bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterizing Nuclear Fallout Patterns in Atlanta, Georgia
Authors: Taylor Morgan , Bell William , Harris Curt
Published: June 2023

Introduction:

Weather significantly affects the distribution of fallout radiation resulting from a nuclear detonation. Prior nuclear detonation models have either utilized a “typical” day for the city of interest or have chosen conditions that optimize fallout radiation. However, models that aid emergency planners should utilize representative weather conditions to capture the most likely distribution of fallout radiation for the region of interest.

Method:

Fallout radiation resulting from an improvised nuclear device detonation in Atlanta, Georgia, USA was simulated for each day in 2019 using the Hazard Prediction and Assessment Capability (HPAC) software and weather from Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2). A partition around medoids cluster analysis was conducted, based on the characteristics of the plumes, population at risk, and estimated proportion of fatalities. A multinomial logistic regression, a decision tree, and a random forest model were then used to predict the cluster from surface-level weather data.

Results:

On average, the fallout plume was 160.25km long, had an area of 3,174.44 km2, and was angled 83.5° from due north. The plume on average contained 3,668,173 individuals at risk for exposure and caused 416,8908 casualties. Four clusters were identified to represent the distribution of fallout radiation. The random forest model was best able to predict the cluster using surface-level weather data, with an average accuracy of 57.24% (kappa = 0.385). The variable importance plot suggests north-westerly winds, cloud coverage at detonation, whether it is summer, and average temperature are among the most important variables for classification.

Conclusion:

Meaningful representation of the variation in the distribution of fallout radiation is imperative while creating nuclear detonation models. While an analysis of the fallout distribution throughout a calendar year provides important insight, future research may examine longer study periods to better understand the climatological impacts on fallout radiation.
Wellbeing of Helicopter Emergency Medical Services (HEMS) Personnel in a Challenging Work Context: A Qualitative Study
Authors: Herpen Merel van , Weme David Nieuwe , Leeuw Marcel de , Colenbrander Renske , Olff Miranda , Brake Hans te
Published: June 2023

Introduction:

Helicopter emergency medical services (HEMS) personnel provide on-scene trauma care to patients with high mortality risk. The HEMS work context is characterized by an exceptionally high exposure to critical incidents, emotionally demanding patient encounters, and having to perform under pressure with limited resources. The aim of this study was to further our understanding of the factors underlying HEMS personnel wellbeing given their challenging work context.

Method:

Sixteen semi-structured interviews were conducted with HEMS personnel from a University Hospital in The Netherlands. Interview topics included work context, personal characteristics, coping, work engagement, and psychosocial support. To analyze the data, a generic qualitative research approach was used inspired by grounded theory, including open, axial and selective coding.

Results:

The analysis revealed ten categories that provide insight into factors underlying the wellbeing of HEMS personnel and their work context: team and collaboration, coping, procedures, informal peer support, organizational support and follow-up care, drives and motivations, attitudes, other stressors, potentially traumatic events, and emotional impact. The findings show that HEMS personnel are highly motivated and have a strong team mentality. Various factors are important to their wellbeing, such as job resources and social support. The HEMS work can have an emotional impact but HEMS personnel use various coping strategies to deal with this. The perceived need for organizational support and follow-up care is low among participants.

Conclusion:

This study identifies factors and strategies that support the wellbeing of HEMS personnel. It also provides insight into the HEMS work culture and help-seeking behavior in this population. The findings may be beneficial to understand and support employee wellbeing in other emergency services work contexts as well.
Prehospital Nursing Volunteer’s Personality Traits: A Motivational Perspective
Authors: Su Po-Hsi , Lin Jun-Dai
Published: June 2023

Introduction:

The aim of this cross-sectional, descriptive study was to determine the personality traits and motivation of nursing volunteers and their effects on pre-hospitalization emergency care.

Method:

Participants were 133 pre-hospital nursing volunteers from Taiwan. This study was performed using self-administered basic demographic information, Eysenck Personality Questionnaire-Revised Short (EPQ-RS), and Volunteer Motivation Scale with Chinese Volunteers (VMS-C). The statistical analysis was performed by SPSS 23.0. The data collections were analyzed by nonparametric statistics, correlation coefficient, covariance analysis, and one-way ANOVA analysis multiple regression analysis.

Results:

Our findings showed that having social desirability and extraversion personality had a positive impact on the attitudes of volunteers in terms of the provision of pre-hospital care. The first identified regulation was highlighted in the motivation scale; intrinsic motivation was secondarily emphasized. Pearson correlation coefficient revealed years of service in volunteering seniority, age, gender and nursing seniority were correlated. On the contrary, the job department and six municipalities were negatively correlated. Equivalence with the other relation, participants’ attending hours per month in volunteering and gender were positively related. Inverse correlations were found in age and nursing seniority. Extraversion personality and involvement in specific municipalities were positively correlated.

Conclusion:

Emergency Medical Services (EMS) has been developed in Taiwan for more than 20 years and must improve the quality of EMS. These results may be used to improve the quality of the pre-hospital care system and encourage nursing staff to join the system. Nursing volunteers in pre-hospital care are a particularly valuable resource, and satisfy a pivotal role early in the process of pre-hospital care. It is recommended that we provide a good interpersonal environment to maintain the good will of the dedicated, experienced, enthusiastic volunteers in Taiwan.
Trauma-related Mental Health in the Context of the COVID-19 Pandemic: Findings from a ‘Living’ Systematic Literature Review
Authors: Duinkerken Anouk van , Bosmans Mark , Baliatsas Christos , Marra Elske , Dückers Michel
Published: June 2023

Introduction:

This contribution is based on the findings from a ‘living’ systematic literature review seeking to understand the short and long term health impact of the COVID-19-pandemic. Emphasis is placed on the prevalence and risk factors of trauma-related mental health outcomes in the context of the pandemic. Especially when it comes to Post Traumatic Stress Disorder (PTSD), it is questionable whether exposure types that are typical to the pandemic match the essence of the disorder. Our objective is to verify whether the international literature sufficiently distinguishes pandemic related exposure from other risk factors such as social demographic characteristics and non-pandemic related exposure to threats and life events.

Method:

This part of the ‘living’ systematic literature review is conducted under the umbrella of the Dutch Integrated Health Monitor COVID-19. In order to guide a research-driven data collection, several databases were searched for studies published during the pandemic. At the moment of abstract submission the protocol was published in Prospero and screening was in progress. Observational, quantitative studies including a specified exposure/event and a trauma-related mental health outcome measure are included. The included studies will be categorized based on type of exposure/event. Pooled prevalence will be calculated if studies are sufficiently homogeneous.

Results:

In progress.

Conclusion:

The results from this literature review are likely going to confirm that a substantial part of the international literature is polluted with studies promising to contain information on PTSD and other trauma-related health effects of the COVID-19 pandemic, yet running short of linking symptomatology to particular types of exposure and risk factors. If this is the case, a risk exists that public health authorities are being recommended to apply preventive and curative trauma-focused interventions based on an ambiguous knowledge base. The results will be presented during the conference.
Methods for Hospital To Promote Disaster Preparedness Against Loss of Power
Authors: Ikeuchi Junko
Published: June 2023

Introduction:

The 2018 Hokkaido earthquake caused a power outage in all of Hokkaido. In Japan, several hospitals have generators for outages. However, when electricity is lost, several hospitals are disrupted because they are accustomed to having a stable power supply on a daily basis. This study describes the efforts of a hospital that were not accustomed to disaster response to evaluate and implement power-loss countermeasures. The purpose of this study is to measure the usefulness of hospital power-loss countermeasures.

Method:

1)

Classification of Japan’s existing power-loss countermeasures.

2)

Hospital evaluation of the classified power-loss measures.

3)

Confirmation of the usefulness of the hospital’s power-loss countermeasures.

Results:

Power-loss countermeasures were classified into four categories. 1.) Equipment enhancement: this measure is expensive but can prevent loss of power, 2.) Purchase of goods: this measure is inexpensive and alternative power is available, 3.) Manual creation, and 4.) Training. Training measures can help smoothen the hospital’s response after a loss of power. A hospital evaluated whether those measures were appropriate for that hospital. As a result, some of the measures were immediately put into practice.

Conclusion:

This hospital was not accustomed to disaster response, and at first, they did not seem to know where to apply countermeasures. However, after implementing the measures, the hospital announced within its organization that the next step was training. It became clear that by presenting specific measures and evaluation methods, the hospital could create good practices. In the future, web-based evaluation methods should be developed so that all hospitals in Japan can work on measures to counteract power loss.
Key Competencies of Pediatric Disaster Medicine as Determined by a Systematic Review of Gray Literature
Authors: Grodman Schyler , Hart Alexander , Hertelendy Attila , Woodward Christina , Voskanyan Amalia , Fadi Issa , Weiner Debra , Ciottone Greg
Published: June 2023

Introduction:

Children are often disproportionately impacted by disasters, and yet pediatric specific considerations are not properly emphasized during disaster planning and training, resulting in the desperate needs of children falling through the cracks during disasters. Children differ from adults developmentally, physiologically, and psychologically, and are more vulnerable to negative long-term medical, social, and behavioral outcomes. Additionally, children lack autonomy and rely on adults to gain access to the healthcare system and other resources. Despite the distinctions between adults and children, time and curricula for pediatric disaster training is insufficient, and workforce capacity and competency to plan for and respond to the disaster related needs of children are inadequate; this is especially true for both physicians and other healthcare responders who do not complete a specific pediatric residency. Our study seeks to determine the key core competencies of pediatric disaster medicine that should be included in the training of responders.

Method:

A systematic gray literature review of existing pediatric disaster medicine curricula was performed, from which a list of the most commonly present key core competencies was created.

Results:

Data collection and analysis is expected to be completed by April 2023 and will yield a ranked list of core competencies.

Conclusion:

There is a need for improved pediatric disaster training that addresses the specific considerations of children; this is especially true for non-pediatricians who may be treating children following a disaster. The gray literature review will identify key components of pediatric disaster medicine, which should be applied to all such training curricula to ensure that the care of children who suffer during and after disasters is equitable across the globe.
International Comparison of Ambulance Times Terminology and Definitions: A Benchmarking Study
Authors: Burton Edel , Crosbie-Staunton Kieran , Deasy Conor , Overton Jerry , Merwick Áine , Willis David , Kearney Patricia , McCarthy Vera , Buckley Claire ,   PHoCoS Stroke Consortium
Published: June 2023

Introduction:

Ambulance times are internationally recognized Key Performance Indicators (KPI) for prehospital care. International benchmarking by comparing ambulance times between countries is a valuable method to help to identify strengths and weaknesses across healthcare systems. However, ambulance times are not standardized across or sometimes even within countries. Thus, this benchmarking study aims to compare terminology and definitions of ambulance times from the ambulance services of a range of countries to facilitate international benchmarking.

Method:

A 23-point questionnaire was developed and pilot-tested on members of international emergency care organizations. The final questionnaire was administered to domestic and international Ambulance Services, who use the Advanced Medical Priority Dispatch System, asking for the terminology and definitions for times from “call received” to “arrival at hospital”. This included “clock start” and “clock stop” times. We asked for the ambulance terms and related variable names in the computer aided dispatch/reporting system. We engaged with clinical stakeholders and Patient and Public Involvement Contributors throughout the process.

Results:

We gathered information from 10 international ambulance services, representing nine countries, and three continents. Some services in the United Kingdom have standardized ambulance times terminology and definitions. However, in the majority of cases terminology differed greatly between countries, and at times within countries and between reports. Definitions of ambulance times varied between countries and regions, with some having different clock start and stop times and others not collecting data on the same time periods.

Conclusion:

The current level of variation in international ambulance times terminology and definitions poses a challenge for international benchmarking and research. International consensus or harmonization of language and definitions would result in more efficient and accurate global comparison. On a smaller scale, defining terms in publications and reports would begin facilitating this process.
Cultural Competence in Academia
Authors: Rizek Jamla
Published: June 2023

Introduction:

Teaching and becoming culturally competent are concepts that have and continue to evolve partly due to the language being used such as culturally competent, culturally sensitive, and cultural humility. With such an influx of ethnically diverse populations, nurses need to become competent in the care of patients from many cultural backgrounds. Faculty must first be culturally competent to provide this pedagogy for nursing students. This paper explores and analyzes the cultural competence of Baccalaureate Nursing Faculty in the United States.

Method:

This study was conducted using a quantitative, descriptive approach among baccalaureate nursing faculty. The Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) tool was used for this study. The survey was sent to 70 randomly selected baccalaureate nursing program Deans and/or Associate Deans listed on a public web site. The sample was purposely chosen to represent at least one program from each of the 50 states across the United States.

Results:

Ninety-four responses were received. Of the 94 responses, 37 surveys were incomplete, leaving a sample size of 57. An analysis was completed on the 57 completed surveys. Limitations include the length of the survey (60 questions) as the authors found that some participants did not answer all the questions. Although faculty rated themselves high regarding being able to identify cultural biases, faculty highlighted the need for more education on culture.

Conclusion:

Faculty appear to be culturally aware and recognize the need for more education to achieve a culturally competent skill set. With the increase in the influx of immigrants from all over the world, the population of the United States is changing. Cultural competence needs to be included in curricula to ensure that patients are advocated for and respected.
Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context
Authors: Sultan Mohammed , Khorram-Manesh Amir , Sørensen Jarle Løwe , Berlin Johan , Carlström Eric , Goniewicz Krzysztof
Published: June 2023

Introduction:

Saudi Arabia has experienced special challenges calling for effective teamwork in the management of disasters and emergencies, such as wars, earthquakes, and major accidents linked to the Hajj pilgrimage over the years. In 2015, 769 pilgrims died in a crowd stampede during Hajj. The outcome of the incident could have been different if the rescuers had the necessary multiagency and collaborative disaster education. This study aims to determine the development of Saudi HCWs’ teamwork during collaboration exercises.

Method:

This study employed two methods to gather data: (observational) during three-level-collaboration (3LC) tabletop-exercises and semi-structured interviews, by employing two theoretical models (team development models). The number of participants was (100) HCWs.

Results:

The results of these exercises had a positive impact on the functionality of HCWs and helped them prepare for disaster management and mitigation inside and outside of a medical facility. Based on the theoretical framework of the integration of team members, the participants reported that the trans-professional team developed because they understood the scenarios. In addition, the participants underscored they developed their skills and knowledge of disaster management because of the attempts made in scenario one. Furthermore, on the theoretical framework of team maturity, several participants indicated that immaturity in scenario one is because of the team members not having the same knowledge and skills. While in scenario two, they are mature because of training and challenges resulting in individual development.

Conclusion:

This study focused on determining the development of healthcare teamwork during collaborative exercises. HCWs were exposed to two scenarios. The tabletop training enabled HCWs to gain the maturity in team building and disaster management. Immature and overripe HCWs cannot easily embrace teamwork. In addition, the public should be made aware of disasters that may come their way. Continuous training of HCWs and creating public awareness are essential parts of disaster management.
ASEAN Strategy for Enhancing Knowledge Management on Disaster Health Management
Authors: Aono Mika , Silapunt Phumin , Yanasan Alisa , Kita Taro , Ikeda Shuichi
Published: June 2023

Introduction:

ASEAN Leaders’ Declaration on Disaster Health Management (ALD on DHM) (2019-2025) was adopted by the ASEAN Summit in November 2017 to strengthen the DHM system at national and regional levels, and the Plan of Action (POA) to implement the ALD on DHM was endorsed by the ASEAN Health Ministers Meeting in August 2019. Knowledge Management (KM) is one of the five priority areas in the POA with the relevant targets including the regional academic network establishment, organization of regional academic conferences, publication of the ASEAN academic journal on DHM, and so forth. The ARCH Project Phase2 (ARCH2), which started in January 2022, focuses on aiming to support implementation of this POA.

Method:

The ARCH2 will support the establishment of the ASEAN Academic Network on DHM (AAN-DHM) and the ASEAN Institute for DHM (AIDHM). In addition, the ARCH2 will support the promotion of academic activities on DHM which shall be conducted under the AAN-DHM in collaboration with the AAN member institutes and AIDHM.

Results:

Terms of Reference (TOR) of AAN-DHM was endorsed by the 15th ASEAN Health Ministers Meeting in May 2022. Afterward, the National Focal Point (NFP) institutes for the AAN were nominated among all ASEAN Member States (AMS). The first meeting of representatives of the NFP was held in September 2022 to discuss several areas such as governance of the AAN-DHM, the organization plan for the ASEAN Academic Conference (AAC), and the publication plan of the ASEAN Journal. Simultaneously, the TOR of the AIDHM was prepared for further discussion of its establishment.

Conclusion:

The AAN has already been established to initiate the preparation of its academic activities. The AAC on DHM is scheduled to be held in November 2023 in Indonesia as the first regional event for accelerating academic activities toward enhancing KM on DHM in the region under the AAN-DHM.
Evaluating the Level of Disaster Preparedness of Tunisian University Hospitals Using the Hospital Safety Index: A Nationwide Cross-sectional Study
Authors: Lamine Hamdi , Cjebili Naoufel , Zedini Chekib
Published: June 2023

Introduction:

Midway through the ‘Sendai Framework for Disaster Risk Reduction 2015-2030’, many nations are spending time, money and effort to enhance their level of preparedness when facing disasters, on the other hand communities, countries and even continents are being left behind. This study was conducted aiming at evaluating the level of disaster preparedness and response of Tunisian University Hospitals.

Method:

This is a cross-sectional nationwide study conducted in Tunisia, from November 2020 to April 2021. Including nine Tunisian University Hospitals and using the Hospital Safety Index. The data were analyzed using the 'Module and safety index calculator'.

Results:

This study showed that seven out of the nine University Hospitals were assigned the ‘B’ category of safety with overall safety indexes that ranged between 0.37 and 0.62. Also, four out of nine University Hospitals had safety scores less than 0.20 regarding their emergency and disaster management.

Conclusion:

This is the first study to evaluate disaster preparedness and response of university hospitals in Tunisia and in north Africa. It showed that the lack of knowledge, resources and willingness, are the most important issues that need to be addressed in order to enhance the preparedness of Tunisian hospitals.
Emergency and Disaster Preparedness Amongst Emergency Medicine Residents in Singapore
Authors: Tan Elizabeth , Yeong Yao Qun , Quah Joy
Published: June 2023

Introduction:

Emergency Medicine (EM) physicians are crucial members of the disaster medical response. In Singapore, the EM residency program spans five years, with junior residents (JRs) progressing to senior residents (SRs) in three years after passing the MRCEM exam or its local equivalent. This study aims to assess the knowledge, attitudes and perceptions toward disaster medicine among EM residents in Singapore.

Method:

A cross-sectional study was performed for 90 EM residents for the academic year 2020/2021. A self-administered, 44-item online questionnaire based on the Emergency Preparedness Information Questionnaire (EPIQ) was delivered via GoogleForms™. This assessed familiarity through 10 dimensions, with a minimal score of one and a maximal score of five. The survey also included questions on attitudes towards emergency preparedness and preferred learning methods. Data was collected from May 2020 to November 2020, and analyzed with SPSS.

Results:

The response rate was 41%. Of these, 75% were JRs and 25% SRs. The overall mean familiarity with disaster preparedness was 2.43 ± 0.90. There was no statistically significant difference of overall mean familiarity between JRs and SRs. Overall, they fared best in the dimension on isolation & quarantine with a mean score of 2.91 ±1.05 and worst in the dimension on psychological issues with a mean score of 2.34 ±0.95.

Residents felt that disaster medicine was relevant to their practice with a mean score of 4.22 ± 0.98. They also felt that it was necessary to learn more about it, with a mean score of 4.16 ±0.90. The highest ranked preferred learning method was workshop/simulation training (45.5%), followed by lectures (23.4%).

Conclusion:

EM Residents have a poor overall familiarity with emergency preparedness, however, they recognized its importance and relevance. The preferred formats of learning were simulation/workshop training. More must be done to improve the overall competency of EM residents in disaster medical response.
Effectiveness of and Adherence to Triage Algorithms during Prehospital Response to Mass Casualty Incidents
Authors: Kamler Jonathan , Taube Shoshana , Koch Eric , Lauria Michael , Kue Ricky , Eastman Alexander , Rush Stephen
Published: June 2023

Introduction:

At mass casualty incidents (MCIs) medical needs exceed available resources, requiring prioritization of response efforts and materials. Principles of triage have evolved since the 18th century into several modern-day algorithms that sort casualties into priority groups based on clinical parameters. It is unclear, however, if such algorithms are effective and practical during real-world MCIs. This analysis reviews the literature on use and efficacy of prehospital MCI triage algorithms.

Method:

The MEDLINE, Scopus, and Google Scholar databases were searched for peer-reviewed and grey literature on prehospital MCI medical response. Articles discussing MCI triage concepts, triage at MCIs, or algorithm efficacy were included. Articles were excluded if they described law enforcement, ethical, psychological or epidemiological perspectives without detailing the medical response.

Results:

Frequently-cited MCI triage algorithms include START (Simple Triage & Rapid Treatment); Triage Sieve; CareFlight; SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport); and RAMP (Rapid Assessment of Mentation & Pulse). They differ in the physiologic parameters assessed, inclusion of numerical measurements, and number of triage categories. Surveyed providers were less likely to have performed full triage at MCIs (16%) than in training (69%), and more likely to have performed no triage (29% vs. 1%). In retrospective trauma registry analyses, algorithms were generally poorly predictive of the need for life-saving interventions (13-58% sensitive, 72-97% specific) in one study, and variably predictive of critical injury (45-85% sensitive, 86-96% specific) in another. The Glasgow Coma Scale motor component was associated with critical injury (73% sensitive, 96% specific if <6); other physiologic variables had sensitivities under 40%. In prospective studies, algorithms were accurate for 36-52% of adults and 56-59% of children. Some suggest clinician judgment may be similarly effective.

Conclusion:

Multiple algorithms exist for MCI triage, but they are infrequently utilized and may be inaccurate. Simpler, more realistic, scalable, and widely accepted response systems need to be instituted.
Issues of the Nuclear Disaster Core Facility Through Nuclear Disaster Training
Authors: Okui Yoko , Cyuta Chiaki , Yoshioka Hayato , Ueda Takahiro , Homma Masato
Published: June 2023

Introduction:

In addition to national nuclear disaster training, local training is conducted once a year to identify issues with training.

Method:

The facility is located in the urgent protective action planning zone (UPZ), an exposure medical facility was built in 2015 and has conducted four trainings so far. The fifth training was conducted this time to develop human resources (training), manage equipment and materials, receive medical teams, collaborate with the Advanced Radiation Medical Support Center, review manuals, and inform local residents.

Results:

There are currently eleven nurses registered as nuclear disaster response nurses at the facility, and two nurses participate in the national nuclear disaster training program each year. On the other hand, unlike physicians and other professionals, the number of nurses enrolled for reasons such as relocation has not increased. The facility also functions as a core hospital in the event of a disaster, and currently has about 30 nurses who are willing to be dispatched in the event of a disaster. It was found that even in core facilities for nuclear disaster response, awareness of nuclear disasters within the facilities is low and few personnel are willing to work there. Previous studies have shown that they are anxious about radiation, the possibility of late effects from low-dose exposure, and concerns about the genetic effects of exposure and its effects on themselves in nursing.

Conclusion:

As a core facility for nuclear disasters, issues were reported on and identified through training, such as human resource development, management of materials and equipment, and review of manuals.
Development of the “Conductor Type Human Resources Development” program for Disaster Medicine and Health Care by Tohoku University and Fukushima Medical University
Authors: Ishii Tadashi , Shimada Jiro
Published: June 2023

Introduction:

On March 11, 2011, the Great East Japan Earthquake with a 9.0 magnitude struck the northeastern coast of Japan. The death toll reached 15,892 and 2,576 people were reported missing. Tohoku University and Fukushima Medical University, both of which are located in the affected prefectures, responded massively to the disaster.

Method:

To deal with the next disaster, both universities established the “Conductor type Human Resources Development” (CHRD) program for Disaster Medicine and Health Care in 2019, not only for doctors, but also other medical professionals (such as dentists, nurses, pharmacists, etc.) supported by the Japanese government. The main course of CHRD program, “Disaster Management course,” which is also a certification program at Tohoku University, comprises 14 practical educational contents (seven practical trainings and seven lectures) based on the work experience of both universities in collaboration with various organizations.

Results:

To date, 59 students have enrolled in the Disaster Management course, two students are enrolled in the board-certified physician in public health and social medicine acquisition course, three students are enrolled in the master's course, a Tohoku University Graduate School of Medicine course, and two students are enrolled in the doctoral course. Until October 2022, a total of 17 people were certified to have completed the "Disaster Management course," and one person completed the board-certified physician in public health and social medicine acquisition course. A total of 68 practical trainings and lectures were held until 2021, the total number of times this program was attended by students until 2021 was 916. Average comprehension rate and satisfaction rate with practical trainings and lectures by students are 97.2% and 98.3%, respectively.

Conclusion:

All the students who complete the CHRD program are believed to acquire comprehensive skills related to disaster health and medical care and will be able to respond effectively in all phases.
Hurricane Ida Emergency Medicine Resident Disaster Response
Authors: Herbert Kyle , Fenton Ronald , Flitter Ben , Kessler Raymond , Maslanka Meghan
Published: June 2023

Introduction:

This report describes the response, action plan, and after-action changes adopted by the Louisiana State University New Orleans (LSU-NO)–Emergency Medicine (EM) Residency Program in response to Hurricane Ida, which occurred in New Orleans, Louisiana in late August through early September 2021. Summarized are the redistribution of emergency department (ED) residents within the primary clinical site, University Medical Center New Orleans (UMCNO); the daily communication flow from chief residents and program leadership; and discussions pertaining to procedural revisions instituted following investigation of pre- and post-hurricane operations.

Method:

Small-group debrief sessions and after-action reports were conducted post-storm to discuss perceived deficiencies from a resident stand-point. Debriefing occurred between chief residents and individual classes through standardized residency forums. Additionally, an after-action committee, comprised of senior residents, academic faculty, and ancillary personnel, convened a separate counsel with hospital administration-level leadership to analyze retrospective limitations that occurred both during, and immediately following, Code Grey activation.

Results:

Following data collection and analysis from the various feedback channels, several changes were made to the residency’s Code Grey activation plan going into the 2022-2023 academic residency year. The information obtained was used to develop a more formalized Code Grey process, and to create more robust orientation and education materials for residents.

Conclusion:

Throughout the events of Hurricane Ida, the LSU-NO Emergency Medicine Department at University Medical Center New Orleans managed a substantial intensification in daily emergency medical activity, while contending with a near-immediate reduction in available resources. Consequently, our program has formalized a more durable residency response to future disasters, including real-time, evolving evacuation correspondence and modernized protocols for rapid re-distribution of resident-power. These procedures are now distributed and practiced throughout each residency year and reinforced on an ad hoc basis in advance of any major weather-related events predicted to impact the greater New Orleans metropolitan area.
Mental Health and Psychosocial Support for Ukrainian Refugees in the Netherlands from Fragmentation to Integration
Authors: Vetten-Mc Mahon Marjonneke , Jansen Noor , Zwart Femke
Published: June 2023

Introduction:

More than 7.8 million people fled Ukraine since the invasion of Russia and are registered as refugees in Europe (as of November 1, 2022). Almost 89,000 of them are registered to the Netherlands (as of November 3, 2022). It is expected that this number will rise. Appropriate and accessible Mental Health and Psychosocial Support (MHPSS) is essential for conflict survivors to address psychological harm from traumatic events and distress both during the escape and after, while trying to adjust to an unfamiliar place. Receiving countries have the obligation to provide MHPSS as part of their international commitment to the right to health. This is recognized in the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of Persons with Disabilities (CRPD). Nevertheless, the Netherlands is failing to honor this commitment with fragmented services that do not seem to fit support needs. The longer it takes to put a comprehensive approach in place, the greater the damage to the refugees will be. This interactive session aims to shed light on practical challenges and opportunities for the implementation of appropriate, accessible and integrated MHPSS. What is needed to go from a fragmented to an integrated approach?

Method:

Being active as advisors in the field of Disaster Health and MHPSS in the Netherlands, the presenters review their experienced challenges thereafter opportunities and good practices are explored together with the participants.

Results:

Experienced challenges include complexity, fragmented organization, lack of ownership and inadequate access to knowledge and information about support needs.

Conclusion:

More is needed to meet the commitment to the right of health and to provide adequate MHPSS to refugees in the Netherlands and beyond. International exchange and learning can help us to understand and overcome implementation challenges.
Pediatric Disaster Readiness and Community Hospitals in a Rural American State
Authors: Kearns Randy , Gross Toni , Perry Amanda
Published: June 2023

Introduction:

Pediatric patients represent a small (but important) subset of the patient population routinely visiting emergency departments (ED) each year. With the aim of better understanding the disaster preparedness level for pediatric-specific mass casualty and surge incidents, a survey was conducted involving all hospitals that routinely manage pediatric patients in their emergency departments, to better understand the preparedness levels for these facilities.

Method:

This is a retrospective analysis of data collected in 2014 and repeated in 2021. Our focus included one predominantly rural state in the United States of America (USA). We examined results from surveys conducted where facilities self-reported objective criteria that resulted in a readiness score (as it relates to pediatric readiness). Reporting stratification reflected the annual pediatric ED volume with groups of; Low (<1800/year), Medium (1800-4999 /year), Medium to High (5000-9999/year), and High (>10,000/year).

Results:

Low-volume hospitals scored (Mean=59/Median=56), Medium volume hospitals scored (Mean=62/Median=60), Medium to High volume hospitals (Mean=67/Median=65), and hospitals with High volumes (Mean=82/Median=83). All hospital volume ranges had outlier hospitals that scored between 82-97. The general tendency, lower volume hospitals had a lower level of readiness, and higher volume hospitals had a higher (to much higher) level of readiness.

Conclusion:

Pediatric disaster readiness needs to be improved at the community level. It is encouraging that pediatric disaster readiness has been addressed in the larger medical centers. Yet, it should be noted that even very low-volume hospitals (had outliers with) scores as high as 94 indicating that with ample support, and resources, pediatric disaster preparedness is achievable in every hospital regardless of size or volume. The results point to a need to develop, improve, and distribute resources and support local hospitals with pediatric disaster readiness.
Impact of Covid-19 in Health Emergency and Disaster Risk Management System: Healthcare Workforce Management in Covid-19
Authors: Chimed-Ochir Odgerel , Amarsanaa Jargalmaa , Yumiya Yui , Kayano Ryoma , Kubo Tatsuhiko
Published: June 2023

Introduction:

COVID-19 conforms to key baseline characteristics of disaster which is defined as “a situation or event that overwhelms local capacity, necessitating a request for national or international level of assistance.” Many countries faced shortages of health workforce, maldistribution, misalignment of needs and skills of healthcare workers.

The research goal is to identify the country responses on the shortage of workforce, their best practices and the lessons learned that may help to better handle any similar crisis in the future.

Method:

The scoping review was conducted in four electronic academic databases, namely, Medline, Web of Science, EBSCO, and TRIP and 24 scientific articles were reviewed. This study is funded by the World Health Organization Centre for Health Development (WKC-HEDRM-K21001).

Results:

The main strategies implemented were a financial coordination mechanism, relaxing standards/rule, redeployment, recruiting volunteers, fast tracking medical students, and using other resources in the workforce such as: the recruitment of inactive healthcare workers, returnees whose registration has lapsed within the last 1-2 years and integration of internationally educated health professionals. All these strategies demonstrated advantages like establishing mutual support across nations, organizations, motivating healthcare workers, lessening the workload of healthcare workers, and creating a new staff model for the next pandemic. If a pandemic lasts longer, financial support mechanisms are no longer feasible and longer working hours result in burnout. Managing volunteers, including supervision of their safety and allocation to the area in need, required hard effort and high-level coordination, especially when a needs assessment is unavailable. Another problem was the absence of an available list of resources, including volunteers and retired medical personnel.

Conclusion:

To date, countries have not yet determined clear policies on how to ensure the sustainability and resilience of the workforce during major health shocks. A follow-up study investigating the strategies implemented is needed.
Emergency Preparedness: Training Outcome in Hospital Staff
Authors: Roblin Patricia , Guzman Jennifer , Arquilla Bonnie , Braynt Clarence , Doukas Donald , Daniel Pia
Published: June 2023

Introduction:

A widely acknowledged aspect of emergency preparedness is hospital-wide staff education. Maintaining interest in hospital emergency preparedness among hospital staff is challenging. A hospital-wide education process involving a robust lecture and hands on donning and doffing sessions followed by periodic disaster drills has been recently undertaken as a quality improvement process.

Method:

A prospective pre- and post-test study of 256 hospital staff were given a six-hour training course in comprehensive Hospital Incident Command Systems (HICS), Hazmat (Hazardous Materials), and CBRNE (Chemical, Biological, Radiation, Nuclear, and Explosive) events. The same pre and post-test were given to all participants that contained questions to assess emergency preparedness knowledge.

Results:

256 registrars within seven months (two classes per month) completed training with pre and post-tests. The average class size was 18.3 (range= 14 to 26 registrars). 3 of 256 (1.1 % 95% confidence interval) registrars achieved the pass mark of 70% in the pre-test survey and 230 (89.8 %) registrars achieved the pass mark in the post-test (χ2-test P < 0.001) with an absolute increase in the pass rate of 84%.

Conclusion:

This finding justifies Emergency Preparedness Training at our institution, showing a marked improvement in staff knowledge of HICS and CBRNE management. This study should encourage continuous widespread use of Emergency Preparedness training in hospital Emergency Preparedness.
EMS and Bioterrorism Response
Authors: Houser Ryan
Published: June 2023

Introduction:

Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the COVID-19 pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services (EMS), even in the accelerating environment of biothreats.

Method:

This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS providers. The survey was available for 1 month in 2021 during which 190 EMS providers responded to the survey.

Results:

Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a biological agent. Provider Clinical Competency levels ranged from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution, and community). Only 10% of the respondents were both willing and able to effectively function in a bioterror environment.

Conclusion:

To effectively prepare for and respond to a bioterrorist attack, all levels of the healthcare system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed to biological agents. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system, which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.
Who Were the Most Vulnerable to the COVID-19 Pandemic? A Nationwide Panel Survey on Infection, Exercise Habits, and Weight in Japan
Authors: Ochi Sae
Published: June 2023

Introduction:

Behaviors to avoid infection are key to minimizing casualties of the COVID-19 pandemic. Even so, infection-avoidance behavior may also cause distant health impacts like immobility and obesity. This research aims at identifying behavioral patterns associated with SARS-CoV-2 infection, exercise habits, and being overweight in the Japanese population.

Method:

Nationwide online questionnaires were conducted five times from October 2020 to October 2021. Individuals who answered with consistency to have been diagnosed with SARS-CoV-2 at a medical facility were categorized into a SARS-CoV-2 group. The difference in lifestyle is compared using multiple regression and inverse probability weighing. In addition, the change in exercise habits, body mass index (BMI), and status of overweight (BMI>25kg/m2) were compared between the first questionnaire and the later ones. Risk factors of losing exercise habits or developing overweight were analyzed using multiple regression.

Results:

Diagnosis of SARS-CoV-2 was negatively correlated with crowd avoidance, mask wearing, hand washing behavior. On the contrary, the diagnosis was positively correlated with some behaviors that appear as preventive actions against the infection, such as changing clothes frequently, sanitizing belongings, and remote working. Regarding exercise habit and overweight, people with high income and elderly females showed higher risk of decreased exercise days. The proportion of overweight was increased from 22.2% to 26.6% in males and from 9.3% to 10.8% in females. Middle-aged males, elderly females, males who experienced SARS-CoV-2 infection were at higher risks of developing overweight.

Conclusion:

It is important to conduct an evidence-based intervention on people’s behaviors and to avoid excessive intervention that is less effective so that people can minimize indirect harm such as exhaustion, economic loss, and other chronic health impacts. Our findings suggest that high-risk groups of COVID-19 infection and immobility and/or overweight are quite different. Further research may enable us to establish more effective interventions for each group.