agency Coordination Framework for the Tactical Emergency Casualty Care Spanish System
Authors: Gutiérrez Beatriz , Aguayo Isidoro , García Belén
Published: June 2023

Introduction:

Despite Spanish experience in counterterrorism, jihadism means new modus operandi, based on active mass casualty incidents, involving new injury patterns as mass bleeding ones. Therefore, the environment is completely different to first responders' structure. This change forced the revision of the tactical response model, led by the Spanish Association for Emergency Medicine's Tactical Care Secretary, who provides a discussion forum to its members, reaching a joint framework document, IBERO, adapted to Spanish tactical emergency capabilities.

Method:

Methodology was based on three parameters:

1)

Literature revision, selecting three sources: Books and academic papers, TCCC and TECC guidelines, and Hartford Consensus, and AARs from the main active incidents with similarities to jihadist ones.

2)

Formation of discussion groups: Threat definition, tactile response, and prehospital care, triage and evacuation systems.

3)

A final group formed by representatives of each discussion group wrote the final document.

Results:

The protocol defines a staged plan of action, adapted to Spanish legislation and institutions, following the acronym IBERO:

1)

Information: threat intelligence and information transmitted to responders from the incident location and dispatchers.

2)

Block the threat by perimeter, zonification and suppression of the threat.

3)

Escalation of resources. Definition of areas of action according to direct threat, indirect threat and safe areas of action.

4)

Response and Rescue. Extrication to safe areas, including different stages of triage and protection against secondary attacks.

5)

Order and evacuation. Access to other emergency services, and psychological first aid.

Conclusion:

The document proves the need for a coordinating framework of the Spanish emergency system to be fully adapted to these new threats. The discussion groups have identified the need for regular training on threat identification, zonification setting, mass bleeding control, extrication, and evacuation techniques during hostile situations. To achieve this goal, realistic training is mandatory.
Terrorism-Related Attacks in Sub-Saharan Africa from 1970-2020: Analysis and Impact from a Counter-Terrorism Medicine Perspective
Authors: Hata Ryan , Hart Alexander , Hertelendy Attila , Tin Derrick , Taubman Cara , Cheng Lenard , Ciottone Gregory
Published: June 2023

Introduction:

Sub-Saharan Africa (SSA) has become a hotspot for global terrorism, with nearly 50% of global terror-related deaths occurring in SSA in 2021. To address growing terrorism-related health implications the field of counter-terrorism medicine (CTM) seeks to study the impacts of terrorism and implement healthcare initiatives. This study is a semi-quantitative analysis of terrorist-related activity in SSA from 1970-2020.

Method:

A retrospective analysis of the Global Terrorism Database (GTD) was performed for the region of SSA between 1970-2020. The number of attacks, deaths, and injuries, as well as primary weapons types, country where attacks occurred, and primary target types, were collated into a Microsoft Excel™ spreadsheet (Microsoft, Redmond Washington, USA) and analyzed.

Results:

A total of 19,320 attacks were recorded, resulting in 77,565 deaths and 52,986 injuries. Nigeria had the greatest number of attacks. Firearms were the most frequent weapons used, followed by explosives, unknown, and incendiary, with all others making up the remainder. Private citizens and property were the most frequently targeted entities, followed by general government facilities, police, business, military, diplomatic government facilities, and religious figures/institutions, with all other targets making up the remainder.

Conclusion:

The majority of deaths from terrorism in SSA are the result of firearm attacks. Nigeria had the largest number of attacks and the highest number of killed and wounded. Private citizens and property are the most frequently targeted. Terrorism poses unique challenges to governments, populations, healthcare systems, and aid organizations. By understanding the impact and scope of terrorist activity in SSA, Counter-Terrorism Medicine (CTM) initiatives can be employed to improve healthcare outcomes.
Terrorist Attacks on Refugees, Internally Displaced Peoples, and Asylum Seekers
Authors: Hata Ryan , Hart Alexander , Tin Derrick , Issa Fadi , Ciottone Gregory
Published: June 2023

Introduction:

The United Nations High Commissioner of Refugees (UNHCR) estimates that there were over 100 million displaced people as of May, 2022, which has left many people without adequate healthcare and strained local healthcare systems. While there is concern about violence that may be brought as a result of these large influxes of people, few are focused on attacks that are perpetrated on these displaced peoples. This study is a semi-quantitative analysis of terrorist attacks on refugees, refugee camps, internally-displaced peoples, and asylum seekers.

Method:

A retrospective search of the Global Terrorism Database (GTD) was performed for all terrorist-related events from 1970 to 2020 that targeted refugees, refugee camps, internally displaced peoples (IDPs), and asylum seekers. The number of attacks, country of attacks, weapon types, numbers wounded, and numbers killed were collated into a Microsoft Excel™ spreadsheet (Microsoft, Redmond Washington, USA) and analyzed.

Results:

There were a total of 683 attacks which resulted in a total of 3148 deaths and 4374 injuries from 1970-2020. These occurred in 56 countries, with Sudan having the largest number of attacks at 113, followed by Germany (71), Iraq (61), Nigeria (51), and Sweden (43). The most frequent weapons used were explosives (213), followed by firearms (210), incendiary (140), unknown (74), melee (45), and chemical (1).

Conclusion:

Terrorist attacks against refugees/IDPs/asylum seekers resulted in 3148 deaths and 4374 injuries in 683 attacks. Sudan had the highest number of terrorist attacks, and the most frequent weapon used was explosives. Attacks against refugees pose unique challenges to government, NGO’s, and other stakeholders due to the lack of healthcare access and transient nature of this population. By understanding the scope and impact of terrorist-related attacks against this vulnerable population counter-terrorism medicine initiatives can be employed to improve healthcare access and outcomes.
The Integration of Point-of-Care Ultrasound into Practical Trauma Training in Ukraine: A Case Study Highlighting Feasibility, Satisfaction, and Pre- and Post-Training Comfort with the Technology
Authors: Nelson Erica , Donnelly Stephen , Bilgram Calley , Quaranta Alyssa , Callaway David
Published: June 2023

Introduction:

As of October 2022, the civilian casualty count of the invasion of Ukraine is reported to be 16,295, with actual figures believed to be considerably higher. As explosive trauma continues to terrorize populations, frontline medical personnel are faced with escalating resource constraints including transport, imaging modalities, and electricity. Point of care ultrasound (POCUS) is considered the gold standard in acute trauma evaluation, but very few hospitals or pre-hospital medics have access to or training in POCUS.

Method:

In collaboration with the Ukrainian Ministry of Health, the World Health Organization, and the Global Health Program at Butterfly Network, Team Rubicon developed and conducted 64 practical trauma trainings and donated 50 Butterfly iQ+ portable ultrasound devices in Ukraine between August and October, 2022. Of these trainings, 19 specifically focused on the use of POCUS for trauma. Pre- and post-surveys were deployed to determine demographics, comfort level with POCUS for trauma care, and usefulness of the course.

Results:

In total, 149 individuals were trained in POCUS for trauma. Of these, 130 were physicians, 15 were paramedics, three were RNs, and one was a pharmacist. Only 14.8% of these clinicians self-reported any previous POCUS training. All participants reported an increase in comfort level, with an average pre- and post-course comfort scores of 1.9 and 3.3 (4=very comfortable), respectively. General satisfaction with the training was high (average score of 9.8/10). Qualitative feedback commended the quality and novelty of this training, requested further examples of pathology, and endorsed more POCUS trainings, generally. The most critical lesson learned was the need to re-orient training around the foundations of POCUS given low levels of experience and training.

Conclusion:

Access and training in POCUS for trauma is critical for resource-constrained medical personnel operating in conflict-affected communities. A one-day POCUS practicum-oriented course is feasible to support awareness and proficiency.
Emergency Nurse Roles, Challenges, and Preparedness in Hospitals in the Context of Armed Conflict
Authors: Mani Zakaria , Plummer Virgnia , Kuhn Lisa
Published: June 2023

Introduction:

Emergency nurses’ views on their roles, challenges, and preparedness in the context of armed conflict are necessary to capture in-depth insights into healthcare needs. They can identify the required education and training for emergency nurses and provide evidence of the situations of care in the context of armed conflicts. Unfortunately, the evidence about these factors in the context of armed conflict is scant.

Method:

A semi-structured interview with 23 participants was conducted using qualitative content analysis. The study was conducted in Saudi border hospitals that are shared with Yemen. The COREQ guideline for reporting qualitative research was followed.

Results:

The emergency nurses’ roles in hospitals in the context of armed conflict discussed clinical nurses’ and head nurses’ roles. The main challenges that emergency nurses faced include poor orientation, access blocks, and communication barriers. Various perspectives about the preparation, including education, training, and strategies for preparing emergency nurses, were identified. The most striking findings in these settings were the diversity of armed conflict injuries, clinical profile, triage of mass causality, trauma care, surge capacity, orientation, communication, and strategies for preparing nurses.

Conclusion:

This study provided an estimate of the scope of ED nurses' roles, and how they were prepared across a range of hospitals in the armed conflict areas and therefore a snapshot of their experiences significant to be an informative resource for these settings. This study has provided essential implications for preparedness and planning. Given the large number of preparational courses being undertaken by ED nurses in these settings, the choice of the required education and training must be planned accordingly considering the clinical profile of patients in armed conflict areas, trauma care, triage of mass causality, surge capacity, safety and security, communication, policies, and law.
Ukraine Report from the Field: TCCC in the Multidomain Battlespace
Authors: Quinn John , Dhabila Trisha , Barach Paul
Published: June 2023

Introduction:

Russia invaded Ukraine in February 2022, leading to significant preventable death across Defense forces and communities. When appropriate and adequate training has been provided, the use of point of injury (POI) care guidelines as exhibited by tactical combat casualty care (TCCC) and the implementation of damage control resuscitation (DCR) and damage control surgery (DCS) can reduce preventable morbidity and mortality in the far foreword environment.

Background: Russia invaded Ukraine in 2014 exacting a heavy increase in preventable morbidity and mortality on the battlefield. Multiple global health engagement strategies by allied forces and health partners have focused on prehospital medicine. The most recent iteration of violence has seen a comprehensive invasion with the use of multi-domain battle and conventional weapons systems across nearly every state in Ukraine. These conventional weapon systems deployed by Russian forces exact a heavy lethality on all communities.

Method:

This report uses anecdotal data from undisclosed locations in Eastern Ukraine from the tactical evacuation care, Role 1, Role 2 to the Role 3 echelons of care as reported.

Results:

Appropriate application of combat application tourniquets (CATs), pressure dressings, access to tranexamic acid (TXA), antibiotics, basics of TCCC care and DCR/DCS, including access to blood as early as possible, save lives.

Conclusion:

Rapid access to tactical evacuation care and initiation of DCR/DCS from Role 1 to Role 2 has good effect. The Ukrainian armed forces have pushed damage control Resuscitation and Surgery as far forward as Role 1, which may require a paradigm shift within the NATO military medical standards and preparations for a peer conflict.

Adequate TCCC, DCR and DCS training in the form of global health engagement have anecdotal success in the reduction of morbidity and mortality and in providing force health and medical readiness across NATO nations and partner forces such as Ukraine.
Framework for Implementing and Measuring Interoperability and Organizational Change Within and Across a Multi-service and Multi-agency Emergency Response System
Authors: Heslop David , Bushby Toni , New Charles , Whelan Georgeina
Published: June 2023

Introduction:

The Australian Capital Territory Emergency Services Agency (ESA) has experienced a significantly increased burden of training and most significantly recurrent major emergency response events correlated with increased bushfire and extreme weather events since 2019. ACT ESA is required to provide comprehensive pre-hospital paramedic, firefighting, and emergency response support to the population of the Australian Capital Territory on a day-by-day basis (business as usual) but also surge to meet extraordinary demand. Historically, operational roles and functional areas within ACT ESA have worked largely autonomously under business-as-usual conditions. Under crisis or disaster conditions, these sub-agencies are required to work harmoniously together and alongside external agencies such as Australian Defense Force and Australian Federal Police. ACT ESA have identified that interoperability and integration between internal ACT ESA sub-agencies and externally with other agencies is a key problem. From 2023-2027 ACT ESA has committed to a program of organizational change to address this problem.

Method:

An organizational change plan focusing on improving interoperability and integration was developed using the Generalized Method for Measuring Interoperability and Continuous Quality Improvement frameworks. A comprehensive framework for measuring organizational change and the effectiveness of interventions across multiple workplace domains, based on Kirkpatrick’s approach, was developed through a co-design process between academia and the ACT ESA.

Results:

The ACT ESA change management framework, research, and implementation plan is presented here, alongside the results of preliminary stakeholder and professional engagement activities providing early feedback, adjustment and evolution.

Conclusion:

The ACT ESA is in a unique position within the Australian emergency response landscape having a much greater degree of centralized command, control, and coordination. Despite this advantage, it has identified interoperability both within the organization and with key partnering organizations as a problem. This study outlines how the ESA is approaching organizational change by applying systematic implementation and change management approaches.
International Military Response to the COVID-19 Pandemic: A Literature Review
Authors: Davis Terri , Hertelendy Attila , Hart Alexander , Ciottone Gregory
Published: June 2023

Introduction:

The COVID-19 pandemic created a public health crisis worldwide. Healthcare workers also became ill at a time when hospitals were overwhelmed with patients, leaving critical staffing shortages. Mass vaccination efforts were initiated in some cases without adequate civilian manpower. The governments of many nations utilized their military assets to fill gaps in care, and to initiate projects promoting public health efforts. The COVID-19 pandemic created a never-before-seen international military response to an infectious disease disaster. This literature review highlights the non-conflict assets allocated, abilities utilized, projects completed, overall effectiveness, and lessons learned by the military community worldwide to support their local populace. By collating this information into a single document, the collective global experience can be better analyzed and this information utilized to develop a framework for future disaster preparedness and mitigation planning efforts.

Method:

Medline (PubMed), GoogleScholar and the JSTOR Security Studies collection were searched for English language articles from January 1, 2020 and onwards. Keywords used included civil-military coordination, hospital, deployment, COVID-19, vaccination, and healthcare. Titles were initially screened for relevance and the abstracts were then reviewed for a decision on inclusion. Article inclusion was determined by author consensus based on relevance to the objectives. Key papers were also hand searched for additional unidentified references.

Results:

Data collection and analysis planned for completion by January 2023.

Conclusion:

The COVID-19 pandemic created a huge need for manpower which was backfilled by militaries around the world. This literature search demonstrates how military resources were able to contribute to the pandemic response, including successes and opportunities for future improvement.
Quantitative Analysis of United States National Guard COVID-19 Disaster Relief Activities April-June 2020
Authors: Davis Terri , Hertelendy Attila , Hart Alexander , Pilcher Katherine , Nouaime Georgina , Ciottone Gregory
Published: June 2023

Introduction:

The COVID-19 pandemic provided a unique opportunity for the United States National Guard (NG) to assist in an infectious disease disaster. This study aims to interpret data from NG situation reports (SITREPS) given to the National Guard Bureau (NGB) by each state national guard headquarters regarding their relief efforts from April to June 2020. This is the first published study about NG disaster relief utilizing quantitative data provided by the US military.

Method:

The SITREPS of all 50 states, the District of Columbia, Guam, Puerto Rico, and the US Virgin Islands are available for the dates of April 10, May 6, May 16, and June 3, 2020 through a NG website that requires government level access. These were examined to evaluate and analyze the activities directed by each state NG headquarters as part of COVID-19 response efforts. No other dates were available for analysis.

Results:

During the COVID-19 pandemic, the NG primarily provided security, tested for COVID-19, ran COVID-19 shelters, assisted foodbanks, delivered meals, provided transportation services, aided mortuaries, supported protective equipment warehouses, and deployed medical personnel to cover hospital shortages. They provided services to children, homeless persons, residents of skilled nursing facilities, and Native Americans living on tribal lands. Service members (SM) sewed masks, provided translation services, and cooked in prison kitchens. All state NGs participated in COVID-19 relief to varying degrees. Numerical data about the services provided such as quantity was rare but is included as available.

Conclusion:

The United States National Guard provided a wide variety of services through activation of its service men and women that impacted COVID-19 response throughout all states and territories. This elucidation of the uses of the National Guard should be considered during future governmental disaster preparedness planning efforts, and can be extrapolated to international military disaster relief.
CBRN Disaster Hospital Response and Preparedness. An Italian Civilian Military Cooperation Teaching Model
Authors: Rossodivita Alessandra , Spaterna Raniero , Folla Lucia , Paganoni Catia , Saporito Tommaso , Ranghieri Massimo , Guidotti Matteo
Published: June 2023

Introduction:

Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies need specific hospital preparedness and resource availability.

Preparing to evaluate and manage victims from CBRN exposure events in one aspect of hospital preparedness, is often underestimated. Specific skills and capabilities are required to manage these events. Emergency department (ED) and hospital staff need adequate training to provide safe and effective care.

Method:

The Hospital Complex of Valtellina and Alto Lario (with three hospitals), in consideration of the geographic location amid mountains, far from urban hospital centers, decided to develop an intensive training program for the hospital emergency staff. Firstly, it was based on an eight-hour initial training program, using a combined civilian military approach that included hazard recognition, substance identification, site safety, response roles, PPE use, and decontamination procedures. The CBRN Operational Unit (for prevention of chemical-biological-radiological-nuclear risks) of the 1st Territorial Unit of the Auxiliary Military Corps of the Order of Malta Italy led such training session showing that a military approach to CBRN threats can be used with civilian and military competencies and tools in managing specific hazardous events hospital first responders may face.

Results:

A drill exercise was performed on a radiological fall-out incident to test the hospital’s emergency response staff preparedness. Hospital management and decontamination
procedures were analyzed to treat victims as well as first responders and to train hospital staff with few resources available.

Conclusion:

Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. Skills and competencies of military personnel can be a resource in these kinds of events to train civilian personnel who are not normally acquainted to or confident to manage this kind of CBRN events, and can represent a new model and challenge of interagency cooperation in the disaster management of complex emergencies involving hazardous materials.
The Effects of Including Blood in First Aid Training on Confidence in Bleeding Control Ability and Intent to Aid
Authors: Friberg Marc , Brodin Wilhelm , Jonson Carl-Oscar , Prytz Erik
Published: June 2023

Introduction:

Educational initiatives such as Stop the Bleed continue to educate medical laypeople in first aid for massive bleedings. The effect of including realistic blood early in Stop the Bleed-type training remains unknown. The aim of this study was to investigate the effects of including realistic blood early in a Stop the Bleed-type training on medical laypeople's intent to provide future aid and self-perceived ability to provide aid.

Method:

In total, 46 medical laypeople participated in this study. Two bleeding control tasks, wound packing and tourniquet application, were performed in a simulated scenario on a manikin with a wound. Participants received brief Stop the Bleed-type training and were divided into two groups: with (Blood) or without (Control) blood present during the tasks. After the experiment, two surveys were administered, one on confidence in their ability to perform each task, and a previously established survey on their intent to aid a bleeding victim in real-life situations.

Results:

The post-trial survey showed that the participants in the Blood group had lower confidence than the Control group in their wound packing ability (MBlood = 2.09, SDBlood = 0.85; MControl = 3.04, SDControl = 0.86), t(43) = 3.725, p < .001, but not regarding their tourniquet application ability, t(43) = 0.019, p = 0.985. Further, there was no difference between the groups in their intent to aid in future real accidents (MBlood = 91.00, SDBlood = 6.10: MControl = 90.39, SDControl = 8.30), t(43) = 0.282, p = .782.

Conclusion:

This study shows that introducing realistic blood early in Stop the bleed-type training of laypeople results in decreased confidence in their wound packing ability. However, it does not decrease their intent to aid in future emergencies. Future studies should investigate when and how complicating factors such as blood should be introduced in laypeople hemorrhage control training.
Preparation of Hospital Disaster Plan in Indonesia: The Mentoring Challenges from Offline to Online Program
Authors: Ariani Madelina , Pamungkas Satrio , Pangaribuan Happy , Donna Bella
Published: June 2023

Introduction:

Located in a disaster-prone country, more than 3000 hospitals in Indonesia must have a Hospital Disaster Plan (HDP). Instead of pursuing only the hospital accreditation requirements, HDP should be beyond that. Since 2008, CHPM UGM has been providing various HDP training. However, during the COVID-19 pandemic, there was a change in offline assistance that shifts to online. This study reports the learning activities, output, and challenges.

Method:

There were three batches of HDP-paid online courses in 2021. Each batch consists of three series courses. The first series was a basic HDP seminar. The second series was for intensive HDP mentoring for two months. In the second series, the participants focused on analyzing risk and hospital safety index (HSI), detailing job action sheets, and detailing disaster standard operating procedures. Moreover, the third series in the fourth month was an online tabletop exercise (TTX).

Results:

25 hospitals and 112 people participated. However, only five hospitals that committed finalized the HDP document. The learning process challenges were the participant’s unstable network and their focus on who was on duty while attending the courses. Although the TTX online was a new trial, it worked to asses hospital preparedness for disaster management through well preparation, detailed scenario and proper evaluation instrument. However, it was still difficult to assist participants in completing the HDP documents online, because observation of the hospital environment cannot be carried out while the evidence provided by participants were limited, for example supporting evidence for the HSI indicators.

Conclusion:

The online series of HDP is feasible because it saves accommodation and transportation costs. However, the intensive online mentoring should be carried out longer to allow participants to do assignments and collect evidence of indicators that must be shown to the facilitators.
Assessing the Sympathetic Response of Medical Doctors and Trainees when Exposed to a Virtual Realty Mass Casualty Incident Simulation
Authors: Tovar Matthew , Zebley James , Zwemer Catherine , Herur-Raman Alap , Higgens Mairead , Pierce Ayal , Ranninger Claudia , Sarani Babak , Phillips James
Published: June 2023

Introduction:

The occurrence of disasters and mass casualty incidents (MCIs) is on the rise, thus training and rehearsal for disaster response remain paramount. Virtual reality (VR) platforms have previously been shown to be well-received, engaging, and immersive for disaster training. The primary objective of this study was to ascertain if a human actor-based VR MCI scenario could elicit a sympathetic response, as measured by heart rate variability (HRV), in medical doctors and trainees compared to a baseline state.

Method:

A simulation was filmed with students, residents, and surgeons on a GoPro 360 camera. Subjects (n=35) were recruited to sufficiently power (1-b=0.8) a Wilcoxon matched-pairs test and Welch’s t-test. Subjects watched the simulation on an Oculus Quest headset while having HRV recorded. Multivariate logistic regression was performed to identify factors associated with increased odds of significant sympathetic activation. Statistical significance was established at p<0.05.

Results:

Thirty-five subjects were enrolled and included three trauma surgeons, three emergency medicine (EM) attendings, eight EM residents, six surgery residents, and 15 medical students. A significant decrease in HRV was observed across all groups in the MCI (median 20 ms IQR 16.2, 31.4 ms) compared to baseline (33.2 ms IQR 27.2, 44.1 ms; p<0.0001). Sympathetic activation was most pronounced in students, then attendings, then residents. There was no significant difference in the fold-difference of sympathetic activation of EM physicians (-48.5% +/- 32.1%) versus surgeons (-49.5% +/- 25.2%; p=0.57). In all groups, SNS activation occurred independently of heart rate, age, sex, number of years in practice, first responder experience, or prior MCI response.

Conclusion:

Live-actor VR MCI simulation elicited a strong sympathetic response from students, residents, and attending physicians. By recruiting and disinhibiting essential neural pathways via controlled SNS activation, VR MCI training has the potential to enhance the encoding and consolidation of disaster training in a low-cost and reproducible manner.
Sustainability First: Evaluating a Digital Training of Trainers Approach for Lay First Responders in a Post-COVID-19 World
Authors: Eisner Zachary , Smith Nathanael , Delaney Peter , Kulkarni Aswhin , Achunine Paschal , Shiada Francis , Raghavendran Krishnan
Published: June 2023

Introduction:

Road traffic injuries (RTIs) are the largest individual contributor to the global burden of injury and were among the five leading causes of global disability-adjusted life years (DALYs) in 2016. In regions with limited emergency medical services, training lay first responders (LFRs) has been shown to increase availability of prehospital care for RTIs, but sustainable mechanisms to scale these programs remain unstudied.

Method:

Using a training of trainers (TOT) model, a six-hour LFR training program was launched in Lagos, Nigeria. The course was taught in a hybrid fashion with primary didactics over Zoom and practical in-person breakout sessions. Thirty TOTs proceeded to train 350 transportation providers as LFRs over one month. A previously validated, 23 question, pre-/post- assessment was administered digitally to assess knowledge acquisition. Participants responded to five-point Likert survey assessing instruction quality and post-course confidence.

Results:

TOTs scored a median of 56.5% (IQR: 43.5%, 71.7%) and 91.3% (IQR: 88.0%, 95.7%) on the pre- and post-assessments, respectively, with bleeding control scores increasing most (+69.4%). Course trainees scored a median of 34.8% (IQR: 26.0%, 43.5%) and 73.9% (IQR: 65.2%, 82.6%) on the pre- and post-assessments, respectively, with airway and breathing increasing most (+48.6%). All score increases were statistically significant with p<0.001 and did not differ by trainer. Participants rated confidence 5/5 (IQR: 5,5) in first aid skills and 5/5 (IQR: 4,5) in emergency transportation, increasing from pre-course confidences of 3/5 (IQR: 3,4) and 4/5 (IQR: 3,5), respectively (p<0.001). Participants rated the quality of education content and TOT instructors to be 5/5 (IQR:5,5).

Conclusion:

This is the first time the efficacy of digital instruction for first responder trainers in LMICs has been investigated and demonstrates knowledge acquisition equivalent to that of prior in-person courses. Future work will examine the cost-effectiveness of the training of LFRs and the effect of LFRs on trauma outcomes.
Scenario-Based Collaboration: Identifying the Role of the NSW Biocontainment Centre in the Response to High Consequence Infectious Diseases
Authors: Varshney Kavita , Friend Caren , Ferguson Patricia , Wyer Mary , Bag Shopna
Published: June 2023

Introduction:

The New South Wales (NSW) Biocontainment Centre (NBC) is the first high-level isolation unit in Australia. This state-wide referral facility, located at Westmead Hospital, Sydney, will provide care for patients with high-consequence infectious diseases (HCIDs), including viral hemorrhagic fevers (VHF). In preparation, a tabletop exercise with key stakeholders was held to introduce and socialize the NBC’s capacity to support NSW’s preparedness for the management of a patient with HCID.

Method:

Invitations were provided to key stakeholders within Westmead Hospital (facility executive, emergency and ICU services, security, switchboard); NSW Preparedness and Response Branch; retrieval services; peripheral hospitals; pediatric hospital network; and NSW Public health units (state and district).

The scenario presented was an unwell patient with suspected VHF arriving at a peripheral hospital emergency department.

Discussion during the four-hour long exercise was facilitated with directed questions and injects, and was recorded. Recommendations and key learnings from the exercise and debrief provided opportunities to enhance current response assumptions.

Results:

Forty-five people participated both face-to-face and virtually. Participant discussion showed increasing appreciation of patient presentations to any part of the NSW health system and available assistance. Recommendations included: enhanced access to NBC support with a direct “1-800 number”, coordination for communication, treatment, and transport, and if required, deployment of an NBC team to peripheral sites. Areas for future collaborative work were identified.

Conclusion:

This exercise successfully achieved collaboration of key stakeholders to develop an updated, comprehensive and robust plan for management of HCID patients within NSW, regardless of their presentation site. It has created an opportunity to brainstorm and optimize how the NBC can interact with other agencies to maximize the NSW HCID response.
Timely Teaching for the Time Poor
Authors: Friend Caren
Published: June 2023

Introduction:

Australian Standard 4080-2010 Planning for Emergencies in Health Care Facilities outlines the requirements for all health care facilities to have procedures in place to respond to internal and external emergencies. These procedures must include mechanisms to activate emergency response systems, and staff should be trained and familiar with these procedures.

Method:

To guide staff, Emergency Procedures Flip Charts have been developed and strategically placed throughout facilities. These Flip Charts address immediate actions for staff to follow, including notification and escalation via an internal emergency number.

Specific training has been developed for identified key staff, such as Fire Wardens, but for the general staff the training in Emergency Codes is generic and does not provide scope for staff to contextualize response actions in relation to their department and its nuances.

A survey of staff across all disciplines was conducted which identified knowledge gaps in the immediate response requirements for the different Emergency Codes. To address this knowledge gap, and to ensure staff have an increased understanding of the response expectations relevant to their department, the Six Minute Intensive Training (SMIT) Tools have been developed. These tools can be delivered by any staff member in any forum, such as safety huddles, handover, in-services and toolbox talks.

Results:

A survey was conducted three months after their implementation which identified an increased understanding of response requirements. This result, combined with After Action Reviews from actual responses, highlighted an increased knowledge of the Emergency Codes and response actions. It also identified areas to improve delivery using localized examples.

Conclusion:

The introduction of the SMITs is a successful first step for increasing staff knowledge and responses to Emergency Codes. The opportunity for staff to deliver these SMITs within their own departments provided an avenue to contextualize responses to local practices and nuances.
Implementation and Evaluation of the WHO Basic Emergency Care Course in Rwanda
Authors: Kadakia Nidhi , Shakya Iju , Lee John , Kharel Ramu , Diaz Maria , Mugemangago Pascal , Ndebwanimana Vincent , Karim Naz
Published: June 2023

Introduction:

Improving access to emergency health services can reduce morbidity and mortality for patients with acute emergent conditions. The WHO and ICRC developed the Basic Emergency Care course to train frontline providers in a systematic approach to common and treatable life-threatening conditions. This study aims to evaluate the knowledge retention of Rwandan emergency care providers after implementation of this course.

Method:

A prospective, quasi-experimental, nonrandomized study was conducted at the University Teaching Hospital of Kigali (CHUK) in Rwanda. A formal survey was conducted to understand the current composition and training of Rwandan emergency care providers. Baseline and post-course assessments of knowledge were collected via an existing 25 multiple choice question survey tool which is an already established part of the BEC curriculum. Forty providers who care for patients with acute emergent illness were included. Data collected included age, gender, preferred language, as well as information about professional background, knowledge and skills. Providers with both baseline and post-test results were included in the analysis (n=40).

Results:

Of the 40 Rwandan providers, 47.5% (n=19) male and 52.5% (n=21) female, 26 were nurses, six were doctors, six were prehospital providers, one was both a prehospital provider and nurse, and one was a midwife. The mean age was 36.3. Out of 25, the mean baseline score was 17.8 (SD=3.2) and this significantly increased to a mean posttest score of 21.9 (SD=2.4). 85% (n=34) of providers’ knowledge improved, 2.5% (n=1) of provider’s knowledge stayed the same, and 12.5% (n=5) of providers' knowledge decreased. The difference between the pre and post-test scores was found to be statistically significant, 4.1 (SD=3.4), (P<0.0001).

Conclusion:

This study demonstrated that implementing the BEC course has significantly improved the emergency provider knowledge base. Further studies are needed to demonstrate the impact of BEC training on patient care and morbidity/mortality outcomes.
Reporting Safely in Crisis Zones: Medical First Response for Journalists and Filmmakers
Authors: Tedeschi Christopher , Matloff Judith
Published: June 2023

Introduction:

Journalists work in dangerous places. In recent years, the risk of illness and injury while reporting has increased, whether in the setting of conflict, protest, extreme weather, or environmental disaster. Journalists are targeted more than ever before. Working safely in remote and dangerous settings, especially without the protection of a large organization, requires a wide range of skills related to safety and security. For several years, the Dart Center for Journalism and Trauma at Columbia University has offered brief, intensive courses focused on personal safety, self defense, cyber-security and medical skills for freelance journalists working in dangerous settings.

Method:

We re-conceptualized the medical first responder portion of the Dart Center's "Reporting from Crisis Zones" course to emphasize basic skills related to acute injury and illness, from trauma resuscitation (e.g, hemorrhage control) to environmental exposure and medical illness. We identified the most common medical concerns that these learners might encounter and incorporated feedback from prior courses to develop a one-day curriculum meant to address the most pressing needs of incidental first responders with minimal medical training, and whose primary mission is not providing medical care to others.

Results:

The resulting 8-10 hour curriculum focuses on hemorrhage control, basic airway and respiratory maneuvers and wound care, with additional focus on medical illness, indications for evacuation, and communication and prevention techniques. The re-structured curriculum was first offered in Spring 2022. Feedback from learners was positive.

Conclusion:

Basic first responder skills are critical for journalists working in dangerous settings, who represent a unique population of learners with specific needs and objectives. Next steps include developing a better understanding of the medical and traumatic problems truly encountered by this population in the field, assessing the long-term educational impact of the course, and developing ongoing opportunities to reinforce learning via online resources, refresher sessions, and guideline development.
The Challenge of Mass Casualty Incident Response Simulation Exercise Design and Creation: A Modified Delphi Study
Authors: Weinstein Eric , Bortolin Michelangelo , Lamine Hamdi , Herbert Teri Lynn , Hubloue Ives , Pauwels Sofie , Burke Rita , Cicero Mark , Dugas Phoebe , Oduwole Elizabeth
Published: June 2023

Introduction:

A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain first responder competencies with the challenge of the FSEx. The translational science (TS) T0 question: How can students achieve similar MCI competencies through the use of simulation MCI exercises as with a FSEx?

Method:

Initial TS phase T1: Scoping Review

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review was conducted to develop statements for the TS second phase T2 modified Delphi study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.

Second TS stage T2: modified Delphi study

The database was analyzed and initial draft statements were created. Selected modified Delphi experts were presented with 27 statements with instructions to rank each statement on a seven-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤1.0.

Results:

After three modified Delphi rounds 19 statements attained consensus and eight did not attain a consensus.

Conclusion:

The modified Delphi experts agreed that the simultaneous integration of individual duty and incident management skills should be incorporated into simulation MCI exercise design to achieve competencies depending on high physical ﬁdelity to develop the individual’s manual abilities, as well as high conceptual ﬁdelity, to develop the individual’s clinical reasoning and problem-solving skills. MCI simulation exercises can be developed to achieve similar competencies as FSExs incorporating the 19 statements that attained consensus through the TS phases of a scoping review (T1) and modified Delphi study (T2). The TS process should continue with development of these exercises in the T3 implementation stage and then evaluated in the T4 stage.
Triage Accuracy Rates Using the New MCI Triage System of Regione Piemonte: What’s New?
Authors: Goldschmidt Nicole , Tommasoni Nicola , Raviolo Mario
Published: June 2023

Introduction:

An adequate Mass-Casualty Incident (MCI) triage system is essential to provide the best possible health care to the greatest number of affected people and to optimize the management of the available resources in the context of a MCI.

Method:

In February 2022, Disaster Medicine Service 118 of Regione Piemonte adopted a new 5-color code-MCI triage system and Emergency Medical System (EMS) personnel was trained through a 3-hours-distance learning course. 515 medical doctors and nurses attended the course and completed the final test (triaging of 50 computer-based simulated patients/cases). Their performance was compared to intended triage designations. We collected the data and conducted a descriptive observational study.

Results:

A total of 25.750 evaluations were carried out: 1.030 white cases, 6.180 green cases, 6.180 yellow cases, 9.270 red cases and 3,090 black cases. Overall triage accuracy was 89,63%. The overall errors were 2.671 (10.37%). Concerning the type of error, there were 1.415 cases under-triaged (5.5%) and 1.256 cases over- triaged (4.88%). Based on color-code, the highest rate of error was in green cases (3.48%), while black patients showed the highest accuracy rate (0.32%). Based on type, the most frequent error was under-triage of red patients, while the less frequent was over-triage of black patients.

Conclusion:

The results of the final test performed by EMS personnel showed the accuracy rates of triage using new 5-color code-MCI triage systems of Regione Piemonte to be in range with data reported in the literature. A study limitation is the fact that the data analyzed are derived from online testing performed in no-time limited and no-stress conditions. Another potential limitation is the distance learning which doesn’t allow a discussion with the teacher or a request for clarification. For this reason, we would plan a future study defining the efficacy of the didactic methodology in comparison with face-to-face courses.
Development of a Learning Support System for Acquiring Disaster Nursing Competencies Required in the Acute Phase of Disaster
Authors: Horiuchi Miyuki , Mastuba Ryuichi , Miyazaki Makoto , Shimizu Sachiko
Published: June 2023

Introduction:

The purpose of this study is to develop a disaster nursing learning support system and a list of learning contents developed by our team to effectively and efficiently acquire the necessary disaster nursing competencies in the acute phase of disasters.

Method:

As the first step, based on the ICN Framework of Disaster Nursing Competencies, we examined the teaching materials using nine competencies extracted through prior literature, interviews with disaster nursing practitioners and reviews of disaster nursing experts. Next, we extracted learning contents that are considered difficult to learn in daily work from textbooks used in disaster relief nurse training. We gained new information on disasters using interviews with experts and internet search review literature.

Results:

Educational materials, including links to five open access sites, a summary of basic knowledge and original videos (case reports on dispatching disaster relief nurses, lectures on evacuation center management by experts, triage using the START-method and the PAT-method, psychological first aid, handling medical records and J-SPEED+ apps), were implemented. A test as an entry point for learning, a rubric to check current learning achievement, learning confirmation tests for each competency, a forum as a place for exchanging opinions among the learning community and an automatic certificate issuance system were set up.

Conclusion:

Disaster nursing is an extension of daily nursing, and many matters can be learned in daily work. There are few things that general clinical nurses should learn in addition as this study showed. However, it is inferred that it is not easy to select and update the knowledge and information that nurses need from the abundance of data available in the information society.

It is meaningful to have a learning support system that allows nurses at medical institutions that are expected to collaborate in the event of an emergency to learn together during the silent phase.