bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective Analysis of Patient Presentations at Belgium's Largest Multi-day Outdoor Hardstyle Dance Event
Authors: Spaepen Kris , Beens Kevin , Cardinas Robby , Hubloue Ives 
Published: June 2023

Introduction:Electronic dance music festivals (EDMF) are a unique subset of music mass gatherings. Besides the already more significant burden on in-event health services (IEHS) that comes with these festivals, EDMF are also known for their illicit drug use, with their attendees at high risk for illegal drug use.Method:Encounter data from all patients seen and treated by IEHS at an annual outdoor multi-day EDMF (focused on hardstyle dance music) in August 2019 were analyzed. Based on the chief complaint, and medical and nursing notes, a list was consolidated into 31 reasons for the consultation of IEHS. The most common reasons for consulting IEHS were analyzed.Results:This outdoor hardstyle dance event had 30,000 attendees, of which 580 visited IEHS. This resulted in a patient presentation rate of 19.3/1,000 attendees. Four were transported to the hospital (transport to hospital rate: 0.13/1,000 attendees). The most prevalent reason to consult IEHS were lacerations and abrasions (9.66%), sprains (9.48%), and headaches (7.59%). Only 4.83% of all patients (n = 12) presented with adverse effects of illicit drug use. Of interest is that twelve patients with intoxications (42.86% of all intoxicated patients) were initially triaged as life-threatening, mainly due to obstructed airways. Only one of these twelve needed endotracheal intubation and was transported to the hospital. All other intoxicated patients returned to the event. No direct relationship between gender and the chief complaint was found.Conclusion:Besides typical patient presentations, illicit drug use with its adverse effects can seriously impact IEHS. These results confirm the need for highly trained (Advanced life support level) IEHS at EDMF. Competent IEHS can mitigate the burden of these events on regular EMS.
A New Model for Postgraduate and Continuing Education in Disaster and Terror Medicine
Authors: Braitberg George , Smith Erin , Knott Jonathon 
Published: June 2023

Introduction:Postgraduate education is important in preparing and enhancing health professionals for the practice of disaster and terror medicine. The World Association for Disaster and Emergency Medicine (WADEM) has formulated a standardized international perspective for education and training in disaster medicine and health. Notwithstanding, there continues to be a reported gap in competency-based training in disaster and terror medicine internationally, particularly across Asia Pacific, which is a known vulnerable region. We report on a new Graduate Diploma in Disaster and Terror Medicine, to be expanded to Master level in 2024. The course is delivered mainly online to a multidisciplinary international audience. This paper summarizes the development of the course and outlines the key influences that have contributed to the design of the course.Method:A survey of the critical care workforce conducted by the Department of Critical Care at the University of Melbourne in early 2020 identified the need to develop education in disaster and terror medicine. A market and competitor analysis identified there was a gap in clinician focused courses offered in Australia and internationally. Based upon these results, a new course was developed to meet these needs.Results:Based on the results of the survey and feedback from expert stakeholders, the new postgraduate courses in disaster and terror medicine were developed. They offer both core and elective subjects, utilizing a modular approach with supervised simulation and practical training. The courses incorporate problem-based learning, the principles and practices of online education and advances in simulation-based learning, providing both a public health and clinical lens.Conclusion:The nested suite of postgraduate disaster and terror medicine courses at the University of Melbourne is at the forefront of learning within this field and meets the contemporary needs of health professionals who practice disaster and terror medicine
Delphi Process Recommendations for Pediatric Disaster Medicine Training Curriculum Key Competencies
Authors: Grodman Schyler , Hard Alexander , Hertelendy Attila , Woodward Christina , Voskanyan Amalia , Issa Fadi , Weiner Debra , Ciottone Greg 
Published: June 2023

Introduction:Children differ from adults, developmentally, physiologically, and psychologically. Additionally, children lack legal agency, and thus rely on adults to gain access to the healthcare system and other resources. Though children are often the face of disaster relief, the desparate needs of children can fall through the cracks during disaster response. Many training programs for disaster responders do not give pediatric concerns and issues the appropriate attention they deserve. Pediatric disaster medicine is often minimally addressed in emergency medicine residencies and prehospital provider training. Furthermore, pediatric disaster supplies and protocols are often lacking and insufficient to meet the needs of children during and after disasters.Method:This is a modified Delphi study. An initial set of pediatric disaster medicine competencies from a systematic review of PubMed, EMBase and the gray literature will be presented to an initial group of Subject Matter Experts (SMEs) comment, additions, and edits. This modified set of competencies will then be distributed to a large group of providers with experience in the field. Through a series of surveys, each competency in the curriculum will be rated. Those competencies which achieve a high overall rating will be reported.Results:Data collection and analysis expected to be completed by April 2023.Conclusion:This modified Delphi study will establish and prioritize a set of core competencies for pediatric disaster response based on expert recommendations. The use of such gold standard core competencies to develop discipline-role-specific pediatric disaster training can increase pediatric disaster workforce capacity and competency critically needed to improve pediatric disaster response.
Disaster Medical Responder’s Course for Training of Field Medical Teams in Singapore
Authors: Pek Jen Heng , Yeo Yi Wen Mathew , Teng Kuan Peng David , Lee Chan Yu Jimmy , Quah Li Juan Joy 
Published: June 2023

Introduction:Casualties need to be triaged, stabilized and treated before they can be evacuated to the hospital. However, when Field Medical Teams (FMTs) arrive at the First Aid Post (FAP), the staff has to perform outside of their usual settings. There are also differences in the conception of medical operations, organization of the FAP, availability of medical equipment and supply, as well as means of communication, command, and control which can affect their performance and eventually the optimal survival of casualties during a mass casualty incident.Method:Guided by Kern’s model for curriculum development, Disaster Medical Responder's Course (DMRC) was developed. The curriculum focused on disaster response operations and processes; roles and responsibilities; command, control and communication; as well as supplies and resources. The content was taught through interactive lectures and skill stations. Course evaluation was based on the Kirkpatrick Model. A feedback form evaluated the reaction of the participants as to whether the course was relevant, if they learnt new knowledge and skills, and if they could apply these to their roles as FMTs. A tabletop exercise evaluated learning with participants working collaboratively.Results:DMRC has been sustainable since 2013 with six to eight courses per year. There had been numerous revisions of the content and delivery to keep up-to-date with the latest concept of operations, best practices from the literature, as well as educational methodologies. The last update was in 2020 in response to the COVID-19 pandemic where course schedule and mode of delivery were adjusted to comply with the safe management measures.Conclusion:FMTs will require training so they can function to their maximum capacity and capability. In Singapore, DMRC is the course for this unique and important training of FMTs. DMRC plays a pivotal role in ensuring the preparedness and operational readiness of FMTs for mass casualty incidents.
The Impact of Hurricane Ida on Emergency Medical Services Operations in New Orleans
Authors: Rosenblatt Joy , Gruen Sean , Marino Meg , Nichols Emily 
Published: June 2023

Introduction:On August 29, 2021 Hurricane Ida struck New Orleans with Category 4 winds. While the most severe weather occurred during a 24-hr period on August 29, the city suffered significant damage to telecommunication systems, medical facilities, and infrastructure for several weeks afterward. At the height of the storm, multiple events affected routine deployment of EMS, including damage to transmission lines causing interruption of the 911 system, and suspension of ambulance travel for safety when the winds exceeded 50 mph. These factors, as well as pre-storm preparations, affected utilization of EMS by residents and thus a “peri-hurricane” period was examined to determine the overall effect of Hurricane Ida on New Orleans EMS operations.Method:Run sheets for calls to NOEMS between August 26-September 9, 2021 were analyzed to assess the most frequently reported medical complaint just prior to and after the hurricane. Run sheets were also evaluated to determine average time from call to arrival on scene, time to arrival at patient (“response time”), and time from leaving scene to arrival at destination (“transport time”). To account for the atypical period during which EMS response was suspended due to wind, both mean and median times were calculated. Data was compared to a control period of Aug 26-Sept 9, 2022.Results:During the study period, 1,971 calls were received, with trauma and respiratory the most common complaints. The mean call-to-arrival time was one hour, although the median time was 15 minutes. Response time was 34 minutes compared to 21 minutes in 2022, and median response time was comparable to the control period. Transport time mean and median were 12.3 and 11.3 minutes, also similar to 2022.Conclusion:Despite citywide infrastructure failures and suspension of operations for over 12 hours during landfall, multiple mitigation strategies enabled NOEMS to quickly resume operations and minimize impact on patient care times.
Patient Factors which Lead to Disagreement in Triage Decisions
Authors: Simon Stephen , Hertelendy Attila , Hart Alexander , Gregory Ciottone 
Published: June 2023

Introduction:Multiple triage algorithms have been proposed to optimize the allocation of medical resources in mass casualty incidents. Despite attempts at standardization, first responders often assign patients to triage categories that deviate from those prescribed by these algorithms. This study seeks to understand what patient level factors cause these deviations, and identify clinical factors which cause variance toward over or under triage. Rather than evaluate these decisions against a gold standard, we instead seek to identify patients that cause controversy among first responders with respect to their choices.Method:This will be an online survey distributed to EMT and Paramedic students in the US. They will be provided with fifty patient cards containing a clinical vignette including description of injuries and vital signs. For each vignette, they will select a triage category (Red, Yellow, Green, or Black.) We will analyze responses to identify areas of controversy, where triage classification showed a significant split between respondents. We can then evaluate these patients for clinical trends.Results:Data collection and analysis are planned for completion by March 30, 2023.Conclusion:Identifying patient-level characteristics that contribute to triage variance can allow emergency managers to anticipate under-triage and over-triage following an MCI. This can aid emergency providers as they plan to receive an influx of patients. It also addresses the sub-cognitive biases that impact first responders decision-making, which may aid EMS educators who train first responders in triage.
Logistics Educational Items Required for Hospital Paramedics to Work in Disaster Medicine Settings.
Authors: Masudome Ruki , Akahoshi Kouki , Koido Yuichi 
Published: June 2023

Introduction:In Japan, the Disaster Medical Assistance Team (DMAT) is dispatched as an Emergency Medical Team (EMT) in major disasters. DMAT consists of a physician, nurse, and operations coordinators. The operations coordinators include all occupations other than physicians and nurses, and are responsible for activities to facilitate medical treatment, gathering information, establishing communications, and ensuring transportation. Therefore, the operations coordinator must have in-depth knowledge of all aspects. Operations coordinators with this knowledge are qualified as logistics team members in addition to DMAT certification. Paramedics receive pre-graduate training in medical care, transport, and coordination with other organizations, and many of their daily duties are related to these areas. However, there are few opportunities to learn about logistics. If paramedics are effectively trained in logistics, they are likely to play an active role as operational coordinators. However, logistics covers a wide range of topics, and there are few studies on items that require focused education. Therefore, this study examines the level of understanding of each logistics item among paramedics active in the field of disaster medicine to identify items that should be emphasized.Method:A questionnaire survey of 36 paramedics was conducted, all of whom hold both DMAT and logistics team certifications, to determine their level of understanding and the importance of each logistics item. The logistics items used in the survey are specified in the Logistics Specialist Certification System of the Japanese Society of Disaster Medicine. The collected questionnaire results were analyzed using SPSS statistical software.Results:Characteristic trends were obtained in the logistics items required of paramedics. Trends were also analyzed according to the age and work history of paramedics.Conclusion:The logistics education for paramedics needs to be enhanced in accordance with the trends obtained from the study. Specific studies on the means and timing of education will be needed in the future.
How People with Hearing Disabilities Deal with Collective vs. Private Emergencies
Authors: Tannenbaum-Baruch Carolina , Aharonson-Daniel Limor , Feder-Bubis Paula 
Published: June 2023

Introduction:People with hearing disabilities (PwHDs) often do not receive the warnings sent out to the general community during emergencies. Our goal was to identify the obstacles preventing PwHDs from accessing vital information in routine circumstances and during general emergencies.Method:This study was conducted from November 2018 through July 2020. We used a mixed-methods approach. The qualitative portion consisted of a standardized, open-ended interview with 19 PwHDs from various socio-economic backgrounds, religions, areas of residence and levels of hearing disability about coping with emergency situations in Israel. Grounded theory was used for analysis of the findings. The quantitative portion consisted of a cross-sectional survey of 288 PwHDs focused on perceptions of their self-efficacy in dealing with emergencies, methods of communication and accessibility of services. Using the Qualtrics survey platform with Israel sign language videoclips that included subtitles in straightforward Hebrew increased the participation. The statistical analysis was conducted using SPSS ver.23.Results:Most respondents explained that their responses differed depending on whether the emergency is collective or personal.1. Collective emergencies: Events such as earthquakes or wars that affect everyone. Most solutions provided to the general population are not accessible to or suitable for PwHDs.2. Private emergencies: PwHDs often encounter personal emergencies such as difficulty asking for help on the street, the inability to contact call centers or the difficulty in obtaining accessible information from organizations.Conclusion:The distinction between types of emergencies requires the development of different resources for dealing with routine issues and public emergencies. The latter affect PwHDs less than private emergencies. Standards of accessibility must be established for places providing services both during the day and at night, such as emergency rooms, telephone service centers, clinics, etc. These standards are the basis that which will allow for PWHDs to communicate independently.
Impact of Virtual Disaster Collaboration Exercises on Disaster Leadership at Hospitals in Saudi Arabia
Authors: Sultan Mohammed , Khorram-Manesh Amir , Carlström Eric , Berlin Johan , Sørensen Jarle Løwe 
Published: June 2023

Introduction:This study measured the impact of virtual three-level collaboration (3LC) exercises on participants’ perceived levels of collaboration, learning, and utility (CLU) at hospitals in the southern region of Saudi Arabia. Our 3LC exercise is a tabletop training tool used to facilitate disaster education and document CLU. This model enables the practitioner to acquire new knowledge and promotes active learning.Method:An English version of the CLU scale, the validated Swedish survey tool, was applied to 100 health-care managers or leaders in various positions at both the operational and tactical levels after conducting the 3LC exercises.Results:The results show that most participants strongly agreed that the exercises focused on collaboration (r2 = 0.767) and that they had acquired new knowledge during the exercises. There was a statistically significant association between participation in the collaboration exercises and perceived learning (r2 = 0.793), as well as between perceived learning and utility (r2 = 0.811).Conclusion:This study confirms the feasibility of three level collaboration exercises conducted virtually. Our work also demonstrates that learning depends on collaboration practices and that collaboration exercises before crises can help to build qualities that people can apply in daily life. Collaboration elements exercised in this study contributed to perceived learning. There was a strong covariation between participation in the participants’ collaboration exercises and perceived learning and utility. The virtual three-level collaboration exercises were well received by the participants and achieved an acceptable collaboration, learning, and utility score. Although exercises were conducted virtually, they were well received by the participants and achieved a value M = 4.4 CLU score, which opens up new dimensions in collaboration simulation exercises, at least from an organizational perspective, in a world with an increasing number of disasters and public health emergencies.
Overview of Medical Countermeasures (MCM) for the Treatment of Monkeypox in United States (US) Children During the 2022 Multinational Monkeypox Response
Authors: Godfred-Cato Shana , Kimball Anne , Yu Yon , Pao Leah Zilversmit , Yu Patrician , Fehrenbach Nicole 
Published: June 2023

Introduction:During the 2022 Multinational Monkeypox Response, cases of Monkeypox illness reported in children and adolescents in the US were rare. Early in the response, little was known about MCM safety and efficacy for treating monkeypox in children and adolescents. As cases in children and adolescents increased, knowledge about safety and efficacy evolved.Method:Cases of monkeypox in children <18 years of age across the US were reported to CDC. MCM consultations from clinical and regulatory affairs subject matter experts supported clinician administration and management of antiviral and immunoglobulin treatment. Data from the first pediatric cases were collected to help answer some of these questions on the use of MCM in pediatric populations.Results:Across the US, 116 cases of monkeypox in children <18 years of age have been verified through October 2022. Of these cases, 41 occurred in patients twelve years of age or less, with 75 cases in adolescents 13-17 years of age. Ten percent of patients were hospitalized, none required ICU care and no deaths occurred. Children were most commonly hospitalized due to young age, rash near or including the eye, secondary bacterial infections, or pain management. At least eleven patients with confirmed orthopoxvirus were treated with tecovirimat and two with Vaccinia Immune Globulin. Those who received MCM recovered and tolerated treatments well with one patient stopping treatment secondary to development of a drug rash.Conclusion:Data on the safety and efficacy of MCM for monkeypox are limited in pediatric populations. As of November 3, 2022, most cases of monkeypox in the pediatric population in the 2022 monkeypox outbreak were mild and self-limited. Patients who received MCM recovered and tolerated treatments without serious adverse events. These findings can inform clinicians and public health providers about the clinical features of monkeypox in children and provide information about MCM treatment options.
Hazmat and Hate: Planning and Response for Special Operations Teams to a Neo-Nazi Public Demonstration
Authors: Abo Benjamin , Slish John 
Published: June 2023

Introduction:October 18, 2017 an unfortunately popular white supremacist brought hate and thousands of protesters to the University of Florida in Gainesville, FL just months after the violent domestic terrorist attacks in Charlottesville, VA. The threats, violent possibilities, and intense planning undertaken by law enforcement and fire-rescue were hugely successful.Method:Multi-faceted planning from law enforcement, to crowd control, to medical emergency response, to fire suppression, to hazardous material detection and response, to rescue task forces, to extreme sides to protesting... all proved hugely successful.Results:While there was still violence, complex plans of violence among protests were successfully thwarted.Conclusion:The coordination between Gainesville Fire Rescue, Gainesville Police Department, Alachua County Sheriff's Office, Florida Highway Patrol, the University of Florida and more was hugely successful and something to be proud of despite such hatred and violence projected while also protecting the first amendment.
Development and Validation of the Parental Expectations Scale (PES)	in Parents From Romania
Authors: Dănilă Ingrid , Balazsi Robert , Tăut Diana , Băban Adriana , Foran Heather 
Published: June 2023

Abstract: Social cognitive models of parenting consider the role of unrealistic parental expectations (UE) regarding children’s abilities and behaviors as antecedents to the occurrence of child abuse. However, existing self-report measures of UE yield inconsistent results, often failing to differentiate aggressive and non-aggressive parents, raising questions about their validity and utility in understanding maladaptive parenting. To address these concerns, we developed and tested a new measure of parental UE in two samples of parents. The first sample ( N = 179) was used to test the initial structure of the scale, while the second sample ( N = 249) was used to replicate the structure and examine the concurrent validity, criterion validity, and internal consistency of the new measure. The final scale demonstrated adequate internal consistency, criterion, and concurrent validity. More unrealistic expectations predicted unique variance in parental negative behavior after controlling for other related variables. The current study provides preliminary evidence for the reliability and validity of the Parental Expectations Scale (PES), discussing its utility in the clinical assessment of parents at risk for child abuse and in tailoring parenting interventions.