bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lessons Learned from a Multiple Casualty Blast Incident
Authors: Juan Li , Quah Joy , Ho Shu Fang , Ng Ming Wei , Chan Wei Xin 
Published: June 2023

Introduction:On February 24, 2021, a large explosion and fire occurred in an industrial estate in Singapore. Eight casualties with major burns were conveyed to the emergency department (ED) at Singapore General Hospital, the designated regional Burns Centre. This article details the events and recommendations arising from this multiple casualty incident.Method:An After-Action Review (AAR) was conducted to examine the prehospital notification process, casualty triage & tagging, medical management, manpower and resource allocation, and command-and-control structure.Results:All eight casualties were conveyed by the national Emergency Medical Services (EMS) and arrived within a 46-minute window. The first three suffered 90% full-thickness burns and inhalational injuries and were intubated. The remaining five suffered between 37% to 64% burns, with three requiring intubations as well.Four major areas were identified for improvement:Firstly, there was scant information from EMS regarding total casualty count. There was also inadequate knowledge of mass burns triage protocols in the ED. Thus, resources were heavily utilized for the first three casualties - all of whom were later deemed unsalvageable, given palliative care and demised.Secondly, casualty identities were initially unknown. They were tagged with similar-looking ten-digit serial numbers, resulting in a near-miss event involving mislabelled blood tubes.Thirdly, there was unfamiliarity with the incident response plan for a multiple casualty incident of this scale. This contributed to lack of situational oversight and inconsistent leadership direction from various stakeholders with resulting conflicting instructions.Fourthly, routine trauma computed tomography pan-scans for all casualties caused delayed reporting by Radiology and created a bottleneck in casualty disposition.A multi-disciplinary workgroup comprising Emergency, Trauma, Burns and Intensive Care departments outlined several recommendations based on the AAR findings. Drills were strongly recommended to resume following a hiatus due to COVID-19.Conclusion:AARs help provide invaluable insights. Response plans should be refined together with relevant stakeholders.
Practical Trauma Training in Ukraine: An EMT Type 1 NGO’s Implementation of Trauma Training for Healthcare Providers and First Responders in Ukraine from March 2022-October 2022
Authors: Chartoff Stanley , Toth Robert , Young David , Nelson Erica , Bilgram Calley , Quaranta Alyssa , Callaway David 
Published: June 2023

Introduction:In March 2022, Team Rubicon deployed an EMT Type 1 mobile team to provide medical care for internally displaced people in Ukraine. Regional medical facilities and universities identified a need for training programs to prepare for the expected increase in wartime casualties.Method:Deployed medical teams researched and compiled initial course content. Presentations were prepared and conducted with the assistance of Ukrainian translators. The curriculum was expanded to include whole blood transfusion and point of care ultrasound. After the prioritization of needs by the MOH, Team Rubicon deployed a seven-member team to conduct training in 16 cities over two months. They provided instruction in whole blood transfusion, hemorrhage control, blast injuries, prehospital triage, shock management, point of care ultrasound, and treatment of chemical exposures. Surveys were conducted pre- and post-training to assess the usefulness of the training provided.Results:In two months, a total of 1549 unique individuals were trained. The participants included 769 physicians, 244 nurses, 299 paramedics, 83 hospital administrators, and 154 additional professionals. They included 614 males and 935 females. The number of participants in each course included: 477 for hemorrhage control, 564 for treatment of chemical exposures, 483 for blast injury and field trauma, 412 for pre-hospital and triage training, 135 for point-of-care ultrasound, and 154 for whole blood transfusion.Conclusion:With the assistance of the Ukrainian Ministry of Health, an NGO was able to conduct 64 sessions training 1549 individuals. This experience demonstrates the ability to create a robust educational platform to fulfill the medical needs of a community affected by warfare.
The Characterization of Trauma Patients Utilizing Private Vehicle Transport (PVT) to the Emergency Department (ED)
Authors: Leidlein Sabryn , Rammal Jo-Ann , Klausner Howard , Johnson Jeffrey 
Published: June 2023

Introduction:Existing studies have identified the national rate of PVT for severely injured patients to be 9-16%, our ED has displayed a PVT incidence of 35.4%, suggesting a substantial difference in ED arrival. This study aims to explore descriptive demographics and injury characteristics of patients who arrived by PVT to our ED.Method:A prospective, single-center observational study conducted in Detroit, Michigan. Included patients aged 15 ≥ years who arrived at the ED by PVT for blunt or penetrating trauma. The sample population consisted of 128 patients from August 2019-April 2021. Each subject completed a survey regarding their injury and prehospital care. A retrospective chart review was conducted to acquire information on their injuries.Results:The mean age was 44.3 ± 20.3 years old, range 15-93. 51/128 female, 77/128 male. Patients comprised 93/128 African American, 19/128 Caucasian, 4/128 Asian, 4/128 Hispanic/Latino, and 8/128 other. The most common insurance was Medicaid, comprising 63/128 patients, 25/128 of patients had Medicare and 38/128 had private coverage. Utilizing ESI indices to evaluate severity levels, 73/128 arrived at the ED with an ESI level of 3, 47/128 level of 2, 5/128 level of 4, and 3/128 level of 1, the most severe. Majority of patients 36/128, presented with trauma-related injuries due to a fall. 25/128 presented with a laceration, and 22/128 presented after a motor vehicle crash. The upper extremities were the most common location of trauma 38/128 followed by the lower extremities 23/128. The mean ED length of stay was 11.18 hours.Conclusion:Overall, the findings from this study allowed us to characterize our population of PVT trauma patients through their demographics and injury characteristics. We were able to establish some descriptive characteristics that delineate the population of patients at our ED in Detroit, which is the first step in identifying why trauma patients choose varying modes of transportation.
An e-learning Course Effect on Swedish Ambulance Commanders' Decision-making in Simulated Road Tunnel incidents–Preliminary findings
Authors: Hylander Johan , Gyllencreutz Lina , Haney Michael , Westman Anton 
Published: June 2023

Introduction:Road tunnel systems are becoming increasingly complex. Regardless of incident, the confined nature of the road tunnel impairs responding emergency services accessibility, with a risk for delay in treatment of time-sensitive injuries such as pneumothorax or internal hemorrhage. Consequently, the need for rapid decision-making by the emergency services commanders is increased. However, in Sweden ambulance commanders lack experience and training in managing road tunnel incidents. This may further delay the medical response.The aim is to investigate if the ambulance commander decision-making in simulated road tunnel incidents may be improved by a specific road tunnel incident e-learning course.Method:A web-based intervention study was performed with 20 participants; 10 participants in the intervention and control group, respectively. The control group received a pre-recorded general lecture on incident management. The intervention group received a specific road tunnel incident e-learning course, consisting of five interactive modules with learning materials (e.g. road tunnel structures, collaboration and safety). All participants participated in web-based simulations of major road tunnel incidents at one and six months post-intervention. In these simulations, participants acted as ambulance commanders and decided on the best course of action in 15 dissimilar and multiple choice-based management decisions. For each decision, time and choice of decision were recorded as outcome measurements.Results:Preliminary analysis from the one-month follow up simulation indicates that none of the participants decided to enter the road tunnel system at the early stage of the incident. The motivation for the participants decision-making was not clear.Conclusion:The cautiousness to enter the road tunnel system will impair the emergency medical services response, including delaying vital medical care. Further research into the reasoning behind this decision is needed and identified causes may be further addressed in updated educational materials and collaborative discussions.
Disaster Training–How Much Educational Impact Does it Really Have?
Authors: Wong Evelyn , Quah Joy 
Published: June 2023

Introduction:In Singapore, disaster training and preparation are taken seriously. Many exercises and training sessions have been planned and run yearly with the hope of being able to respond effectively to an emergent disaster. This presentation aims to evaluate the effectiveness of our training programs to determine if the learner participants are equipped to manage disasters when they happen based on their learning objectives.Method:The disaster training programs that Singapore General Hospital participates in, both nationally and internally, were analyzed based on Bloom’s taxonomy for educational objectives. At the lowest level, the learner demonstrates the ability to remember the facts that he learned, followed by understanding the concepts, applying the information, analyzing the learning undertaken, evaluating his performance, and creating new methods to learn or train to improve his performance.Results:Based on the analysis of the various exercises and training sessions, most learning objectives are pegged to the remembering to application levels (90%) while very few participants, especially the instructors and evaluators (<10%) may achieve learning objectives of being able to analyze and evaluate the training sessions. As disaster training involves multiple interprofessional teams there is also a risk of rapidly diminishing retention of knowledge and skills over time because of the high turnover of manpower especially from residents and medical officers who are attached to the departments for a few months.Conclusion:There is room for more targeted disaster training aimed at more participants and with learning objectives determined at the higher level of Bloom’s taxonomy, at least to achieve the ability to analyze and evaluate one’s performance for improvement. Creating opportunities for more participants to be able to do that would be a challenge.
Retrospective Analysis to Assess the Admission Rate Trends in an Irish Public Hospital between February 2014-September 2022
Authors: van Rensburg Rochelle Janse , Conradie Maria , Jordaan Phillip , Smit Marco , Van Der Vegte Andrea , Taqvi Syed , Orsmond Brendan , Andrews Robin , Abraham Ria , Dowle Ashleigh , Vythilingam Darshini , Kennedy Keith , Bilal Muhammad , Wickham Bryce , Kelly Thomas , Molloy Michael 
Published: June 2023

Introduction:As the population in the Republic of Ireland increases, the number of Emergency Department (ED) attendances and admission rates increase, placing significant pressure on the health care system, the limited staff and hospital resources.The aim of this study is to assess the admission rates in an Irish Public Hospital Emergency Department between 2014 and 2022.Method:This retrospective study was done using information provided by the Health Service Executive Integrated Patient Management System. Data for the period between February 2014 to September 2022 were collected. From the data, the admission rate can be calculated and trends observed.Results:Emergency department attendance rates have increased from 29,236 to 42,637 between 2014 and 2019, with a decline noticed in 2020 to 37,751 and a drastic increase in 2021 at 43,182. Currently up until September 2022 there has been 35,503 attendances and 8,570 admissions, with an admission rate of 24.14%. The number of admissions has ranged from 9,056 in 2014 to the highest being 12,175 in 2019. This means the admission rate is averaging between 24% to 31% per annum, with the highest being 31,04% in 2015, and the lowest in 2017 at 24,99%.Conclusion:This study showed a steady increase in attendances per annum, which correlates to an increase in the total admissions from 2014 to 2022, with approximately one third of all ED attendances resulting in admission. The increase in attendances and admission rate could be related to the population growth from 4.6 to 5.1 million from 2014 to 2022. The decrease in attendances during 2020 could be attributed to the Covid-19 pandemic restrictions being implemented, and lifted in 2021 which showed a drastic increase in ED numbers. Ultimately, the increase in admissions will place a burden on the Public Hospitals in Ireland.
Climate Change Impact on Floods and Water Borne Disease in Nepal
Authors: Acharya Radha Subedi , Yew Ying , Gonzalez Pedro , Delgado Rafael , Patrikiou Edna Yamasaki , Subedi Baburam 
Published: June 2023

Introduction:Nepal’s reported risk to Climate Change adaptation reported by Notre Dame Global Adaptation Initiative Index (ND-GAIN Index) 2020 is 5.2 and ranked 71% high in country vulnerability, 126th of the total 180 countries. According to the report of the Ministry of Forest and Environment in 2018, flood is one of the principal climatic hazards in Nepal. According to the Department of Health Services Nepal, 3,500 children die each year due to water-borne diseases (WBD). The objective of this study is to analyze the climate change impact focusing on floods and WBD for the past two decades.Method:A secondary data analysis method was used to analyze the impact of floods and WBD attributed to climate change. Data was obtained from Nepal Risk Reduction Portal (http://drrportal.gov.np), Nepal Annual Health Reports (2000-2021), Nepal Government Vulnerability and Risk Assessment reports, and reputable journals.Results:Climate-related disasters have increased by six-fold in 2021, as compared to 2000 in Nepal. Among the people affected by disasters 71% of them are due to floods. Flood events during the last 21 years have a fluctuating trend with highest and lowest events observed in 2017(388) and 2015(15) respectively. Heavy and unusual rainfall patterns as a major indicator of climate change is likely to cause riverine floods and flash flooding by melting the glaciers. The incidence of diarrhea disease rose by 4.39% for 1°C increase in ambient temperature in data analysis collected on temperature and diarrhea from July 2002-June 2014.Conclusion:The findings suggested that increased temperatures in Nepal might have induced a change in flood events and the incidence of WBD (such as diarrhea), thus emphasizing the importance of climate change adaptation plans, flood risk management, and WBD surveillance to be prioritized and put in place to mitigate the effects of climate change.
Development and Validation of a Repeatable Exsanguination Simulator Using Live Tissue (RESULT)
Authors: Arkestål Lukas , Friberg Marc , Loftås Per , Prytz Erik , Jonson Carl-Oscar , Junker Johan 
Published: June 2023

Introduction:Proper packing technique is crucial to minimize blood loss and successfully stop fatal junctional (axilla, groin, and neck) bleedings. Several medical simulators and mannequins are used to teach techniques for manual pressure and wound packing. Live tissue training (LTT) using animal models represents a high-fidelity simulator, but the number of times massive hemorrhage can be practiced is limited due to cumulative blood loss of the animal. Moreover, the animal’s potent coagulation limits the reuse of injuries. The study aimed at creating and validating a reproducible and repeatable exsanguination simulator to be used for high-volume training.Method:This study was approved by the regional animal ethics committee (Dnr 17953-2020). All animals were fully anesthetized throughout the duration of experiments. A repeatable exsanguination simulator using live tissue (RESULT) was created using commonly available materials to add reproducible junctional bleedings in an LTT context. A canister of porcine or bovine blood is connected to a standard gravity infusion set with roll clamp and pump chamber removed and added to a 100 cm 3-way stopcock connected to a 60 ml syringe. The free end of tubing is surgically inserted into the hind leg of a pig and placed inside a 5 cm long and 5 cm deep wound cavity. The simulator was evaluated with instructors controlling the rate of bleeding using the syringe while training participants packed the wound.Results:According to the instructors, participants benefited from the additional training made possible by using RESULT. Instructors received direct feedback on applied manual pressure and packing through the resistance of the syringe plunger. Moreover, participants found the increased number of repetitions beneficial to their training. The animals had no change in status from the multiple bleeding interventions.Conclusion:Both participants and instructors found the novel bleeding model useful for high-volume training in stopping massive junctional bleeding.
A Modified Delphi Study to Improve Prehospital Mass Casualty Incident Response
Authors: Cuthbertson Joseph , Weinstein Eric , Franc Jeffrey , Magalini Sabina , Gui Daniele , Jones Peter , Montan Kristina , Faccincani Roberto , Ragazzoni Luca , Caviglia Marta 
Published: June 2023

Introduction:The Novel Integrated Toolkit for Enhanced Pre-Hospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE) project was awarded to a consortium to design an innovative toolkit featuring different technological solutions for prehospital mass casualty incident (MCI) response. Translational science (T) methodology was undertaken to develop evidence-based guidelines for MCI response.Method:The consortium was divided into three work groups (WGs) MCI Triage, Prehospital Life Support and Damage Control and Prehospital Processes. Each WG previously collected data through the project T1 scoping review stage to provide the foundation for the initial T2 modified Delphi draft statements to present to WG internal focus groups for content and NIGHTINGALE study objectives. Their refined statements proceeded to WG specific external focus groups for further editing to be clear and concise for the following modified Delphi consensus rounds. Final WG statements were presented to modified Delphi experts for their consensus using the STAT59 platform with instruction to rank each statement on a seven-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤1.0.Results:After three modified Delphi rounds, 18 of 24 statements attained consensus by the MCI Triage experts, eight of 25 by the Prehospital and Life Support and Damage Control experts, and 23 of 28 by the Prehospital Processes experts.Conclusion:The three work groups will utilize consensus statements during the NIGHTINGALE project T3 phase to create evidence-based MCI response guidelines.
Current Disaster Triage Methods in Mass Casualty Incidents
Authors: Sarkisian Simon 
Published: June 2023

Introduction:Triage in a disaster scenario centers around doing the greatest good for the greatest number of people. There are a variety of triage systems, and to this date there is no US national endorsement of one system because triage is a dynamic procedure and there is no fixed rule for it. The Simple Triage and Rapid Treatment (START); Sort, Assess, Life-saving interventions, Treatment/Transport (SALT); Sacco; CareFlight; JumpSTART; and Pediatric Triage Tape (PTT) triage systems are discussed with emphasis on how they perform.Method:There are approximately 20 adult and two pediatric triage systems that exist for primary disaster triage. The focus is on six primary triage systems. A literature search was performed using textbooks and original research.Results:A basic assignment to immediate, delayed, minimal, or expectant can sort a large group of casualties in a matter of minutes, but improper category assignment can lead to under-triage or over-triage.When assessed by a trained paramedic arriving at a Level 1 pediatric trauma center, SALT was found to be the most accurate triage system at 59% compared to JumpSTART, CareFlight, and TriageSieve. All triage systems exhibited under-triage rates of at least 33% and SALT had the highest over-triage rate at 6%. In another study, the START triage system was found to be 85% sensitive and 86% specific in predicting critical injury in designated trauma patients.Conclusion:Mass casualty incidents are unfortunately becoming more common as the increasing numbers of violent attacks produce an overwhelming number of victims. One triage process may not work in all disasters, but first responders should be trained to evaluate for the most critical patients in a sea of evolving patient presentations. Furthermore, randomized, controlled trials in real-world conditions are nearly impossible to perform given the specific circumstances of disasters.
Hypothermia Management, an Evaluation of a Novel Lightweight System.
Authors: Caine Philippa , Zhelezniakova Tatiana , Taylor Mark , Smart Colin , Pennells Simon , Hall John 
Published: June 2023

Introduction:Accidental hypothermia remains an important contributory factor to the mortality of trauma patients in both civilian and military environments. As a component of the ‘lethal triad’ it poses a significant problem in patients at risk of hemorrhage from traumatic injuries. Systems used to mitigate hypothermia in the prehospital environment must strike a balance between weight: size ratio and optimal performance.Method:This study compared three hypothermia mitigation systems; two leading products and the novel Xtract™SR Heatsaver, over a three-day trial period. Seven subjects were placed in a closed system, held at around 0°C, to promote the onset of mild hypothermia. Individuals with a tympanic temperature recording of < or = 35°C were placed into one of the three systems. Recordings of aural temperature and a numerical perceived comfort score were made every 15-20 minutes to assess rate of rewarming and subject’s perceptions of the process. An additional study was carried out by an experienced consultant in military and civilian emergency medicine, on day three of the trial, to determine the ease of clinical assessment of individuals placed inside the Xtract™SR Heatsaver prototype.Results:On all three days, subjects placed in the Xtract™SR Heatsaver recovered from their hypothermic state faster than those placed in the other systems. Clinical assessment could easily be performed on a patient placed in the Xtract™SR Heatsaver system.Conclusion:Results demonstrate that the new Xtract™SR Heatsaver system is superior with regards to reducing heat loss, increasing patient comfort and allowing for clinical assessment. The study also highlights the importance of the use of adjuncts such as heat cell blankets and insulation matts alongside hypothermia mitigation systems deployed in the prehospital environment. Furthermore, data gathered provides scope for future research into nuances surrounding the effects and onset of hypothermia.