bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Physician Response and Recall When Activated for Mass Casualty Incidents
Authors: Yeo Mathew 
Published: June 2023

Introduction:Mass casualty incidents (MCI) overwhelm existing resources in the emergency department. The existing method to recall staff in an MCI is text notification through the hospital call center. This study aims to assess the effectiveness of a novel method to recall senior emergency physicians during an MCI.Method:For this method, upon notification of a MCI, the senior physician on duty will start call tree activation based on four different senior physician job grades. He/she will call the first physician for each grade, who takes over calling and activating the remaining physicians in the same grade with a maximum of two attempts. Each physician receiving the activation call then texts an acknowledgement and estimated time of arrival at the department in the group chat. An unannounced, simulated MCI event was conducted at 02:00 and 14:00 on a weekday. Effectiveness was determined by the proportion of senior physicians available within 60 minutes of activation.Results:For the 02:00 activation, three of the 25 senior physicians were on clinical duty in the hospital while nine were contactable within 15 minutes and thirteen after 30 minutes. Eleven were able to return to the hospital in 60 minutes or less and one beyond 60 minutes. Nine were local but unable to return and one was overseas.For the 14:00 activation, four of the 25 senior physicians were on clinical duty in the hospital while 15 were contactable within 15 minutes and six after 30 minutes. Nine were able to return to the hospital in 60 minutes or less and four beyond 60 minutes. Three were local but unable to return and five were overseas.Conclusion:This method can achieve rapid manpower augmentation with more than half the staff present in the hospital within 60 minutes. Drills involving physical recall should be performed to further test this workflow.
Assessment of Disaster Preparedness Levels of Emergency Department Physicians in Kuwait
Authors: Alburaidi Abdulaziz , Hart Alexander , Hertelendy Attila , Issa Fadi , Ciottone Gregory 
Published: June 2023

Introduction:Global disasters have increased over the last century, with growing numbers of people affected. In the Middle East and North Africa, natural disasters have tripled since the 1980s. Education and training for disaster preparedness for healthcare providers can help reduce vulnerability to disasters by improving their knowledge and response effectiveness. Physicians working in the emergency department are integral members of the response to those incidents. Currently, no studies describe how much training or experience in disaster preparedness exists for physicians working in the emergency departments in Kuwait. However, comparable studies in different regions have illustrated the importance of researching this field. This paper aims to assess the disaster preparedness levels of emergency department physicians in Kuwait.Method:An online survey will be sent to the physicians working in the emergency departments of the seven general hospitals in Kuwait. This survey consists of four domains:1)Demographics: personal and professional characteristics of participants.2)Education and training: exploring the involvement of participants in prior formal training courses or exercises in disaster preparedness.3)Experience: assessing the involvement of participants in the mitigation or response to previous disasters.4)Knowledge and perception: participant awareness of local hospital plans and systems as well as their attitudes and opinions about disaster preparedness.Results:Data collection and analysis are planned for completion by March 31, 2023.Conclusion:The needs assessment is essential to developing educational curriculums for any discipline. In disaster medicine, tailoring the training curriculum is especially important because learners might not have experience in the field due to the high acuity and low frequency of disasters. The results can be used to develop a roadmap for Emergency Physician training in disaster preparedness in Kuwait. In addition, the approach adopted in this paper can be used to assess further disciplines for disaster preparedness.
Pediatric Disaster Medicine Literature: A Scoping Review
Authors: Jeong Yae Sul , Clark Cullen , Chung Sarita , Timm Nathan , Wright Chris , Kappy Brandon , Brumberg Elizabeth Hewitt , Goralnick Eric , Parish April , Stanley Rachel , Miller Susi , Stephens Caroline 
Published: June 2023

Introduction:Over the last 20 years disasters have increasingly involved children, and pediatric disaster medicine research is growing. However, this research is largely reactive, has not been categorized in terms of the disaster cycle, and the quality of the research is variable. To understand the gaps in current literature and highlight areas for future research, we conducted a scoping review of pediatric disaster medicine literature. This work will help create recommendations for future pediatric disaster medicine research.Method:Using a published framework for scoping reviews, we worked with a medical librarian and a multi-institutional team to define the research question, develop eligibility criteria, and to identify a search strategy. We conducted a comprehensive Medline search from 2001-2022, which was distributed to nine reviewers. Each article was independently screened for inclusion by two reviewers. Discrepancies were resolved by a third reviewer.Inclusion criteria included articles published in English, related to all stages of the disaster cycle, and disaster education, focused on or included pediatric populations; published in academic, peer-reviewed journals, and policies from professional societies.Results:967 pediatric disaster medicine articles were imported for screening and 35 duplicates were removed. 932 articles were screened for relevance and 109 were excluded. In 2000, three articles met inclusion criteria and 66 in 2021. We noticed reactive spikes in the number of articles after major disasters. Most articles focused on preparedness and response, with only a few articles on recovery, mitigation, and prevention. Methodology used for most studies was either qualitative or retrospective. Most were single site studies and there were < 10 meta-analyses over the 20 years.Conclusion:This scoping review describes the trends in and quality of existing pediatric disaster medicine literature. By identifying the gaps in this body of literature, we can better prioritize future research.
Mass Gathering Events - Health Care Facility Notification Template
Authors: O'Brien Cian , O'Sullivan David , Fitzgerald Mary Rose 
Published: June 2023

Introduction:Every year many concerts, festivals, public meetings and major events take place in Ireland. Depending on the nature of the event such as: location, the number of attendees, and performers–these events present varying amounts of risk. The Health Service Executive is concerned with managing risks and advocates that event organizers put comprehensive event management plans in place. Healthcare arrangements for outdoor crowd events should be specified in the Event Medical Plan section of the event management plan by the event organizer. As part of the event notification process, event organizers engage with the HSE South Emergency Management Office which in turn liaises with the various care groups across the Cork Kerry region to inform them of events that may impact their service. Historically, event organizers have informed the Emergency Management office of events in a wide variety of formats and varying levels of information.Method:The HSE South Emergency Management Office engaged with Cork University Hospital (Major Trauma Center) to identify the information hospitals require from various events around the region. In addition, the Emergency Management Office liaised with a subject matter expert in Mass Gatherings from Australia to discuss key indicators/data points healthcare facilities could benefit from knowing in advance of mass gathering events.Results:A standardized Word document template was developed as a proof of concept that lists key data that healthcare facilities have identified as important for them to be made aware of as part of the notification process. This template now lends itself to be developed into an online editable form to enable event organizers to inform the relevant healthcare facilities of mass gathering events.Conclusion:Health care facilities require timely and accurate information regarding mass gathering events to ensure appropriate plans and preparations are in place. A standardized notification template would assist in the preparation phase.
Massive Influx of Victims: Staff Preparedness and Facility Readiness of Tunisian General University Hospitals.
Authors: Lamine Hamdi , Chebili Naoufel , Zedini Chekib 
Published: June 2023

Introduction:Hospital preparedness for a massive influx of victims relies, to a certain extent, on actions, programs, and systems that are created and executed ahead of time, but also on the knowledge, skills, and professional competences of the hospital's staff. This study aims to understand the factors influencing the preparedness of Tunisian University Hospital staff in facing a massive influx of victims.Method:This is a multi-method qualitative descriptive study, conducted in nine general University Hospitals (UH) in Tunisia; the first component was a phenomenological design via open-ended interviews; the second component was a qualitative observational non-participatory design via field observations.Results:17 participants were recruited, in an intentional non-probabilistic way. Participants to this study discussed issues related to the material and financial resources of their hospitals; the psychological impact of managing an influx of victims; their training, their involvement in the process, and the norm versus the circumstances in the field. Which led to the conclusion that: "For multiple reasons, the Tunisian University Hospitals are not ready to properly manage a massive influx of victims"Conclusion:This multi-method qualitative study discussed the factors that affected the preparedness of staff and readiness of UHs included. Factors were mainly resources (material and financial), psychological burden, lack of training, lack of involvement in the process and issues related to evidence-based practice. Data collected supports the idea that more research and more practical interventions need to be performed to increase the preparedness level of Tunisian UHs and their staff.
Simulation Model of Required Pre-deployed Auto-injectors and Stockpiled Antidotes against Chemical Terrorism
Authors: Koido Yuichi , Akaboshi Kouki , Masudome Ruki , Ichikawa Manabu , Takahashi Ayako , Wakai Akinori , Anan Hideaki 
Published: June 2023

Introduction:Chemical terrorist attacks using nerve gas require patients with immediate administration of antidote, or otherwise they will experience abnormal neurological activity, respiratory arrest, and death. When it occurs in large stadiums at mass gatherings such as the Olympics, under normal medical care systems, preventable deaths occur due to insufficient deployment of on-site auto-injectors and stockpiled antidotes in hospitals. In Japan, the government has stockpiled antidotes in confidential warehouses and deployed auto-injectors around possible terrorist sites. When a chemical attack occurs, a stockpile of antidotes go to hospitals, auto-injectors go to the site, and firefighters and police are allowed to administer auto-injectors to patients. However, few studies are conducted on pre-deployment of auto-injectors and antidotes in chemical terrorisms. Therefore, the number of pre-deployment was examined.Method:A single chemical attack with 750 patients was assumed. Response was divided into five steps: (1) transportation of stockpiles to hospitals, (2) transportation of auto-injectors to the site, (3) on-site use of auto-injectors, (4) transportation of patients to hospitals, and (5) patient care in hospitals. Computer estimation was used for the time required for transportation for (1), (2), and (4). Desktop exercises were conducted for on-site response time, outpatient response time, and the number of beds available at hospitals for (3) and (5). The values obtained from computer estimation and desktop exercises were imported into the simulation model to measure the number of paramedics, auto-injectors required to be deployed in advance, and the amount of stockpiles required to be delivered to hospitals.Results:A minimum of 80 auto-injectors and ten paramedics were required to be pre-positioned at the scene. A minimum of 100 ampules of antidote was required immediately at the nearest hospitals.Conclusion:The pre-deployment of auto-injectors and personnel are essential to reduce the number of deaths in the event of chemical terrorisms.
Comparison of Injury Epidemiology and Treatments by Gender Among Persons Seeking Emergent Care in Kigali, Rwanda
Authors: Aluisio Adam , Uwamahoro Chantal , Garbern Stephanie , Uwamahoro Doris , Mumporeze Lise , Marqués Catalina González 
Published: June 2023

Introduction:Variations in the incidence and patterns of injuries exist between genders which may impact treatments and outcomes. The study aimed to describe the epidemiology, treatments, and outcomes based on the gender of persons presenting with injuries to an Emergency Department (ED) in Kigali, Rwanda.Method:This was a secondary analysis of a prospective cross-sectional study conducted in January-June 2021 at the Centre Hospitalier Universitaire de Kigali ED. Descriptive statistics were performed and variable comparisons based on binary gender self-designation (male or female) were conducted.Results:A total of 601 patients were included in the analysis of whom 25.6% were female and 74.4% were male. Gender differences were found in the mechanism of injury with females more likely to be injured via falls (43.5% versus 23.0%, p=0.001), while males were more likely to be in a road traffic accident (52.6% versus 39.6%, p=0.006), have stab and/or laceration (9.0% versus 2.0%, p=0.004) or have been assaulted (6.9% versus 2.6%, p=0.047). Injury severity was not significantly different between genders based on the median Kampala Trauma Score and presence of triage hypotension. For treatments females were more likely to have been transported by prehospital services (87.7% versus 72.9%, p=0.001), but were less likely to received acute ED treatments of intubation, wound care, tourniquets, blood products, thoracostomy and point-of-care ultrasound during the first six hours of care (67.5% versus. 78.1%, p=0.009). Hospital admission was significantly greater among females as compared to males, (31.2% versus 41.8%, p=0.019) but no difference in mortality was observed (2.0% versus 1.3%, p=0.568).Conclusion:This study provides data on differences in epidemiologic and care characteristics between males and females presenting for emergency injury care in Rwanda. These findings can inform future research and help the development of gender-centered healthcare delivery in Rwanda and other similar contexts.
Crisis Collaboration Exercises: Are They Useful?
Authors: Sørensen Jarle 
Published: June 2023

Introduction:Crisis collaboration exercises are perceived as developing and testing cross-sectoral team integration, preparedness efforts, and response. However, the general problem is that crisis collaboration exercises may tend to produce results with limited usefulness in actual crisis work. The purpose of this quantitative, non-experimental, survey-based study was to examine to what extent there was a statistically significant relationship between participation in Norwegian maritime crisis collaboration exercises and the perceived levels of learning and usefulness in an actual crisis. The scope was limited to relevant public, military, and non-governmental exercise participants.Method:Surveys were electronically distributed among participants in three 2016 Norwegian maritime crisis collaboration exercises. The data collection instrument was the Collaboration, Learning, and Utility scale (Berlin & Carlström, 2015). The CLU-Scale is specially designed to measure collaboration exercise participants' perceived levels of learning and utility. The scope was limited to relevant public and non-governmental exercise participants including health, law enforcement, and military stakeholders.The effects of collaboration, learning, and usefulness were tested in two bivariate regression analyses, where the first tested the relationship between collaboration and learning, and the second tested the relationship between learning and usefulness. To measure the linear dependence between the variables, Pearson’s r was calculated. The coefficients of determination (r2) were calculated to determine what proportions of the variance in the dependent variables could be considered predictable from the independent variables.Results:The joint collaborative characteristics predicted 27% (r2 = 0.27) of the learning variance, which meant that the remaining 73% of the predicted variance was unaccounted for. The perceived learning items predicted 34% (r2 = 0.34) of the usefulness variance.Conclusion:This study found a moderately strong statistically significant relationship between participation in Norwegian maritime crisis collaboration exercises and perceived levels of learning and usefulness. More focus on collaboration learning techniques in exercise planning and evaluation is recommended.
Hemipelvectomy following Trauma: Burden less Identified. A Ten-year Experience from the Level-1 Trauma Center
Authors: Sagar Sushma 
Published: June 2023

Introduction:Hemipelvectomy occurs seldom, yet it is a serious injury. Hemipelvectomy following trauma is associated with high incidence of morbidity and mortality. Successful management requires early recognition with a multi-speciality approach and meticulous surgical technique.Method:Retrospective data from hospital records of the Level-1 Trauma Center, between December 2011 through September 2022 was obtained. Clinical details including mechanism of injury, trauma scoring, associated injuries, hemodynamic status, surgical procedures, wound complications, ICU stays, hospital stay, prosthesis application, and their outcome were analyzed. Patients were followed up physically in OPD or telephonically.Results:Total footfall 615,274 patients with 16,786 admissions in trauma surgery, 1,299 amputations and 13 hemipelvectomy patients during the study period of ten years. Seven were in shock on presentation, of which, four were non responders and three responded to initial resuscitation. Seven patients had associated Genitourinary injuries, four had anorectal involvement, five had vascular injuries and six had associated extremity injuries. Six patients underwent hemipelvectomy in the primary surgery and seven ended up in hemipelvectomy on consecutive surgeries. Multiple surgeries were required for all the patients both for control of local sepsis and adequate soft tissue cover. Eight of thirteen patients developed wound infections, and related sepsis, one survived a covid infection and three had MODS. Four out of thirteen patients died and of the nine survivors, prosthesis is being used by three patients, two returned to work without prosthesis and two lost to follow up.Conclusion:With a multidisciplinary and dedicated team approach, we can expect favorable outcomes in post-trauma hemipelvectomy patients.
Evaluating the Knowledge, Readiness, and Satisfaction Level of Emergency Medical Service Personnel after an Online Chemical Mass Casualty Response Training Program
Authors: Shin Heejun , Hertelendy Attila , Hart Alexander , Issa Fadi , Tin Derrick , Woodward Christina , Ciottone Gregory 
Published: June 2023

Introduction:Compared to trauma-based injuries, chemical injuries can inflict widespread and persistent injuries to exposed victims. Emergency medical services (EMS) personnel are vulnerable to chemical injuries. Specialized training is required, including zone setup, personal protective equipment (PPE), decontamination, and antidote use, beyond simple advanced trauma life support. The purpose of this study is to evaluate the educational effectiveness of the online chemical-mass casualty incident response education module (C-MCIREM) for EMS personnel.Method:This study is a retrospective pre-and post-test comparison. Subjects were EMS personnel who enrolled in the C-MCIREM program at the EMS Korea online conference between August 27, 2021 and September 5, 2021. Subjects provided demographic data and completed pre-course and post-course knowledge tests and self-assessments of readiness, as well as a satisfaction survey after the course. For readiness and satisfaction surveys, an 11-point Likert scale was used. The Wilcoxon Rank Sum test was used to compare the two samples.Results:A total of 322 respondents were enrolled. Two-hundred (62.1%) responded that they were most motivated to take the course because of curiosity about the subject. The median pre-course knowledge score was 57/100 (47, 66) and the post-knowledge score was 80/100 (66, 91) (p<0.001). Participants stated they felt their readiness to provide triage, treatment, transport, decontamination, to select correct antidotes, and to use correct PPE (all p<0.001) increased. 90.4% stated they were satisfied with the course. Participants were overall satisfied with the use of the online format (7.71/10 SD 2.05), and were willing to recommend the training to other EMS providers (7.63/10 SD 2.1).Conclusion:The online C-MCIREM program showed high satisfaction with a significant increase in knowledge and self-assessed readiness to respond to a chemical mass casualty incident.
Aunty Next Door - A Qualitative Study of Community Prevention and Control for COVID-19
Authors: Nak-AI Worayuth , Suphaudomphon Thira , Khotmanee Supaporn , Wicharit Lerkiat , Sinwath Suratsawadee , Ruangrattanatrai Wilailuk , Krateth Juraporn , Kitphati Rungrueng 
Published: June 2023

Introduction:The Thai government has established public health policies to cope with COVID-19 and reduce the spread of disease by promulgating the Emergency Decree since March 26th 2019 in concept “stay at home, stop the spread of the virus for the sake of nation.” Those measures had been affected to people in all social levels whether it be urban or rural. The objective of this qualitative study was aimed to study the mechanisms and experiences of village health volunteers who work to control COVID-19 at the community level.Method:Forty village health volunteers in the 8th health region were included in the study. Data collection by using focus group discussion combined with audio recordings and the data were analyzed by content analysis.Results:The community’s context in the upper northeastern region of Thailand live in kinship. This is a factor supporting the operation of village health volunteers (VHVs) in the surveillance, prevention, and control of disease in the community. The mechanisms for disease prevention and control in the community are a virtual "Spider web" that connects people in the community, VHVs, Community Leaders, Public Health Officers, and Sub-district Administrative Organization (SAO) officers that operate together. While people in the community, especially "women", act in surveillance in the form of "watchdogs" that report abnormalities of community member movements to the VHV for coordination in surveillance, prevention, and control of disease in their community. The VHV and partners use management guidelines as prescribed by the Ministry of Public Health and adapted to the social and cultural context.Conclusion:The community's COVID-19 surveillance mechanism that mediates kinship begins with fear and panic from a lack of knowledge in the early stages of the outbreak. The kinship of people in the community is one of the strengths and factors of success in preventing and controlling the disease.