bluuebunny/crossref_metadata_2025_split huggingface dataset:
IBERO Protocol: A Multi-agency Coordination Framework for the Tactical Emergency Casualty Care Spanish System
Authors: Gutiérrez Beatriz , Aguayo Isidoro , García Belén 
Published: June 2023

Introduction:Despite Spanish experience in counterterrorism, jihadism means new modus operandi, based on active mass casualty incidents, involving new injury patterns as mass bleeding ones. Therefore, the environment is completely different to first responders' structure. This change forced the revision of the tactical response model, led by the Spanish Association for Emergency Medicine's Tactical Care Secretary, who provides a discussion forum to its members, reaching a joint framework document, IBERO, adapted to Spanish tactical emergency capabilities.Method:Methodology was based on three parameters:
1)Literature revision, selecting three sources: Books and academic papers, TCCC and TECC guidelines, and Hartford Consensus, and AARs from the main active incidents with similarities to jihadist ones.2)Formation of discussion groups: Threat definition, tactile response, and prehospital care, triage and evacuation systems.3)A final group formed by representatives of each discussion group wrote the final document.Results:The protocol defines a staged plan of action, adapted to Spanish legislation and institutions, following the acronym IBERO:
1)Information: threat intelligence and information transmitted to responders from the incident location and dispatchers.2)Block the threat by perimeter, zonification and suppression of the threat.3)Escalation of resources. Definition of areas of action according to direct threat, indirect threat and safe areas of action.4)Response and Rescue. Extrication to safe areas, including different stages of triage and protection against secondary attacks.5)Order and evacuation. Access to other emergency services, and psychological first aid.Conclusion:The document proves the need for a coordinating framework of the Spanish emergency system to be fully adapted to these new threats. The discussion groups have identified the need for regular training on threat identification, zonification setting, mass bleeding control, extrication, and evacuation techniques during hostile situations. To achieve this goal, realistic training is mandatory.
Terrorism-Related Attacks in Sub-Saharan Africa from 1970-2020: Analysis and Impact from a Counter-Terrorism Medicine Perspective
Authors: Hata Ryan , Hart Alexander , Hertelendy Attila , Tin Derrick , Taubman Cara , Cheng Lenard , Ciottone Gregory 
Published: June 2023

Introduction:Sub-Saharan Africa (SSA) has become a hotspot for global terrorism, with nearly 50% of global terror-related deaths occurring in SSA in 2021. To address growing terrorism-related health implications the field of counter-terrorism medicine (CTM) seeks to study the impacts of terrorism and implement healthcare initiatives. This study is a semi-quantitative analysis of terrorist-related activity in SSA from 1970-2020.Method:A retrospective analysis of the Global Terrorism Database (GTD) was performed for the region of SSA between 1970-2020. The number of attacks, deaths, and injuries, as well as primary weapons types, country where attacks occurred, and primary target types, were collated into a Microsoft Excel™ spreadsheet (Microsoft, Redmond Washington, USA) and analyzed.Results:A total of 19,320 attacks were recorded, resulting in 77,565 deaths and 52,986 injuries. Nigeria had the greatest number of attacks. Firearms were the most frequent weapons used, followed by explosives, unknown, and incendiary, with all others making up the remainder. Private citizens and property were the most frequently targeted entities, followed by general government facilities, police, business, military, diplomatic government facilities, and religious figures/institutions, with all other targets making up the remainder.Conclusion:The majority of deaths from terrorism in SSA are the result of firearm attacks. Nigeria had the largest number of attacks and the highest number of killed and wounded. Private citizens and property are the most frequently targeted. Terrorism poses unique challenges to governments, populations, healthcare systems, and aid organizations. By understanding the impact and scope of terrorist activity in SSA, Counter-Terrorism Medicine (CTM) initiatives can be employed to improve healthcare outcomes.
Terrorist Attacks on Refugees, Internally Displaced Peoples, and Asylum Seekers
Authors: Hata Ryan , Hart Alexander , Tin Derrick , Issa Fadi , Ciottone Gregory 
Published: June 2023

Introduction:The United Nations High Commissioner of Refugees (UNHCR) estimates that there were over 100 million displaced people as of May, 2022, which has left many people without adequate healthcare and strained local healthcare systems. While there is concern about violence that may be brought as a result of these large influxes of people, few are focused on attacks that are perpetrated on these displaced peoples. This study is a semi-quantitative analysis of terrorist attacks on refugees, refugee camps, internally-displaced peoples, and asylum seekers.Method:A retrospective search of the Global Terrorism Database (GTD) was performed for all terrorist-related events from 1970 to 2020 that targeted refugees, refugee camps, internally displaced peoples (IDPs), and asylum seekers. The number of attacks, country of attacks, weapon types, numbers wounded, and numbers killed were collated into a Microsoft Excel™ spreadsheet (Microsoft, Redmond Washington, USA) and analyzed.Results:There were a total of 683 attacks which resulted in a total of 3148 deaths and 4374 injuries from 1970-2020. These occurred in 56 countries, with Sudan having the largest number of attacks at 113, followed by Germany (71), Iraq (61), Nigeria (51), and Sweden (43). The most frequent weapons used were explosives (213), followed by firearms (210), incendiary (140), unknown (74), melee (45), and chemical (1).Conclusion:Terrorist attacks against refugees/IDPs/asylum seekers resulted in 3148 deaths and 4374 injuries in 683 attacks. Sudan had the highest number of terrorist attacks, and the most frequent weapon used was explosives. Attacks against refugees pose unique challenges to government, NGO’s, and other stakeholders due to the lack of healthcare access and transient nature of this population. By understanding the scope and impact of terrorist-related attacks against this vulnerable population counter-terrorism medicine initiatives can be employed to improve healthcare access and outcomes.
The Integration of Point-of-Care Ultrasound into Practical Trauma Training in Ukraine: A Case Study Highlighting Feasibility, Satisfaction, and Pre- and Post-Training Comfort with the Technology
Authors: Nelson Erica , Donnelly Stephen , Bilgram Calley , Quaranta Alyssa , Callaway David 
Published: June 2023

Introduction:As of October 2022, the civilian casualty count of the invasion of Ukraine is reported to be 16,295, with actual figures believed to be considerably higher. As explosive trauma continues to terrorize populations, frontline medical personnel are faced with escalating resource constraints including transport, imaging modalities, and electricity. Point of care ultrasound (POCUS) is considered the gold standard in acute trauma evaluation, but very few hospitals or pre-hospital medics have access to or training in POCUS.Method:In collaboration with the Ukrainian Ministry of Health, the World Health Organization, and the Global Health Program at Butterfly Network, Team Rubicon developed and conducted 64 practical trauma trainings and donated 50 Butterfly iQ+ portable ultrasound devices in Ukraine between August and October, 2022. Of these trainings, 19 specifically focused on the use of POCUS for trauma. Pre- and post-surveys were deployed to determine demographics, comfort level with POCUS for trauma care, and usefulness of the course.Results:In total, 149 individuals were trained in POCUS for trauma. Of these, 130 were physicians, 15 were paramedics, three were RNs, and one was a pharmacist. Only 14.8% of these clinicians self-reported any previous POCUS training. All participants reported an increase in comfort level, with an average pre- and post-course comfort scores of 1.9 and 3.3 (4=very comfortable), respectively. General satisfaction with the training was high (average score of 9.8/10). Qualitative feedback commended the quality and novelty of this training, requested further examples of pathology, and endorsed more POCUS trainings, generally. The most critical lesson learned was the need to re-orient training around the foundations of POCUS given low levels of experience and training.Conclusion:Access and training in POCUS for trauma is critical for resource-constrained medical personnel operating in conflict-affected communities. A one-day POCUS practicum-oriented course is feasible to support awareness and proficiency.
Emergency Nurse Roles, Challenges, and Preparedness in Hospitals in the Context of Armed Conflict
Authors: Mani Zakaria , Plummer Virgnia , Kuhn Lisa 
Published: June 2023

Introduction:Emergency nurses’ views on their roles, challenges, and preparedness in the context of armed conflict are necessary to capture in-depth insights into healthcare needs. They can identify the required education and training for emergency nurses and provide evidence of the situations of care in the context of armed conflicts. Unfortunately, the evidence about these factors in the context of armed conflict is scant.Method:A semi-structured interview with 23 participants was conducted using qualitative content analysis. The study was conducted in Saudi border hospitals that are shared with Yemen. The COREQ guideline for reporting qualitative research was followed.Results:The emergency nurses’ roles in hospitals in the context of armed conflict discussed clinical nurses’ and head nurses’ roles. The main challenges that emergency nurses faced include poor orientation, access blocks, and communication barriers. Various perspectives about the preparation, including education, training, and strategies for preparing emergency nurses, were identified. The most striking findings in these settings were the diversity of armed conflict injuries, clinical profile, triage of mass causality, trauma care, surge capacity, orientation, communication, and strategies for preparing nurses.Conclusion:This study provided an estimate of the scope of ED nurses' roles, and how they were prepared across a range of hospitals in the armed conflict areas and therefore a snapshot of their experiences significant to be an informative resource for these settings. This study has provided essential implications for preparedness and planning. Given the large number of preparational courses being undertaken by ED nurses in these settings, the choice of the required education and training must be planned accordingly considering the clinical profile of patients in armed conflict areas, trauma care, triage of mass causality, surge capacity, safety and security, communication, policies, and law.
Ukraine Report from the Field: TCCC in the Multidomain Battlespace
Authors: Quinn John , Dhabila Trisha , Barach Paul 
Published: June 2023

Introduction:Russia invaded Ukraine in February 2022, leading to significant preventable death across Defense forces and communities. When appropriate and adequate training has been provided, the use of point of injury (POI) care guidelines as exhibited by tactical combat casualty care (TCCC) and the implementation of damage control resuscitation (DCR) and damage control surgery (DCS) can reduce preventable morbidity and mortality in the far foreword environment.
Background: Russia invaded Ukraine in 2014 exacting a heavy increase in preventable morbidity and mortality on the battlefield. Multiple global health engagement strategies by allied forces and health partners have focused on prehospital medicine. The most recent iteration of violence has seen a comprehensive invasion with the use of multi-domain battle and conventional weapons systems across nearly every state in Ukraine. These conventional weapon systems deployed by Russian forces exact a heavy lethality on all communities.Method:This report uses anecdotal data from undisclosed locations in Eastern Ukraine from the tactical evacuation care, Role 1, Role 2 to the Role 3 echelons of care as reported.Results:Appropriate application of combat application tourniquets (CATs), pressure dressings, access to tranexamic acid (TXA), antibiotics, basics of TCCC care and DCR/DCS, including access to blood as early as possible, save lives.Conclusion:Rapid access to tactical evacuation care and initiation of DCR/DCS from Role 1 to Role 2 has good effect. The Ukrainian armed forces have pushed damage control Resuscitation and Surgery as far forward as Role 1, which may require a paradigm shift within the NATO military medical standards and preparations for a peer conflict.Adequate TCCC, DCR and DCS training in the form of global health engagement have anecdotal success in the reduction of morbidity and mortality and in providing force health and medical readiness across NATO nations and partner forces such as Ukraine.
Framework for Implementing and Measuring Interoperability and Organizational Change Within and Across a Multi-service and Multi-agency Emergency Response System
Authors: Heslop David , Bushby Toni , New Charles , Whelan Georgeina 
Published: June 2023

Introduction:The Australian Capital Territory Emergency Services Agency (ESA) has experienced a significantly increased burden of training and most significantly recurrent major emergency response events correlated with increased bushfire and extreme weather events since 2019. ACT ESA is required to provide comprehensive pre-hospital paramedic, firefighting, and emergency response support to the population of the Australian Capital Territory on a day-by-day basis (business as usual) but also surge to meet extraordinary demand. Historically, operational roles and functional areas within ACT ESA have worked largely autonomously under business-as-usual conditions. Under crisis or disaster conditions, these sub-agencies are required to work harmoniously together and alongside external agencies such as Australian Defense Force and Australian Federal Police. ACT ESA have identified that interoperability and integration between internal ACT ESA sub-agencies and externally with other agencies is a key problem. From 2023-2027 ACT ESA has committed to a program of organizational change to address this problem.Method:An organizational change plan focusing on improving interoperability and integration was developed using the Generalized Method for Measuring Interoperability and Continuous Quality Improvement frameworks. A comprehensive framework for measuring organizational change and the effectiveness of interventions across multiple workplace domains, based on Kirkpatrick’s approach, was developed through a co-design process between academia and the ACT ESA.Results:The ACT ESA change management framework, research, and implementation plan is presented here, alongside the results of preliminary stakeholder and professional engagement activities providing early feedback, adjustment and evolution.Conclusion:The ACT ESA is in a unique position within the Australian emergency response landscape having a much greater degree of centralized command, control, and coordination. Despite this advantage, it has identified interoperability both within the organization and with key partnering organizations as a problem. This study outlines how the ESA is approaching organizational change by applying systematic implementation and change management approaches.
International Military Response to the COVID-19 Pandemic: A Literature Review
Authors: Davis Terri , Hertelendy Attila , Hart Alexander , Ciottone Gregory 
Published: June 2023

Introduction:The COVID-19 pandemic created a public health crisis worldwide. Healthcare workers also became ill at a time when hospitals were overwhelmed with patients, leaving critical staffing shortages. Mass vaccination efforts were initiated in some cases without adequate civilian manpower. The governments of many nations utilized their military assets to fill gaps in care, and to initiate projects promoting public health efforts. The COVID-19 pandemic created a never-before-seen international military response to an infectious disease disaster. This literature review highlights the non-conflict assets allocated, abilities utilized, projects completed, overall effectiveness, and lessons learned by the military community worldwide to support their local populace. By collating this information into a single document, the collective global experience can be better analyzed and this information utilized to develop a framework for future disaster preparedness and mitigation planning efforts.Method:Medline (PubMed), GoogleScholar and the JSTOR Security Studies collection were searched for English language articles from January 1, 2020 and onwards. Keywords used included civil-military coordination, hospital, deployment, COVID-19, vaccination, and healthcare. Titles were initially screened for relevance and the abstracts were then reviewed for a decision on inclusion. Article inclusion was determined by author consensus based on relevance to the objectives. Key papers were also hand searched for additional unidentified references.Results:Data collection and analysis planned for completion by January 2023.Conclusion:The COVID-19 pandemic created a huge need for manpower which was backfilled by militaries around the world. This literature search demonstrates how military resources were able to contribute to the pandemic response, including successes and opportunities for future improvement.
Quantitative Analysis of United States National Guard COVID-19 Disaster Relief Activities April-June 2020
Authors: Davis Terri , Hertelendy Attila , Hart Alexander , Pilcher Katherine , Nouaime Georgina , Ciottone Gregory 
Published: June 2023

Introduction:The COVID-19 pandemic provided a unique opportunity for the United States National Guard (NG) to assist in an infectious disease disaster. This study aims to interpret data from NG situation reports (SITREPS) given to the National Guard Bureau (NGB) by each state national guard headquarters regarding their relief efforts from April to June 2020. This is the first published study about NG disaster relief utilizing quantitative data provided by the US military.Method:The SITREPS of all 50 states, the District of Columbia, Guam, Puerto Rico, and the US Virgin Islands are available for the dates of April 10, May 6, May 16, and June 3, 2020 through a NG website that requires government level access. These were examined to evaluate and analyze the activities directed by each state NG headquarters as part of COVID-19 response efforts. No other dates were available for analysis.Results:During the COVID-19 pandemic, the NG primarily provided security, tested for COVID-19, ran COVID-19 shelters, assisted foodbanks, delivered meals, provided transportation services, aided mortuaries, supported protective equipment warehouses, and deployed medical personnel to cover hospital shortages. They provided services to children, homeless persons, residents of skilled nursing facilities, and Native Americans living on tribal lands. Service members (SM) sewed masks, provided translation services, and cooked in prison kitchens. All state NGs participated in COVID-19 relief to varying degrees. Numerical data about the services provided such as quantity was rare but is included as available.Conclusion:The United States National Guard provided a wide variety of services through activation of its service men and women that impacted COVID-19 response throughout all states and territories. This elucidation of the uses of the National Guard should be considered during future governmental disaster preparedness planning efforts, and can be extrapolated to international military disaster relief.
CBRN Disaster Hospital Response and Preparedness. An Italian Civilian Military Cooperation Teaching Model
Authors: Rossodivita Alessandra , Spaterna Raniero , Folla Lucia , Paganoni Catia , Saporito Tommaso , Ranghieri Massimo , Guidotti Matteo 
Published: June 2023

Introduction:Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies need specific hospital preparedness and resource availability.Preparing to evaluate and manage victims from CBRN exposure events in one aspect of hospital preparedness, is often underestimated. Specific skills and capabilities are required to manage these events. Emergency department (ED) and hospital staff need adequate training to provide safe and effective care.Method:The Hospital Complex of Valtellina and Alto Lario (with three hospitals), in consideration of the geographic location amid mountains, far from urban hospital centers, decided to develop an intensive training program for the hospital emergency staff. Firstly, it was based on an eight-hour initial training program, using a combined civilian military approach that included hazard recognition, substance identification, site safety, response roles, PPE use, and decontamination procedures. The CBRN Operational Unit (for prevention of chemical-biological-radiological-nuclear risks) of the 1st Territorial Unit of the Auxiliary Military Corps of the Order of Malta Italy led such training session showing that a military approach to CBRN threats can be used with civilian and military competencies and tools in managing specific hazardous events hospital first responders may face.Results:A drill exercise was performed on a radiological fall-out incident to test the hospital’s emergency response staff preparedness. Hospital management and decontamination
procedures were analyzed to treat victims as well as first responders and to train hospital staff with few resources available.Conclusion:Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. Skills and competencies of military personnel can be a resource in these kinds of events to train civilian personnel who are not normally acquainted to or confident to manage this kind of CBRN events, and can represent a new model and challenge of interagency cooperation in the disaster management of complex emergencies involving hazardous materials.