bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traumatic Cardiac Arrest in Polytrauma–There are Survivors: A 10-Year Analysis from a German Helicopter Base
Authors: Frank Mark , Braun Jörg , Haelke Laura , Petrowski Katja 
Published: June 2023

Introduction:In Germany, emergency care is provided by ambulances and rescue helicopters. Emergency physicians are part of prehospital care. The rescue helicopter in Dresden covers the city with 540.000 inhabitants and surrounding areas. The goal of the study was to evaluate cases of traumatic cardiac arrest (TCA) and to describe factors that affect the primary success of prehospital cardiopulmonary resuscitation (CPR) in trauma.Method:Data of all emergencies from the German Air Rescue (DRF-Luftrettung®) Helicopter Base Dresden were recorded on a standardized protocol and transferred to a central database (MEDAT®, HEMSDER®). Data from all patients with severe injuries, classified as polytrauma between January 2006 and December 2015 were analyzed.Results:There were a total number of 14,126 emergency cases involving the rescue Helicopter. The Helicopter was on the scene within 10.9 minutes [4-34]. Polytraumatized patients were identified in 673 cases (4.76%), the mean age was 43.73 years [2-98], and 498 patients were male (73.99%). In 444 cases, traffic accidents were responsible, in 188 cases falls from high. In 46 cases a suicide was documented. Mean ISS was 34,04 [16-75]. The main injury regions were head, extremities and chest. In 115 patients (17.08%) a TCA was observed. 43 pat. were pronounced dead initially and no treatment was initiated. 72 pat. (62.6%) received CPR. 39 of these pat. (54,17%) were also pronounced dead after treatment. 14 pat. (19.44%) were transported to hospital with ongoing CPR. 19 pat. (27.38%) reached the return of spontaneous circulation (ROSC). Male pat. reached more often ROSC.Conclusion:According to present guidelines for TCA, it is important that reversible causes of cardiac arrest in trauma pat. are to be treated. If we ensure the treatment of hypoxia, hypovolemia, tension pneumothorax and cardiac tamponade consequently, there will be a survival chance. Regular training for manual skills and simulation can be a key factor.
Normalized Deviance from Approved Personal Protective Equipment (PPE) Donning and Doffing Protocol—Towards a Hazard Reduction Index
Authors: Barach Paul , Pham Trang , Hughes Ashley , Doos Devin , Ahmed Rami 
Published: June 2023

Introduction:Reusing PPE is not recommended but was common during COVID-19 pandemic. Limited guidance on proper PPE use and its reuse heightened the hazards to health care worker (HCW) safety. Emerging data on PPE use suggests that most HCWs were contaminated by donning and doffing of PPE while adhering to standards of care.Method:A prospective observational study was conducted to understand HCW behaviors in donning, doffing, and reusing PPE. Emergency Department physicians and nurses were video-recorded donning, doffing, and reusing PPE within a simulated acute care environment. Participants performed five donning and doffing PPE procedures. PPE kit included gown, face shields, and N95 respirator masks. Participants had access to disposable gloves and hand sanitizer. Recordings were reviewed and coded independently by two trained coders based on checklist of key behaviors. Agreement between coders was high (81.9%). All participants reported completing PPE training.Results:28 videos of participants capturing 278 procedures were reviewed. None of the participants followed the CDC’s order for donning across five scenarios. Majority of participants failed to perform hand hygiene before donning or re-donning PPE or when doffing PPE. For contaminant spread risk, 92.85% (n=26) touched patient-facing side of PPE during re-donning and/or doffing PPE (M= 3.75, SD= 2.37, Median = 4; 0-9 times). The most common area of self-contamination was hands (n= 111 across all participants in 5 donning/doffing sequences). Touching patient-facing side of PPE was more likely to occur during donning than doffing (70.5% vs. 20.1% of sequences).Conclusion:The study found wide variation in PPE donning/doffing practices among HCW in violation of CDC guidance. This first study to review PPE reuse through a human factors lens, identifyied deviant behaviors that contribute to HCW self-contamination. Efforts are needed to redesign PPE and develop effective ways to train staff using PPE equipment safely.
Impact of Access Block Is Increasing Mortality in Emergency Departments in Nepal
Authors: Maharjan Ramesh , Maharjan Rashmisha 
Published: June 2023

Introduction:Emergency patients have to stay in the Emergency Department (ED) for hours to days to get ward admission for definite care in Nepal. Access block is a major issue in the ED of University Level Teaching Hospitals (ULTH) in Nepal. This study aimed to analyze the impact of access blocks in the EDs of Nepal.Method:Meta-analysis of different publications on ‘duration of ED Boarding’ and ‘mortality outcome of ED’ of ULTHs of Nepal till November 15, 2022Results:9.7% of ED patients were admitted to the ward. The time period from ED arrival to respective ward team consultation is 5.7 hours, consultation to ward admission is 5.6 hours, and admission to ward transfer is 8 hours. The average ED boarding time is 18.1 hours. 38% of patients arrived in ED via Ambulances. The time period from ED arrival to ward team consultation for those who need transfer to another center are 6.9 hours, consultation to admission is 5.7 hours, and admission to transfer is 8.7 hours (ED Boarding time 21.3 hours). Meta-analysis of three major ULTH’s showed mortality with respect to ED boarding time to be 17% in < 1 hour, 40.4% in 1 - 6 hours, 27.4% in 6-12 hours, 9.1% in 12-24 hours, 4% in 24-28 hours and 2.1% in >48 hours. Among them, higher age, greater mortality rate. The immediate causes of mortality comparing 2018 vs 2010 are Sepsis & Septic shock 32.2% vs 18%, Cardiac Causes 21.8% vs 14.8%, Aspiration Pneumonia 19.5% vs 14.8%, Severe Lung Diseases 12.7% vs 16.4%, Hypovolumic & Haemorrhagic Shock 9.2% vs 34.4% and Poisoning 4.6% vs 1.6%.Conclusion:Prolonged ED boarding due to Access Block is triggering increased mortality in the ED.
Role of General Practice Led Observation Ward to Support Emergency Ward to Improve Health Outcomes at a Major Kathmandu Hospital in Nepal
Authors: Shakya Yogendra 
Published: June 2023

Introduction:Tribhuvan University Teaching Hospital (TUTH) is a tertiary care hospital in Kathmandu. The emergency department sees between 130 to 140 cases per day. These patients get initial evaluation and basic investigation for acute emergency management and treatment. Those requiring further treatment are then admitted to the department of General Practice for post emergency care which acts as an observation ward. This step allows for the patients to be observed on a short-term basis and permits patient monitoring and/or treatment for an initial 24-48 hour period and up to a maximum of five days. These steps allow for focused follow up, improved efficiency and minimizes inappropriate admissions to other hospital inpatient wards. This paper evaluates functionality, admission criteria, patient categorization and subspeciality referral to specialty patient care, discharge criteria and cost effectiveness.Method:A descriptive observational study was carried out of the patients admitted to the observational ward between 2020-2021.Results:Most articles suggest these wards improve patient satisfaction and clinical care, decrease length of stay, reduce unnecessary inpatient hospital admissions and are useful in fever under evaluations, COPD, poisoning, pneumonia, mild head injuries, high sugar, hypertension, gastroenteritis etc. Around 14% of patients were sent to the observation ward after acute emergency care. 84% were discharged from observation ward with a mean stay of three days and were followed up in community care or GP OPD. Nine percent were admitted to hospital wards, and 7% transferred to yellow/red area emergencies for derange vitals.Conclusion:Observation wards seem to have advantages, excluding those who will inevitably need longer treatment, reduces cost savings and unnecessary burden of hospital admission.
Decision Maker's Experiences with Rapid Evidence Summaries to Support Real-time Evidence-Informed Decision Making in Crises: A Mixed Methods Study
Authors: Khalid Ahmad Firas , Grimshaw Jeremy , Parakh Nandana , Charide Rana , Rab Faiza , Sohani Salim 
Published: June 2023

Introduction:There is a clear need for research evidence to drive policymaking and emergency responses so lives are saved and resources are not wasted. The need for evidence support for health and humanitarian crisis is pertinent because of the time and practical constraints that decision makers in these settings face. To improve the use of research evidence in policy and practice, it is important to provide evidence resources tailored to the target audience. This study aims to gain real-world insights from decision makers about how they use evidence summaries to inform real-time decision making in crisis settings, and to use the findings to improve the format of evidence summaries.Method:This study used an explanatory sequential mixed method study design. First, a survey was used to identify the views and experiences of those who were directly involved in crisis response in different contexts, and who may or may not have used evidence summaries. Second, the insights generated from the survey helped inform qualitative interviews with decision makers in crisis-settings to derive an in-depth understanding of how they use evidence summaries and their desired format for evidence summaries.Results:Twenty-six decision-makers working in health and humanitarian emergencies were interviewed. The study identified challenges decision makers face when trying to find and use research evidence in crises, including insufficient time and increased burden of responsibilities during crises. Decision makers preferred the following components in evidence summaries: title, target audience, presentation of key findings in an actionable checklist, implementation considerations, and assessment of the quality of evidence presented. The study developed an evidence summary template with accompanying training material to inform real-time decision making in crisis settings.Conclusion:The study provided a deeper understanding of the preferences of decision-makers working in health and humanitarian emergencies regarding the format of evidence summaries to enable real-time evidence-informed decision-making.
Keeping our Healthcare Workers Safe–Ebola and COVID-19
Authors: Turang Yanti 
Published: June 2023

Introduction:Over the past decade, the world has wrestled with two major pandemics: Ebola and COVID-19. While Ebola revealed that we needed a strategy, Covid-19 showed we still didn't have one. Apart from ensuring that we isolate and contain the virus, one of the major concerns in responding to a pandemic is limiting transmission to healthcare personnel.Method:This presentation describes a clinician's experience with employing the same infection control strategies used for Ebola in a makeshift Ebola Treatment Unit in a school in Sierra Leone and at a COVID-19 alternate care facility built in a convention center in the US.Results:Transmission control strategies used for healthcare workers during Ebola were also successful for COVID-19. Both facilities, despite grossly different access to financial resources, ensured all clinicians didn’t break protocol of safety, due to rigorous donning and doffing entrances and exits, internalized individual risk, separated spaces with tape, and zoned areas.Conclusion:Two facilities with access to vastly different resources to treat two distinct infectious diseases used the same infection control measures for staff with success. Highlighting the priority of internalization of risk by healthcare workers alongside critical infection control measures proves to be the most valuable resource over multi-million dollar facilities erected during COVID.
Straddling the Fields of Disaster Preparedness and Disaster Epidemiology: Lessons Learned from Planning a Study for Implementation Within Weeks of an Unpredictable Natural Disaster
Authors: DiGrande Laura , Frasier Alicia , Martin Maurice , Cummings Stirling , McMichael Joseph 
Published: June 2023

Introduction:Studies on the impact of disasters on communities often occur months to years after the event. Pre- and peri-event details collected from participants may be imprecise or even unobtainable as memory is affected by time. More so, delays in data collection can introduce recall bias when participants with adverse outcomes provide differential responses about exposure. In 2019, the US Centers for Disease Control (CDC) and RTI International designed a study to mitigate these issues by surveying within weeks of a natural disaster to examine associations of preparedness to peri-event exposures, emergency services, and health.Method:Given the unpredictability of natural disasters, a significant challenge for the team was to plan a rigorous study design applicable to several types of severe weather events. This presentation will review our forethought, planning, and resulting strategy, including important considerations related to IRB and OMB applications with unspecified disaster/location details. We will share decision-making on sampling, instrumentation, communication materials, and multi-mode data collection procedures. The impact of delays due to COVID-19 and waiting to select a disaster that met a prior disaster inclusion/exclusion criteria will also be presented.Results:Results are forthcoming. We will present details on RTI’s 2022 survey implementation in the Fort Myers area of Florida within weeks of Hurricane Ian landfall including information on our final sampling strategy, field period, and outcome rates among key community groups and exposures.Conclusion:Conclusions will be presented. Pragmatic lessons learned related to timeline, labor, and other resources will be used to compare our strategy to rapid needs assessment methodology as well as more typical self-report surveys with later post-disaster data collection periods. Researchers working in emergency preparedness/response and disaster epidemiology will have gained a solid understanding of the advantages and disadvantages to planning studies for the immediate aftermath of undefined disasters.
Development of an Enhanced Surveillance and Epidemiology Program to Support the Birmingham 2022 Commonwealth Games in England: Outcomes and Lessons Learned
Authors: Hughes Helen , Jarratt Reece , Harrison Melissa , Logan Sophie , MairJenkins John , Chatt Carol , Elliot Alex 
Published: June 2023

Introduction:The 2022 Commonwealth Games (B2022) was hosted by Birmingham, United Kingdom (UK) from July, 28 2022 to August 8, 2022. As a major global sporting event and mass gathering, B2022 included over 4,500 athletes (from 72 countries and territories) and attracted 1.5 million spectators. Robust public health surveillance and support for health protection incidents was required from the UK Health Security Agency (UKHSA) to protect the health of both those directly involved in B2022, and the local population.Method:UKHSA surveillance activities in the UK West Midlands region were enhanced, utilizing lessons learned from the response to the London 2012 Olympic and Paralympic Games and the 2021 G7 Summit (hosted in England). Enhancements included: adaptation of existing and development of new methods for the identification of increased activity of a range of pathogens/diseases/conditions of particular concern to a mass gathering; standardized daily situation reporting to inform both public health action and the B2022 organizing committee. Three streams of routine UKHSA surveillance data were assessed each day: a UKHSA health protection/clinical management system, statutory laboratory reports of infection, and syndromic surveillance. Bespoke surveillance was also implemented using B2022 health data sources.Results:Enhanced daily surveillance activities successfully met the need for next-day public health surveillance and reporting during B2022. No outbreaks or incidents of public health significance to the Games were identified. Syndromic surveillance reported an increased impact on local health services due to periods of extremely hot weather before and following the competition period, although these impacts were not unique to the Birmingham area.Conclusion:Surveillance and epidemiology reporting for B2022 provided reassurance there were no incidents/outbreaks of public health significance to the Games. The enhancements made will inform future routine surveillance and reporting activities and will be employed for similar activities during future mass gathering events.
Development of the Matrix for Regional Collaboration on Disaster Health Management in the ASEAN Region
Authors: Sutthalak Sukanya , Yanasan Alisa , Utthasit Ob-orm , Kita Taro , Ikeda Shuichi 
Published: June 2023

Introduction:The ASEAN Leaders’ Declaration on Disaster Health Management (ALD on DHM) was adopted at the 31st Summit in Manila in 2017. The Plan of Action (POA) to implement the ALD on DHM was adopted by the ASEAN Health Ministers Meeting in 2019, with Regional Collaboration Committee on Disaster Health Management (RCCDHM) established as a primary implementing mechanism under the purview of ASEAN Health Cluster two and Senior Officials Meeting on Health Development (SOMHD) to operationalize the implementation of the POA with its priority areas and targets to be realized by 2025. The first RCCDHM Meeting was organized in-person in Bangkok in 2020. The RCCDHM is composed of two representatives from each ASEAN member state (AMS), one representative from the ASEAN Secretariat and one representative from AHA Centre, and the secretariat role for the RCCDHM is carried out by the Ministry of Public Health, Thailand. The RCCDHM Meeting decided to develop the Matrix of Detailed Activities (MDA) addressing the five priority areas of the POA-ALD on DHM.Method:The RCCDHM Meeting organized a core group consisting of the Philippines and Thailand to develop the MDA which identifies information on activities, expected outputs, indicators, lead country, source of support, and the timeline for achieving objectives of the POA. During the COVID-19 pandemic, online communication was applied to discuss and coordinate among the AMS.Results:The core group developed the draft MDA in consultation with the ASEAN Secretariat/Health Division. After a series of discussions, the RCCDHM endorsed the MDA which confirms necessary activities and commitment of AMS.Conclusion:The review and endorsement process for the MDA will be elevated to the higher level meetings in the ASEAN Health sector for final approval. The RCCDHM also confirmed to strengthen collaboration with other ASEAN initiatives, non-health ASEAN sectors, UN, or other international partners, and the ARCH Project.
Systematically Identifying and Evaluating Strategies for Strengthening Community Resilience
Authors: Ryan Benjamin , Kako Mayumi , Brooks Bryan , Rahman Moshiur , Rahman Sohel , Hardin Mike , Swienton Raymond , Novak Jeremy , Fink Rok , Simsek Perihan 
Published: June 2023

Introduction:Vulnerable populations were the most impacted by the COVID-19 pandemic. This included those with underlying health conditions, self-employed, low-income, people with limited access to health care, and the elderly. To capture these lessons and identify resilience actions, the Health Emergency and Disaster Risk Management (Health EDRM) Framework was used to guide the application of the Public Health System Resilience Scorecard (Scorecard).Method:This study was conducted in Australia, Bangladesh, Japan, Slovenia, Turkey, and the United States. Participants included emergency professionals, doctors, nurses, environmental health specialists, researchers, and government officials. The Scorecard was used to rank the level of preparedness from 0-5 (5 the highest) for the public health system resilience indicators. Following the individual workshops, recommendations were collated and interpreted to develop consolidated priority actions.Results:The priority actions related to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. To address surge capacity issues, determining whether existing disaster structures have the capacity to provide support for hospitals during patient surges. This could include services that enable telehealth and primary health care to support hospitals during a crisis. Mental health services at the local government level should be evaluated and awareness of ecosystem risks in urban and rural areas needs to increase. Strategies for achieving reciprocal trust are required to enable uptake of public health information, and the extent at which pre-existing chronic health issues are likely to exacerbate needs to be understood and addressed.Conclusion:This study revealed several areas for strengthening public health system resilience. Priority actions relate to addressing needs relating to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. This serves as a framework for transforming public health systems to become more adaptive, flexible, and focused on enabling societies to function at the highest possible level when responding to a disaster or pandemics.
The UK Health Security Agency (UKHSA) Planning, Preparation, and Response to the Birmingham 2022 Commonwealth Games–Learning for Future Mass Gatherings, Including Multi-sport Events
Authors: Cox Caryn 
Published: June 2023

Introduction:The Birmingham 2022 Commonwealth Games (CWG) met the World Health Organization (WHO) definition of a mass gathering: events attended by sufficient people to strain the planning and response resources of a community, state or nation’. It was a key opportunity for the UK in terms of tourism and economy, but a major challenge in terms of the potential for adverse events e.g. infectious disease outbreaks, terrorist attacks. This increased scrutiny and threatened reputational risk. For UKHSA, as a new organization amidst a rapidly changing public health landscape–continued COVID-19 pandemic and increases in Monekypox, this was a very public test.Method:In 2021, a small team was established to accelerate preparation including:
assurance structuresadvice to the Organizing Committee and Government departmentsadvice on COVID-19 including testing policystaff/stakeholder preparation through exercising/trainingincreased staff numbers and skill mix able to adaptbudgetoperational response structureplans in place and tested for a health protection response in the event of an incidentother mass gatherings reviewed for transferable learning enhanced surveillance systemsResults:Daily epidemiology reporting provided reassurance that there were no significant public health issues requiring escalation. Enhanced surveillance provided reassurance to the community that there were no population ill effects linked to the CWG. Overall, COVID-19 positivity was low. No outbreaks were detected linked to the CWG.Conclusion:The UKHSA successfully identified, planned and prepared for and mitigated the risks of a mass gathering of 1.5 million people. Early engagement, support, advice and cross- government collaboration has been regarded as exemplary with surveillance data indicating no outbreaks linked to the Games. Despite the breadth of risks visitors were able to attend the event in contrast to the restrictions placed at the Tokyo Olympics. This contributes to the worldwide body of knowledge for planning and delivering mass gatherings – sporting or otherwise.