bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Students’ Education in Disaster Medicine: A Systematic Literature Review of Existing Curricula
Authors: Voicescu George , Valente Martina , Corte Francesco Della , Ragazzoni Luca , Caviglia Marta 
Published: June 2023

Introduction:Disaster Medicine (DM) is currently underrepresented in medical schools’ curricula worldwide, and existing DM courses for medical students are extremely heterogeneous due to the lack of pragmatic and standardized guidelines. Moreover, there is a gap in knowledge regarding the curriculum development methodology used for DM courses. This study aims to identify DM courses for medical students worldwide and to map their curriculum development methodologies by reviewing available literature.Method:The search was conducted on three databases using the terms “Disaster medicine” AND “Education”. Following the PRISMA approach, twenty-five articles that described the content and implementation of DM curricula were included in the analysis.Results:Nine studies thoroughly described the curriculum development process. Expert opinion and literature review were the methodologies mostly used to develop DM curricula. Only four studies followed a multi-method process made up of four different methodologies, including expert opinion, literature review, survey, and Delphi methodology. Most of the courses adopted a face-to-face approach combining different training modalities, including the use of virtual reality simulations and drills.Conclusion:This systematic review provides a compendious analysis of the curricula and curriculum development processes in DM training for medical students. The scarce usage of reproductible, comprehensive curriculum development methodologies and consequently a great heterogenicity of the covered topics and course design were brought forward. Therefore, there is a need for standardization in DM education. Overall, this systematic review highlights the need for evidence-based educational curricula in DM and provides recommendations for developing DM courses following a scientific approach.
Analysis of Delphi Study Seven-Point Linear Scale Data by Parametric Methods–Use of the Mean and Standard Deviation
Authors: Franc Jeffrey , Hung Kevin , Pirisi Alessandro , Weinstein Eric 
Published: June 2023

Introduction:The Delphi technique is a unique survey method that involves an iterative process to gain consensus when consensus is challenging to establish and is widely used in Disaster Medicine research. Participants typically rate a variety of statements using a specified rating scale. The survey is repeated for several rounds, and at each round statements that do not reach a predefined level of consensus are advanced to the next round while giving the participants information about the responses of other participants for their comparison. The final statements are then ranked in order of the average rating. The statistical methods to analyze Delphi studies are not well described. This study investigates the use of a 1 to 7 linear rating scale along with parametric summary statistics for assessment of consensus and ranking of statements.Method:A study set of 9297 individual ratings on the 1 to 7 scale were obtained from previously performed Delphi studies and used to create 490,000 simulated Delphi ratings with various numbers of participants.Results:While the overall distribution of ratings was strongly left skewed the sampling distribution was near normally distributed for studies with five or more participants. The average difference between the standard deviation and interquartile range was -0.26/7. The overall risk of falsely concluding consensus using the standard deviation as a summary statistic was 7.3% when compared to using the interquartile range. The average difference between mean and median was -0.20/7. The risk of falsely ranking the statements by a value of 0.5 or more was near zero for all sample sizes when the mean was compared to the median.Conclusion:This study suggests that the use of the 1 to 7 linear rating scale in combination with the parametric summary statistics of standard deviation and mean is a valid method to analyze ratings from Delphi studies.
Mixed Reality–Exploring the Requirements of Realism in the Context of Mass Casualty Incident Training
Authors: Schulz Fredrik , Nguyen Quynh , Baetzner Anke , Schrom-Feiertag Helmut , Gyllencreutz Lina 
Published: June 2023

Introduction:The occurrence of mass casualty incidents is increasing globally. Training is an essential cornerstone in achieving disaster preparedness, yet studies show that medical first responders perceive their level of readiness to face disaster incidents as inadequate. As real-world disaster training exercises can be characterized as resource-intensive in terms of cost and time, virtual training environments have been highlighted as a potential alternative to mass casualty incident training. In order to increase the preparedness of medical first responders, a deeper understanding of their requirements in the context of disaster training exercises is needed.Method:Individual, contextual interviews were conducted with a total of 26 medical first responders from four European emergency service organizations: Hellenic Rescue Team (Greece), Summa 112 (Spain), Sanitätspolizei Bern (Switzerland), and Johanniter Österreich (Austria). The interviews were analyzed using qualitative content analysis.Results:The preliminary results indicate that real-world disaster training exercises have limitations regarding realism. The participants described a need to train in an environment that accurately represents what they might face amidst a real-world incident site. This included the recreation of potential environmental dangers that had to be taken into consideration before approaching the incident site. The participants also highlighted the importance of realistic representations of injuries and reactions from the victims during training. The limited possibilities to provide a realistic training environment that corresponds to the set requirements lead to the participants feeling less prepared to face a real-world mass casualty incident.Conclusion:Medical first responders’ need for increased realism in real-world disaster training exercises deserves attention. Training solutions that could potentially increase the level of preparedness needs to be taken into consideration. How the degree of realism in Virtual or Mixed Reality based training platforms affects the perception of preparedness among medical first responders warrant further research.
Deployment of Composite Emergency Medical Team (EMT) in West Sulawesi Earthquake during the Middle of the Covid-19 Pandemic
Authors: Donna Bella , Ariani Madelina , Yogadhita Gde 
Published: June 2023

Introduction:Deployment of EMT from one institution is a common thing to do in Indonesia. However, it is still rare to deploy a composite team that is combining two or more different institutions and area of origin. CHPM UGM had coordinated composite EMT deployment during West Sulawesi Earthquake in 2021. They sent a management team from Yogyakarta and a medical teams from Central Sulawesi. This paper aimed to report the experience of sending composite EMT to earthquake disasters amid the COVID-19 pandemic.Method:Documentation studies were carried out during the process of coordination, planning, and deployment of EMTs. Initial coordination was carried out with the Central Sulawesi Health Office which was the nearest neighboring province to affected West Sulawesi. The Central Sulawesi’s medical team arrived in Mamuju in less than 24 hours. Followed by the health cluster management team on the second day.Results:Three composite EMTs came from different institutions and diverse competencies (midwives from PHC, nurses and medical doctor from hospital, health promotion and management from university) were deployed during the emergency response. Coordination activities were carried out through WHATSAPP chat, Zoom, and telephone. The handover process was carried out via online streaming. In addition, prevention of infected COVID-19 was conducted by preparing PPE for personal and team, limiting service time only during the day, ensuring sufficient rest and nutrition, as well as screening and isolation before and after duty. However, there were two people who were infected with COVID-19 at the exit screening.Conclusion:Intense coordination is required during the preparation and deployment process, including an extra personal approach when the team first meets on the field. In addition, the Covid-19 pandemic situation has made the composite team's task even more challenging.
Activation of the Health Cluster Coordination Post in Lumajang District Health Office During the Management of Mount Semeru Eruption Disaster
Authors: Yogadhita Gde , Ariani Madelina , Donna Bella 
Published: June 2023

Introduction:The ambiguity of the command system is still the main challenge during the activation of health cluster coordination. It begins with the unclear division of tasks, communication channels that are not yet optimal, and do not have an alternative plan. This study reported the management of health cluster coordination posts during the disaster of Mount Semeru Eruption, in December 2021.Method:This study was a case study of qualitative research methods, data collection was carried out by observing the health cluster operation of Lumajang District Health Office (DHO) and supported by an analysis of health cluster activation policy reviews.Results:Resources to manage health clusters were limited due to a lack of staff knowledge in health cluster management. Therefore, the head of the Lumajang DHO appointed the Office Secretary as the health cluster coordinator. The Head of Referrals Health Services is the emergency medical team focal person and the Head of Health Promotion is the spokesperson. East Java Provincial Health Office, Ministry of Health, and Disaster Task Force of Faculty of Medicine UGM assisted in the management of health cluster post operations. Then, assisting was concerned with the most fundamental thing in facilitating health clusters such as establishing an organizational structure based on the incident command system approach as well as mapping the capacity of existing health resources on the field to visualize the geographical situation of health service capacity and emergency medical teams distribution.Conclusion:Although located in prone and high-risk or periodically eruption areas, the staff still have a low capacity in disaster health management. Thus, capacity building in the pre-disaster phase is highly required in the management of health clusters and emergency medical team coordination by the mandate of the Ministry of Health Regulation.
Utilization of Physiotherapy in Prehospital Care During Emergency and Disaster: Improving Care and Increasing Capacity
Authors: Mitchell Megan 
Published: June 2023

Introduction:Emergency medical teams (EMT) are utilized during national and international disasters to improve the response capabilities and provision of quality of care to those impacted. The inclusion of rehabilitation professionals on EMTs is slowly increasing but still has not become standard on Type I teams. The goal of rehabilitation is to optimize function and reduce disability for patients of all ages and in all treatment locations. SPHERE humanitarian standards mandate country emergency response frameworks should include rehabilitation in disaster starting at the acute phase of the incident, but services are typically not provided at the right time or the right place, if at all. After an injury, early education and intervention by rehabilitation can reduce long term injury and improve function. Rehabilitation services continue to be limited to post-acute care and available only to those who have required hospitalization or long-term rehabilitation services. There is a growing body of evidence for the use of physiotherapy in prehospital medical management of acute urgent and emergency injuries and within the emergency department to improve access to care, reduce imaging, reduce use of opioid use.Method:Literature review was conducted regarding prehospital injuries and rehabilitation services using Google Scholar and University of South Florida library access services.Results:No reports or documentation for prehospital or emergency department care during natural disasters or conflict response are available from the World Health Organization or other NGOs.Conclusion:There is a recognition from the medical community of the value and necessity of rehabilitation services across the disaster continuum but remains an under-utilized resource for improving patient care. Conclusion: Rehabilitation should not be available to only those with the most severe long-term injury but should be included at all levels of response with integration into all EMTs.
Introduction of Emergency Medical Team Coordination Cell Assistance Activities in 2022 Moldova EMTCC Operation and Future Suggestions
Authors: Toyokuni Yoshiki , Paasma Raido , Trewin Terry , Kubo Tatsuhiko , Nakamori Tomoki , Oba Jiro , Habano Yukiko , Shiota Kohei , Ito Atsushi 
Published: June 2023

Introduction:Emergency Medical Team Coordination Cell (EMTCC) was established in WHO Moldova Country Office to coordinate responding International EMTs in March 2022. Japan International Cooperation Agency (JICA) sent an EMTCC assistance team to support the WHO-approved minimum data collection for emergency medical teams, Minimum Data Set (MDS), operations and other coordination activities. Introducing activities of the JICA EMTCC assistance team at the Moldova EMTCC will suggest future use.Method:EMTCC assistance team activities were reviewed.Results:There was a wide range of high-level administrative functions in EMTCC, such as planning, logistics, assurance and governance, and human resources. One of the significant functions was introducing MDS to the medical team and extracting the data summaries for reporting to the Moldova Ministry of Health. All these tasks require considerable time to manage and must be completed promptly for effective EMTCC operations.Conclusion:The EMTCC coordinator should function as a decision-maker to control the coordination of EMTs communicating with WHO and implementing the EMT initiative. In a disaster, especially in the acute phase of EMTCC activities, more high-level administrative functions will be required with immediate processing. Therefore, it is considered that the EMTCC assistance team should work with the coordinator as early as possible. In addition, all these EMTCC assistance team activities should be standardized and specified in the EMTCC handbook for future operation reference.
Characteristics of Patients Treated by Helicopter Emergency Medical Services in Ireland from 2012 to 2022: A Retrospective Analysis of Ten Years of Data
Authors: Hennelly David , Deasy Conor , Masterson Siobhan , O'Donnell Cathal , Jennings Paul 
Published: June 2023

Introduction:A dedicated primary scene landing Helicopter Emergency Medical Services (HEMS) has been in operation in Ireland since 2012. Commencing with a unique collaboration between the Irish Aer Corps and civilian Emergency Medical Services (EMS) it has expanded to include a second charity funded model in the south west of the country. Both services operate under a single governance and dispatch system and provide an Advanced Paramedic level of care to the patients they serve. There is limited published literature on prehospital care in Ireland and to date no detailed descriptive study of patients treated by HEMS in Ireland. This research describes the characteristics of the patients treated by HEMS in Ireland.Method:This retrospective study will investigate the data of an excess of 8000 patients responded to by HEMS (2012-2022) in the republic of Ireland. Descriptive statistics will be used to interpret patient demographics, geographical spread, receiving facilities, mechanism/etiology of disease or injury, vital trends, transportation decisions and clinical interventions and short-term clinical outcomes.Results:Early stage data extraction shows seasonal variation in HEMS use with increased use in the summer months. Almost twice as many male patients vs. females were treated by HEMS while the most common age profile was 55-65 yrs. Trauma presentations have increased over the past 10 years and now account for over 60% of the overall caseload. The most common medical etiology was cardiac arrest or post resuscitation care followed by STEMI Care, the most common trauma cases were from road traffic collisions followed by falls and farm accidents.Conclusion:This study will be the first to describe the overall characteristics of HEMS patients in Ireland over a decade of service provision. As the Irish health system continues to evolve, so must its aeromedical services.
Survey on Applications of Emergency Medical Drones
Authors: Wang Soon-Joo , Kim In Byung 
Published: June 2023

Introduction:Traditionally, helicopters or special types of airplanes have been used to transport emergency patients when an aeromedical transport is necessary. However, despite its excellent utility, the cost of each flight is relatively expensive and has many limitations. So as an alternative to traditional aircrafts, there has been a movement to overcome the limitations of traditional air transport through the development and application of emergency medical drones. In this study, practical applications of emergency medical drones were investigated.Method:As a first step, through literature and internet searches, the current state of development, field of use, results, and problems of emergency medical drones were investigated. Based on this first investigation, a second Delphi survey of experts was conducted to investigate the appropriate fields for the use of emergency medical drones and the expected future applications.Results:Currently, emergency patient support drones are being used to transport first aid equipment including an automatic external defibrillator, manage emergency patient status and on-site remote evaluation, and transport human organs during organ transplantation. Emergency medical drones for emergency patients are being developed, including systems that manage the patient's condition by applying additional advanced technologies.Conclusion:Emergency medical drones were classified into drones for transporting emergency patients and drones for emergency medical support according to whether emergency patients were on board. Drones for emergency patient support were being used to transport first aid equipment, manage emergency patient status and on-site remote evaluation, and transport organs during organ transplantation. The trend of air transport in the future is expected to change to a futuristic means of transportation in the form of emergency medical drones.
Evacuating Premature and Critically Ill Neonates When Hospitals are Endangered by Disasters: A Case Study of the PANDA Team Evacuation of a Neonatal Intensive Care Unit During Severe Wildfires in Oregon, USA
Authors: Leppold Kathryn 
Published: June 2023

Introduction:In September 2020, severe wildfires in Oregon (USA) came dangerously close to Hospital A. The entire county was under evacuation orders. The Neonatal Intensive Care Unit (NICU) at Hospital A needed to evacuate patients to other areas for safety, however the characteristics of premature and critically ill neonates required a specialized transport team. This presentation outlines a case study of how the Pediatric and Neonatal Transport team (PANDA), based at Oregon Health and Science University (Portland, Oregon, USA), responded to evacuate neonatal and infant patients to other metro area NICUs during the wildfires.Method:Case study.Results:During a six-hour period, both PANDA transport teams on shift were activated to complete back-to-back transports of neonates and infants by ground ambulance to fire safe locations. Each patient was transported by a PANDA Registered Nurse and PANDA Respiratory Therapist, with an Emergency Medical Technician who drove the ambulance and Medical Control available by phone. The PANDA team normally operates in non-disaster settings. This was the first time PANDA was activated to evacuate patients from a hospital during a disaster. This presentation will discuss lessons learned and implications for future practice.Conclusion:Wildfire frequency and severity is predicted to increase due to climate change. Evacuation of premature and critically ill neonates requires a specialized transport team due to patient size, weight, and other considerations. Specialized transport teams should develop disaster evacuation workflows and resources, and regularly practice for these events. There is also a need for trauma-informed care in the post-evacuation setting to transport staff and parents of patients who were unable to travel with their child during transport. A full team pre-transport risk assessment is crucial in these circumstances.
The Association of Total Prehospital Time to Severe Trauma Patient Outcomes in Physician Staffed Emergency Medical Teams in Sarajevo, Bosnia, and Herzegovina
Authors: Jevtić Tatjana , Ahmić Amela Tuco , Bošnjak Melica Imamović 
Published: June 2023

Introduction:The Institute for Emergency Medical Assistance of Canton Sarajevo covers 1,777 square kilometers. All teams are physician staffed and are organized in ten geographic points. Patients are transported to a tertiary care level facility–University Clinical Center Sarajevo. Our objective was to determine the association between total prehospital time and severe trauma patient outcomes in a physician staffed emergency medical system with the hypothesis that the length of prehospital time is insignificant to patient outcome if physician treatment begins on scene.Method:This was a descriptive, retrospective, analytical study conducted from June to December 2020. The data of 153 patients with an ISS score of ≥ 16 was selected from patient registries of both facilities. According to transport duration, patients were assigned to one of four groups: <15 minutes (group 1); 16 to 30 minutes (group 2); 31-45 minutes (group 3) and > 45 minutes (group 4). Both groups according to the TRISS score were equal in mortality with an expected survival rate margin taken at 70% due to this being the approximate intrahospital survival rate of our patients. The primary outcome was in-hospital mortality, and secondary outcomes included length of hospital stay, length of ICU stay and 30-day survival rate.Results:We found no statistically significant difference to in-hospital mortality in relation to the length of pre-hospital transport when physician treatment begins on scene (p = 0,186). We ruled out any significant difference in length of stay and ICU stay (p = 0,179 and p = 0,173, respectively) among the preselected groups in relation to the length of prehospital time. Also, the 30 day survival rate was unaffected by the length of transport in physician led teams (p = 0,156).Conclusion:With strategically placed physician staffed EMS teams and physician treatment beginning on scene, patient outcome is unaffected by the length of transport.