bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined Trauma and CBRN Exposure
Authors: McIsaac Joseph 
Published: June 2023

Introduction:Whether it is COVID in New York, chemicals in Syria, or a radiological exposure from a dirty bomb or nuclear detonation, trauma is increasingly mixed with CBRN. Decontamination, isolation, and newer treatments all impact the patient as well as the physician. Military physicians regularly plan for these patients, but the civilian world has not. Civilian CBRN training has been spotty, at best. Our recent experience with COVID and the current threats of nuclear attack, emphasize the need to integrate CBRN exposure into our trauma treatment plans, both to help our patients and to protect the caregivers.Method:Literature review and US Department of Health and Human Services Guidelines.Results:A template for patient flow and treatment priorities is presented along with just-in-time references. Triage guidelines for trauma patients with Acute Radiation Syndrome (ARS) are also provided.Conclusion:Civilian preparation for managing the CBRN contaminated trauma patient starts with a mental model of treatment priorities and self-protection strategies. Just-in-time treatment references can provide additional support and confidence.
Utilizing AEMS (Assess-EOP-Map-Simulate) Algorithm to Assess and Spatially Link Prehospital Emergency Medical Services Resources in Road-Traffic Mass Casualty Incidents in Kumasi, Ghana
Authors: Richter Roxane , Flowers Thomas , Oduro George , Bonney Joe , Forson Paa , Oppong Chris , Cobbold Sonia , Richter Rainier 
Published: June 2023

Introduction:Due to the high number of road traffic accidents with acute injuries and fatalities–particularly in Mass Casualty Incidents (MCI) in low-resource urban sub-Saharan African cities–research was undertaken to create an evidence-based algorithm that could be used to assess and geospatially link EMS needs in Kumasi, Ghana, to trauma resources. Our examination showed that non-MCI fatalities was approximately 2.5%, however, MCI fatalities were found to be 1.8 times higher–at 4.3%, indicating significant opportunities in the planning, preparedness, care, and transport among MCI patient management.Therefore, several studies (funded through Fulbright-Fogarty and Fulbright Specialist programs), supported the development of the A-E-M-S (Assess-EOP-Map-Simulate) Medical Mass Casualty Algorithm that began networking accident ‘hotspots’ to existing trauma-level capabilities and surge capacity competencies in eight specified Kumasi hospitals. This low-cost response model promises to be an innovative alternative to long-term infrastructure development and high-priced resource distributions. Use of GIS and UAV drones allowed response systems to geospatially locate, classify, shift, and/or augment resources as needed in conjunction with hotspots.Method:Sample sizes were averaged at 295 for all patients' ages, with only a sample size of 292 for adults at 95% confidence intervals, and a standard deviation of 0.5. A total of 300 road-traffic accident victims were collected at KATH A&E in February-May, 2017, utilizing handheld devices by four researchers 24/7 daily.Results:Our examination showed that non-MCI fatalities were approximately 2.5%, however, MCI fatalities were found to be 1.8 times higher–at 4.3%, indicating significant opportunities in the planning, preparedness, care, and transport among MCI patient management.Conclusion:To date–and in partnership with Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Ghana Medical Council, Health Services, National Disaster Management Organization, and others–over 306 Ghanaian healthcare providers from 80 different facilities have been trained in the AEMS program.
Foot Injuries at Music Festivals–One of the Most Common Presentations to On-site Medical Services
Authors: Munn Matthew , Hanrahan Page , Mema Silvina 
Published: June 2023

Introduction:Foot injuries are a common patient presentation at music festivals, and are resource-intensive patient encounters by virtue of their comparative volume. There are no published accounts devoted to these ubiquitous, typical, predictable festival injuries leading to presentation to on-site medical services for treatment.Method:A retrospective chart review was performed of visits to medical services for first aid or medical care involving feet at a multi-day music festival in Canada. Data extracted included demographics, injury characteristics, and type of footwear. Encounters were classified as initial or repeat visits, and repeat visits were assessed for having had previous dressings applied.Results:Over the five day festival period, foot care visits accounted for 416 of 1129 (37%) patient presentations for minor care. Most common injuries were blisters (51%), ankle sprains (10%), lacerations (8%), abrasions (6%), and bug bites (6%). Footwear was reported as shoes (28%), shoes and socks (28%), flip-flops (19%), sandals (28%) and bare feet only (5%). The most common blister sites were toes (48%) and the posterior heel (17%). 12% of cases were repeat visits, and 50% of repeat visits were for dressings failure.Conclusion:Foot injuries make up a significant portion of presentations, and often re-presentations, to medical services at music festivals. Preparation for these common injuries should include (1) a dedicated and purposeful bandage selection and supply, (2) provider training in best foot care practices, including bombproof, danceable dressings, and (3) educational resources to inform attendees of risks and provide preventative upstream measures that might allow them to avoid injury.
The Role of Nurses in the Reclassification Exercise of the Japan Disaster Relief Search and Rescue Team (the JDR Rescue Team)
Authors: Ohyama Futoshi , Minamida Teppei , Oishi Saori , Yamaguchi Naoki , Sakamoto Yoshiko , Takekawa Reiko , Hirokawa Masahito , Akamatsu Yukiko , Yamasaki Noriko , Sung Junho , Takahashi Mirai , Takami Hiroki , Sakamoto Taigo , Ihara Noriyuki , Inoue Junichi 
Published: June 2023

Introduction:The JDR Rescue Team has successfully completed the INSARAG External Re-Classification (IER) process, which evaluates the operational capability and capacity of Urban Search and Rescue (USAR) teams and has achieved the highest “Heavy” reclassification in November 2022. Two nurses participated in the IER process as part of the medical unit of JDR Rescue Team. In addition, ten registered nurses cooperated as Exercise Control (EXCON).Method:Summarize the JDR Rescue Team and medical unit and make observations on what nurses did in the IER.Results:The JDR Rescue Team is dispatched by the Government of Japan in response to large-scale disasters overseas. The task force team has 75 members from various specialties, including the rescuer, and medical unit. The medical unit consists of one medical manager, 2 doctors, and two nurses. There are currently about 50 registered medical unit members in our team, and of these, a total of 23 nurses are registered. The role of nurses during the IER process, includes a 36-hour non-stop scenario-based exercise. The team nurses are involved in various roles, such as Confined Space Medicine (infusion for patients, assisting on-site amputation), caring or treating injured rescuers and search dogs, providing health and welfare monitoring and operating a decontamination system. The EXCON nurses were involved in managing the simulation. One of their key roles was to play as a victim realistically so as to provide a sense of tension for the simulation.Conclusion:The JDR Rescue Team has more medical unit members than those in other countries. In particular, teams with so many nurses are rare. nurses played a vital role in this IER. The contribution of nurses is identified in order to make the international USAR team more strong and more flexible.
Thicker Posterior Subcutaneous Adipose Tissue (SAT) and Slighter Difference of SAT During the Peri-arrest Period are Associated with Favorable Neurological Outcomes at Hospital Discharge in Patients with In-Hospital Cardiac Arrest
Authors: Zhou Tingyuan , Cao Yu 
Published: June 2023

Introduction:Subcutaneous adipose tissue (SAT) and bony thorax will deform and conduct driving force during cardiac arrest (CA). The association between short-term prognosis and deformation of adult thorax for patients acquired return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR) was unclear.Method:Clinical records and CT images were collected from eligible patients admitted to the hospital who received CPR and achieved sustained ROSC from May 31st, 2019 to June 30, 2021. The patients were divided into different groups according to discharge outcome, then into three subgroups according to the ventilation mode before and after CPR. After that, patients with the same ventilation mode before and after CPR are combined and analyzed.Results:Records from 1663 patients were reviewed. After selection, 70 patients were included into this study. Significantly thicker posterior SAT post-compression was found at the 7/8/10/11 spinous process plane in patients with favorable neurological outcome (p<0.05). For patients receiving same kind of respiratory support before and after CPR, significantly thicker posterior SAT pre-compression at the 6/7/8/9/10/11 spinous plane and thicker posterior SAT post-compression at the 7/8/9/10/11/12 spinous plane (p<0.05). For patients without mechanical ventilation before or after CPR, significantly thicker posterior SAT post-compression was found at the 10/11 spinous plane in patients with favorable neurological outcome (p<0.05). For patients receiving mechanical ventilation before or after CPR, thicker posterior SAT post-compression was found at the 10/11/12 spinous plane was associated with favorable neurological outcome. No difference was found in the bony thorax within a different vertebral plane after subgroup analysis (p>0.05).Conclusion:Thicker posterior SAT and greater SAT depth difference after compression was associated with favorable neurological outcome at the discharge of patients who obtained ROSC after CA. A shorter duration of chest compression (<6 minutes) doesn’t cause calculable changes in patients’ bony thorax in patients who obtained ROSC after CA.
Updated Comprehensive Framework for Disaster Evaluation Typologies
Authors: Wong Diana , Dam Jacqueline Van 
Published: June 2023

Introduction:The Comprehensive Framework for Disaster Evaluation Typologies (CFDET) was originally developed in 2017 with minor updates in 2018 (CFDET2.0). CFDET was created to unify and provide agreement on the identification, structure and relationships between multiple evaluation typologies found in the disaster setting. Since the publication of this framework, the world has witnessed unprecedented disaster-related events including two (2) Public Health Emergencies of International Concern (PHEIC): COVID-19 and Monkey Pox as well as the emergence and continuation of armed conflict in various countries around the world. This work presents CFDET3.0 which incorporates updates on international disaster frameworks, disaster health updates and evaluation guidelines.Method:A scoping literature review on international disaster frameworks, disaster health updates and evaluation guidelines has been undertaken and included reviewing peer-reviewed and grey literature.Results:The scoping literature review revealed updates on the following important publications:World Health Organization (WHO) Health Emergency Disaster Risk Management (H-EDRM) (2019);
International Health Regulations;Universal Health Coverage (UHC);Climate Change Conference (COP27);Fragile and Conflict-affected Contexts (FCAC);Public Health Emergencies of International Concern, andUpdated evaluation standards, guidelines, evidence-based reviews and knowledge management.
Conclusion:Incorporation of these international updates into CFDET2.0, strengthens global health and international disaster health responses with a focus on disaster health evaluation. The updated framework will be referred to as CFDET3.0. Future research is scheduled to develop a series of toolkits that will support an improved disaster evaluation process.
Implementation of Hospital Disaster Preparedness and Response Plan in Nepal: A Mixed Study in 3 Public Hospitals of Nepal
Authors: Singh Prinka , Lamine Hamdi , Eriksson Anneli 
Published: June 2023

Introduction:Considering the need for hospital disaster preparedness post-Nepal earthquake 2015, the Ministry of Health and Population of Nepal developed a Hospital Disaster Preparedness and Response Plan (HDPRP) for mass casualty management. However, until now, there is no scientific literature on how the district hospitals, which are the major health service providers in Nepal, implemented their HDPRP during mass casualty incidents (MCIs). So, this study aims to understand how the HDPRP was implemented during MCIs in three district public hospitals of Nepal.Method:A mixed sequential QUANT-QUAL study was designed. Out of seven districts under the severely hit category by Nepal Earthquake 2015, three districts were selected randomly. For the quantitative component, the WHO hospital emergency response checklist was adapted which was self-administered in each hospital. Based on a scoring system, each hospital was placed in one of three categories (effective, insufficient, unacceptable), to assess the level of HDPRP implementation. For the qualitative component, semi-structured interviews were conducted to understand how the HDPRP was implemented in each hospital. An inductive thematic analysis was carried out. All information was collected for the most recent management of MCI reported in the hospital.Results:Out of three hospitals, two hospitals have effectively implemented their HDPRP, whereas one has insufficient implementation. Three themes emerged during the data analysis: enablers in implementation of HDPRP, barriers in implementation of HDPRP, and recommendations for the future. Multiple enablers and barriers were identified for the implementation of HDPRP, and the recommendations were identified for the hospital, hospital staff, and external stakeholders.Conclusion:Implementation of HDPRP as per the protocol is difficult due to many external and internal factors that arise while managing the MCIs. The findings of this study provide the basis for the Ministry of Health and Population and district hospitals for the future update of HDPRP and planning of MCIs.
Significance of the “Coordination Headquarters for Healthcare and Medical Support” in Japan; comparison with Emergency Medical Team Coordination Cell (EMTCC)
Authors: Nakamori Tomoki , Toyokuni Yoshiki , Kondo Hisayoshi , Kubo Tatsuhio , Koido Yuichi 
Published: June 2023

Introduction:The Japan Disaster Medical Assistance Team (DMAT) was established in 2005. Although it had become possible to gather medical teams at an early stage in the fields of health and welfare, there had still been a lack of personnel. In 2017, the Japanese government decided to establish the Health and Medical Coordination Headquarters when we had major disasters. Not only the medical team, but also the public health nurse and the welfare team gathered at this headquarter, and activities that integrated health, medical care, and welfare started from an early stage. On the other hand, WHO indicates to establish EMTCC within the Ministry of Health, in order to manage and coordinate EMT activities and aggregate data.Method:The Japanese Headquarters and the EMTCC were compared in terms of their functions and issues.Results:In Japanese headquarters, the director of the local public health center will be the director, and the secretariat for the headquarters will be run by supporters. Participants in the headquarter meeting include leaders of public institutions involved in health risk management. Furthermore, leaders of unions such as medical, dentist, pharmacists and nurses on the side of supporters, leaders of medical, healthcare, and welfare will participate. To establish EMTCC, WHO dispatches a coordinator, information manager, and data analyst.EMTCC collects medical information by using Minimum Data Set (MDS), which is similar to Japanese Surveillance in post extreme emergencies and disasters (J-SPEED). The most significant difference is that EMTCC does not deal with health and welfare issues.Conclusion:Regarding medical care, information is summarized in a similar way at headquarters. These facts indicate the Japanese headquarters management experience is applicable to EMTCC.
Web-Based Multistate Disaster Rehearsal of Concepts Exercises
Authors: Little Charles , Noll Samantha , Nielsen Brianna , Ellen Steve , Nally Britta , Persson Carolyn , Price Connie 
Published: June 2023

Introduction:The Mountain Plains Regional Disaster Health Response System (Mountain Plains RDHRS) works to build disaster capacity across US Federal Region VIII, a rural western six-state region. It conducts an annual rehearsal of concepts and exercises to identify gaps and inform policy development. In 2022, a multi-state exercise was conducted involving responders from individual hospitals coordinating with Healthcare Coalitions and State Public Health. These responses rolled up to a multi-state emergency operations center overseen by the Mountain Plains RDHRS.Method:A fictitious mass multi-state botulism incident generated a pediatric surge across the region. Individual patient cards with demographic information were given to a set of hospitals in participating states. The communication pathways within states were identified. Communication between local and regional pediatric transfer centers were assessed. Overall situational awareness was tracked.The exercise format was incident occurrence and notifications by normal channels and a Zoom conference call held on day one. Situational awareness and patient movement occurred in multiple Zoom rooms on day two. An after-exercise review occurred by Zoom on day three including all participants from the exercise.Results:There was generally good information flow within states, but minimal information exchange across states There was poor regional situational awareness with a lack of complete patient lists and transfers. The Mountain Plains RDHRS planned to exceed the hospital’s patient capacities with a large number of pediatric patients to practice patient movement across state lines. Instead the hospitals showed a surprising willingness to keep and manage critical pediatric patients instead of transferring to tertiary care pediatric centers. This was identified as a consequence of the COVID-19 experience.Conclusion:Web-based exercises vertically spanning responses from individual hospitals to multi-state regional entities are feasible. This exercise demonstrated multiple gaps in regional disaster response.
Public Conformism with Health Regulation is Crumbling as COVID-19 Becomes a Chronic Threat – A Cohort Study
Authors: Bodas Moran , Wine Leora 
Published: June 2023

Introduction:Three years into the COVID-19 pandemic, experience and studies have shown that public behavior significantly contributes to the disease spread increase or reduction. As the pandemic becomes a chronic threat, maintaining public trust to comply with health regulations proves challenging as people develop pandemic fatigue. This study aims to analyze the long-term trends in public attitudes toward the COVID-19 pandemic and compliance with health regulations.Method:A longitudinal cohort study was performed from February 2020 until January 2022, collecting data from nationally representative samples (N=2,568) of the adult population in Israel. Data Collection was timed with the first five morbidity waves of the COVID-19 pandemic. We examined public trust in Israeli health regulations, public panic, worry, and compliance with health regulations, particularly self-quarantine.Results:The data shows that public trust in health regulations in January 2022 is at an all-time low (25%) compared to the maximum value measured in March 2020 (~75%). The perceived worry from COVID-19 is steadily declining, whereas the perception of public panic is increasing as the pandemic progresses into a chronic threat. While public compliance with self-quarantine was reported to be close to 100% in the early stages of the pandemic, it has dropped to 38% in early 2022, mainly when compensation for lost wages is not offered. Regression analysis suggests that trust is a significant predictor of compliance with health regulations.Conclusion:The findings, spanning more than two years of the pandemic, highlight the importance of maintaining public trust as a significant driver of public compliance with health regulations. The "fifth wave" of the pandemic resulted in an all-time low in public trust. The Israeli public, usually highly compliant, shows signs of crumbling conformity. Decision-makers ought to consider means to foster public trust.
Evaluating the Effect of Brief Disaster Education on Emergency Department Staff: Can Short, Low-cost Education Improve Disaster Readiness of Non-DMAT Healthcare Personnel?
Authors: Moon Sungbae , Kim Jung Ho 
Published: June 2023

Introduction:Some incidents require early deployment of emergency department personnel not designated as disaster medical assistance team (DMAT). Although not as trained as DMAT members, they should be aware of basic disaster response concepts and knowledge. Educating disaster readiness to every healthcare staff in emergency departments would be ideal but it is very costly in both time and expense. To overcome this problem, we tried to evaluate the effectiveness of teaching basic concept and knowledge to non-designated personnel in a short-session and measure the effect.Method:This study is a before-and-after comparison study. From July 2020 to July 2022, a two-hour education was given to volunteers among doctors, nurses, paramedics and administrative staff working in emergency departments across four hospitals in Korea. Educational sessions consisted of basic disaster concept, pre-deployment DMAT preparations, initial actions required on incident site, key elements of incident response (command, control, safety, communication), and triage. Attendees were given a pretest before the session and another test after the session. Chi-square test and Wilcoxon rank test were used to compare the results.Results:Total of 105 volunteers participated in the study. Participants were mostly nurses (62.9%) followed by paramedics (23.8%). Overall knowledge level reported to be increased, including knowledge regarding DMAT deployment (29.5% to 93.3%, p<0.001), DMAT personnel (26.7% to 94.3%, p<0.001), DMAT-designated equipment (23.8% to 60.0%, p<0.001), initial response (27.6% to 69.5%, p<0.001) and patient transport priority (74.3% to 94.3%, p<0.001). Questions testing triage and rate of participants answering every question showed improvement with post-test median score of 67% and rate of 1.0% to post-test median score of 100% and rate of 35.2%, respectively (both p<0.001).Conclusion:Educating non-DMAT personnel in emergency departments with a short session showed significant improvement in basic knowledge of disaster response. It may help institutions with limited resources.