bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Including Blood in First Aid Training on Confidence in Bleeding Control Ability and Intent to Aid
Authors: Friberg Marc , Brodin Wilhelm , Jonson Carl-Oscar , Prytz Erik 
Published: June 2023

Introduction:Educational initiatives such as Stop the Bleed continue to educate medical laypeople in first aid for massive bleedings. The effect of including realistic blood early in Stop the Bleed-type training remains unknown. The aim of this study was to investigate the effects of including realistic blood early in a Stop the Bleed-type training on medical laypeople's intent to provide future aid and self-perceived ability to provide aid.Method:In total, 46 medical laypeople participated in this study. Two bleeding control tasks, wound packing and tourniquet application, were performed in a simulated scenario on a manikin with a wound. Participants received brief Stop the Bleed-type training and were divided into two groups: with (Blood) or without (Control) blood present during the tasks. After the experiment, two surveys were administered, one on confidence in their ability to perform each task, and a previously established survey on their intent to aid a bleeding victim in real-life situations.Results:The post-trial survey showed that the participants in the Blood group had lower confidence than the Control group in their wound packing ability (MBlood = 2.09, SDBlood = 0.85; MControl = 3.04, SDControl = 0.86), t(43) = 3.725, p < .001, but not regarding their tourniquet application ability, t(43) = 0.019, p = 0.985. Further, there was no difference between the groups in their intent to aid in future real accidents (MBlood = 91.00, SDBlood = 6.10: MControl = 90.39, SDControl = 8.30), t(43) = 0.282, p = .782.Conclusion:This study shows that introducing realistic blood early in Stop the bleed-type training of laypeople results in decreased confidence in their wound packing ability. However, it does not decrease their intent to aid in future emergencies. Future studies should investigate when and how complicating factors such as blood should be introduced in laypeople hemorrhage control training.
Preparation of Hospital Disaster Plan in Indonesia: The Mentoring Challenges from Offline to Online Program
Authors: Ariani Madelina , Pamungkas Satrio , Pangaribuan Happy , Donna Bella 
Published: June 2023

Introduction:Located in a disaster-prone country, more than 3000 hospitals in Indonesia must have a Hospital Disaster Plan (HDP). Instead of pursuing only the hospital accreditation requirements, HDP should be beyond that. Since 2008, CHPM UGM has been providing various HDP training. However, during the COVID-19 pandemic, there was a change in offline assistance that shifts to online. This study reports the learning activities, output, and challenges.Method:There were three batches of HDP-paid online courses in 2021. Each batch consists of three series courses. The first series was a basic HDP seminar. The second series was for intensive HDP mentoring for two months. In the second series, the participants focused on analyzing risk and hospital safety index (HSI), detailing job action sheets, and detailing disaster standard operating procedures. Moreover, the third series in the fourth month was an online tabletop exercise (TTX).Results:25 hospitals and 112 people participated. However, only five hospitals that committed finalized the HDP document. The learning process challenges were the participant’s unstable network and their focus on who was on duty while attending the courses. Although the TTX online was a new trial, it worked to asses hospital preparedness for disaster management through well preparation, detailed scenario and proper evaluation instrument. However, it was still difficult to assist participants in completing the HDP documents online, because observation of the hospital environment cannot be carried out while the evidence provided by participants were limited, for example supporting evidence for the HSI indicators.Conclusion:The online series of HDP is feasible because it saves accommodation and transportation costs. However, the intensive online mentoring should be carried out longer to allow participants to do assignments and collect evidence of indicators that must be shown to the facilitators.
Assessing the Sympathetic Response of Medical Doctors and Trainees when Exposed to a Virtual Realty Mass Casualty Incident Simulation
Authors: Tovar Matthew , Zebley James , Zwemer Catherine , Herur-Raman Alap , Higgens Mairead , Pierce Ayal , Ranninger Claudia , Sarani Babak , Phillips James 
Published: June 2023

Introduction:The occurrence of disasters and mass casualty incidents (MCIs) is on the rise, thus training and rehearsal for disaster response remain paramount. Virtual reality (VR) platforms have previously been shown to be well-received, engaging, and immersive for disaster training. The primary objective of this study was to ascertain if a human actor-based VR MCI scenario could elicit a sympathetic response, as measured by heart rate variability (HRV), in medical doctors and trainees compared to a baseline state.Method:A simulation was filmed with students, residents, and surgeons on a GoPro 360 camera. Subjects (n=35) were recruited to sufficiently power (1-b=0.8) a Wilcoxon matched-pairs test and Welch’s t-test. Subjects watched the simulation on an Oculus Quest headset while having HRV recorded. Multivariate logistic regression was performed to identify factors associated with increased odds of significant sympathetic activation. Statistical significance was established at p<0.05.Results:Thirty-five subjects were enrolled and included three trauma surgeons, three emergency medicine (EM) attendings, eight EM residents, six surgery residents, and 15 medical students. A significant decrease in HRV was observed across all groups in the MCI (median 20 ms IQR 16.2, 31.4 ms) compared to baseline (33.2 ms IQR 27.2, 44.1 ms; p<0.0001). Sympathetic activation was most pronounced in students, then attendings, then residents. There was no significant difference in the fold-difference of sympathetic activation of EM physicians (-48.5% +/- 32.1%) versus surgeons (-49.5% +/- 25.2%; p=0.57). In all groups, SNS activation occurred independently of heart rate, age, sex, number of years in practice, first responder experience, or prior MCI response.Conclusion:Live-actor VR MCI simulation elicited a strong sympathetic response from students, residents, and attending physicians. By recruiting and disinhibiting essential neural pathways via controlled SNS activation, VR MCI training has the potential to enhance the encoding and consolidation of disaster training in a low-cost and reproducible manner.
Sustainability First: Evaluating a Digital Training of Trainers Approach for Lay First Responders in a Post-COVID-19 World
Authors: Eisner Zachary , Smith Nathanael , Delaney Peter , Kulkarni Aswhin , Achunine Paschal , Shiada Francis , Raghavendran Krishnan 
Published: June 2023

Introduction:Road traffic injuries (RTIs) are the largest individual contributor to the global burden of injury and were among the five leading causes of global disability-adjusted life years (DALYs) in 2016. In regions with limited emergency medical services, training lay first responders (LFRs) has been shown to increase availability of prehospital care for RTIs, but sustainable mechanisms to scale these programs remain unstudied.Method:Using a training of trainers (TOT) model, a six-hour LFR training program was launched in Lagos, Nigeria. The course was taught in a hybrid fashion with primary didactics over Zoom and practical in-person breakout sessions. Thirty TOTs proceeded to train 350 transportation providers as LFRs over one month. A previously validated, 23 question, pre-/post- assessment was administered digitally to assess knowledge acquisition. Participants responded to five-point Likert survey assessing instruction quality and post-course confidence.Results:TOTs scored a median of 56.5% (IQR: 43.5%, 71.7%) and 91.3% (IQR: 88.0%, 95.7%) on the pre- and post-assessments, respectively, with bleeding control scores increasing most (+69.4%). Course trainees scored a median of 34.8% (IQR: 26.0%, 43.5%) and 73.9% (IQR: 65.2%, 82.6%) on the pre- and post-assessments, respectively, with airway and breathing increasing most (+48.6%). All score increases were statistically significant with p<0.001 and did not differ by trainer. Participants rated confidence 5/5 (IQR: 5,5) in first aid skills and 5/5 (IQR: 4,5) in emergency transportation, increasing from pre-course confidences of 3/5 (IQR: 3,4) and 4/5 (IQR: 3,5), respectively (p<0.001). Participants rated the quality of education content and TOT instructors to be 5/5 (IQR:5,5).Conclusion:This is the first time the efficacy of digital instruction for first responder trainers in LMICs has been investigated and demonstrates knowledge acquisition equivalent to that of prior in-person courses. Future work will examine the cost-effectiveness of the training of LFRs and the effect of LFRs on trauma outcomes.
Scenario-Based Collaboration: Identifying the Role of the NSW Biocontainment Centre in the Response to High Consequence Infectious Diseases
Authors: Varshney Kavita , Friend Caren , Ferguson Patricia , Wyer Mary , Bag Shopna 
Published: June 2023

Introduction:The New South Wales (NSW) Biocontainment Centre (NBC) is the first high-level isolation unit in Australia. This state-wide referral facility, located at Westmead Hospital, Sydney, will provide care for patients with high-consequence infectious diseases (HCIDs), including viral hemorrhagic fevers (VHF). In preparation, a tabletop exercise with key stakeholders was held to introduce and socialize the NBC’s capacity to support NSW’s preparedness for the management of a patient with HCID.Method:Invitations were provided to key stakeholders within Westmead Hospital (facility executive, emergency and ICU services, security, switchboard); NSW Preparedness and Response Branch; retrieval services; peripheral hospitals; pediatric hospital network; and NSW Public health units (state and district).The scenario presented was an unwell patient with suspected VHF arriving at a peripheral hospital emergency department.Discussion during the four-hour long exercise was facilitated with directed questions and injects, and was recorded. Recommendations and key learnings from the exercise and debrief provided opportunities to enhance current response assumptions.Results:Forty-five people participated both face-to-face and virtually. Participant discussion showed increasing appreciation of patient presentations to any part of the NSW health system and available assistance. Recommendations included: enhanced access to NBC support with a direct “1-800 number”, coordination for communication, treatment, and transport, and if required, deployment of an NBC team to peripheral sites. Areas for future collaborative work were identified.Conclusion:This exercise successfully achieved collaboration of key stakeholders to develop an updated, comprehensive and robust plan for management of HCID patients within NSW, regardless of their presentation site. It has created an opportunity to brainstorm and optimize how the NBC can interact with other agencies to maximize the NSW HCID response.
Timely Teaching for the Time Poor
Authors: Friend Caren 
Published: June 2023

Introduction:Australian Standard 4080-2010 Planning for Emergencies in Health Care Facilities outlines the requirements for all health care facilities to have procedures in place to respond to internal and external emergencies. These procedures must include mechanisms to activate emergency response systems, and staff should be trained and familiar with these procedures.Method:To guide staff, Emergency Procedures Flip Charts have been developed and strategically placed throughout facilities. These Flip Charts address immediate actions for staff to follow, including notification and escalation via an internal emergency number.Specific training has been developed for identified key staff, such as Fire Wardens, but for the general staff the training in Emergency Codes is generic and does not provide scope for staff to contextualize response actions in relation to their department and its nuances.A survey of staff across all disciplines was conducted which identified knowledge gaps in the immediate response requirements for the different Emergency Codes. To address this knowledge gap, and to ensure staff have an increased understanding of the response expectations relevant to their department, the Six Minute Intensive Training (SMIT) Tools have been developed. These tools can be delivered by any staff member in any forum, such as safety huddles, handover, in-services and toolbox talks.Results:A survey was conducted three months after their implementation which identified an increased understanding of response requirements. This result, combined with After Action Reviews from actual responses, highlighted an increased knowledge of the Emergency Codes and response actions. It also identified areas to improve delivery using localized examples.Conclusion:The introduction of the SMITs is a successful first step for increasing staff knowledge and responses to Emergency Codes. The opportunity for staff to deliver these SMITs within their own departments provided an avenue to contextualize responses to local practices and nuances.
Implementation and Evaluation of the WHO Basic Emergency Care Course in Rwanda
Authors: Kadakia Nidhi , Shakya Iju , Lee John , Kharel Ramu , Diaz Maria , Mugemangago Pascal , Ndebwanimana Vincent , Karim Naz 
Published: June 2023

Introduction:Improving access to emergency health services can reduce morbidity and mortality for patients with acute emergent conditions. The WHO and ICRC developed the Basic Emergency Care course to train frontline providers in a systematic approach to common and treatable life-threatening conditions. This study aims to evaluate the knowledge retention of Rwandan emergency care providers after implementation of this course.Method:A prospective, quasi-experimental, nonrandomized study was conducted at the University Teaching Hospital of Kigali (CHUK) in Rwanda. A formal survey was conducted to understand the current composition and training of Rwandan emergency care providers. Baseline and post-course assessments of knowledge were collected via an existing 25 multiple choice question survey tool which is an already established part of the BEC curriculum. Forty providers who care for patients with acute emergent illness were included. Data collected included age, gender, preferred language, as well as information about professional background, knowledge and skills. Providers with both baseline and post-test results were included in the analysis (n=40).Results:Of the 40 Rwandan providers, 47.5% (n=19) male and 52.5% (n=21) female, 26 were nurses, six were doctors, six were prehospital providers, one was both a prehospital provider and nurse, and one was a midwife. The mean age was 36.3. Out of 25, the mean baseline score was 17.8 (SD=3.2) and this significantly increased to a mean posttest score of 21.9 (SD=2.4). 85% (n=34) of providers’ knowledge improved, 2.5% (n=1) of provider’s knowledge stayed the same, and 12.5% (n=5) of providers' knowledge decreased. The difference between the pre and post-test scores was found to be statistically significant, 4.1 (SD=3.4), (P<0.0001).Conclusion:This study demonstrated that implementing the BEC course has significantly improved the emergency provider knowledge base. Further studies are needed to demonstrate the impact of BEC training on patient care and morbidity/mortality outcomes.
Reporting Safely in Crisis Zones: Medical First Response for Journalists and Filmmakers
Authors: Tedeschi Christopher , Matloff Judith 
Published: June 2023

Introduction:Journalists work in dangerous places. In recent years, the risk of illness and injury while reporting has increased, whether in the setting of conflict, protest, extreme weather, or environmental disaster. Journalists are targeted more than ever before. Working safely in remote and dangerous settings, especially without the protection of a large organization, requires a wide range of skills related to safety and security. For several years, the Dart Center for Journalism and Trauma at Columbia University has offered brief, intensive courses focused on personal safety, self defense, cyber-security and medical skills for freelance journalists working in dangerous settings.Method:We re-conceptualized the medical first responder portion of the Dart Center's "Reporting from Crisis Zones" course to emphasize basic skills related to acute injury and illness, from trauma resuscitation (e.g, hemorrhage control) to environmental exposure and medical illness. We identified the most common medical concerns that these learners might encounter and incorporated feedback from prior courses to develop a one-day curriculum meant to address the most pressing needs of incidental first responders with minimal medical training, and whose primary mission is not providing medical care to others.Results:The resulting 8-10 hour curriculum focuses on hemorrhage control, basic airway and respiratory maneuvers and wound care, with additional focus on medical illness, indications for evacuation, and communication and prevention techniques. The re-structured curriculum was first offered in Spring 2022. Feedback from learners was positive.Conclusion:Basic first responder skills are critical for journalists working in dangerous settings, who represent a unique population of learners with specific needs and objectives. Next steps include developing a better understanding of the medical and traumatic problems truly encountered by this population in the field, assessing the long-term educational impact of the course, and developing ongoing opportunities to reinforce learning via online resources, refresher sessions, and guideline development.
The Challenge of Mass Casualty Incident Response Simulation Exercise Design and Creation: A Modified Delphi Study
Authors: Weinstein Eric , Bortolin Michelangelo , Lamine Hamdi , Herbert Teri Lynn , Hubloue Ives , Pauwels Sofie , Burke Rita , Cicero Mark , Dugas Phoebe , Oduwole Elizabeth 
Published: June 2023

Introduction:A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain first responder competencies with the challenge of the FSEx. The translational science (TS) T0 question: How can students achieve similar MCI competencies through the use of simulation MCI exercises as with a FSEx?Method:Initial TS phase T1: Scoping ReviewA Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review was conducted to develop statements for the TS second phase T2 modified Delphi study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.Second TS stage T2: modified Delphi studyThe database was analyzed and initial draft statements were created. Selected modified Delphi experts were presented with 27 statements with instructions 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 19 statements attained consensus and eight did not attain a consensus.Conclusion:The modified Delphi experts agreed that the simultaneous integration of individual duty and incident management skills should be incorporated into simulation MCI exercise design to achieve competencies depending on high physical ﬁdelity to develop the individual’s manual abilities, as well as high conceptual ﬁdelity, to develop the individual’s clinical reasoning and problem-solving skills. MCI simulation exercises can be developed to achieve similar competencies as FSExs incorporating the 19 statements that attained consensus through the TS phases of a scoping review (T1) and modified Delphi study (T2). The TS process should continue with development of these exercises in the T3 implementation stage and then evaluated in the T4 stage.
Triage Accuracy Rates Using the New MCI Triage System of Regione Piemonte: What’s New?
Authors: Goldschmidt Nicole , Tommasoni Nicola , Raviolo Mario 
Published: June 2023

Introduction:An adequate Mass-Casualty Incident (MCI) triage system is essential to provide the best possible health care to the greatest number of affected people and to optimize the management of the available resources in the context of a MCI.Method:In February 2022, Disaster Medicine Service 118 of Regione Piemonte adopted a new 5-color code-MCI triage system and Emergency Medical System (EMS) personnel was trained through a 3-hours-distance learning course. 515 medical doctors and nurses attended the course and completed the final test (triaging of 50 computer-based simulated patients/cases). Their performance was compared to intended triage designations. We collected the data and conducted a descriptive observational study.Results:A total of 25.750 evaluations were carried out: 1.030 white cases, 6.180 green cases, 6.180 yellow cases, 9.270 red cases and 3,090 black cases. Overall triage accuracy was 89,63%. The overall errors were 2.671 (10.37%). Concerning the type of error, there were 1.415 cases under-triaged (5.5%) and 1.256 cases over- triaged (4.88%). Based on color-code, the highest rate of error was in green cases (3.48%), while black patients showed the highest accuracy rate (0.32%). Based on type, the most frequent error was under-triage of red patients, while the less frequent was over-triage of black patients.Conclusion:The results of the final test performed by EMS personnel showed the accuracy rates of triage using new 5-color code-MCI triage systems of Regione Piemonte to be in range with data reported in the literature. A study limitation is the fact that the data analyzed are derived from online testing performed in no-time limited and no-stress conditions. Another potential limitation is the distance learning which doesn’t allow a discussion with the teacher or a request for clarification. For this reason, we would plan a future study defining the efficacy of the didactic methodology in comparison with face-to-face courses.