bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lessons Learned from an OB / Newborn / Neonatal Intensive Care Full-Scale Exercise
Authors: Frogel Michael , Jermyn John , Foltin George , Cooper Arthur 
Published: June 2023

Introduction:Children are frequently victims of disasters. However, gaps remain in disaster planning for pediatric patients. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty incidents that involve large numbers of children.On April 26, 2018, the NYC PDC conducted a first in NY, full-scale exercise with the NYC Fire Department (FDNY) testing evacuation, patient tracking, communications, and emergency response of the Obstetrics, Newborn and Neonatal units at a NYC based hospital. The goal of the exercise was to evaluate current Ob/Newborn/Neonatal plans and assess the hospital’s ability to evacuate patients.Method:The exercise planning process included a review of existing OB / Newborn / Neonatal plans, four group planning meetings, as well as, targeted specific area meetings and plan revisions. The exercise incorporated scenario-driven, operations-based activities, which challenged participants to employ the facility's existing evacuation plans during an emergency.Results:The Exercise assessed the following: Communication, Emergency Operation Plans, Evacuation, Patient Tracking, Supplies and Staffing. Internal and external evaluators rated exercise performance on a scale from 1-4. Evaluators completed an exercise evaluation guide based on the Master Scenario Event List.An After Action Report was written based on the information from the exercise evaluation guides, participant feedback forms, hot-wash session, and after action review meeting. Strengths included the meaningful improvement of plans before the exercise (including the fire department) and the overall meeting of exercise objectives.Conclusion:Lessons learned included: addressing gaps in effective internal and external communications, adequate supplies of space, staff, equipment needed for vertical evacuations; providing staging and alternate care sites with sufficient patient care and electrical-power resources. The lessons learned are being utilized to improve existing hospital plans to prepare for future full-scale exercise and or real-time events.
Comparison of Public Health IT Reporting Capabilities Between a Large Network Hospital and Small Independent Hospital During Disaster Response
Authors: Daniel Pia , Arquilla Bonnie , Roblin Patricia , Senathirajah Yalini , Cato Kenrick , Kaufman David 
Published: June 2023

Introduction:Management of outbreaks rely on hospitals’ health information technology (IT) to electronically share data to public health systems. Studies show that half of non-federal hospitals reported a lack of capacity to exchange information with public health agencies, placing a variable burden on institutions to meet the government mandated reporting requirements. This study aims to contrast the impact of COVID-19 reporting requirements across two New York City institutions with disparate health IT capabilities.Method:A retrospective, qualitative study contrasting the impact of reporting requirements on a small independent hospital (SIH) with 198 staffed beds and a large, networked hospital (LNH) with eleven campuses during the COVID-19 pandemic. Researchers conducted 51 interviews with hospital leadership, clinical directors, and infection control personnel. Interviews were transcribed and coded using qualitative analysis software.Results:The LNH had a 50-person analytic team that handled reporting tasks, a centralized data warehouse that was automatically updated, electronically generated reports with universal access, and limited burden of clinical staff. The SIH had no dedicated analytic team. Seventeen departments were utilized to handle reporting tasks with no centralized place to share electronic data, limited capacity to create automatically updated reports, a daily manual information gathering processes, and significant need of clinical staff to collect data. Both SIH and LNH faced challenges associated with the distribution of responsibilities and resources with pressure to report in a timely fashion. However, the burden on the SIH was so onerous that it significantly impeded routine hospital work and patient care.Conclusion:The disparity in health IT capabilities highlights significant institutional inequities and variability in response during a pandemic. The findings have implications for how government and other regulatory bodies may adjust policies to equitably meet public health needs and not unfairly burden small hospitals.
Improving Hazardous Material Incident Preparedness for Emergency Medicine Physician Trainees: A Quality Improvement Project
Authors: Maksimenko Yevgeniy , Ryan Kevin , Dugas Julianne , Hahn Laura 
Published: June 2023

Introduction:Hazardous materials (HazMat) training is not a requirement for accreditation of US Emergency Medicine (EM) residencies, nor for EM board certification by the American Board of Emergency Medicine (ABEM). However, the US Occupational Safety and Health Administration (OSHA) requires hospitals train all personnel expected to deal with contaminated patients. This QI project aimed to develop an EM physician-specific HazMat course and evaluate the physician comfort level with HazMat personal protective equipment (PPE) donning and doffing, triage, procedural skills, and decontamination.Method:A four-hour “HazMat for Docs” course was designed at a large urban academic trauma center and offered to second-year EM residents. Additionally, we performed a quantitative survey of a cohort of 72 current and recently graduated EM residents (classes 2019-2024), some of whom had taken the course in person. Our primary outcome was to measure improvement in comfort level with essential HazMat tasks after completing the course. Our secondary outcome was to evaluate the current or recently graduated EM physician's overall comfort levels with managing a HazMat incident, as well as HazMat skills and knowledge retention.Results:A total of 53 responses (73.6%) were obtained. 45.3% of the respondents were male and 54.7% female. 37.8% of the respondents were recent EM graduates, with 20.8% PGY-4, 13.2% PGY-3, 15.1% PGY-2, 13.2% PGY-1. 16/53 (30.2%) had prior EMS experience. EM Physicians were most comfortable with donning and doffing PPE (4.92 on a 7-point scale) and least comfortable with decontamination procedures (2.98/7). After completing the HazMat course, EM physicians increased their comfort level with HazMat decontamination procedures by 8.6% and with organizing a multi-disciplinary ED HazMat response by 10.5%.Conclusion:EM Physician comfort levels with HazMat procedures are low. Increased training aimed at improving physician knowledge, preparedness, and comfort level for such events is necessary and can be accomplished through a short course.
“Is Resilience Useful, Usable, and Used? Outlining the Social Characteristics of a Resilient System”
Authors: Bell Olivia , Pickering Christina , Denton Neil , O'Connor Eve , Ahmed Kanza , Archer Frank , Spencer Caroline , Bracken Louise , Murray Virginia 
Published: June 2023

Introduction:The COVID-19 pandemic has underlined the international priority to systemically operationalise resilience in the face of increasing prevalence of complex and cascading hazards. This concept paper identifies the components of a resilient society, establishing the usefulness and usability of the application of ‘resilience’, and proposes the characteristics used by a resilient system.Method:Through the review of case-based examples and previously published concept papers, this paper underwent a concept analysis to understand and qualify the characteristics of a resilient community. Through extensive research and critical analysis of disaster risk responses both effective and not, the authors condensed the literature to identify the key components of a resilient society.Results:To respond to this evolving landscape of disaster risk, community and governmental responses should be collaborative in order to be successful and sustainable to increase resilience across communities, societies and networks. To unpick the complexity of how communities and governments might promote resilience effectively, we explore whether community and social capital are useful resources to create and sustain resilient approaches to disaster risk reduction and management. We consider that by exploring how social capital links, bridges and bonds actors within a system are qualitative key facets of a resilient community. A resilient system is the product of trust and collaboration between asset-based networks of bonded and bridged communities and risk and support-based networks of bonded and bridged organizations.Conclusion:By evaluating the usefulness and usability of the concept, we consider that a resilient system is an iterative learning process, asset based, trusting across power and resource gradients and is best built before or even if essential during a crisis. Noting that resilience is a dynamic process which requires integrated collaboration and continual adjustment to develop a sustainable framework, we consider that social characteristics of a resilient system are useful, useable and should be used.
Thai Hospitals’ Evacuation Preparedness: A Survey Among 42 Hospitals According to the Flexible Surge Capacity Concept.
Authors: Phattharapornjaroen Phatthranit , Carlström Eric , Holmqvist Lina , Sittichanbuncha Yuwares , Khorram-Manesh Amir 
Published: June 2023

Introduction:Hospitals are subject to internal and external threats which could necessitate an evacuation. Such evacuation needs deliberate surge and collaboration, particularly collaborative use of community capacities to handle affected patients, personnel, devices, and hospital structures using consensus systems. Therefore, it is crucial to identify hospital evacuation procedures’ flaws and assess the possibility of implementing measures using community resources. This study aimed to explore Thai hospitals’ current evacuation readiness and preparation regarding surge capacity and collaboration according to the Flexible Surge Capacity concept.Method:The previously used hospital evacuation questionnaire was adopted. It contained relevant questions about hospital evacuations’ responses and preparedness encompassing surge capacity and collaborative elements and an open-ended question to collect possible perspectives/comments.Results:The findings indicate glitches in evacuation protocols and triage systems and inadequacies in surge planning and multi-agency collaboration. Additionally, it was evident that hospitals had limited information about communities' capabilities and limited collaboration with other public and private organizations.Conclusion:Although implementing the measures for concept integration to hospital evacuation is challenging, pragmatic research exploring planning for community engagement according to the flexible surge capacity to build a concrete hospital evacuation plan would enhance hospital readiness and its generalizations. The latter needs to be tested in simulation exercises.
Use of Bedside Ultrasound at Wexford General Hospital Emergency Department: Compliance to NICE Guidelines [NG158] for Venous Thromboembolic Disease
Authors: Dowle Ashleigh , Orsmond Brendan , Vythilingam Darshini , Abraham Ria , Andrews Robin , Rensburg Rochelle Janse Van , Smit Marco , Vegte Andrea Van der , Jordaan Philip , Conradie Maria , Kennedy Keith , Wickham Bryce , Kelly Thomas , Molloy Michael 
Published: June 2023

Introduction:Ultrasound is the standard imaging technique for diagnosing lower limb deep venous thrombosis (DVT). The National Institute for Health and Care Excellence (NICE) guidance 158 recommendation 1.1.3 states that all patients with sufficient pretest probability for DVT should be offered a proximal leg vein ultrasound within four hours. However, due to high patient volumes, formal radiology department ultrasound wait times often exceed one week. Point-of-care ultrasound (POCUS) is used to bridge diagnostic delay in our emergency department (ED) .This study aimed to quantify numbers offered POCUS for suspected proximal lower DVT in our ED and accuracy of such studies.Method:A retrospective review of electronic records was conducted for patients who underwent formal lower-limb ultrasound for suspected DVT at our hospital over a three-month period (August 1, 2022-October 12, 2022). Patient charts for all ED presentations were assessed to determine whether POCUS was offered and whether DVT was diagnosed.Statistical analysis was conducted using PRISM v9.Results:80 formal ultrasound scans were performed at our hospital for lower limb DVT. 58 were requested for patients presenting to ED, of which 42 had complete records available meeting selection criteria.POCUS was offered to 24 patients in ED (57.1%). Sensitivity was 66% (95% CI 12%- 98%), and specificity was 94.1% (95% CI 75%-99%). Overall accuracy was 90%, with only one false negative study identified at formal follow-up ultrasound.Conclusion:Although sample size was small, our results suggest that POCUS is an accurate but underused tool to diagnose lower limb DVT. Developing a standardized protocol for performing and reporting POCUS DVT scans in ED should allow for earlier diagnosis and initiation of appropriate treatment where necessary.
Enhancing Severe Weather Planning and Preparedness Across the Health Service Executive South Cork & Kerry Region
Authors: O'Brien Cian , O'Sullivan David , Fitzgerald Mary Rose , Neville Karen , Pope Andrew 
Published: June 2023

Introduction:According to the Climate Change Advisory Council, Ireland is woefully unprepared for future extreme weather events such as heatwaves, flooding, and coastal surges, which are going to be more extreme and frequent in the future. Met Éireann issued numerous red weather warnings since the inception of the severe weather forecasting system. Storms Ophelia (Ex. Hurricane) and Emma (Snow Storm) proved to be extremely challenging weather events for the Health Service across Ireland.Method:A comprehensive review of debriefs and lessons identified processes completed across the health system was conducted, in connection with lived experiences of emergency management staff, following Storm Ophelia and Storm Emma.Results:As part of the emergency management life cycle and an attempt to enhance severe weather preparations, this study lists over 50 actions (development of specific HR policies, creating 4X4 capacity, severe weather preparations sessions, development of service-specific red weather event action cards, development of severe weather care plans for community palliative care and renal dialysis patients, sharing critical health care facilities with Local Authorities for road salting and gritting etc.) that were taken across the Health Service Executive South (Cork and Kerry) to enhance the preparations for severe weather events,Conclusion:The frequency and intensity of severe weather events will increase in Ireland over the coming years, as a result, it is essential that healthcare facilities and services have learned from previous severe weather events to ensure that the necessary plans and procedures are in place for future events, ensuring the delivery of safe and effective patient care and staff safety.
Exploratory Laparotomy Following the Mosul Offensive, 2016-2017: Results from a Dedicated Trauma Center in Erbil, Iraqi, Kurdistan
Authors: Egelko Aron , Muhrbeck Måns , Haweizy Rawand , Schreeb Johan von , Älgå Andreas 
Published: June 2023

Introduction:The Battle of Mosul (2016-2017) involved asymmetric warfare and excess civilian causalities. Emergency Management Centre (EMC) was a designated trauma center for the battle, located 80 km from Mosul. Exploratory laparotomy outcomes in local hospitals are poorly studied compared to military hospitals. Improving response to complex emergencies requires better contextual understanding.Method:Prehospital and hospital data were collected from all patients undergoing exploratory laparotomy at EMC during the battle. Data were collected and validated by EMC’s chief surgeon. New Injury Severity Scores (NISS) were calculated from operative data.Results:Seventy-three patients were included. 22 (30.1%) were children; 40 (54.8%) were non-combatant adults. 51 (69%) were male. Bullets caused 74.0% of injuries. Children had prolonged time from injury to first laparotomy compared to adults (600 vs 208 minutes, p<0.05). Median hospital length of stay (LOS) was six days (IQR 4-10; children 16.4 days vs adults 8.6 days, p=0.05). Median NISS was 18 (IQR 12-27). NISS were significantly higher for women (28.5 vs 19.8), children (28.8 vs 20), and re-laparotomy (32.0 vs 19.0) compared to men, adults, and primary laparotomy, respectively. In univariate and multivariate analysis, NISS was associated with hospital, but not ICU, LOS (p<0.01). Twelve patients were re-laparotomies after surgery elsewhere: ten (83.3%) were for failed repairs or missed injuries. Median time to re-operation was 5.5 days (IQR 1-8). Re-operations had longer ICU (4.5 vs 2.9, p<0.01) and hospital stays (20.7 vs 7.6, p<0.01). Three (4%) patients died; two of which were re-laparotomies.Conclusion:During the battle, civilians and combatants had similar injury mechanisms and outcomes. Children had a long time to present and LOS. Low mortality likely reflects high prehospital mortality. Prolonged times to admission suggest the need for improved hospital transport. Re-operation was associated with increased complications and LOS. NISS demonstrated predictive value for hospitals, but not ICU, or LOS.
Characterizing Nuclear Fallout Patterns in Atlanta, Georgia
Authors: Taylor Morgan , Bell William , Harris Curt 
Published: June 2023

Introduction:Weather significantly affects the distribution of fallout radiation resulting from a nuclear detonation. Prior nuclear detonation models have either utilized a “typical” day for the city of interest or have chosen conditions that optimize fallout radiation. However, models that aid emergency planners should utilize representative weather conditions to capture the most likely distribution of fallout radiation for the region of interest.Method:Fallout radiation resulting from an improvised nuclear device detonation in Atlanta, Georgia, USA was simulated for each day in 2019 using the Hazard Prediction and Assessment Capability (HPAC) software and weather from Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2). A partition around medoids cluster analysis was conducted, based on the characteristics of the plumes, population at risk, and estimated proportion of fatalities. A multinomial logistic regression, a decision tree, and a random forest model were then used to predict the cluster from surface-level weather data.Results:On average, the fallout plume was 160.25km long, had an area of 3,174.44 km2, and was angled 83.5° from due north. The plume on average contained 3,668,173 individuals at risk for exposure and caused 416,8908 casualties. Four clusters were identified to represent the distribution of fallout radiation. The random forest model was best able to predict the cluster using surface-level weather data, with an average accuracy of 57.24% (kappa = 0.385). The variable importance plot suggests north-westerly winds, cloud coverage at detonation, whether it is summer, and average temperature are among the most important variables for classification.Conclusion:Meaningful representation of the variation in the distribution of fallout radiation is imperative while creating nuclear detonation models. While an analysis of the fallout distribution throughout a calendar year provides important insight, future research may examine longer study periods to better understand the climatological impacts on fallout radiation.
Wellbeing of Helicopter Emergency Medical Services (HEMS) Personnel in a Challenging Work Context: A Qualitative Study
Authors: Herpen Merel van , Weme David Nieuwe , Leeuw Marcel de , Colenbrander Renske , Olff Miranda , Brake Hans te 
Published: June 2023

Introduction:Helicopter emergency medical services (HEMS) personnel provide on-scene trauma care to patients with high mortality risk. The HEMS work context is characterized by an exceptionally high exposure to critical incidents, emotionally demanding patient encounters, and having to perform under pressure with limited resources. The aim of this study was to further our understanding of the factors underlying HEMS personnel wellbeing given their challenging work context.Method:Sixteen semi-structured interviews were conducted with HEMS personnel from a University Hospital in The Netherlands. Interview topics included work context, personal characteristics, coping, work engagement, and psychosocial support. To analyze the data, a generic qualitative research approach was used inspired by grounded theory, including open, axial and selective coding.Results:The analysis revealed ten categories that provide insight into factors underlying the wellbeing of HEMS personnel and their work context: team and collaboration, coping, procedures, informal peer support, organizational support and follow-up care, drives and motivations, attitudes, other stressors, potentially traumatic events, and emotional impact. The findings show that HEMS personnel are highly motivated and have a strong team mentality. Various factors are important to their wellbeing, such as job resources and social support. The HEMS work can have an emotional impact but HEMS personnel use various coping strategies to deal with this. The perceived need for organizational support and follow-up care is low among participants.Conclusion:This study identifies factors and strategies that support the wellbeing of HEMS personnel. It also provides insight into the HEMS work culture and help-seeking behavior in this population. The findings may be beneficial to understand and support employee wellbeing in other emergency services work contexts as well.