bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention and Preparedness for Mass Gathering Disasters: Our Efforts and Successes in Hyogo, Japan
Authors: Nakayama Shinichi , Ukai Takashi , Kozawa Shuichi , Kawase Tetsunori , Ishihara Satoshi , Kai Soichiro , Yoshida Takeshi 
Published: June 2023

Introduction:Both prevention and preparedness are essential to avoid casualties and deaths in mass gathering disasters (MGDs). What countermeasures should be taken?Method:Retrospective analysis of a MGD at Akashi City Fireworks Festival in 2001; discussion of countermeasures at Kobe Luminarie, an annual light festival to commemorate the Great Hanshin Earthquake. Retrospective analysis of mass casualty incidents (MCIs) between 2003 and 2022 in which the alert function of EMISHP (Emergency Medical Information System in Hyogo Prefecture) was activated. Duration from emergency call to activation of alert function (activation time), number of casualties, and number of destination hospitals were evaluated.Results:More than 200 persons were injured and eleven people died in the Akashi Fireworks crowd crush. The main cause of this MGD was lack of gateway control and one-way flow control of visitors. With such measures in place, no MGD has occurred at Kobe Luminarie. In the past nineteen years in Hyogo, the alert function has been activated for 288 MCIs, such as vehicle accidents and fires. Activation time ranged from 1 to 73 minutes (median value=12). The casualty count ranged from 0 to 662 (median value=5). The number of destination hospitals ranged from 0 to 54 (median value=2). In all cases, emergency medical coordinators at Hyogo Emergency Medical Center, a principal hub hospital for disasters, directly or indirectly contributed to the medical response, e.g. securing hospital capacity, dispatching doctor-attending cars/helicopters and other medical teams to the scene, sharing information on the MCI between fire departments and hospitals.Conclusion:Prevention of MGDs requires taking proactive measures, such as gateway restriction and one-way flow control without bottlenecks. Preparedness is made possible by the alert function of EMISHP; it enables smoother patient transport to hospitals and contributes much in securing sufficient time and resources for medical response in MCIs, including MDGs.
How the Deadliest Nightclub Fire in History Improved Medical Interventions and Regulations and Impacted Legal Enforcement
Authors: Williams Joyce , Williams David 
Published: June 2023

Introduction:This presentation is a continuation of a WADEM presentation from 2013 entitled: Fires in Social Settings: An Examination of Prevention Strategies.Method:Nightclubs should be a place of fun and frivolity, but sometimes they become a place of death and destruction. The fire at the Cocoanut Grove in Boston Massachusetts, USA, in November, 1942 was the deadliest nightclub fire worldwide with a death toll of 492 and over 130 injured. Since that tragedy, regulations that could prevent or mitigate lethal incidents at nightclubs continue to be unenforced globally. This presentation will describe not only elements leading up to the Cocoanut Grove fire, but the resulting advances that have improved the lives and safety of the public.Results:The discussion begins by examining the general environment within the U.S. in fall of 1942. Appointed and elected officials tasked with protecting the public to reduce occurrences for such disasters failed in their performance of their respective roles. Groundbreaking medical advances used to treat the victims include the use of penicillin, methods of treating cutaneous burns, the use of electrolyte balance to aid in determining the ongoing treatment of burn victims, as well as other medical advances improved directly as a result of the fire. Additionally, the first systematic study of grief and survivors’ guilt and the recognition of what is now called Post Traumatic Stress Disorder commenced.Conclusion:Finally the divergent theories of the sources of the fires, how fire codes have changed in the aftermath as well as how the parties that were directly or indirectly responsible for the fire were disciplined by the judicial system will be reviewed.
Stadium Disasters
Authors: Tin Derrick , Hata Ryan , Ciottone Gregory 
Published: June 2023

Introduction:Stadiums are an important part of the entertainment and sporting cultures of communities around the world, but the combination of outdated infrastructure with poor safety planning, large numbers of people gathering within a confined space, and the high frequency of such events have led to a number of significant disasters in the past.This is a descriptive analysis of stadium disasters occurring between 1901-2021 which may provide useful insight for event safety personnel and disaster medicine specialists to better prevent and mitigate the effects of potential future stadium disasters.Method:Data was collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all stadium-related accidental disasters occurring between January 1, 1901-July 30, 2022. A disaster is defined by CRED in its glossary as “technological accidents of an industrial nature, or involving industrial buildings”. All categories and definitions are predetermined by the EM-DATS as per their glossary.Results:The May 24, 1964 Estadio Nacional disaster in Lima, Peru was the worst (in terms of deaths) to date with 350 deaths. This is followed by the 1982 Luzhniki Stadium disaster in Moscow, Russia (340 deaths), the 2001 Accra Sport Stadium disaster in Ghana (123 deaths), and the 1985 Hillsborough Stadium disaster in Sheffield, England (96 deaths) as well as 14 of the 40 stadium disasters occurred in Africa, 11 in Europe, 10 in the Americas, and five in Asia.Conclusion:A total of 40 stadium disasters were included, leading to 2,025 deaths and 6,640 injuries. This equated to an average of 50.6 deaths and 166.0 injuries per disaster. Given the potential risk of mass casualty events, stadiums should incorporate disaster medicine education, training, and expertise in their emergency medical plans.
It’s Sinking: Coastal Cities of Jakarta and Semarang, Indonesia
Authors: Pradana Atha , Yew Ying , Demetriou Christiana , Prayitno Harun , Delgado Rafael , González Pedro , Utami Ratnasari Dyah 
Published: June 2023

Introduction:Jakarta and Semarang are predicted to be engulfed by seawater by 2050, based on evidence by the Copernicus Sentinel-6 satellite. The current sinking rate is reaching almost 20 cm annually in both coastal cities, as reported at the World Economic Conference in May 2022, due to climate change, rising sea levels and excess groundwater extraction leading to land subsidence. Therefore, the objective of this study is to analyze the sinking of both coastal cities of Jakarta and Semarang, using indicators of vulnerability, exposure, and impact by 2050.Method:The YEW Disaster Severity Index (DSI) was used to analyze the impact, vulnerability, and exposure attributed to sinking. Data were obtained from real-time Google, Copernicus Sentinel-6 satellite, and triangulated with United Nations Office for Disaster Risk Reduction, World bank Data, Government of Indonesia Central Bureau of Statistics, as well as reputable journals.Results:The impact analysis on the sinking of Jakarta and Semarang, calculated in April 2022, using the YEW DSI, scored a High DSI impact of 6.03 and a Moderate DSI impact of 5.76, for each town respectively. Jakarta and Semarang also scored more than 100% baseline ability to cope on the YEW DSI indicators, which accounted for five vulnerability indicators and one exposure indicator of a total 13 million population affected. By 2050, both cities will be 5.6 meters below sea-level, with a constant current sinking of 20 cm per year.Conclusion:At present, vulnerability and exposure of the affected population account for a total of 13 million in both coastal cities. The analysis showed the inability to cope within local capacity, indicating a response is needed. The future of Jakarta and Semarang is in the hands of local, national, and global decisions and policymakers, in mitigating its impact through forest land conservation, adaptation, and relocation of the affected population.
Multilateralism as a Determinant of COVID-19 Outcomes in Small Island Developing States: Mitigating Disaster Impact Through Foreign Affairs Investment.
Authors: Dookeeram Darren , Borquez Sabastian , Seetharaman Hariharan , Bidaisee Satesh , Maharaj Sandeep , Dookeeram Dave 
Published: June 2023

Introduction:The United Nations (UN) recognizes Small Island Developing States (SIDS) as a heterogenous group with common geographic and socio-economic challenges. Their vulnerability to disasters was exacerbated during COVID-19 because of emerging nationalism and protectionism towards supply chains and resources. This study aimed to determine if multilateralism engagement improved COVID-19 outcomes and if Foreign Affairs investment improved short term COVID-19 outcomes.Method:Metrics were developed to reflect country parameters, clinical impact of COVID-19, engagement in multilateralism, health systems strength and integration in the International Political Economy. Open-source information was used to quantify proxy measures with the calculated percent spent on foreign affairs being the major proxy of multilateralism and disaster impact as lag time to vaccination, case burden and deaths in the first six months of 2020. Data was collected for each of the 38 SIDS. SPSS was used to assess possible correlations with short- and long-term clinical outcomes of the COVID-19 pandemic.Results:SIDS were noted to have an average lag of 4.1 months to begin vaccination rollout compared with developed nations and prolonged below global average vaccination rates. Expenditure on Foreign Affairs reduced the vaccination lag (p=0.03), decreased short-term cases (p<0.001) and deaths (p<0.001), Human Development Index improved vaccination rates (p<0.001) and lowered total cases (p=0.03). Foreign Direct Investment (FDI) inflow also decreased vaccination lag (0.02). Dependence on Foreign Aid decreased vaccination rates (p=0.01).Conclusion:These relationships suggest that there were multiple factors that determined short- and long-term health outcomes in SIDS. Mitigating the impact of a disaster therefore requires a multiple level investment solution that recognizes the importance of other actors in the global system. The COVID-19 experience suggests that engagement in multilateralism is important in countries that have a high vulnerability to disasters such as SIDS. This is valuable for future disasters in vulnerable states.
Innovations in Disaster Preparedness Training: An Emergency Preparedness Curriculum within a Pediatric Emergency Medicine Fellowship
Authors: Aspiotes Christine , Brumberg Elizabeth Hewett 
Published: June 2023

Introduction:Improved understanding of pediatric emergency preparedness can ensure the safety of children during disaster events, a population that is often overlooked.1 2 One method to minimize disparities is to increase the pediatric preparedness workforce by providing education to trainees about the foundations of this field.Method:A pediatric emergency preparedness curriculum was created as part of an elective prehospital track within a pediatric emergency medicine fellowship program at a quaternary pediatric hospital.Results:The curriculum focuses on three domains: education, research, and administration. The trainee is required to participate in local and regional educational opportunities. Locally, trainees create and facilitate at least one tabletop exercise about a preparedness topic of their choice. They also attend regional and state-wide preparedness drills to foster better understanding of integrated system processes. Additional educational opportunities involve the creation of asynchronous learning modules for their division and development of just-in-time resources for disaster events. For research, they have the opportunity to pursue an original project in the field and participate in other research activities with the track director. The administration domain prepares the trainee to be a leader in the field. Trainees are active participants within the emergency department’s preparedness committee and during hospital-wide preparedness meetings. These meetings develop protocols and policies as well as educational initiatives. Fellows are also encouraged to join national collaborative preparedness efforts through the American Academy of Pediatrics and the EMSC innovation and Improvement Center (EIIC).Conclusion:This curriculum provides an introduction to and continued education about disaster preparedness to pediatric emergency fellows early in their career. Completion of the sub-track fosters future leaders in the disaster medicine field. In the future, this curriculum can be adopted by other medical training programs to expand understanding of pediatric preparedness concepts.
The Impact of COVID-19 Patient Surges on the Burn Care System
Authors: Kearns Randy , Carter Jeffrey 
Published: June 2023

Introduction:Burn mass casualty incident (BMCI) planning efforts have been in practice and publication for 40+ years. While COVID-19 has no direct connection to burn injuries, the impact of COVID-19 on the healthcare system including burn care was and remains significant.Method:A retrospective analysis of data was conducted voluntarily submitted to the American Burn Association from March 2020 to June 2021 which generally coincides with the first three waves of the pandemic. We focused on the self-reported data specific to the three critical components in managing a surge of patients: staffing, space, and supplies (to include pharmaceuticals and equipment).Results:Staff: These data were collected over a period that coincided with the first three waves seen in the USA. Staffing shortages were noted during each of the surges but were most excessive when a regional surge paralleled surges in other parts of the country (November-December 2020).Space: Late November and early December 2020, space was in short supply with the surge of patients for more of the region than at any other time during the 28 weeks of reporting. While single facilities reported other episodes of limited space or supplemented with temporary structures, the peak was early December.Supplies: As the first surge began to subside, the supply shortages were abated. However, as additional surges occurred; the supply chain had not recovered. Supply shortages were reported in greater numbers than either space or staffing needs through the multiple waves of the pandemic.Conclusion:The COVID-19 pandemic directly led to a diminished available capacity for burn care in such a way that it compromised the ability to confront a surge of burn-injured patients. Future BMCI planning efforts must consider this aspect of the process. Crisis Standards of Care may come into play during such an event.
Which Ethical Principles Guided the Ethical Decision During the COVID-19 Pandemic in the UK, Ireland, and the US? Findings from a Qualitative Systematic Reviews
Authors: Hussein Ghaiath , Raajakesary Kesidha , Galvin Lucy , Peters Joseph , Prendiville Kate , Newport Sarah , MacAnulty Calum 
Published: June 2023

Introduction:With the Covid-19 pandemic impacting the world at such a quick rate and with many unknown variables and dangers, there was an immediate need for ethical guidance to ensure those in many different healthcare settings such as researchers and other professionals could perform ethically in this new and complex situation. This study aims to take existing research on those ethical guidance documents in the UK/Ireland and compare them with those from the United States.Method:This study used a qualitative systematic review methodology with thematic synthesis to analyze the included ethics-related guidance documents, as defined in this review, published in the UK and Ireland between March 2020 and March 2022. The search included a general search in Google Scholar and a targeted search on the websites of the relevant professional bodies and public health authorities in the three countries. The ethical principles in these documents were analyzed using the constant comparative method (CCM).Results:In the UK and ROI review, 44 guidance documents met the inclusion and exclusion criteria, and 11 main ethical principles were identified, which were then categorized under two main themes: respect and duty. The 11 main ethical principles were: fairness, honesty, minimizing harm, proportionality, responsibility, autonomy, respect, informed decision-making, community, the duty of care and reciprocity.In the US review, 270 documents were found from searching several public health United States government bodies. Of these documents, 50 were deemed to be Covid-19 ethical guidance, each ethical principle was tallied from every document and compared with the results from the UK/Ireland study.Conclusion:There were remarkable similarities in some ethical principles prioritized in the Covid-19 pandemic ethical guidelines across the Atlantic Ocean. However, there were differences in the interpretations and frequencies in which these principles were used across different regions.
Resources Used by People with Hearing Disabilities to Cope with Emergency Situations
Authors: Tannenbaum-Baruchi Carolina , Aharonson-Daniel Limor , Feder-Bubis Paula 
Published: June 2023

Introduction:People with hearing disabilities (PwHDs) face many challenges in their everyday lives, as their environments were not designed to accommodate their needs. They may have a communication disability as well as a hearing disability. To cope, PwHDs rely on the assistance of others, their communities, technology, and personal resources. In emergency situations challenges become greater and resources scarcer.Method:This study was conducted from November 2018 through July 2020. A mixed-methods approach consisting of in-depth interviews and online quantitative surveys with PwHDs in Israel was used. The qualitative part enquired about the resources they used to cope during emergencies and the obstacles they faced. Grounded theory was used for the analysis of the findings. The quantitative part focused on their perceptions of self-efficacy, methods of communication, and accessibility of services in emergency situations. The participants were deaf or hard of hearing individuals, and those who used hearing aids and/or had a cochlear implant, as well as individuals who chose not to use them. The study excluded people over 60, because we focused on those who didn’t suffer from hearing loss caused by age. The survey was accessible in Israeli sign language using Qualtrics survey platform. The statistical analysis was conducted using SPSS ver.23.Results:PwHDs’ resources for coping with emergencies were identified and classified under four categories.1. Characteristics of the PwHD: type, methods of communication (sign language, read lips, speech) and accessibility of services.2. Personal resources: Independent communication and self-efficacy.3. Time of event: Daytime or nighttime.4. Characteristics of the emergency: Personal vs. collective.Conclusion:The study identified the resources PwHDs used to cope with emergencies. Results can help develop standards of accessibility for places providing services during both day and night that will allow PwHDs to communicate independently.
Applying a “Whole-of-Health-System” Approach in Mass Casualty Management
Authors: Alesi Andrea , Bortolin Michelangelo , Ragazzoni Luca , Lamberti-Castronuovo Alessandro 
Published: June 2023

Introduction:In 2019, the World Health Organization published the Health Emergency and Disaster Risk Management (H-EDRM) framework, detailing how all actors in the health system can contribute to reducing negative health outcomes of emergencies and disasters, including mass casualty incidents (MCI). The H-EDRM framework’s whole-of-health-system approach stresses the need for each level of healthcare systems to be involved in all phases of the disaster cycle, particularly preparedness and response. This approach highlights the critical role that lower levels of care, including primary healthcare, can play during MCI, demonstrating the need to integrate these into countries’ disaster plans. Nevertheless, countries’ disaster management plans have historically focused on hospitals and few recommendations exist for how to practically proceed with such an integration. This study explores what has been published on the topic of reverse triage (RT), namely the process used by healthcare workers (HCWs) to determine which patients can safely be discharged to lower levels of care, resulting in increased surge capacity at hospitals. The objective of this work is to collect evidence around existing criteria, tools or referral pathways used by HCWs during MCI, ultimately integrating lower levels of care in MCI management.Method:A systematic literature review was performed and a total of 12 studies were analyzed.Results:Literature focusing on RT towards lower levels of care during MCI is scant and limited to few case studies. There is no standardized tool or guidelines for how to perform RT and existing referral pathways are described in only isolated case studies.Conclusion:Published evidence on RT criteria is limited. The results of the current review can serve as groundwork upon which to design further research studies. It can be used to help devise strategies and policies for the integration of lower levels of care during MCI.
Current Status of the Disaster Health, Medical, and Welfare Coordination in Japan
Authors: Chishima Kayako , Akahoshi Kouki , Toyokuni Yoshiki , Kondo Hisayoshi , Koido Yuichi 
Published: June 2023

Introduction:Non-coordinated support during disasters has negative effects on affected communities and people. From the 2004 Indian Ocean Tsunami, the United Nations introduced a cluster approach to avoid gaps and duplication of aid. Japan's disaster coordination of support for health and medical care was organized after the 2017 Kumamoto earthquake. The Ministry of Health, Labour and Welfare (MHLW) announced and issued the notice that the prefectures need to establish a system related to health and medical activities in the event of a large-scale disaster. In July 2022, welfare content was added. This study investigated the current status of health sector organizational coordination among health, medical, and welfare responders during 2022 the Large-Scale Earthquake National Exercise (LSENE).Method:The 2022 LSENE was conducted on October 1, 2022 with participation from the Disaster Medical Assistant Team (DMAT) and responders from each prefecture's health and welfare divisions and organizations. Each responder's exercise log sheet and the exercise controller's evaluation were reviewed.Results:Even though there was a notice from the MHLW, organized coordination was conducted only by several medical and health teams. DMAT is the only team with a system to dispatch teams from non-affected prefectures and coordinate well to allocate teams. Some other health and welfare organizations did not have a dispatching system. They had difficulty sending teams to affected areas, especially due to a lack of a systematic response system, training, coordination headquarters, and information sharing. It was suggested that information sharing and coordination among responders is necessary, although information gathering and request judgments related to dispatch coordination are different for each organization.Conclusion:In order to smoothly coordinate support teams for health, medical, and welfare in the event of a disaster, it is necessary not only to improve the coordination headquarters for health, medical, and welfare but also to verify its operation through training.