bluuebunny/crossref_metadata_2025 huggingface dataset:
Injury Outcomes of the 2017 Charlottesville TARMAC Attack
Authors: Phillips James , Young Jeffrey , Brady William
Published: June 2023

Introduction:

Targeted Automobile Ramming Mass Casualty attacks (TARMAC) have occurred worldwide since 2010. The dramatic increase in incidence warrants special attention to the unique pattern of injury associated with such attacks as they are unlike any other type of intentional trauma. This study characterizes the resulting injuries from the 2017 Charlottesville, Virginia TARMAC attack.

Method:

Patient records of victims were identified and analyzed for injuries, demographics, and surgical needs. The data were evaluated for patterns.

Results:

Nineteen TARMAC victims were treated in the UVAHS Emergency Department. Most were female (68%). Average age was 29.4 years (range 13 – 72 years). Data showed seven ICU admissions, four standard admissions, and seven discharges. There was one fatality and the specific injury data was unavailable. Most injuries were orthopedic: lower extremity fractures (n=7) [2 open], upper extremity fractures (n=7), axial skeleton fractures (n=6), and a facial fracture (n=1). Arterial injuries required interventional radiology (n=1) or observation (n=2). Organ injuries included a Grade 1 spleen laceration (n=1) and pneumomediastinum (n=1). six victims required one or more operative interventions during admission: emergent procedures (n=6) and delayed procedures (n=4). In the Emergency Department, two bony reductions were performed, five lacerations were repaired, and one thoracotomy was performed. Injury Severity Scores were calculated (mean=11.5; median 6; range 1-75).

Conclusion:

Due to the mechanism of injury, TARMAC attacks inflict a unique wounding pattern. Intentional mass blunt trauma is previously unknown to emergency medicine. Vehicle variables including weight, speed, and bumper height affect the injury location and severity. This vehicle, a low-height sports car, inflicted primarily lower extremity injuries. Mortality rates have been higher in attacks involving taller, heavier vehicles, as seen in France, Germany, and Sweden. Analysis of victim data from TARMAC attacks will help emergency medicine physicians, surgeons, and disaster medicine specialists to prepare, train, and mitigate against this increasingly frequent tactic.
A Scoping Review of the Literature on Landmines in Egypt and their Resultant Disaster Impact
Authors: Abdel-Fattah Areej , Alexakis Lykourgos , Issa Fadi
Published: June 2023

Introduction:

A scoping review of the literature available on landmines in Egypt and their resultant disaster impact (human losses, material losses, economic losses and environmental losses) on the Bedouin communities inhabiting contaminated regions and on Egypt is presented. A narrative approach is taken to map the data extracted from the available literature to: the domains of losses; evidence of external assistance; and progress, revealing the widespread impacts of the hazard of landmine contamination.

Method:

The review question was mapped based on the JBI and the Arksey and O’Malley Frameworks with reference to Aromataris and Munn (2020), and Peters (2022). The research question was identified starting with the search strategy, and is broken down using PCC as recommended for Scoping Reviews (Peters, 2022).

Searches of scientific literature were conducted using multiple databases, further searches of search engines, social media and of grey literature were conducted. The search results were then screened over two stages to determine their relevance. Data was then extracted using the PRISMA-ScR checklist before being tabulated and charted.

Results:

The data collated evidently shows human losses manifest as mortality, physical disability, psychological trauma, financial instability and social impacts; while material losses include blocks to considerable areas of the country’s landmass suitable for urban housing, agricultural and touristic potential, as well as mineral, and oil and gas reserves; economic losses include impedance to development, lost revenues and deterrence from investment; environmental losses comprise extensive contamination of Egypt’s land.

Conclusion:

Evidence of external assistance being sought and provided is ample, signifying the overwhelm of Egypt’s coping capacity; rather, positive steps to de-mine the land and provide mine risk education and survivor assistance are beneficial in risk reduction. While landmine contamination is not classically considered to carry a disaster risk, this study proposes it does.
Regional Program for Knowledge Co-creation on Disaster Health Management in ASEAN and Japan
Authors: Kita Taro , Silapunt Phumin , Yanasan Alisa , Ito Yusuke , Ikeda Shuichi , Aono Mika , Katsube Tsukasa , Koido Yuichi , Kai Tatsuro
Published: June 2023

Introduction:

Knowledge management on Disaster Health Management (DHM) is one of the priority areas in the Plan of Action to implement the ASEAN Leaders’ Declaration on DHM (POA/ ALD DHM) (2019-2025). The Japan International Cooperation Agency (JICA) has been implementing the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) since 2016 to assist the ASEAN region in strengthening coordination capacity on DHM. A regional training course on DHM for ASEAN member states (AMS) in Japan was proposed to be implemented in 2022 as a JICA’s Knowledge Co-creation Program (KCCP).

Method:

The training curriculum of the KCCP included emergency and disaster medicine in Japan, international trends on DHM, and underwent reviews by AMS representatives of the ARCH Project. Prior to the training, participants were required to prepare country reports (CRs) outlining information on legislation, system and structure related to emergency and disaster medicine, as well as systems to receive international emergency medical teams (I-EMTs).

Results:

The four-week KCCP course contained a trial implementation of a four-day training program for receiving I-EMTs and coordination among stakeholders in ASEAN disaster response, based on the regional standard curriculum developed by the ARCH Project, and invited experts in DHM not only from Japan but also from AMS as instructors. Participants analyzed and identified challenges on DHM in their countries, and developed draft action plans (APs) to improve the situation through the knowledge obtained from the program.

Conclusion:

The draft APs, the training deliverables, will be shared with the ARCH Project, and used to build a support mechanism to achieve national level targets of the POA/ ALD DHM, and the progress will be reflected in the CR in the subsequent year. The KCCP on DHM is expected to facilitate knowledge sharing in AMS and Japan, and contribute to fostering the culture of mutual learning.
Impact of a Simulation Game (MASS) on the Undergraduate’s Experience and Performance in Triage Training–A Pilot Study
Authors: Cao Yu , Wang Zhi-yuan
Published: June 2023

Introduction:

The use of simulation games in education has been rising in recent years. Triage is not only a major content among the EMS (emergency medical services) but also a necessary skill for students to improve their first-aid ability. This study aims to investigate a game for education called MASS (movement, assessment, sort, and sending), which attempts to enhance students’ capability of disaster response.

Method:

A randomized controlled trial was conducted among students who took the course: “Understanding Disaster and Surviving Risk” during the term and volunteered to participate in teaching research from different faculties in Sichuan University. Participants were trained by using the simulation game or the online course before class. The simulation game is MASS, which uses virtual reality techniques to create a realistic 3D tanker explosion scene, and the online course is a Massive Open Online Course created by the teaching team. In the class, questionnaires with subjective and objective multiple choices were carried out after a discussion. With SPSS version 27.0, statistical significance among groups was determined by Mann-Whitney U-test for rank variables, Fisher’s exact test for binary variables.

Results:

73 students were included in this study, including 45 in the online course group and 28 in the simulation game group. The qualitative experience survey showed the two groups were significantly different in experience of disaster scene challenges, application scenes, and method of triage (P=0.031, 0.007, 0.031, respectively). Students in the simulation game group showed significantly better performance in knowledge acquisition including application scene of triage, key of the expectant’s assessment, and rescue condition for thoracentesis than in the Online game group (P=0.048, 0.020, 0.010, respectively).

Conclusion:

Simulation games can improve students’ experience and performance in triage training. Due to the unrepeatability of disaster, the study suggests that games can be used to conduct simulation education for disaster medicine.
Evaluation of the Degree of Crisis Awareness and Behavioral Change Through Disaster Exercise: A Case Study of a Disaster Response Exercise in a Pharmacy Department
Authors: Kajihara Chisato , Kashiwabara Michishi , Yamao Makiko , Aoki Yuki , Yabe Katsushige , Kaneko Masaaki , Sano Masataka , Munechika Masahiko
Published: June 2023

Introduction:

The authors developed an evaluation tool to measure changes in exercise participants' awareness of disaster risk and their disaster preparedness behaviors. To create the tool, a mechanism was modeled to visualize the process of changing people's crisis awareness and behavior and questions were developed for each of the twelve factors and two outcomes within the mechanism. In this study, we conducted a disaster exercise in the pharmacy department of Hospital A, one of the disaster base hospitals, and measured the effectiveness of the exercise using the tool.

Method:

In the disaster exercise, participants were asked to perform dispensing tasks on five dummy prescriptions using actual medicines, based on the assumption that the dispensing support system was out of order due to a major earthquake. Participants were paired up and dispensed as much as possible within a time limit of 30 minutes. Pre- and post-education sessions were conducted before and after the exercise. Respondents were asked to score each question on a 5-point scale at three time points: before the pre-education, immediately after the disaster exercise, and after post-education.

Results:

59 people, including 16 participants, responded to the questionnaire using the evaluation tool. The analysis of the evaluation results revealed that the disaster exercise increased the participants' crisis awareness. Furthermore, participants improved their scores on the questions on feelings of anxiety about the current situation, assumptions about the impact, sense of ownership, and fear of not acting, but no change was observed among non-participants. However, there was no significant difference in scores between the two groups regarding whether they had taken action for disaster preparedness in the period following the exercise.

Conclusion:

The exercise raised the participants' crisis awareness, but did not encourage them to change their behavior. Future research should consider ways to encourage staff members to take action to prepare for disasters.
Disaster Management Simulation–A Novel Virtual Exercise
Authors: El-Baba Mazen , Mazurik Laurie
Published: June 2023

Introduction:

Disaster management and emergency preparedness relies on the collaboration, communication, and expertise of a multidisciplinary team. Skills in preparation, communication, and management of disasters are core competencies of an emergency physician. To learn the principles of disaster management, simulations are critical as mass casualty/rapid surge events seldom occur. The COVID-19 pandemic resulted in the cancellation of in-person events. In response to these restrictions, the University of Toronto, EM Program developed a successful virtual interprofessional mass casualty simulation.

Method:

The novel online simulation event was piloted in 2021 and ran for three-hours. The exercise focused on developing soft skills (e.g., communication, team-work, and debriefing) and hard skills (e.g., triage, casualty distribution, and activation of plans). Groups were composed of members of each post-graduate year to facilitate near-peer learning. A total of six groups were formed: Adult, Children, Community Hospitals, EMS, Government, and Media. Each Team used multiple communication tools (i.e., Whatsapp groups, Zoom breakout rooms, Shared Google Documents) to swiftly pivot and manage a mass casualty event. Post-exercise debriefing and anonymous evaluations were gathered.

Results:

A total of 28-residents (nine PGY1, ten PGY2, and eight PGY3 learners) and 11-staff observers participated (25-respondents). Nineteen participants rated the simulation exercise as excellent and six as “very good”. Twenty participants rated the workshop as “very useful” and five as “useful”. Positive feedback centered around content applicability, exercise creativity, level of engagement, and learning value. Constructive feedback included the need for more pre-exercise orientation time, increasing disaster management time, and inviting allied-health staff.

Conclusion:

There is a clear need for EM residents to learn and develop skills related to disaster management and emergency preparedness. This exercise showed that disaster management and emergency preparedness competencies can be learned in a virtual format. This virtual format has encouraged its continuation and further inspired the curation of a four-year program.
Past, Present, and Future of Korea National Radiation Emergency Medicine Education
Authors: Kim Jungjin , Nam Hyungwoo , Cho Minsu
Published: June 2023

Introduction:

In Korea, there are various medical and industrial researchers who use radiation as part of their research. But radiation can cause extensive long-term damage in case of an accident. Therefore, national-level policy and training for the response workforce have been established for a professional response. Since 2002, the KIRAMS has been providing emergency medical response education based on the five mandatory contents (including legislation, protection measures, and emergency medicine).

Method:

The training content can be divided into theoretical and practical courses. Early education included theoretical courses on cases of accidents and their effects on the human body, as well as practical courses on treatment for contaminated patients. The current education program offers group practice using a HPS and mobile learning. As for the future of national radiation emergency education, the paradigm of education will change with the fourth industrial revolution, the advancement of the IT industry, and the advent of the ‘untact’ era. Therefore, research and development on XR technology–based educational content that can overcome reality’s constraints, is being conducted. Simulation-based education courses to increase effectiveness and immersion will be implemented.

Results:

Currently, there are approximately 900 radiation emergency medical personnel, and more than 30 new and supplementary education contents are provided each year to improve their proficiency and response abilities. Approximately eight types of content using XR technology will be developed and tested (2021-2023) before being implemented in actual education programs (2024). Advancements in education reflecting special conditions, such as COVID-19, and technological advancements will continue indefinitely.

Conclusion:

Efforts are ongoing to improve the educational content and to train excellent radiation emergency medical personnel. With the implementation of XR technologies and new education trends, the future of national Korean radiation emergency medical education is expected to advance and diversify, and further improvements in the educational content can be expected.
Feasibility and Effectiveness Assessment of the New Triage System Adopted by the Disaster Medicine Service of Regione Piemonte: Results of a Controlled Randomized Study
Authors: Goldschmidt Nicole , Donati Maria Chiara , Roasio Agostino , Vaselli Giorgio , Raviolo Mario
Published: June 2023

Introduction:

Validation of the new MCI Triage protocol of Regione Piemonte by comparing it with the already published and internationally used START/Jump START protocol. Compare its accuracy, execution time, over and under triage indices and the influence of any rescuer characteristics in reference to adult and pediatric victims when in use in a simulated multi-casualties event setting.

Method:

We conducted a randomized controlled experimental study in a simulation setting. A group of 35 people involved in an incident (volunteer participants) was assessed by a population of trained and untrained healthcare professionals (nursing students and nurses). The participants were randomly divided into two homogenous groups to which the two protocols were explained separately and carried out the simulation in single-blind. Evaluation data were collected and statistically processed. The resulting items were used to compare the accuracy, over- and under-triage rates and any items related to rescuer characteristics for each triage system.

Results:

74 subjects were included in the study. Of these, 56.7% were healthcare professionals in training and 43.4% were trained nurses. Compared to standard criterion definitions, the MCI triage protocol showed a higher accuracy rate than START (88.4% vs 80.4%, p<0.01). MCI triage had a significant lower rate of underestimation compared to START (8.9 vs 13.6%, p< 0.01) as well as overestimation (3.2% vs. 6.8%, p< 0.01). Time is only correlated with the performance of MCI triage, influencing its accuracy. There were no significant differences in the accuracy of diagnosis in pediatric patients.

Conclusion:

We found that MCI method triaged adult patients more often correctly than START method. Underestimation and overestimation were lower than in the control method, although there tended to be a significant overestimation of white codes which were not present in the START system. In the assessment of pediatric patients, the protocols are equivalent.
Using a Tabletop Game to Teach Emergency Department Nurses Comprehensive Emergency Management and Hazard Vulnerability Analysis: Influences and Possible Reasons
Authors: Chou Wei-Kuo , Liu Hung-Chieh , Lin Chien-Hao
Published: June 2023

Introduction:

Comprehensive emergency management (CEM) and hazard vulnerability analysis (HVA) are two vital concepts in hospital emergency management (EM). Teaching these two concepts by lectures may be less effective and interesting. Therefore, a tabletop game was used to teach CEM and HVA. This study aimed to evaluate the effect of teaching and possible reasons.

Method:

A tabletop game was created based on the concepts of CEM and HVA. Players of the game needed to manage hospitals against six kinds of emergencies. The impact of each emergency is different. Each hospital in the game has its vulnerability. The game players needed to use different strategies of prevention, mitigation, preparedness, response, and recovery to win the game.

The player’s knowledge was tested by 15 yes-no questions (10 points for each question). The interest in further learning and willingness of hospital EM participation were evaluated by questionnaire. The test and questionnaire were conducted before and after the game. Possible reasons for learning by the game were surveyed after the game.

Results:

Fifteen emergency department (ED) nurses were taught by the game and completed both pre- and post-game tests and questionnaires. The post-game test average score (103) was significantly higher than the pre-game average score (84) (p=0.008). The participants’ interest and willingness also increased significantly after the game. The most frequently mentioned reasons for learning by the game were “the game is more interesting than lectures”, “the chance to discuss with other participants in the game”, “the chance to see many CEM methods in the game”, and “ability to compare with other players”.

Conclusion:

A well-designed tabletop game can be an effective tool to teach CEM and HVA. The game can increase knowledge, interest in learning, and willingness of CEM participation, and it should be promoted in the future.
Medical Students’ Education in Disaster Medicine: A Systematic Literature Review of Existing Curricula
Authors: Voicescu George , Valente Martina , Corte Francesco Della , Ragazzoni Luca , Caviglia Marta
Published: June 2023

Introduction:

Disaster Medicine (DM) is currently underrepresented in medical schools’ curricula worldwide, and existing DM courses for medical students are extremely heterogeneous due to the lack of pragmatic and standardized guidelines. Moreover, there is a gap in knowledge regarding the curriculum development methodology used for DM courses. This study aims to identify DM courses for medical students worldwide and to map their curriculum development methodologies by reviewing available literature.

Method:

The search was conducted on three databases using the terms “Disaster medicine” AND “Education”. Following the PRISMA approach, twenty-five articles that described the content and implementation of DM curricula were included in the analysis.

Results:

Nine studies thoroughly described the curriculum development process. Expert opinion and literature review were the methodologies mostly used to develop DM curricula. Only four studies followed a multi-method process made up of four different methodologies, including expert opinion, literature review, survey, and Delphi methodology. Most of the courses adopted a face-to-face approach combining different training modalities, including the use of virtual reality simulations and drills.

Conclusion:

This systematic review provides a compendious analysis of the curricula and curriculum development processes in DM training for medical students. The scarce usage of reproductible, comprehensive curriculum development methodologies and consequently a great heterogenicity of the covered topics and course design were brought forward. Therefore, there is a need for standardization in DM education. Overall, this systematic review highlights the need for evidence-based educational curricula in DM and provides recommendations for developing DM courses following a scientific approach.
Analysis of Delphi Study Seven-Point Linear Scale Data by Parametric Methods–Use of the Mean and Standard Deviation
Authors: Franc Jeffrey , Hung Kevin , Pirisi Alessandro , Weinstein Eric
Published: June 2023

Introduction:

The Delphi technique is a unique survey method that involves an iterative process to gain consensus when consensus is challenging to establish and is widely used in Disaster Medicine research. Participants typically rate a variety of statements using a specified rating scale. The survey is repeated for several rounds, and at each round statements that do not reach a predefined level of consensus are advanced to the next round while giving the participants information about the responses of other participants for their comparison. The final statements are then ranked in order of the average rating. The statistical methods to analyze Delphi studies are not well described. This study investigates the use of a 1 to 7 linear rating scale along with parametric summary statistics for assessment of consensus and ranking of statements.

Method:

A study set of 9297 individual ratings on the 1 to 7 scale were obtained from previously performed Delphi studies and used to create 490,000 simulated Delphi ratings with various numbers of participants.

Results:

While the overall distribution of ratings was strongly left skewed the sampling distribution was near normally distributed for studies with five or more participants. The average difference between the standard deviation and interquartile range was -0.26/7. The overall risk of falsely concluding consensus using the standard deviation as a summary statistic was 7.3% when compared to using the interquartile range. The average difference between mean and median was -0.20/7. The risk of falsely ranking the statements by a value of 0.5 or more was near zero for all sample sizes when the mean was compared to the median.

Conclusion:

This study suggests that the use of the 1 to 7 linear rating scale in combination with the parametric summary statistics of standard deviation and mean is a valid method to analyze ratings from Delphi studies.
Mixed Reality–Exploring the Requirements of Realism in the Context of Mass Casualty Incident Training
Authors: Schulz Fredrik , Nguyen Quynh , Baetzner Anke , Schrom-Feiertag Helmut , Gyllencreutz Lina
Published: June 2023

Introduction:

The occurrence of mass casualty incidents is increasing globally. Training is an essential cornerstone in achieving disaster preparedness, yet studies show that medical first responders perceive their level of readiness to face disaster incidents as inadequate. As real-world disaster training exercises can be characterized as resource-intensive in terms of cost and time, virtual training environments have been highlighted as a potential alternative to mass casualty incident training. In order to increase the preparedness of medical first responders, a deeper understanding of their requirements in the context of disaster training exercises is needed.

Method:

Individual, contextual interviews were conducted with a total of 26 medical first responders from four European emergency service organizations: Hellenic Rescue Team (Greece), Summa 112 (Spain), Sanitätspolizei Bern (Switzerland), and Johanniter Österreich (Austria). The interviews were analyzed using qualitative content analysis.

Results:

The preliminary results indicate that real-world disaster training exercises have limitations regarding realism. The participants described a need to train in an environment that accurately represents what they might face amidst a real-world incident site. This included the recreation of potential environmental dangers that had to be taken into consideration before approaching the incident site. The participants also highlighted the importance of realistic representations of injuries and reactions from the victims during training. The limited possibilities to provide a realistic training environment that corresponds to the set requirements lead to the participants feeling less prepared to face a real-world mass casualty incident.

Conclusion:

Medical first responders’ need for increased realism in real-world disaster training exercises deserves attention. Training solutions that could potentially increase the level of preparedness needs to be taken into consideration. How the degree of realism in Virtual or Mixed Reality based training platforms affects the perception of preparedness among medical first responders warrant further research.
Deployment of Composite Emergency Medical Team (EMT) in West Sulawesi Earthquake during the Middle of the Covid-19 Pandemic
Authors: Donna Bella , Ariani Madelina , Yogadhita Gde
Published: June 2023

Introduction:

Deployment of EMT from one institution is a common thing to do in Indonesia. However, it is still rare to deploy a composite team that is combining two or more different institutions and area of origin. CHPM UGM had coordinated composite EMT deployment during West Sulawesi Earthquake in 2021. They sent a management team from Yogyakarta and a medical teams from Central Sulawesi. This paper aimed to report the experience of sending composite EMT to earthquake disasters amid the COVID-19 pandemic.

Method:

Documentation studies were carried out during the process of coordination, planning, and deployment of EMTs. Initial coordination was carried out with the Central Sulawesi Health Office which was the nearest neighboring province to affected West Sulawesi. The Central Sulawesi’s medical team arrived in Mamuju in less than 24 hours. Followed by the health cluster management team on the second day.

Results:

Three composite EMTs came from different institutions and diverse competencies (midwives from PHC, nurses and medical doctor from hospital, health promotion and management from university) were deployed during the emergency response. Coordination activities were carried out through WHATSAPP chat, Zoom, and telephone. The handover process was carried out via online streaming. In addition, prevention of infected COVID-19 was conducted by preparing PPE for personal and team, limiting service time only during the day, ensuring sufficient rest and nutrition, as well as screening and isolation before and after duty. However, there were two people who were infected with COVID-19 at the exit screening.

Conclusion:

Intense coordination is required during the preparation and deployment process, including an extra personal approach when the team first meets on the field. In addition, the Covid-19 pandemic situation has made the composite team's task even more challenging.
Activation of the Health Cluster Coordination Post in Lumajang District Health Office During the Management of Mount Semeru Eruption Disaster
Authors: Yogadhita Gde , Ariani Madelina , Donna Bella
Published: June 2023

Introduction:

The ambiguity of the command system is still the main challenge during the activation of health cluster coordination. It begins with the unclear division of tasks, communication channels that are not yet optimal, and do not have an alternative plan. This study reported the management of health cluster coordination posts during the disaster of Mount Semeru Eruption, in December 2021.

Method:

This study was a case study of qualitative research methods, data collection was carried out by observing the health cluster operation of Lumajang District Health Office (DHO) and supported by an analysis of health cluster activation policy reviews.

Results:

Resources to manage health clusters were limited due to a lack of staff knowledge in health cluster management. Therefore, the head of the Lumajang DHO appointed the Office Secretary as the health cluster coordinator. The Head of Referrals Health Services is the emergency medical team focal person and the Head of Health Promotion is the spokesperson. East Java Provincial Health Office, Ministry of Health, and Disaster Task Force of Faculty of Medicine UGM assisted in the management of health cluster post operations. Then, assisting was concerned with the most fundamental thing in facilitating health clusters such as establishing an organizational structure based on the incident command system approach as well as mapping the capacity of existing health resources on the field to visualize the geographical situation of health service capacity and emergency medical teams distribution.

Conclusion:

Although located in prone and high-risk or periodically eruption areas, the staff still have a low capacity in disaster health management. Thus, capacity building in the pre-disaster phase is highly required in the management of health clusters and emergency medical team coordination by the mandate of the Ministry of Health Regulation.
Utilization of Physiotherapy in Prehospital Care During Emergency and Disaster: Improving Care and Increasing Capacity
Authors: Mitchell Megan
Published: June 2023

Introduction:

Emergency medical teams (EMT) are utilized during national and international disasters to improve the response capabilities and provision of quality of care to those impacted. The inclusion of rehabilitation professionals on EMTs is slowly increasing but still has not become standard on Type I teams. The goal of rehabilitation is to optimize function and reduce disability for patients of all ages and in all treatment locations. SPHERE humanitarian standards mandate country emergency response frameworks should include rehabilitation in disaster starting at the acute phase of the incident, but services are typically not provided at the right time or the right place, if at all. After an injury, early education and intervention by rehabilitation can reduce long term injury and improve function. Rehabilitation services continue to be limited to post-acute care and available only to those who have required hospitalization or long-term rehabilitation services. There is a growing body of evidence for the use of physiotherapy in prehospital medical management of acute urgent and emergency injuries and within the emergency department to improve access to care, reduce imaging, reduce use of opioid use.

Method:

Literature review was conducted regarding prehospital injuries and rehabilitation services using Google Scholar and University of South Florida library access services.

Results:

No reports or documentation for prehospital or emergency department care during natural disasters or conflict response are available from the World Health Organization or other NGOs.

Conclusion:

There is a recognition from the medical community of the value and necessity of rehabilitation services across the disaster continuum but remains an under-utilized resource for improving patient care. Conclusion: Rehabilitation should not be available to only those with the most severe long-term injury but should be included at all levels of response with integration into all EMTs.
Introduction of Emergency Medical Team Coordination Cell Assistance Activities in 2022 Moldova EMTCC Operation and Future Suggestions
Authors: Toyokuni Yoshiki , Paasma Raido , Trewin Terry , Kubo Tatsuhiko , Nakamori Tomoki , Oba Jiro , Habano Yukiko , Shiota Kohei , Ito Atsushi
Published: June 2023

Introduction:

Emergency Medical Team Coordination Cell (EMTCC) was established in WHO Moldova Country Office to coordinate responding International EMTs in March 2022. Japan International Cooperation Agency (JICA) sent an EMTCC assistance team to support the WHO-approved minimum data collection for emergency medical teams, Minimum Data Set (MDS), operations and other coordination activities. Introducing activities of the JICA EMTCC assistance team at the Moldova EMTCC will suggest future use.

Method:

EMTCC assistance team activities were reviewed.

Results:

There was a wide range of high-level administrative functions in EMTCC, such as planning, logistics, assurance and governance, and human resources. One of the significant functions was introducing MDS to the medical team and extracting the data summaries for reporting to the Moldova Ministry of Health. All these tasks require considerable time to manage and must be completed promptly for effective EMTCC operations.

Conclusion:

The EMTCC coordinator should function as a decision-maker to control the coordination of EMTs communicating with WHO and implementing the EMT initiative. In a disaster, especially in the acute phase of EMTCC activities, more high-level administrative functions will be required with immediate processing. Therefore, it is considered that the EMTCC assistance team should work with the coordinator as early as possible. In addition, all these EMTCC assistance team activities should be standardized and specified in the EMTCC handbook for future operation reference.
Characteristics of Patients Treated by Helicopter Emergency Medical Services in Ireland from 2012 to 2022: A Retrospective Analysis of Ten Years of Data
Authors: Hennelly David , Deasy Conor , Masterson Siobhan , O'Donnell Cathal , Jennings Paul
Published: June 2023

Introduction:

A dedicated primary scene landing Helicopter Emergency Medical Services (HEMS) has been in operation in Ireland since 2012. Commencing with a unique collaboration between the Irish Aer Corps and civilian Emergency Medical Services (EMS) it has expanded to include a second charity funded model in the south west of the country. Both services operate under a single governance and dispatch system and provide an Advanced Paramedic level of care to the patients they serve. There is limited published literature on prehospital care in Ireland and to date no detailed descriptive study of patients treated by HEMS in Ireland. This research describes the characteristics of the patients treated by HEMS in Ireland.

Method:

This retrospective study will investigate the data of an excess of 8000 patients responded to by HEMS (2012-2022) in the republic of Ireland. Descriptive statistics will be used to interpret patient demographics, geographical spread, receiving facilities, mechanism/etiology of disease or injury, vital trends, transportation decisions and clinical interventions and short-term clinical outcomes.

Results:

Early stage data extraction shows seasonal variation in HEMS use with increased use in the summer months. Almost twice as many male patients vs. females were treated by HEMS while the most common age profile was 55-65 yrs. Trauma presentations have increased over the past 10 years and now account for over 60% of the overall caseload. The most common medical etiology was cardiac arrest or post resuscitation care followed by STEMI Care, the most common trauma cases were from road traffic collisions followed by falls and farm accidents.

Conclusion:

This study will be the first to describe the overall characteristics of HEMS patients in Ireland over a decade of service provision. As the Irish health system continues to evolve, so must its aeromedical services.
Survey on Applications of Emergency Medical Drones
Authors: Wang Soon-Joo , Kim In Byung
Published: June 2023

Introduction:

Traditionally, helicopters or special types of airplanes have been used to transport emergency patients when an aeromedical transport is necessary. However, despite its excellent utility, the cost of each flight is relatively expensive and has many limitations. So as an alternative to traditional aircrafts, there has been a movement to overcome the limitations of traditional air transport through the development and application of emergency medical drones. In this study, practical applications of emergency medical drones were investigated.

Method:

As a first step, through literature and internet searches, the current state of development, field of use, results, and problems of emergency medical drones were investigated. Based on this first investigation, a second Delphi survey of experts was conducted to investigate the appropriate fields for the use of emergency medical drones and the expected future applications.

Results:

Currently, emergency patient support drones are being used to transport first aid equipment including an automatic external defibrillator, manage emergency patient status and on-site remote evaluation, and transport human organs during organ transplantation. Emergency medical drones for emergency patients are being developed, including systems that manage the patient's condition by applying additional advanced technologies.

Conclusion:

Emergency medical drones were classified into drones for transporting emergency patients and drones for emergency medical support according to whether emergency patients were on board. Drones for emergency patient support were being used to transport first aid equipment, manage emergency patient status and on-site remote evaluation, and transport organs during organ transplantation. The trend of air transport in the future is expected to change to a futuristic means of transportation in the form of emergency medical drones.
Evacuating Premature and Critically Ill Neonates When Hospitals are Endangered by Disasters: A Case Study of the PANDA Team Evacuation of a Neonatal Intensive Care Unit During Severe Wildfires in Oregon, USA
Authors: Leppold Kathryn
Published: June 2023

Introduction:

In September 2020, severe wildfires in Oregon (USA) came dangerously close to Hospital A. The entire county was under evacuation orders. The Neonatal Intensive Care Unit (NICU) at Hospital A needed to evacuate patients to other areas for safety, however the characteristics of premature and critically ill neonates required a specialized transport team. This presentation outlines a case study of how the Pediatric and Neonatal Transport team (PANDA), based at Oregon Health and Science University (Portland, Oregon, USA), responded to evacuate neonatal and infant patients to other metro area NICUs during the wildfires.

Method:

Case study.

Results:

During a six-hour period, both PANDA transport teams on shift were activated to complete back-to-back transports of neonates and infants by ground ambulance to fire safe locations. Each patient was transported by a PANDA Registered Nurse and PANDA Respiratory Therapist, with an Emergency Medical Technician who drove the ambulance and Medical Control available by phone. The PANDA team normally operates in non-disaster settings. This was the first time PANDA was activated to evacuate patients from a hospital during a disaster. This presentation will discuss lessons learned and implications for future practice.

Conclusion:

Wildfire frequency and severity is predicted to increase due to climate change. Evacuation of premature and critically ill neonates requires a specialized transport team due to patient size, weight, and other considerations. Specialized transport teams should develop disaster evacuation workflows and resources, and regularly practice for these events. There is also a need for trauma-informed care in the post-evacuation setting to transport staff and parents of patients who were unable to travel with their child during transport. A full team pre-transport risk assessment is crucial in these circumstances.
The Association of Total Prehospital Time to Severe Trauma Patient Outcomes in Physician Staffed Emergency Medical Teams in Sarajevo, Bosnia, and Herzegovina
Authors: Jevtić Tatjana , Ahmić Amela Tuco , Bošnjak Melica Imamović
Published: June 2023

Introduction:

The Institute for Emergency Medical Assistance of Canton Sarajevo covers 1,777 square kilometers. All teams are physician staffed and are organized in ten geographic points. Patients are transported to a tertiary care level facility–University Clinical Center Sarajevo. Our objective was to determine the association between total prehospital time and severe trauma patient outcomes in a physician staffed emergency medical system with the hypothesis that the length of prehospital time is insignificant to patient outcome if physician treatment begins on scene.

Method:

This was a descriptive, retrospective, analytical study conducted from June to December 2020. The data of 153 patients with an ISS score of ≥ 16 was selected from patient registries of both facilities. According to transport duration, patients were assigned to one of four groups: <15 minutes (group 1); 16 to 30 minutes (group 2); 31-45 minutes (group 3) and > 45 minutes (group 4). Both groups according to the TRISS score were equal in mortality with an expected survival rate margin taken at 70% due to this being the approximate intrahospital survival rate of our patients. The primary outcome was in-hospital mortality, and secondary outcomes included length of hospital stay, length of ICU stay and 30-day survival rate.

Results:

We found no statistically significant difference to in-hospital mortality in relation to the length of pre-hospital transport when physician treatment begins on scene (p = 0,186). We ruled out any significant difference in length of stay and ICU stay (p = 0,179 and p = 0,173, respectively) among the preselected groups in relation to the length of prehospital time. Also, the 30 day survival rate was unaffected by the length of transport in physician led teams (p = 0,156).

Conclusion:

With strategically placed physician staffed EMS teams and physician treatment beginning on scene, patient outcome is unaffected by the length of transport.
Traumatic Cardiac Arrest in Polytrauma–There are Survivors: A 10-Year Analysis from a German Helicopter Base
Authors: Frank Mark , Braun Jörg , Haelke Laura , Petrowski Katja
Published: June 2023

Introduction:

In Germany, emergency care is provided by ambulances and rescue helicopters. Emergency physicians are part of prehospital care. The rescue helicopter in Dresden covers the city with 540.000 inhabitants and surrounding areas. The goal of the study was to evaluate cases of traumatic cardiac arrest (TCA) and to describe factors that affect the primary success of prehospital cardiopulmonary resuscitation (CPR) in trauma.

Method:

Data of all emergencies from the German Air Rescue (DRF-Luftrettung®) Helicopter Base Dresden were recorded on a standardized protocol and transferred to a central database (MEDAT®, HEMSDER®). Data from all patients with severe injuries, classified as polytrauma between January 2006 and December 2015 were analyzed.

Results:

There were a total number of 14,126 emergency cases involving the rescue Helicopter. The Helicopter was on the scene within 10.9 minutes [4-34]. Polytraumatized patients were identified in 673 cases (4.76%), the mean age was 43.73 years [2-98], and 498 patients were male (73.99%). In 444 cases, traffic accidents were responsible, in 188 cases falls from high. In 46 cases a suicide was documented. Mean ISS was 34,04 [16-75]. The main injury regions were head, extremities and chest. In 115 patients (17.08%) a TCA was observed. 43 pat. were pronounced dead initially and no treatment was initiated. 72 pat. (62.6%) received CPR. 39 of these pat. (54,17%) were also pronounced dead after treatment. 14 pat. (19.44%) were transported to hospital with ongoing CPR. 19 pat. (27.38%) reached the return of spontaneous circulation (ROSC). Male pat. reached more often ROSC.

Conclusion:

According to present guidelines for TCA, it is important that reversible causes of cardiac arrest in trauma pat. are to be treated. If we ensure the treatment of hypoxia, hypovolemia, tension pneumothorax and cardiac tamponade consequently, there will be a survival chance. Regular training for manual skills and simulation can be a key factor.
Normalized Deviance from Approved Personal Protective Equipment (PPE) Donning and Doffing Protocol—Towards a Hazard Reduction Index
Authors: Barach Paul , Pham Trang , Hughes Ashley , Doos Devin , Ahmed Rami
Published: June 2023

Introduction:

Reusing PPE is not recommended but was common during COVID-19 pandemic. Limited guidance on proper PPE use and its reuse heightened the hazards to health care worker (HCW) safety. Emerging data on PPE use suggests that most HCWs were contaminated by donning and doffing of PPE while adhering to standards of care.

Method:

A prospective observational study was conducted to understand HCW behaviors in donning, doffing, and reusing PPE. Emergency Department physicians and nurses were video-recorded donning, doffing, and reusing PPE within a simulated acute care environment. Participants performed five donning and doffing PPE procedures. PPE kit included gown, face shields, and N95 respirator masks. Participants had access to disposable gloves and hand sanitizer. Recordings were reviewed and coded independently by two trained coders based on checklist of key behaviors. Agreement between coders was high (81.9%). All participants reported completing PPE training.

Results:

28 videos of participants capturing 278 procedures were reviewed. None of the participants followed the CDC’s order for donning across five scenarios. Majority of participants failed to perform hand hygiene before donning or re-donning PPE or when doffing PPE. For contaminant spread risk, 92.85% (n=26) touched patient-facing side of PPE during re-donning and/or doffing PPE (M= 3.75, SD= 2.37, Median = 4; 0-9 times). The most common area of self-contamination was hands (n= 111 across all participants in 5 donning/doffing sequences). Touching patient-facing side of PPE was more likely to occur during donning than doffing (70.5% vs. 20.1% of sequences).

Conclusion:

The study found wide variation in PPE donning/doffing practices among HCW in violation of CDC guidance. This first study to review PPE reuse through a human factors lens, identifyied deviant behaviors that contribute to HCW self-contamination. Efforts are needed to redesign PPE and develop effective ways to train staff using PPE equipment safely.