bluuebunny/crossref_metadata_2025 huggingface dataset:
Twenty Years on from WCDEM-13, Melbourne 2003: Impact of the Melbourne Statement
Authors: Archer Frank , Spencer Caroline , Cuthbertson Joe
Published: June 2023

Introduction:

Melbourne hosted WCDEM-13 in May 2003 when Congress participants endorsed a Melbourne Statement with five actions. Twenty years on, WCDEM-22 in Ireland provides an opportunity to reflect on the impact of the Melbourne Statement.

Method:

A desktop review of Congress and subsequent documents informed by the personal experiences of the co-authors, who contributed to the Local Organizing Committee for the Melbourne Congress and/or subsequently through the WADEM Oceania Chapter.

Results:

The WADEM Education Sub-committee, co-chaired by a Melbourne member, followed through with one of the key actions from the Melbourne Statement: “WADEM will promote international professional standards and education programs for persons involved in disaster prevention, preparedness, response, and recovery.” The Education Sub-committee held a series of European meetings, resulting in an international meeting in Brussels in 2004 producing ‘International Guidelines and Standards for Education and Training to Reduce the Consequences of Events that May Threaten the Health Status of a Community’. This was presented to the 2005 WCDEM in Edinburgh, and later published in PDM (2007), thereby meeting a second action from the Melbourne Statement. However, this energetic, collaborative, and productive process subsequently ‘failed to thrive.’ The influence of three further Melbourne Statement actions, were harder to analyze. WADEM members in Australia led other identifiable actions e.g. formation and leadership of the WADEM Oceania Chapter (2008); a National Framework for Disaster Health Education in Australia (2010); and Teaching Emergency and Disaster Management in Australia: Standard’s for Higher Education Providers (2017).

Conclusion:

The insightful Melbourne Statement reflected the times and led to identifiable, but limited, WADEM outcomes. Congress participants endorsed an Outcomes Statement at WCDEMs in Edinburgh (2005) and Amsterdam (2007) but not at subsequent WCDEMs. Outcome Statements have become commonplace in professional congresses, and it may be timely to re-introduce Congress Statements as a feature of future WCDEMs.
Promoting Useful and Usable Scientific Evidence in Health Emergencies and Disaster Risk Management: The WHO Health EDRM Knowledge Hub
Authors: Kayano Ryoma , Clarke Mike , Gan Connie , Murray Virginia , Chan Emily
Published: June 2023

Introduction:

In order to promote useful and usable scientific evidence for health emergency and disaster risk management (Health EDRM), the World Health Organization (WHO) Health EDRM Knowledge Hub has been established as part of the WHO Thematic Platform for Health EDRM research network (Health EDRM RN). The Knowledge Hub aims to extend scientific knowledge; strengthen evidence-based practice in the management of health risks in emergencies and disasters; create and develop a competent network in the Health EDRM community; and integrate research, policy and practice.

Method:

To begin with, the Knowledge Hub has five interconnected research themes: (1) health data management; (2) psychosocial support; (3) health needs of sub-populations; (4) health workforce development; and (5) research methods. Systematic literature reviews and expert consultations have assessed current research under each theme and identified potential knowledge gaps. The work of the Knowledge Hub is advised by members of the Health EDRM RN and staff in WHO regional offices.

Results:

The WHO Health EDRM Knowledge Hub will be a platform for providing and exchanging up-to-date evidence. This will include information on validated methods for managing health data and identifying health needs in specific subpopulations. The Knowledge Hub will raise awareness of psychosocial support, health workforce development and research before, during and after disasters. It is targeted to policy-makers, researchers, practitioners and the broader community with the aim of accelerating evidence-informed policy and programs. This will support implementation of the Sendai Framework for Disaster Risk Reduction 2015–2030, the WHO Health EDRM Framework, and other related global, regional and national agendas.

Conclusion:

This paper introduces this new initiative and describes its objectives, design, and implementation. Additionally, it provides an overview of the Knowledge Hub and invites session participants to provide insights into their current needs and to make recommendations for improvement.
Integration of Simulation-Based Exercises and Practical Skills into a Public Health Emergency Management Curriculum
Authors: Noll Samantha , Little Charles , Silversmith David
Published: June 2023

Introduction:

As public health emergency management (PHEM) is a growing field, so is the development of its workforce. Ensuring workforce readiness from graduate-level education and courses can be challenging given the limitations of the traditional classroom environment. This presentation highlights a novel curriculum created and taught by first responders consisting of simulation and application of practical skills developed within a public health graduate certificate program.

Method:

The semester-long course reviews foundations of PHEM and students progress through a sequence of increasingly complex discussions and operation-based exercises for both domestic and international disaster preparedness and response. Students progress through case studies, tabletops, functional exercises, and full-scale exercises with practical skills interspersed. This includes creation of SMART objectives and incident action planning, crisis communication and public messaging drills, use of radios, personal protective donning and doffing, and Geiger counter use.

During the COVID-19 pandemic, the curriculum was adapted for asynchronous and live virtual sessions with further offerings including various online trainings that are required for most employments in the field and guest speakers with national recognition for their experiences in public health and healthcare emergency management and subject matter expertise in various fields related to preparedness and response.

Results:

Since commencing in 2016, approximately 100 students have completed the course and feedback has been overwhelmingly positive even with limitations of in-person activities during the COVID-19 Pandemic. Student feedback has noted that the majority of students feel that the knowledge and skills from the coursework is applicable to future employment and that their ability to think critically about the subject matter increased as a result of taking the course.

Conclusion:

Implementation of this innovative graduate level course can serve as a model to enrich students’ education through practical activities and hands-on simulations.
Development of Standard Operation Procedures for Receiving International Emergency Medical Teams. Cooperation Between the United States National Disaster Medical System (NDMS) Disaster Medical Assistant Team (DMAT) and Japan DMAT
Authors: Wakai Akinori , Toyokuni Yoshiki , Koido Yuichi , Ono Tatsuo , Kubo Tatsuhiko
Published: June 2023

Introduction:

Japan DMAT and US DMAT have been conducting several tabletop exercises to prepare for major earthquake disasters in Japan. Japan is predicting overwhelming disasters on Japanese soil soon, which needs efficient and optimum use of resources in medical assistance, including additional support from the US. The Japanese government established a large-scale Earthquake/Tsunami Disaster Emergency Response protocol in 2020. However, this protocol does not include any standard operation procedure (SOP) to receive an international medical team. The purpose of this study is to establish the SOP of receiving medical assistance from US-DMAT based on the WHO International Emergency Team (EMT) initiative through tabletop exercises.

Method:

Collaborated with the Office of the Administration for Strategic Preparedness and Response (ASPR) of the United States Health and Human Services, tabletop exercises assuming that a large-scale earthquake occurred during the hosting of the 2025 Osaka Expo was conducted utilizing an online meeting system.

Results:

A provisional SOP was composed. Even though Japan had several disaster medical assistance collaborations with US DMAT and is well-familiarized with the Classification and Minimum Standards for Emergency Medical Teams", many issues need to be prepared to accept US DMAT.

Conclusion:

Numerous procedures need to be conducted to receive US DMAT assistance during a large-scale earthquake in Japan. With this SOP, receiving US medical team assistance will be conducted promptly, eventually saving many lives. This SOP can be modified for other international teams' acceptance in Japan. It could reference other countries seeking to have SOP for receiving international medical team assistance shortly.
Recommendations for the Implementation of a Competency Matrix for Volunteers of an Emergency Medical Team
Authors: Yeung Tiffany
Published: June 2023

Introduction:

Emergency Medical Teams (EMT) training is moving towards competency training. Although there exist a few systematic reviews regarding the competency training, there has been little investigation on how the competencies can be effectively translated into the EMT personnel’s training.

In a humanitarian organization in Hong Kong, a competency matrix for EMT volunteers was developed in 2018. The organization relies on a steady base of volunteers to perform its services. With these competencies, volunteers can be encouraged to undertake a multitude of available trainings to fit with the needs of the organization, or for their own personal benefit.

Method:

The aim of the study is to recommend methods to improve uptake of the competency matrix among volunteers of the organization. A mixed methods study was completed, encompassing literature search, a quantitative questionnaire and qualitative one-to-one semi-structured interviews.

The Behavior Change Wheel and the Capability-Opportunity-Motivation-Behavior (COM-B) interactive system were used to guide the research rationale and to frame the questions asked to investigate perceptions regarding the competency matrix.

Results:

Data collected from the questionnaire and interviews were collated and organized into the corresponding Theoretical Domains Framework as specified from the Behavior Change Wheel, and the respective intervention functions and policy categories were lined up accordingly. Analysis of data identified a series of key factors influencing the potential incorporation of the competency matrix among volunteers. Data collected from volunteers largely agree with and is supported by the literature on adult training, volunteer management and specifically on EMT training.

Conclusion:

Although EMT training is moving towards competency-based training, research publications on how to effectively deliver competency-based training, and on the effectiveness of various didactic methods within EMT training are scarce. This calls for more research to be done in the area of competency-based training of EMT.
Reviewing the Implementation of the Emergency Medical Team Minimum Data Set
Authors: Kubo Tatsuhiko , Odgerel Chimed-Ochir
Published: June 2023

Introduction:

The Emergency Medical Team (EMT) Strategic Advisory Group of the WHO has endorsed the EMT Minimum Data Set (MDS) Daily Reporting Form in 2017 and the revised EMT Minimum Standards of the WHO suggests EMTs report it regularly in case national reporting forms are not available.

Method:

This study searched and listed previous use cases of the MDS by reviewing published papers including gray literature and interviews with national authorities, organizations, and experts.

Results:

In 2019, the MDS had been activated for the first time in Mozambique during international scale response at the tropical cyclone Idai; also in Japan it was used at the typhoon Faxai/Hagibis response; further in the Independent State of Samoa during the measles outbreak. In 2020, the MDS was used during a COVID-19 mega-cluster incident on the Diamond Princess Cruise Ship in Japan, the tropical cyclone Harold in Vanuatu and the Kumamoto Heavy Rain in Japan. In 2021, the one was used during the Izuyama landslide response in Japan; and the typhoon Rai response in the Philippines. In 2022, it was used during the cyclone Batsirai response in Madagascar; and in Moldova, Poland, and Ukraine to respond to the armed conflict situation in Ukraine.

Many countries are preparing to use the form; in 2022 the Association of SouthEast Asian Nations (ASEAN) has officially endorsed the form as a regional standard form for EMT daily reporting. Military partners also were testing the form, in 2019 forces from eight nations at the 39th Cobra Gold 20 in Thailand used the form for training purposes.

Conclusion:

The MDS was used in at least 14 emergencies in nine countries. Mozambique and Japan have published academic literature using the MDS. The use of MDS would strengthen Health Emergency and Disaster Risk Management (H-EDRM) in a data-based manner.
Diamond Princess Cruise Ship. COVID-19 Medical Operation by the National EMT, Japan DMAT.
Authors: Kondo Hisayoshi , Koido Yuichi , Wakai Akinori , Kohayagawa Yoshitaka , Matsuda Hiroki , Anan Hideaki
Published: June 2023

Introduction:

The Diamond Princess cruise ship (DP) arrived in Yokohama, Japan, on February 3, 2019, with a confirmation of the Polymerase Chain Reaction test (PCR) positive for the Coronavirus disease 2019 (COVID-19) in a passenger who disembarked at Hong Kong. Japan National Emergency Medical Team (N-EMT), and Japan Disaster Medical Assistance Team (DMAT), were dispatched and measures to prevent the spread of viruses were taken for 3,711 (2,666 passengers and 1,045 crew members) on board.

Method:

Japan DMAT was dispatched and managed the medical operation for DP passengers and crew members. The records of communication logs for the DMAT were evaluated. In this study, evaluation of DMAT medical operations in the DP was conducted to find any positive effects

Results:

472 (157 doctors, 123 nurses, 161 medical logisticians, 31 pharmacists) members responded. Among them, 283 (97 doctors, 66 nurses, 91 medical logisticians, 29 pharmacists) worked inside the DP, and 189 (60 doctors, 57 nurses, 70 medical logisticians, two pharmacists) operated outside mainly for patient transport. DMAT conducted a strategic operation and developed categorization for medical care and patient transport. Eventually, DMAT constructed flow to provide rapid medical care and prescription distributions for passengers and crew members.

Conclusion:

DMAT has been required to respond to unforeseen disasters in the framework since the Fukushima Nuclear Plant accident in 2011. All the past several types of disaster response were contributed to managing medical operations at the DP. These operations are thought to reduce preventable deaths from COVID-19.
Integrating Management and Operations of Rapid Response Teams and Emergency Medical Teams Programs Globally
Authors: Shamout Mays , Relan Pryanka , Fitzgerald Bridget , Correa Ayramana , Salio Flavio , Greiner Ashley
Published: June 2023

Introduction:

Health emergencies such as the COVID-19 pandemic, strain health systems and emergency response mechanisms. Identifying critical points during the response cycle where the emergency workforce and operational capacity can be improved can help break the protracted nature of responses. Global health emergency workforce, or health emergency and alert response teams such as multidisciplinary Public Health Rapid Response Teams (RRTs) and Emergency Medical Teams (EMTs), play critical roles in response to public health emergencies.

The project aims to explore and understand how countries manage and operationalize their RRT and EMT programs. With anecdotal evidence of countries integrating the two historically disparate groups, we propose to examine how countries are jointly or separately addressing legal frameworks and policies; management practices, reporting processes and protocols, training, as well as program operations and standards.

Method:

Through existing global partnerships and networks, a convenience sample of national focal points responsible for the management of their RRT and EMT program are sent an online survey followed by participating in a one-on-one interview, and descriptive and thematic analyses.

Results:

Sixteen countries representing all six World Health Organization regions with both RRT and EMT programs have been selected for engagement.

Conclusion:

Factors contributing to/or against countries’ integration of RRT and EMT programs will be identified. Areas of divergence or synergy of plans and standard operating procedures will be mapped. Recommendations for strengthening global health emergency alert and response teams will be generated.
The Response by International Emergency Medical Teams Following the Beirut Harbor Explosion in 2020–Who Were They, When Did They Arrive, What Did They Do, and Were They Needed?
Authors: Wolff Emeli , Shankiti Iman , Salio Flavio , Schreeb Johan von
Published: June 2023

Introduction:

On August 4, 2020 a massive explosion struck the Beirut Harbor in Lebanon. Approximately 220 people were killed and over 7000 were injured, of which 12% were hospitalized. Despite being weakened by an economic crisis and increasing numbers of COVID-19 cases, the national healthcare system responded promptly. Within a day, International Emergency Medical Teams (I-EMTs) started arriving. Previous studies have found that I-EMTs have arrived late and have not been adapted to the context and dominating healthcare needs. The aim of this study was to document the organization, type, activity, and timing of I-EMTs deployed to Beirut and to discuss their relevance in relation to medical needs.

Method:

Data on all deployed I-EMTs were retrieved from all available sources, including internet searches, I-EMT contacts, and from the World Health Organization (WHO) EMT coordination cell (EMT CC) in Lebanon. The WHO EMT classification was used to categorize deployed teams. Information on characteristics, timing, and activities was retrieved and systematically assessed.

Results:

Nine I-EMTs were deployed to Beirut following the explosion. Five were equivalent to EMT Type 2 (field hospitals), of which three were military. The first I-EMT arrived within 24 hours, while the last I-EMT was set up one month after the explosion. Four civilian I-EMTs provided non-clinical support as EMT Specialized Care Teams. A majority of the I-EMTs were focused on trauma care. Three I-EMT Specialized Care Teams were rapidly re-tasked to support COVID-19 care in public hospitals.

Conclusion:

A majority of the deployed I-EMT Type 2 were military and focused on trauma care rather than the normal burden of disease, including COVID-19. Re-tasking of EMTs requires flexible EMTs. To be better adapted, the I-EMT response should be guided by a systematic assessment of both healthcare capacities in the affected country as well as the varying health effects of hazards before deployment.
Relationship Between Incontinence and Disease Severity in Patients Transported by Ambulance
Authors: Yanagawa Youichi , Hamada Michika , Yanagawa Yoshiko , Ota Soichiro , Fujita Wataru , Nagasawa Hiroki , Takeuchi Ikuto , Ohasaka Hiromichi , Jitsuiki Kei , Ishikawa Kouhei
Published: June 2023

Introduction:

As there have been no reports concerning the relationship between incontinence and disease severity in patients in the prehospital setting, a retrospective investigation examined this relationship using data from Shimoda Fire Department.

Method:

Patients who were transported by Shimoda Fire Department from January 2019 to December 2021 were investigated. The following details of the subjects were collected: age, sex, contents of incontinence, season of transportation, weather, wind speed, temperature, place of collapse, scene time, classification of disease, disease severity (as judged by a physician at a receiving hospital) and mortality rate at the initial treatment. The subjects were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [-]). We compared the variables mentioned above between these groups.

Results:

There were 499 cases with incontinence and 8,241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the Incontinence (+) group were significantly greater in comparison to the Incontinence (-) group, while the average temperature in the Incontinence (+) group was significantly lower than that in the Incontinence (-) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions.

Conclusion:

This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.
Potential Effect of a Heat Wave on Body Temperature of Patients at the Emergency Department and in the Hospital: A Comparative Retrospective Study
Authors: Heedfeld Juul , Devloo Jan , In Jill Van , Desruelles Didier , Sabbe Marc
Published: June 2023

Introduction:

The impact of a heat wave on body temperature of patients being admitted to the emergency department (ED) and of patients that were already hospitalized was investigated. This can provide insight into measures or infrastructural adjustments that still need to be made.

Method:

A retrospective study comparing the measured body temperature of patients admitted to the ED and patients already hospitalized during a heat wave from August 11-13, 2020 versus a period in which no heat wave, no manifest presence of COVID-19, and no other endemism was present (October 10 and October 20, 2019, and November 5, 2019) was conducted. Two groups were created per period: morning and afternoon measurements.

Results:

Comparing the heat wave to the control period, no statistical difference was observed in morning temperature measurements at the ED. In the afternoon temperature measurements at the ED, however, a statistically significant difference (p < 0.01) was measured. Afternoon measurements during the control period showed a mean of 36.842 °C, whereas the measurements during the heat wave showed a mean body temperature of 37.191 °C. For hospitalized patients, a statistical difference (p < 0.01) was measured in both morning and afternoon temperature measurements. The control period showed a mean morning body temperature of 36.629 °C and a mean afternoon body temperature of 36.7154 °C, as opposed to the heat wave mean body temperatures in the morning (36.698 °C) and afternoon (36.7937 °C).

Conclusion:

This study emphasizes the rise in body temperature during a heat wave, independently of other factors that influence body temperature. Hospitals should focus on preventive measures, such as air conditioning and providing good temperature control. Further research is needed.
Emergency Medical Services Response: Outcomes of Non-Transported Patients
Authors: Chermiti Ines , Mahjoubi Mokhtar , Ghazali Hanene , Jeddi Camillia , Ellouz Morsi , Keskes Syrine , Turkia Héla Ben , Souissi Sami
Published: June 2023

Introduction:

As a part of a primary intervention, Emergency Medical Services (EMS) may leave a patient at the scene. This decision is made in partnership with the dispatching center. The prognosis of these patients is often unknown. The aim of our study was to assess the outcomes of non-transported EMS patients.

Method:

It was a descriptive, prospective study conducted over a two-year-period. We included all alive non-transported EMS patients from the site of intervention after a primary mission of the EMS team based on a medical decision. The prognosis was assessed by unexpected events (UE) defined by death, second EMS call, urgent consultation or hospitalization/surgery within seven days. We considered two groups: a group with UME (UME+) and a group with good evolution (UE-).

Results:

We included 97 patients. The average age was 56±19 years. Seventeen patients (17,5%) had no medical histories. Hypoglycemia was observed in 43% of patients. Thirty-four patients (35%) had an UE. These UEs were distributed as the following: ten consulted a private doctor, ten consulted their family physician, seven called the EMS, three visited the emergency department and four died. There were no significant differences in demographic, anamnestic characteristics between two groups. Psychiatric pathology was more common in the UE- group(28% vs. 9%; p=0.0037). Intravenous injections were more common in the UE+ group (64% vs 39% ; p=0,019). Among the four deaths, three were unexpected.

Conclusion:

One-third of non-transported EMS patients had UE. Unexpected death was rare (one patient). Setting-up a system for these patients including scores and algorithms, and a post-EMS compulsory visit in collaboration with family physicians could be beneficial.
Increasing Effectiveness of Large-scale Prehospital Care during Crisis and Disasters.
Authors: Roessel Will , Cools Carian
Published: June 2023

Introduction:

In the Netherlands several additional facilities and working methods are created to strengthen the effectiveness and capacity of the regular daily health care during large incidents and disasters. One system is called GGB (Large-scale medical assistance). The daily healthcare is organized in 25 safety-regions, which are far too small to handle big incidents. GGB provides in organizing assistance between regions, increasing the effectiveness of ambulance care, the deployment of other emergency services and volunteers, and coordination of this all. GGB is developed to deal with an incident with 250 injuries. This method was investigated to determine value.

Method:

Based on a standard questionnaire, key persons of ambulance care, trauma care, Red Cross and Offices of Public Health and Safety per safety region were asked about their experiences with GGB. (125 forms)

Subsequently, the regional outcomes for each discipline were evaluated in a national conferences (four conferences). To conclude, an interdisciplinary national meeting was held to bring the results together. The authors developed the questionnaires, supervised the research process, and presented the results to the authorities.

Results:

Results indicated that the working methods for scaled-up care is useful and should be continued. The extra financial costs outweigh the gained strength. The cooperation between professionals and volunteers also receives a lot of support. Proposals have been made for further improvements, in particular concerning cooperation between organizations. Bottlenecks have also been identified in the collaboration between health care, fire services and community care.

Conclusion:

In the perception of the care providers there is added value and cost-effectiveness. This is important for the support of the system. As a next step, the authors want to focus on measuring the actual effectiveness. For that, we want to be able to compare systems in several countries. The presentation ends with a call to do so.
Prevalence and Risk Factors for Workplace Violence in the Ambulance Service
Authors: Viking Magnus , Hugelius Karin , Kurland Lisa
Published: June 2023

Introduction:

Workplace violence within the ambulance services is a serious problem. A prevalence of up to 8.5% of all ambulance missions has previously been reported. Prior research used a retrospective design and the knowledge of risk factors for workplace violence is weak. Therefore, the aim of the current study was to measure the prevalence of workplace violence within the ambulance service in a Swedish region.

Method:

This was a prospective cohort study using data from all ambulance missions in a region in Sweden during one year. The data was analyzed with descriptive and analytic statistics using SPSS.

Results:

Data was collected from 28,648 ambulance missions. A total of 209 unique workplace violence incidents were reported, corresponding to a prevalence of 0.7%. Seventy-three of all incidents reported physical violence and 161 verbal threats, where some of the incidents included both physical and verbal violence. The most common risk factors for workplace violence were: the perpetrator was under the influence of alcohol or drugs (70.5%), mental illness (60.5%) and communication problems (15.3%). The perpetrator was most often a man (n=68%) between 18 and 29 years of age. Co-variation between the risk factors was high. No significant differences in the occurrence of workplace violence could be seen in relation to time of the year, weekday, or time of day.

Conclusion:

The prevalence of workplace violence was one of the lowest reported. An understanding of risk factors could be used within the ambulance service and dispatch centers to identify situations with an increased risk of workplace violence and mitigate the risk of such incidents.
Association Between Ambulance Prehospital Time and Maternal and Perinatal Outcomes in Sierra Leone: A Countrywide Study
Authors: Caviglia Marta , Putoto Giovanni , Conti Andrea , Tognon Francesca , Jambai Amara , Vandy Matthew , Hubloue Ives , Corte Francesco Della , Ragazzoni Luca , Barone-Adesi Francesco
Published: June 2023

Introduction:

Sierra Leone, one of the countries with the highest maternal and perinatal mortality in the world, launched its first National Emergency Medical Service (NEMS) in 2018. We carried out a countrywide assessment to analyze NEMS operational times for obstetric emergencies with access to timely essential surgery within 2 hours. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality.

Method:

We collected prehospital data of 6,387 obstetric emergency referrals from primary health units to hospital facilities between June 2019 and May 2020 and we estimated the proportion of referrals with a prehospital time (PT) within 2 hours. The association between PT and mortality was investigated using Poisson regression models for binary data.

Results:

At the national level, the proportion of emergency obstetric referrals with a PT within 2 hours was 58.5% (95% CI 56.9% to 60.1%) during the rainy season and 61.4% (95% CI 59.5% to 63.2%) during the dry season. Results were substantially different between districts, with the capital city of Freetown reporting more than 90% of referrals within the benchmark and some rural districts less than 40%. Risk of maternal death at 60, 120, and 180 min of PT was 1.8%, 3.8%, and 4.3%, respectively. Corresponding figures for perinatal mortality were 16%, 18%, and 25%.

Conclusion:

NEMS operational times for obstetric emergencies in Sierra Leone vary greatly and referral transports in rural areas struggle to reach essential surgery within two hours. Maternal and perinatal risk of death increased concurrently with operational times, even beyond the two-hour target, therefore, any reduction of the time to reach the hospital may translate into improved patient outcomes.
The Role of the Louisiana EMS Designated Regional Coordinator in Emergency Response During 2020/2021 COVID Pandemic and Hurricane Season
Authors: Goldfine Shayna , Volpi Nicole
Published: June 2023

Introduction:

Post Katrina Louisiana’s Health Department (LDH) used some of the Hospital Preparedness Program (HPP) funding to create a regional Emergency Medical Services liaison position entitled EMS Designated Regional Coordinators (EMS DRC). Regional EMS DRCs work with local pre-hospital agencies, hospital coalitions, and local/state/federal counterparts during the preparedness and response phases of a disaster. This presentation explores the EMS DRCs role during the 2020/2021 COVID pandemic and annual hurricane season.

Method:

The EMS DRCs were activated at the beginning of the COVID-19 pandemic. EMS agencies across the country were struggling to meet the call volume demand while balancing sick employees. The eleven LA Region 1 EMS agencies reached out to the EMS DRC for assistance. The EMS DRC coordinated with the LA State Health Department to provide surge ambulances to any ambulance agency in need. These units were utilized for COVID response, but once hurricane season hit in both 2020 and 2021 Surge ambulances were quickly transitioned to COVID and Hurricane response.

Results:

During the initial COVID outbreak, 18 state surge ambulances were divided amongst four agencies. In 2020 Louisiana saw six named storms, one of which caused significant damage. After Hurricane Laura hit in 2020 the EMS DRCs managed 80 Federal surge ambulances stationed across 41 non-congruent hotel shelters. The 2021 COVID response brought another 21 Federal Surge ambulances to the region. Once Hurricane Ida hit that year over 60 surge ambulances got reassigned to six regional EMS agencies for COVID and Hurricane response.

Conclusion:

The COVID-19 pandemic and subsequent hurricane devastation exposed gaps in EMS response capabilities to response. The EMS DRCs play a significant role in providing continuous care through working relationships with local, state and federal partners
Effects of the COVID-19 Pandemic on Prehospital Emergency Care for Adults With Stroke and Transient Ischaemic Attack: A Systematic Review and Meta-analysis
Authors: Burton Edel , Aladkhen Johnny , O'Donnell Cathal , Masterson Siobhán , Merwick Áine , McCarthy Vera , Kearney Patricia , Buckley Claire
Published: June 2023

Introduction:

The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions, like stroke and transient ischaemic attack (TIA). Thus, the aim of this study was to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA.

Method:

Following a published study protocol, a systematic search of databases was conducted up to May 31, 2022. Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic were considered for inclusion. The methodological quality of the included studies was assessed using the appropriate Joanna Briggs Institute tool. Overall pooled estimates of ambulance times (activation, response, patient care time) were calculated. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Stroke/TIA emergency call volume was reported using a narrative synthesis. Clinical stakeholders and Patient and Public Involvement Contributors were involved from research question development to dissemination of results.

Results:

Of 4083 studies identified, 56 unique articles met the inclusion criteria. Early data from 8/12 studies reporting ambulance times, suggests that patient care time increased. Furthermore, emergency call volume for stroke/TIA decreased during the COVID-19 pandemic, according to 43/56 studies that reported this outcome. Terminology for ambulance time intervals differed between studies. The majority of studies reported time from call to hospital arrival, whereas the minority of studies reported activation time.

Conclusion:

Preliminary results from our systematic review and meta-analysis show that conflicting evidence exists on the impact of the COVID-19 pandemic on ambulance times and emergency call volume for stroke/TIA. Thus, this review synthesized available evidence on the varied effects across different countries, healthcare systems and ambulance time terminology. Review findings may inform our understanding of healthcare system resilience in response to crises on a broader level.
Framework and Thematic Analysis of Historical After Action Review Reports from the Australian Capital Territory Emergency Services Agency
Authors: Heslop David , Bushby Toni , New Charles , Whelan Georgeina
Published: June 2023

Introduction:

Emergency services organizations routinely undertake internal quality improvement activities following training and operational activities. One form of a quality improvement activity is the After Action Review (AAR). An AAR is a facilitator-led post-event review where data is collected from individuals and groups of individuals using either surveys, focus group-like meetings, or individual interviews. Data is collected using a semi-structured data collection tool which is usually customized to the specific tasks being reviewed and the priorities and goals of the organization. The quality of AARs has been noted to vary significantly across organizations with reporting biases and differences between exercise or real event AARs and biases introduced by utilization of internal rather than external evaluators, and limited justification for data selection and collection rationales. The Australian Capital Territory Emergency Services Agency (ACT ESA) has identified that interoperability and integration between internal ACT ESA sub-agencies and externally with other agencies is a key problem. The aim of this study was to identify specific areas of consistent interoperability concern through the examination of historical AARs.

Method:

In this qualitative study a Framework Analysis of historical AAR text documents was conducted, following the standard five step process. This was followed by detailed thematic analysis in aggregate and examined longitudinally, with emergent themes undergoing further analysis.

Results:

AARs relating to major emergency response and training activities 2016-2022 were examined. There was a substantial variation in quality, level of detail, completeness and structure across the different AAR documents. Consistent themes emerging from the data highlighted concerns regarding inter-agency culture, uncertainty when conducting joint activities and its impact on decision making, logistics concerns, resourcing and breakdown of shared understanding and communication between teams.

Conclusion:

Despite a centralized command structure, historical AAR analysis shows ACT ESA has had persistent operationally impacting interoperability and integration problems within the organization and with external agencies.
The Implementation and Evolution of Helicopter Emergency Medical Services in the Republic of Ireland
Authors: Hennelly David , Deasy Conor , Masterson Siobhan , O'Donnell Cathal , Jennings Paul
Published: June 2023

Introduction:

Helicopter Emergency Medical Services (HEMS) have formed an integral component of the Irish healthcare system for the past decade, yet the factors leading its commencement, its evolutions over this time, the current model of service delivery have not been widely published.

Aeromedical service provision may vary significantly from country to country and may also vary regionally within countries. Health systems necessities, capacity and maturity, the level of state, corporate, private or community investment and capacity of the contracted service provider are all factors that influence the service provision.

Method:

This research provides a descriptive analysis of the historic factors leading to the implementation of HEMS during an era of healthcare reform, its key evolutions and current model of service delivery.

Results:

Health system reform in a time of global financial recession led to a unique collaboration between the Irish Defense Forces and civilian Emergency Medical Systems (EMS) to provide a sustainable foundation of primary scene landing Helicopter Emergency Medical Services for the Irish state. This sharing of professional knowledge, logistics and operational experience lead to many further system reforms and will inform future aeromedical service provision.

Conclusion:

Over the past decade the Irish health system has undergone significant reconfiguration and centralization of services, leading to increased demands on emergency medical ground and aeromedical services. Future advancements in aeromedical service provision require an innate understanding of the current model.

This research will add to the knowledge base and inform policy makers and support decision making surrounding Helicopter Emergency Medical Services reform and enhanced service provision in the Irish state.
Evaluation of Readaction Quality of Initial Medical Certificate In An Emergency Department
Authors: Ghazali Hanene , Akkari Sarra , Chermiti Ines , Sebai Jihen , Keskes Syrine , Turkia Héla Ben , Mejdoub Yosra , Souissi Sami
Published: June 2023

Introduction:

The initial medical certificate (CMI) is a medico-legal document of great importance. Writing CMIs is a frequent act in emergency medicine. In 2011, the Haute Authority of Medicine (HAS) published good practice recommendations concerning the writing and content of these certificates. Nevertheless, this practice faces a difficult reality in the emergency services. The aim of this study was to analyze the writing quality of CMIs in terms of compliance of all the criteria collected with respect to HAS recommendations.

Method:

This was a retrospective study, evaluating professional practices over a period of two years in Ben Arous ED. We analyzed CMIs written by EPs. The certificates were subjected to a critical reading to begin a comparative study of the quality of writing of these certificates with the HAS recommendations using a criteria grid relating to the theoretical content of the certificates.

Results:

207 CMIs were analyzed (Acts of violence 88%, work accidents 12% and AVP less than 1%). The medical writers were mainly represented by general practitioners (98%). Not all of the CMIs complied with writing recommendations. The identity of the physician, the identity of the patient, the date of the examination and of the facts, the nature of the lesions, the handwritten signature of the doctor and the stamp were mentioned in more than 95% of the CMIs. The presence of CNOM registration number, the profession, the address and the number of the national identity of the patient, the place of the facts, the medical history and the previous condition of the patient were absent in more than 95% of the CMIs. The duration of the ITT was written in full in 36% of the cases.

Conclusion:

The study revealed insufficiencies in the quality of CMI drafting written by EP. Specific training is underway to improve certificate redactions.
Aiming for a Society Where No One is Left Behind in a Humanitarian Crisis: Examples of Cooperation Among Health, Medical Care, and Welfare
Authors: Harada Nahoko , Koda Masahide , Chishima Kayako , Suzuki Nobuaki , Ichikawa Manabu
Published: June 2023

Introduction:

Japan is geographically prone to natural disasters such as earthquakes, volcanoes, and tsunamis, economically advanced, and socially characterized as a super-aged society. The SDGs are a concrete strategy to achieve a society where no one is left behind. So what exactly can we do to protect the vulnerable populace? This presentation will introduce the system of cooperation and implementation of medical, health, and welfare disaster relief in Japan.

Method:

Government documents were received on developing national policies regarding the strategy for the unification of medical, health, and welfare. For implementation, the status of support teams specializing in disaster welfare and training status was reviewed.

Results:

National policy level achievements: The Ministry of Health, Labor and Welfare (MHLW) issued a "Notification on Enhancing and Strengthening the Medical System in Times of Disaster" in 2012 and conducted a critical review of the initial response to the Kumamoto earthquake in 2016 in the "Initial Response Verification Report." This process reaffirmed the need to support vulnerable populations such as the disabled, children, and the elderly. In 2021, the Disaster Welfare Assistance Team was added to the Basic Plan for Disaster Management and the MHLW Disaster Management Work Plan.

Implementation level Achievement: As of 2022, 24 of the 47 prefectures have a DWAT in place. Gunma, Kyoto, and Miyazaki prefectures were the most advanced, with 1) ongoing meetings to strengthen cooperation with medical and health care teams, 2) participation in joint drills, and 3) DWAT awareness-raising activities through training for municipal administrative staff.

Conclusion:

While this review revealed that the national government had made progress in developing policies, the implementation revealed that some prefectures have not yet established DWATs.
CHRONOS Project: The Transformation of Time-dependent Clinical Trajectories into Intelligent Ones Using an Innovative Technological Solution
Authors: Morissette Nathalie , Shabah Abdo
Published: June 2023

Introduction:

The health system faces many challenges including the lack of personnel or resources and the overcrowding of emergency rooms. In this context, Real Time Locating Systems (RTLS) offer the possibility of improving the efficiency, safety and quality of care management. Clinical trajectories are currently very dependent on manual processes. We believe that real-time management systems that use geolocation can optimize time-dependent clinical trajectories, improve critical care and transform the health network for patients, caregivers and managers. Typically, RTLS tools require a significant investment in terms of installation, configuration, and integration.

Method:

The Nano Data Center (NDC) system developed by Humanitas Solutions is equipped with an advanced and low-cost IT infrastructure. It is self-deploying, self-configurable and allows geolocation and autonomous telecommunication with multiple interfaces (WIFI, Bluetooth, electrical). It requires a power source and operates without requiring access to technological infrastructures, which is the major difference with similar products based mainly on cloud computing and dependent on internet connectivity. We tested, as a pilot project, the deployment of the NDC system in a complex hospital environment (Centre intégré de la santé et des services sociaux de la Montérégie-Centre, Quebec, Canada) in order to demonstrate its potential use.

Results:

Using the NDC system, we were successful in establishing an autonomous communication network over several hospital floors. This innovation made it possible to support the real-time geolocalization of fictive patients and the creation of a real-time dashboard for monitoring clinical trajectories, analyzing data, and evaluating performance.

Conclusion:

The next development phases of the CHRONOS project include real-time notification and transformation of clinical trajectories into smart trajectories. The independence of the NDC system in terms of infrastructures would allow its deployment in low-resource environments, such as temporary installations or remote areas. Thus, its potential benefit in creating connected environments in disaster situations.