bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Delphi Consensus Study to Define Non-Consultant Hospital Doctor Competencies Essential for a Focussed Curriculum in Major Emergency Management
Authors: Dasari Kantikiran , McCarthy Nora 
Published: June 2023

Introduction:In this era of increasingly fragile hospital systems, major emergency preparation is firmly being placed under the spotlight. The response to major emergencies requires the mobiliZation of numerous resources to ensure an effective, coordinated response. Yet, studies confirm a global deficit in the knowledge and skills of staff responding to these events in Ireland. Non-consultant hospital doctors (NCHDs) provide a useful and necessary surge response during these events, but currently there are no training programs specifically focused on their major emergency training requirements. The aim of this research was to define the essential elements of a focused curriculum for non-consultant hospital doctors responding to a major emergency (ME).Method:A two-step process was employed. Initially, a comprehensive ME competency set was compiled from relevant literature, consulting field-specific experts and from current ME training programs. A sample of experts was paneled from several acute hospitals in Ireland using purposive and snowball recruitment. A modified Delphi process, using on-line surveys, was utilized to identify the competencies deemed essential for NCHDs responding to an ME event.Results:Three Delphi rounds were required to complete this study. Of the 116 initial survey items, 68 competencies were confirmed as essential NCHD competencies, a total reduction of 40%. A 70% consensus rate was applied to 71 survey items in the final round, resulting in an agreement in 68 competencies (96%). A preponderance of the rejected competencies were specific to managerial and administrative tasks, whilst many retained competencies related to direct clinical care.Conclusion:This study has defined the essential elements of a curriculum for NCHD doctors responding to a major emergency in Ireland, using the Delphi methodology. This derived competency set should be useful to national bodies, regional organizations, and hospital stakeholders to allow the creation of bespoke NCHD major emergency training programs.
A Comparative Study of Business Continuity Planning in Long-Term care Settings in the U.S. and Japan Based on Literature Review
Authors: Ikari Ryoko , Bell Sue 
Published: June 2023

Introduction:Business continuity planning (BCP) ensures that critical healthcare operations are not interrupted and are recovered quickly, in the event of a disaster. BCP has an important role in avoiding adverse health impacts, particularly in long-term care settings. The purpose of this study is to conduct a literature review and comparison of the U.S. and Japanese BCP in long-term care to identify and compare challenges and desirable approaches in each country to support older adults.Method:We systematically searched PubMed, CINAHL, Japan Medical Abstracts Society and EMBASE databases, gray literature, and conducted a hand search of high-impact journals for studies published between 2000 and 2022 that assessed BCP in the United States and Japan.Results:From the literature, a challenge identified in the U.S. is the limited coordination within and across regions and between healthcare institutions and long-term care settings. The advantages are that an established structure of planning, training and evaluation is in place, with evidence from recent disasters showing net positive effects. In Japan, a significant challenge is that, despite an emphasis on continuity in the provision of medical care and welfare to individuals, cooperation between BCP at healthcare institutions and BCP at long-term care facilities is underdeveloped. The advantage is that BCP at medical institutions is incorporated into the national healthcare plan in Japan, making it easy to design BCP protocols and plans according to local needs.Conclusion:Future research should focus on two points. 1) In the U.S., there is a need for evaluation of BCP cooperation and coordination among healthcare networks, especially in long-term care settings. 2) In Japan, it is necessary to promote BCP in healthcare sectors and accumulate training and evaluation across the fields of medical institutions and long-term care facilities.
Appropriate Imaging Modalities in the Emergency Department for Assessment of Renal Stones
Authors: Bilal Muhammad , Heerden Xander , Jansen Charissa , Kelly T Paul , Wickham Bryce , Molloy Michael S. 
Published: June 2023

Introduction:Urolithiasis prevalence is approximately 15-20%, the third most common urological presentation to emergency departments (ED). In the ED, renal stones are usually diagnosed by clinical presentation, but imaging modalities play a role in confirmation and exclusion of hydronephrosis. 85% of stones are calcium oxalate/calcium phosphate, which are radio opaque, and 15% are radiolucent uric acid or cysteine stones. Non-contrast CT scans have 95% and 97% sensitivity and specificity rates, while x-rays have 57% and 76% respectively. In Wexford General Hospital, radiology prefers plain film x-rays prior to CT scans in assessing kidney stones.Method:The aim of this study was to assess the sensitivity of x-rays in patients undergoing low dose non-contrast CT for kidney stones and to apply this information to clinical practice. A retrospective audit was conducted using NIMIS/PACS from December 1, 2021-March 31,2022. All patients who underwent CT KUBS for evaluation of renal stones were included, and CT KUB findings were compared with initial x-ray findings.Results:A CT KUB was performed on 56 patients to assess renal stones, and 29 patients had renal stones. Among 29 patients, 21 had x-rays and CT scans performed, and 12 had x-ray findings that indicated renal stones, indicating 57% sensitivity. The study found 36 patients had x-rays for renal stones, but no CT scan was scheduled for 15 patients who might have undiagnosed radiolucent stones.Conclusion:Radiological imaging plays a central role in the management of suspected renal stones. CT KUB is a useful tool for evaluating patients with radio-opaque kidney stones as well as detecting radiolucent stones and renal pathologies that can be missed with plain radiographs. Low-dose CT KUB is recommended as a first-line investigation for renal stone patients to reduce radiation risks and unnecessary abdominal x-rays while assisting clinicians in accurately diagnosing patients and excluding other possible causes.
Train the Trainer for Implementing Treatment Guidelines
Authors: Ljungwald Sara , Carlsson Henrik , Blaku Valbona , Hasani Gylxhan , Lidberg Henrik , Hodza-Beganovic Ruhija , Berggren Peter 
Published: June 2023

Introduction:A collaborative project between Sweden and Kosovo with the aim to develop treatment guidelines for the ambulance services was undertaken. Firstly, relevant guidelines were identified, then translated, and processed to fit with the Kosovan ambulance service system. The next step was to train instructors in becoming proficient in training colleagues to use the guidelines. A train the trainer approach was chosen as it can be seen as grounded in Kolb's experiential learning theory and Crossan et al. organizational learning theory. Those theories describe how individuals learn and how organizations develop.Method:This implementation project supported training of local instructors to become proficient in training colleagues in 13 selected treatment guidelines for the ambulance services using scenario training. Initially, Kosovar instructors received directions from Swedish instructors then they observed the Swedish instructors. After this, they took more responsibility for the training. Seven Swedish instructors instructed eight Kosovar instructors for a week where about 100 Kosovan doctors and nurses were trained in patient assessment and treatment guidelines. The trainees were divided into four parallel groups of 4-5 participants with one Kosovar instructor supported by a Swedish instructor.Results:After the training week, eight instructors from two different ambulance service centers achieved proficiency in training colleagues in using treatment guidelines. Each Kosovar instructor was involved in 30 training occasions.Conclusion:The training resulted in the involved Kosovar ambulance service centers being able to train new colleagues in providing standardized patient assessment and treatment using treatment guidelines. In addition, the trained Kosovar instructors will be able to contribute to the development of new guidelines and revision of established guidelines.Applying a train the trainer approach, theoretically grounded in learning theories, provides a sound basis to achieve systematic change for improving patient safety. Here, the knowledge distribution among practitioners is improved in an inexpensive manner.
Efforts at our Emergency Department as a Designated Medical Institution for the Tokyo 2020 Games: How We Prepared for it during COVID-19 Pandemic
Authors: Iwasaki Yohei , Nakatsutsumi Keita , Ohara Toshiyuki , Kato Nagisa , Ueki Yutaka , Otomo Yasuhiro 
Published: June 2023

Introduction:The Tokyo 2020 Games were held without spectators in the fifth wave of the COVID-19 pandemic after one-year postponement. From all over the world, approximately 11,000 Olympians and 4,400 Paralympians participated in the games. As one of the designated medical institutions, Tokyo Medical and Dental University Hospital provided emergency medical care for the personnel referred by medical staff at the venues or the Olympic Village clinics. On the other hand, it played a central role in treatment and care for COVID-19 patients in the Tokyo metropolitan area. The aim of this study was to review the emergency medical care system of the hospital as a designated hospital for the Tokyo 2020 Games and discuss the measures for future large-scale international events.Method:A retrospective analysis of persons involved in the Games who visited our emergency department by request was conducted. COVID-19 patients who were admitted were also analyzed. The study period was from July 13 to August 11 for the Olympics and from August 17 to September 11 for the Paralympics, respectively in 2021. The data was derived from electronic health records from the hospital.Results:The total number of ED visits was 38 during the period. One patient was hospitalized, and another patient was transferred. Twenty-one (55%) were athletes, seven (18%) were staff members, and ten (26%) were others. The reason for the visit was medical disease in 23 (61%) and surgical disease in 15 (39%). There was one COVID-19 positive patient. The number of COVID-19 inpatients was 124.Conclusion:Emergency medical care was provided for the persons involved in the Tokyo 2020 Games in cooperation with all the staff at the hospital. The COVID-19 pandemic ‘disaster’ may have had some impact on our hospital’s role as the designated medical institution.
Disaster Medicine Compendium and the Necessity of Preparation of Medical Techniques for Handling NBC/CBRNE Hazards, for General Surgeons
Authors: Haraguchi Yoshikura , Hoshino Masami , Tomoyasu Yozo , Tsubata Tohru 
Published: June 2023

Introduction:The risks of NBC (Nuclear, Biological and Chemical) or CBRNE (R: radiological, E: explosive) hazards are rapidly increasing even in civilian areas, as well as those of natural disasters (earthquakes, hurricanes, etc.). Therefore, one of the most important and emergent issues for medical staff, especially for general surgeons is the necessity of skills to deal with various mega- or major disasters to help people as well as, protecting themselves. This has been a point of emphasis since 2005, when the Disaster Medicine Compendium was published and continues to be updated today.Method:The research focuses on NBC/CBRNE hazards: Pandemics such as COVID-19, Monkeypox, influenza, the Tokyo Subway Sarin Incident, and the 2011 Tōhoku Earthquake, followed by Fukushima Plant Incident, Chernobyl, earthquakes with tsunami, such as the 2004 Indian Ocean earthquake, and the September 11 terrorist attacks in the US.Results:The skills that should be accustomed to are protection, prevention, diminution of toxicity, decontamination, as well as routine medical/surgical treatments. The relevant education is varied and not easily performed. For example, it was found that Japan DMAT or disaster medical assistant teams struggled with a lack of techniques to deal with the nuclear plant hazard during the above-mentioned Fukushima plant accident.Conclusion:In the event of hazards including NBC/CBRNE, surgical skills are necessary. However, medical teams require training in advance. Surgical methods and other skills, intensive care, and examinations performed wearing PPE or personal protection equipment is important, as well as the safety and security of the medical teams, in addition, to supporting the vulnerable/weak victims, ensured using an Incident Command System.
Focused Needs Assessment and Tailored Training Pilot for Emergency Care Providers in Rwanda
Authors: Karim Naz , Marques Catalina Gonzalez , Zhang Angela , Baird Janette , Belsky Mikaela , Uwitonze Jean Marie , Nyinawankusi Jeanne D'arc , Mugemangango Pascal , Mutabazi Zeta , Aluisio Adam 
Published: June 2023

Introduction:In lower- and middle-income countries (LMIC), 45% of deaths could be prevented by implementation of emergency care systems. Prehospital care is critical for emergency medical services (EMS) worldwide, and basic affordable training improves EMS systems. This study conducted a needs assessment in addition to a tailored prehospital training intervention. Subsequent changes in prehospital care as well as patient outcomes were measured.Method:Thirty providers identified through the prehospital medical command office participated. A prospective, nonrandomized interrupted time-series approach was utilized for a needs assessment and training intervention. Data collected included age, gender, training level, and a knowledge assessment, and was used to create an 18-hour training, with immediate and 11-month posttests. Prehospital process indicators evaluated on-the-ground application of skills, including airway intervention, intravenous fluid administration, and glucose administration. Linked prehospital and hospital care datasets allowed for evaluation of patient outcomes.Results:Of 30 providers, 60% (n=18) female and 40% (n=12) male, 19 were nurses and 11 were nurse anesthetists. Median age was 36 and median years providing care was 10 (IQR: 7,11). 24 (80%) participants completed immediate and post-test assessments, showing a 56% (95%CI: 36.2, 75.8) relative increase in mean knowledge score across 12 core skills that was maintained across post-tests. 324 of 572 total patients transported to the ED during the study were transported during the pre-training period (56.4%). Prehospital oxygen administration for patients with a saturation level of <95% increased pre- to post-intervention (66.7% to 71.7%; Δ = 5.0%; Δ95%CI: 1.9, 8.1%).Conclusion:This study is the first LMIC-based prehospital provider training efficacy study that includes analysis of patient outcomes and clinical process indicators. Results offer important insights on Rwanda’s prehospital care system and demonstrate that affordable, tailored educational interventions targeting process indicators have positive impacts on provider knowledge and practice.
Stress and Coping Strategies Among Those Affected by Ebola Virus Disease (EVD) Epidemic in Sierra Leone, West Africa
Authors: Smith Montray , Klein Elizabeth , Okunoren Oladoyin , Currie Charles , Crea Thomas 
Published: June 2023

Introduction:The 2014-2016 Ebola Virus Disease (EVD) outbreak in West Africa resulted in 28,000 infected and over 10,000 deaths. Sierra Leone was one of the hardest hit countries. The purpose of this study is to examine the coping strategies employed by those most affected by EVD and its related stressors in Sierra Leone.Method:228 EVD-infected individuals, EVD-affected individuals, and community leaders were recruited using purposive maximum variation sampling. Key-informant interviews (n=42) and focus group discussions (n=27) were conducted across five districts in Sierra Leone. Data were analyzed and coded inductively by a team of researchers, using Thematic Content Analysis using NVivo (k=0.80 or above for interrater reliability).Results:Participants described stressors, coping and support on four levels: individual, family, community, and society. On the individual level, theft and spoiled belongings were leading sources of stress while faith and spirituality were main sources of coping and support. On the familial level, lack of financial resources and inability to work emerged as primary stressors, while engaging with family was a main source of support. On the community level, social exclusion emerged as a prominent stressor and community reintegration as a source of support. On the societal level, participants' lack of governmental support and termination of support from NGOs emerged as stressors, and provision of formal material assistance as a source of support.Conclusion:In a widespread public health crisis, understanding people’s perceptions of the most salient stressors and sources of support can inform future responses. In this study, participants experienced stressors and support across multiple levels of the social ecology, such as grief and faith, household financial pressure and kinship care, and formal material resources for survivors. Results also showed the importance of community-led initiatives that addressed material needs, as well as social acceptance and social support.
Japan DAMT COVID-19 response. The Temporary Medical Facility for Hospitalization Waiting and Doctor Home Response System in Sapporo City, Hokkaido
Authors: Mimura Seiji , Toyokuni Yoshiki , Wakai Akinori , Kondo Hisayoshi , Koido Yuichi 
Published: June 2023

Introduction:In Japan, the response to COVID-19 has been a disaster response. In May 2021, the number of patients requiring hospitalization increased rapidly in Sapporo City, Hokkaido. Almost all medical institutions and clinics were overcrowded, and patients were forced to wait at home. Sapporo City requested a response from the Japan Disaster Medical Assistance Team (DMAT).Method:DMAT collaborated with the Sapporo City Public Health Center to set up a patient waiting station (The Temporary Medical Facility for Hospitalization Waiting) utilizing an unused hotel. DMAT placed the patient under medical care, provided oxygen therapy and other procedures, and coordinated hospitalization referrals. DMAT also organized a doctor home response system for patients who need emergency hospitalization and those who have returned home from The Hospital Waiting Stations.Results:64% of the patients were admitted to hospitals, 27% back to their homes, 9% were sent to residential care facilities, and 1% were sent to welfare facilities. The doctor home response system was able to redirect 52% of patients requiring emergency hospitalization.Conclusion:For the rapidly increasing number of patients with COVID-19, DMAT established a temporary medical facility and home visit system and was able to minimize the number of preventable deaths.
International EMT-Operational Plan–ODESA Escalation
Authors: Oba Jiro , Kubo Tatsuhiko , Toyokuni Yoshiki , Nakamori Tomoki , Habano Yukiko 
Published: June 2023

Introduction:Since February 24, 2022, at the time of writing this plan, approximately 400,000+ refugees had entered Moldova and 282,842 had exited Moldova. EMTCC will need to coordinate international medical teams assisting with the increasing refugee numbers crossing into Moldova from southern Ukraine for the MOH and international EMT’s in support of trauma management in Palanca and related borders and referral to health care facilities within Moldova.Method:This EMTCC operational plan sets objectives and explores trigger points that require actions in the context of International EMT’s, two service levels were trauma triage/stabilization and primary health care.Results:Odesa was a city located approximately 60 kilometers from the Moldova border crossing of Palanca. Trauma patients reaching the Palanca border would need to be identified in vehicular columns by roving triage teams (EMT 1 M) and expedited through the border. Survivability of severe trauma patients proceeding through the border crossing and expected to transit through to tertiary level care would be low without the intervention of trauma stabilization teams (damage control). The initial positioning of at least 2 trauma stabilization points would require the support, skills, logistics and self sustainability of classified EMT’s or similar. These would also need the additional support of specialized trauma/surgical cells at both Stefan Voda and Causeni Hospitals.Conclusion:Odessa escalation should have been the worst scenario, but we were able to work with MOH in Moldova to develop a plan to save more lives for trauma patients reaching the Palanca border.
Resolving the Gap: National Pediatric Disaster Coalition
Authors: Frogel Michael , Frost Patricia , Cooper Arthur 
Published: June 2023

Introduction:Children younger than 18 years constitute approximately 25% of the US population. During disasters, they are the most vulnerable population and have age-specific vulnerabilities that heighten their risks and magnify their unique needs. These include physiological vulnerability to pathogens, toxins, radioactive isotopes, and harsh conditions. Increased skin permeability, faster metabolism, more active cell division, higher respiratory rate, and higher surface area–to–mass ratio all contribute to greater susceptibility to physical threats. Behavioral/Developmental differences such as more hand-to-mouth contact, under-developed sense of self-preservation, more time spent outdoors, difficulty communicating symptoms and increased vulnerabilities. Children in disasters may develop mental health problems, including acute and post-traumatic stress disorder, and depression. Some children with disabilities are dependent on medical technology.Method:A US national conference in 2015 determined that significant gaps in pediatric disaster preparedness include transport, space, staffing, equipment, supplies, and training capabilities. To address these gaps the National Pediatric Disaster Coalition (NPDC) was established to advocate for enhanced pediatric disaster preparedness, and advance community healthcare preparedness, mitigation, response, and recovery for infants, children, and families in disasters.Results:The NPDC consists of subject matter experts, national advisory committees, commissions, agencies, and organizations. It utilizes pediatric SME knowledge to help plan for the allocation of appropriate and essential resources to address pediatric specific needs in disasters. It serves as an information clearinghouse on pediatric disaster preparedness informed by real events, research and evolving best practice. The NPDC disseminates information through organizing and participating in conferences, and web-based training.Conclusion:Based on the special needs of children in disasters, the NPDC assessed current gaps and has established an effective advocacy and information sharing platform to match resources to pediatric needs during disasters. The NPDC can serve as a model for addressing gaps in the special needs of children and their families during disasters.