bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Ambulatory Care Sensitive Conditions to Assess Primary Health Care Performance during Disasters
Authors: Lamberti-Castronuovo Alessandro , Valente Martina , Aleni Chiara , Hubloue Ives , Ragazzoni Luca , Adesi Francesco Barone 
Published: June 2023

Introduction:Ambulatory care sensitive conditions (ACSCs) are health conditions for which appropriate primary care intervention could prevent hospital admission. ACSC hospitalization rates are a well established parameter for assessing the performance of primary health care (PHC). Although this indicator has been extensively used to monitor the performance of PHC systems in peacetime, its consideration during disasters has been neglected. The World Health Organization (WHO) has acknowledged the importance of PHC in guaranteeing continuity of care during and after a disaster for avoiding negative health outcomes.Method:A systematic review was conducted to evaluate the extent and nature of research activity on the use of ACSCs during disasters, with an eye toward finding innovative ways to assess the level of PHC function at times of crisis. Online databases were searched to identify papers.Results:A final list of nine publications was retrieved. The analysis of the reviewed articles confirmed that ACSCs can serve as a useful indicator of PHC performance during disasters, with several caveats that must be considered.Conclusion:The reviewed articles cover several disaster scenarios and a wide variety of methodologies showing the connection between ACSCs and health system performance. The strengths and weaknesses of using different methodologies are explored and recommendations are given for using ACSCs to assess PHC performance during disasters.
Physical Trauma Following Rocket Warning Sirens in Israel
Authors: Apterman Sagy , Manor Uri , Ben - Haim Gal , Prat Dan 
Published: June 2023

Introduction:Civilians constitute a significant wartime target, and trauma accounts for most of their injuries. Air raid sirens have long been used to alert civilians of incoming attacks and have since expanded to warn of natural disasters. Sirens are known to cause significant emotional distress and physiological changes. Injuries inflicted from trauma during a run for shelter have yet to be described in the medical literature.Method:During the recent Israel-Gaza conflict of May 2021, most of Israel's population experienced rocket warning sirens. We collected all adult patients arriving at a major tertiary medical center emergency department (ED), attesting to having suffered their injury while running for shelter. Clinical and demographic data were retrieved and analyzed.Results:A total of 48 patients were identified, with a mean age of 59.6±20.0. Ten (21%) patients were admitted, and their mean length of stay was 4.4±3.7 days. Women had a higher probability of being hospitalized (42.9% vs. 5.9%, p=0.04), and those hospitalized tended to be older (68.8±16.4 vs. 54.8±20.8, p=0.06). Extremity injuries were most common (50%), before head trauma (29%), and torso injuries (25%). Most patients (38/48, 79.2%) were discharged from the ED, and the rest were hospitalized for observation or surgery. One patient died from a head injury.Conclusion:This study implies that injuries while running for shelter were the most significant cause of physical injury to Israeli civilians during the Israel-Gaza 2021 conflict. Warning siren injuries should be given appropriate attention from prevention by directed media campaigns to post-conflict reimbursement.
Learning from Each Other, Improving Medical Command and Control after the COVID-19 Pandemic: Experiences from a Bosnian-Swedish Collaboration.
Authors: Berggren Peter , Björnqvist Anton , Pettersson Jenny , Hodza-Beganovic Ruhija , Jonson Carl-Oscar 
Published: June 2023

Introduction:The Covid-19 pandemic strained health care organizations to their limits, and sometimes beyond. Different countries took different approaches to minimize the effects of the pandemic, both to protect public health and to safeguard the capability of the health care system.A collaborative project between Sweden and Bosnia-Hercegovina with the aim to share and learn from experiences of managing the COVID-19 pandemic from a medical command and control perspective, initiated in 2021.The project departed from three theoretical stances: sociotechnical systems perspective, experiential learning theory, and organizational learning theory. Framing the problem using a holistic systems approach, compared to focusing on individual experts, allows for understanding interactions on a system level. Hence, could these theories contribute to supporting individuals' learning and organizational change?Method:A two-day workshop involving participants from both Swedish and Bosnian (N=21) medical command and control allowed for the exchange of experiences and another's perspective on similar challenges. During the workshop, two themes were addressed: common operational picture and evaluation. First, an introductory presentation was held, then the theme was discussed and reflected upon in small groups. After this, the groups presented their conclusions, and a full group discussion was moderated.Results:The discussions resulted in participants sharing perspectives on the selected themes, providing personal insights and experience, allowing for deepened and increased understanding of the theme. In spite of major differences between the Swedish and the Bosnian health care systems and Covid-19 approaches, several shared conclusions were identified. For example, reflections on decision processes and strategies, as well as interest in improving the crisis organization.Conclusion:Exposing participants to different views on well-known processes and challenges allows for reflecting, verbalizing, and reaching a deeper understanding. By displaying a culturally differently organized way of approaching the challenges the contrast is even more evident.
Assessment of Emergency Department Key Performance Indicators about Surge Response Actions Across Three Periods of the COVID-19 pandemic in an Italian Hospital
Authors: Rodi Paolo , Foti Francesco , Weinstein Eric , von Schreeb Johan 
Published: June 2023

Introduction:At the beginning of the COVID-19 pandemic, Italian emergency departments (EDs) had to hastily implement current surge response plans or create new ones. The objectives of this study are to quantitatively assess ED performance improvements between selected non-pandemic and pandemic periods at Sant’Anna hospital in Como, Italy, and to relate these to adopted and adapted surge response actions.Method:The average length of stay (LOS), time-to-physician initial assessment (TPIA) and left-without-being seen (LWBS) rates were calculated during two ED periods prior to the pandemic and then three periods during the pandemic in the COVID ED (C-ED) dedicated to treat COVID patients, and the COVID-free ED (NC-ED) dedicated to treat all other patients. Then quantitative data analysis based on hypothesis testing was performed.A qualitative theme and subtheme data analysis based on the Hospital Surge Preparedness and Response Index (HSPRI) was performed on baseline strategies before each pandemic period and on the actions implemented in the subsequent period.Results:The LOS increased across all periods, while the TPIA decreased in the first two pandemic periods in comparison to pre-pandemic periods. The NC-ED LOS was lower than the C-ED LOS, and the C-ED TPIA was lower than the NC-ED TPIA in all three pandemic periods. The LWBS decreased between pre-pandemic and pandemic periods, with an increasing trend towards pre-pandemic levels in the last pandemic period. Of the 20 action items listed in the HSPRI, six were implemented in the first pandemic period, eight in the second and one in the third.Conclusion:The LOS, TPIA and LWBS rates are useful indicators to rapidly obtain an overview of ED performance but failed to provide an exhaustive assessment because ED performance depends on countless external and internal variables. Close collaboration of ED leaders with other healthcare agencies is critical to respond to a pandemic surge.
A Comprehensive Coalition-Based Regional Approach to Pediatric Disaster Planning
Authors: Frogel Michael , Jermyn John , Foltin George , Cooper Arthur 
Published: June 2023

Introduction:Children, who comprise 25% of the US population, are frequently victims of disasters and have special needs during these events. To prepare NYC for a large-scale Pediatric Disaster, NYCPDC has worked with an increasing number of providers that initially included only a small number of hospitals and agencies. Through a cooperative team approach, stakeholders now include local public health, emergency management and emergency medical services, 28 hospitals, community-based providers, and the Medical Reserve Corps.Method:The NYCPDC utilized an inclusive iterative process model whereby a desired plan was achieved by stakeholders reviewing the literature and current practice through repeated discussion and consensus building. NYCPDC used this model in developing a comprehensive regional pediatric disaster plan.Results:The plan included disaster scene triage (adapted for pediatric use) to transport (with prioritization) to surge and evacuation. Additionally, site-specific plans utilizing guidelines and templates now include Pediatric Long-Term Care Facilities, Hospital Pediatric Departments including Pediatric and Neonatal Intensive Care Services and Outpatient/Urgent Care Centers. A force multiplier course in critical care for non-intensivists has been provided. An extensive Pediatric Exercise program has been used to develop, operationalize and revise plans based on lessons learned. This initially included pediatric tabletop, functional and full-scale exercises at individual hospitals leading to citywide exercises at 13 and subsequently all 28 hospitals caring for children.Conclusion:The NYCPDC has comprehensively planned for the special needs of children during disasters utilizing a pediatric coalition based regional approach that matches pediatric resources to needs to provide best outcomes.The NYCPDC has responded to real time events (H1N1, Haiti Earthquake, Superstorm Sandy, Ebola), and participated in local (NYC boroughs and executive leadership) and nationwide coalitions (including the National Pediatric Disaster Coalition). The NYCPDC has had the opportunity to present their Pediatric Disaster Planning and Response efforts at local, national and International conferences.
Emergency Department Attendance Gap during COVID-19 Pandemic: A Comparison of Attendance Trends at Wexford General Hospital from 2014 to 2022
Authors: Smit Marco , Orsmond Brendan , Molloy Michael , Andrews Robin , Bilal Muhammad , Van Der Vegte Andrea , Abraham Ria , van Rensberg Rochelle Janse , Taqvi Syed , Jordaan Phillip , Conradie Maria , Dowle Ashleigh , Vythilingam Darshini , Wickham Bryce , Kelly Thomas , Kennedy Keith , Fayyaz Fahd , Neduchelyn Yuni 
Published: June 2023

Introduction:COVID-19 resulted in 1.8 million reported deaths in 2020 and an excess mortality of at least 3,000,000 to date. Following the announcement of emergency measures mandating various public health interventions, international studies demonstrated a decline in ED attendances, potentiating a delay in seeking health services.The objective was to examine ED attendance trends by age group and to categorize the attendances following the implementation of regulations related to COVID-19.Method:A single-center retrospective observational study of ED attendances from 2014 to 2022 at Wexford General Hospital, a 225-bed acute general hospital. Monthly attendance trends were analyzed covering all phases of the national response. Information was extracted from the electronic health record system iPMS.Results:Overall attendances decreased by 11.5% {42,637 (2019) to 37,751 (2020)}, well below expected annual growth projections from 2019 to 2020. A significant reduction in pediatric attendance (≤16 years) occurred, with 31.68% negative growth (10,351 to 7,071) in 2020 and sustained decrease of 15.3% (8,767 attendances) in 2021. In contrast, geriatric (≥65 years) attendances were unchanged in 2020 (17,751), with a surge of 8.9% to 19,333 attendances in 2021, the largest year-on-year growth since 2018. Comparisons of month-to-month trends in relation to public health measures correlated to a marked decline in attendances at the extremes of age during “lockdown” periods.Conclusion:The reduction in attendances is likely multifactorial, such as a reduction in school-related stress and patients deciding to stay home for fear of attending during the pandemic with non-emergent conditions. The increase in geriatric presentations in 2021 may reflect continuing restricted access to primary care and GP services, or neglect of prior conditions. Examining changing demographic attendances may offer opportunities to develop alternative ways of supporting frail populations and families in community care avoiding ED presentations.
Japan Disaster Medical Assistance Team Boot Camp for the Trainer in KOBE : Corona Era Experience of Hyogo Emergency Medical Center
Authors: Kawase Tetsunori , Nakayama Shinichi , Ishihara Satoshi , Kai Soichiro 
Published: June 2023

Introduction:Japan Disaster Medical Assistance Team (JDMAT) consists of four personnel. They are selected in 47 local governments in Japan, and after the completion of a four day boot camp, they are registered in the list of JDMAT. Hyogo Emergency Medical Center (HEMC) has been playing an important role as one of the oldest boot camps with Disaster Medical Center in Tachikawa. The boot camp's significance is obvious, but the JDMAT system requires a trainer for the course. Many courses were discontinued and affected by the COVID-19 Pandemic.Method:Retrospective, single institute data, observed in the number of participants for instruction. The periods are from March 2019 to September 2022. Instructing members of this boot camp consist of three categories of Drs, Nurses, and logisticians.Results:In FY2019, from April to March during the pre-pandemic year, a boot camp was held nine times. During those days, the total number of instructors, including potential ones, was 659 persons, and fortunately 75 people participated for the very first time. However, during the Corona era, in FY2020, the boot camp was held only four times. The total number of instructors was 161 persons, and 14 people participated for the first time. In FY2021, the boot camp was held only three times. The total number of instructors was 141 persons, and 11 people participated for the first time. In FY2022, after two quarters passed, the boot camp was held five times according to the schedule. The total number of instructors was 256 persons, and 18 people participated for the very first time.Conclusion:Officers were not trained for future disaster response for two years because of the pandemic.
Using the Experience of Natural Disasters to Prevent Health Hazards in Shelters
Authors: Kasaoka Shunji , Naito Hisaki 
Published: June 2023

Introduction:The number of deaths from natural disasters that have occurred in Japan since 1989 is in the order of (1) the Great East Japan Earthquake, (2) the Great Hanshin-Awaji Earthquake, and (3) the Kumamoto Earthquake, but the ratio of related deaths to the total number of deaths was highest for the Kumamoto earthquake.Method:In the case of the Kumamoto earthquake, an inland earthquake of the same scale as the Great Hanshin-Awaji Earthquake, direct deaths due to the earthquake were suppressed, but related deaths are thought to have increased due to the effects of evacuation life and other factors. According to a report by Kumamoto Prefecture, the majority of direct deaths from the Kumamoto earthquake were caused by trauma such as excessive pressure or asphyxiation. As for related deaths, most of the victims were aged 60 years or older, more than 80% of them had pre-existing medical conditions, and respiratory and circulatory system diseases were the most common causes of death.Results:A survey of victims transported by ambulance from evacuation centers to medical institutions after the Kumamoto earthquake showed that a large number of victims were transported in the acute phase after the disaster. The reasons for transport are diverse injuries and illnesses, including trauma from falls, dyspnea, impaired consciousness, and fever, suggesting that stress from the earthquake and problems in the living environment of the evacuation centers had an impact on the deterioration of health conditions.Conclusion:It is important to identify issues and consider countermeasures based on past experiences in order to prevent health hazards in evacuation centers.
Survey Evaluation of Nursing Emergency Preparedness Training
Authors: Roblin Patricia , Guzman Jennifer , Arquilla Bonnie , Daniel Pia 
Published: June 2023

Introduction:An effective response to CBRNE requires that frontline staff, such as nurses, are adequately trained in Emergency Preparedness (EP). Understanding the current gaps in nursing knowledge of CBRNE is the first step in creating an effective training program. This study assessed EP training gaps and needs among nursing staff.Method:A web-based survey was distributed to all hospital nursing staff. The survey evaluated the CBRNE training that nurses received. Staff listed the types of training they had received and were asked to rate their confidence in performing various disaster-related competencies or capabilities. Competency confidence levels were also surveyed as those who feel; not at all confident or not very confident.Results:The survey assessed previous EP training. 572/763 Nursing Staff had completed the survey, for a response rate of 75%. Of the nurses who responded, areas in which they have been trained included: preparedness for radiological and nuclear agents (17.66% trained), preparedness for biological agents (22.20% trained), preparedness for chemical agents (27.45% trained), hazardous materials and patient decontamination (25% trained), and their own role within the hospital's ICS (31.29% trained), Patient evacuation (63.61% trained) and the hospital's EP plan (54.55% trained). The survey also assessed respondents' confidence in performing EP activities. The respondents reported lacking confidence in treating patients exposed to a radioactive material (59.9%), treating patients exposed to a biological agent (57.17%), and performing decontamination procedures (54.71%). The respondents reported having confidence in evacuating patients from units, departments, or hospitals (69.1%). The top incentives for participating in “nonrequired” training were no costs to complete the training (83.1%) and receiving continuing education credits (79.2%).Conclusion:A majority of nurses reported inadequate training in CBRNE events with a self-reported lack of confidence in responding to these events. A targeted and educational CBRNE curriculum and materials to enhance EP among nursing professionals are clearly indicated.
NO-FEAR Project - What Have we Learned
Authors: Rafalowski Chaim , Laist Itamar 
Published: June 2023

Introduction:As the COVID-19 pandemic started, the NO-FEAR project shifted to real-time experience sharing to improve response to an unknown new threat. The lessons observed during more than 20 webinars were collected and analyzed at the end of 2019 to identify those relevant for future preparedness and response to another outbreak or new threats.Method:A questionnaire using a 0-4 Likert scale was distributed to the wider NO-FEAR community, where they were asked to identify the relevance of the item for future preparedness. Later the results were discussed by the consortium and put for feedback in a large meeting in Madrid in March 2022. The 78 observations were clustered into five categories: 1) The human factor (23) 2) Knowledge sharing, cooperation and coordination (11) 3) Equipment and supplies (15) 4) Standard Operating Procedures (SOP) (20) 5) PPE (9).Results:The Top-rated observations were the following:
The human factor: 2.3 need for updated, trustful information sharing with personnel (e.g. regarding treatment protocols, PPE, updates, etc.) to allow them a comprehensive understanding of the situation (3.73).Personal Protective Equipment (PPE): 6.1 need for PPE stockpile management, considering transportation, storage space, and risk of throwing away out-of-date PPE (3.63).Equipment and supplies: 4.3 need for solutions to increase equipment and beds capacity (3.56).The human factor: 2.22 need for management of fake news and mitigation of violent incidents against healthcare personnel (3.56).Knowledge sharing, cooperation and coordination: 3.5 need to collect data, needs, gaps, and lessons in preparation for future outbreaks (3.56).Better integrating health care into crisis management structures was highlighted during the Madrid conference.Conclusion:NO-FEAR highlighted the importance of real-time international real-time knowledge sharing in a crisis, the need to better address the needs of the personnel during a long-term crisis, and better integrate health into crisis management structures
Emergency Medical Team Type 2 and Intensive Care Unit: A Necessary Binomial
Authors: Raviolo Mario , Goldschmidt Nicole , Tommasoni Nicola 
Published: June 2023

Introduction:A disaster involving significant casualties in a populated area demands the rapid development of a field hospital with personnel specialized in Disaster Medicine. In this scenario, the clinical response of Emergency Medical Teams should be guided by the knowledge of how the medical needs of the population change after the disaster itself. In order to reduce the loss of life and prevent long-term disability, it is essential to have the right tools to treat critical patients. In fact, disasters cause a variety of conditions ranging from minor to life-threatening injuries requiring admission to Intensive Care Unit (ICU).Method:A systematic review was carried out and electronic healthcare databases were searched using terms such as “Disaster” or “Flood” or “Storm” or “Earthquake” or “Mass Casualty Incidents” and “Intensive Care Unit” or “Intensive Care” or “Health Impact”. Articles that met the search criteria, published in the last 15 years in the English language, were analyzed and summarized. The objective of the review was to identify the main health problems following disasters and, in particular, the diseases that may require intensive care in order to assess the need to include ICU in the minimum technical standard for Emergency Medical Teams type 2.Results:The review included 12 studies identified as relevant and significant for our purpose. Health problems were sorted for disaster type and severity of the injury. The review demonstrates that health problems after a disaster are different depending on disaster type, but in all the scenarios there are diseases that potentially may require timely intensive care.Conclusion:The presence of an ICU within an Emergency Medical Team type 2 (according to WHO EMT classification) is an essential part of disaster management plans as ICU plays an irreplaceable role in saving lives and in reducing the health impact of a disaster.