bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mapping Acute Care Systems’ Surge Capacity and Response Priorities – the ‘7S’ Framework Tool
Authors: Martin Bronte L. 
Published: November 2022

Background/Introduction:During health emergencies, significant disruptions occur concurrently within critical components of acute care systems such as workforce, medical supplies, clinical workflows, patient care pathways, and hospital essential support services. The ability to map both existing and surge capacities across the acute care health system is a complex, nuanced, and often lengthy process which is heavily dependent upon localized knowledge applied in specific, individual contexts.Objectives:Outline an innovative, “All Hazards” tool developed through a standardized framework approach to rapidly and consistently identify, assess, and prioritize key system-wide health capacity indicators in acute care hospital settings during health emergencies.Method/Description:Initially designed as a health systems preparedness and planning tool for use in sudden-onset disasters in 2017, the “7S” framework has been successfully applied during recent AUSMAT outbreak emergency responses to assist local Ministries of Health to effectively identify, articulate, rationalize, and prioritize clinical and operational health response priorities.Results/Outcomes:Multiple operational health leaders found the “7S” framework valuable in efficiently managing both the assessment of and priority allocation of resources in health systems under duress. The tool was simple to understand and explain, time efficient, and comprehensive. Additionally, the tool provided an effective structure for communicating with local health and response leaders.Conclusion:The “7S” framework has demonstrated excellent utility as a highly effective and scalable, locally adapted “All Hazards” tool for use during health planning, preparedness, and acute care response phases in diverse health emergencies contexts.
The Ethical Triage and Management Guidelines of the Entrapped and Mangled Extremity in Resource Scarce Environments: A Systematic Literature Review
Authors: Weinstein Eric S. , Gosney James E. , Hebert Teri Lynn , Weinstein Brielle , Ragazzoni Luca 
Published: November 2022

Background/Introduction:While there are accepted triage and treatment guidelines for the entrapped and mangled extremity in civilian and military resource rich environments, there are none for resource-scarce environments.Objectives:A PRISMA systematic literature review was performed to elucidate the current triage and treatment of the entrapped and mangled extremity to understand the factors that contribute to the decision to amputate, or not amputate, and to extract data to develop clinical guidelines.Method/Description:A lead researcher followed the PRISMA systematic literature review search strategy inclusion and exclusion criteria.A first reviewer was randomly assigned sources. One of the two lead researchers was the second reviewer. Each determined the Level of Evidence (LOE) and Quality of Evidence (QE) from each source.Results/Outcomes:Five-hundred ninety-seven (597) records were screened. Fifty-eight (58) articles were entered into the final study. There was one study determined to be LOE-1, 29 LOE-2, and 28 LOE-3 with 15 determined to achieve QE-1, 37 QE-2, and six QE-3.Data extracted included relevant information to develop clinical guidelines to include physiologic parameters, injury patterns or procedures, imaging, rehabilitation, ethics, and the informed consent process.Conclusion:This systematic literature review showed that there is a lack of studies producing strong evidence to support the triage and treatment of an entrapped or mangled extremity in resource-scarce environments. A Delphi method study is suggested to adapt and modify available evidence extracted to create clinical guidelines in the resource-scarce environment.
Stress and Burnout Levels among Emergency Medical Technicians Working during COVID-19 Pandemic: A Cross-Sectional Study in Spain
Authors: Amor Tahreer , Delgado Rafael , González Pedro , Viñuales Eduardo 
Published: November 2022

Background/Introduction:Among all health care workers, EMTs have played a notable role during COVID-19; working as a frontline, they faced many challenges, including working overload and an extremely cautious environment that requires a rapid and precise response, which led to experiencing higher severity of mental health symptoms.Objectives:To explore the association between stress and burnout among EMTs while working during the COVID-19 pandemic.Method/Description:A cross-sectional quantitative study with a descriptive design. It was conducted from March-April 2021 on 280 Spanish EMTs, using an online survey of 42 items about workload and working conditions during COVID-19 and other variables specific to COVID-19. The Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), and Pearson’s correlation coefficient were used to determine the relationships between the variables.Results/Outcomes:The study revealed a moderate positive correlation between the perceived level of stress and burnout among the EMTs. Specifically, findings showed a strong positive correlation between stress and EE (0.62) and a moderate positive correlation with DP (0.48). However, it found a moderate negative correlation between the level of stress and the third subdimension of burnout, PA (0.45), where the increase in the stress level correlated with a decrease in PA of the EMTs.Conclusion:Burnout might be related to the persistent stress of the EMTs working during the COVID-19 pandemic, considering their work conditions and the socio-demographic variables. The mental health of the first responders is crucial, as it influences their achievement and works satisfaction, and it might affect the quality of the service they provide.Tables and Figures (optional)Table 1.Pearson Correlation: Correlation between the Stress and Burnout among the Emergency Medical Technicians (n = 280)
Mental Health in Disaster Medical Response Teams: An Assessment of Existing Resources and Applications for Telemedicine
Authors: Woodward Christina A. , Voskanyan Amalia , Benham Todd L. , Issa Fadi S. , Hart Alexander , Ciottone Gregory R. 
Published: November 2022

Background/Introduction:Disaster responders operate in situations that are cognitively, emotionally, and morally distressing. The prevalence of mental health sequelae amongst disaster responders is well-documented. The World Health Organization (WHO) has published minimum standards for Emergency Medical Teams (EMTs), which requires them to assess the mental health and psychosocial support needs of their patients and staff, provide first aid, and ensure referral pathways for follow-up care are available. Specific to EMT staff and volunteers, the standards require that support services are always accessible. However, there is no requirement for EMTs to have their own mental health specialists, nor is having a mental health specialist assigned to each team and mission necessarily practical.Objectives:This study will assess the existing mental health resources of WHO EMTs and their use of telemedicine in mental health care.Method/Description:A survey will be distributed to the leadership of all WHO EMTs that are currently credentialed to capture descriptive statistics.Results/Outcomes:Data expected to be collected and analyzed by October 1, 2022.Conclusion:The absence of a mental health specialist significantly limits the availability of support services for EMT personnel. Given that the use of telemedicine in both disaster response and mental health services has been well-documented, telemedicine could be a low-resource method to link WHO EMT staff and volunteers with mental health specialists throughout the deployment cycle.
Tonga’s National EMT Response to the Hunga-Tonga Hunga-Ha’apai Volcanic Eruption and Tsunami
Authors: Poloniati Penisimani , Akauola Ana , Fusi Sela K. , Setoya Yutaro , Tavo Kaloafo , Casey Sean T. 
Published: November 2022

Background/Introduction:The Tonga Emergency Medical Assistance Team (TEMAT) responded to the Hunga Tonga-Hunga Ha’apai (HTHH) volcano and tsunami in early 2022. The HTHH volcano erupted violently on January 15, 2022 triggering a tsunami that struck many of Tonga’s 169 islands.1 84% of the country’s population was affected.2 Tonga’s undersea internet cable was cut, stopping most communication. At the time of the eruption/tsunami, Tonga was COVID-19-free with its borders effectively closed, forcing reliance on national emergency resources, including TEMAT.Objectives:Describe TEMAT’s response to the 2022 HTHH volcano eruption and tsunami.Method/Description:TEMAT deployed four rotations of clinical and public health teams in response to the eruption/tsunami. Team members included clinicians from the Ministry of Health, with logistics support from His Majesty’s Armed Forces. TEMAT carried out emergency assessments, facilitated medical evacuations, aided in the evacuation of an entire island’s population, and provided essential health services.Results/Outcomes:From January 17 through March 4, 2022, TEMAT cared for 381 patients including patients with non-communicable diseases (>50), psychosocial complaints (39), communicable diseases (27), and traumatic injuries (13). The team supported five referrals to higher level care, conducted patients home visits, aided in health center repairs, and responded to a boat sinking during their deployment.Conclusion:TEMAT’s deployment demonstrates that deployment-ready and self-sufficient national EMTs are essential for response to sudden-onset disasters in vulnerable countries. A trained and well-prepared national EMT can respond independently, quickly, and effectively to emergencies, despite limited resources and high-impact events.
Review of the Senegalese Military Emergency Medical Team (EMT) Deployment Following a Tanker Explosion in Freetown, Sierra Leone
Authors: Kamara Rashidatu Fouad , Oyugi Boniface , Kamara Ibrahim Franklyn , Kabba Mustapha , Relan Pryanka , Baldé Thierno 
Published: November 2022

Background/Introduction:In November 2021, a tanker exploded in Freetown, injuring and killing people. The WHO facilitated a seven-week first deployment of the Senegalese military to support the Ministry of Health (MOH) in providing care to the wounded in three referral hospitals.Objectives:Review the deployed team’s processes and outputs of medical care provided to burns patients.Method/Description:This is a cross-sectional After-Action Review (AAR) debrief of the deployment, including the WHO and MOH staff (n =14) in a virtual workshop. Six thematic areas: mobilization, deployment, coordination, case management activities, national capacity, and community acceptance were analyzed.Results/Outcomes:The WHO facilitated the team’s deployment and mobilized medical supplies and equipment whilst the MOH provided accommodation and logistics through collaboration. The team dispensed their functions with professionalism, adapted to the environment and available resources, and augmented the care provided by the available health workers. They offered additional care: reconstructive surgery, pain management, palliative and wound care, rehabilitation, physiotherapy, and psychosocial counselling, which were initially inadequate. 87 out of 155 patients were discharged home at the end, the national clinicians acquired additional skills, and the community appreciated the team. Despite being perceived as a weakness, the language barrier did not hinder the patient-doctor/nurse relationship or the provision of clinical care.Conclusion:This sub-regional response had significant benefits, including speed, political acceptability, and health context experience to support rapid and safe deployment. Mechanisms to facilitate rapid and quality-assured deployment of EMTs at regional and sub-regional levels in collaboration with WHO should be strengthened in region to support future responses.
Establishing a National Emergency Medical Team in the Republic of Palau
Authors: Uherbelau Gaafar J. , Mekoll Ngirachisau , Omengkar Wally , Casey Sean T. , Noste Erin E. , Ferguson May M. 
Published: November 2022

Background/Introduction:Palau is a small island/large ocean nation in the Pacific with a population of approximately 18,000 and a high level of vulnerability to natural or climate-related disasters. In June 2022, Palau became the smallest nation in the world by population to establish a national Emergency Medical Team (EMT). The team is named “Klemat,” after the rope that holds the sails of Palau’s traditional canoes.Objectives:To establish a national EMT capable of self-sufficient, high-quality clinical response to disasters and outbreaks that may occur locally or in neighboring jurisdictions.Method/Description:The development of Klemat required a multi-step process with support from technical and funding partners. Online orientation webinars and meetings were held in 2019 and 2020, and a national Technical Working Group (TWG) was formed in 2022. A national EMT coordinator was jointly hired by the WHO and the Ministry of Health and Human Services of Palau in 2022, and EMT Standard Operating Procedures were drafted.Results/Outcomes:Klemat is the nation’s deployable clinical response capacity, capable of fully self-sufficient tented out-patient and emergency care in the most austere disaster or outbreak circumstances. There are now 18 fully trained clinical and support team members. Klemat is working with relevant stakeholders to be codified in the national disaster risk management framework of Palau.Conclusion:Palau’s development of a national EMT demonstrates that even the smallest of countries can establish self-sufficient EMTs capable of national or regional response.
Multi-Agency Collaboration Leading to WHO EMT Classification: The Korea Disaster Relief Team
Authors: Choi Eun-Young , Choi Wonmi , Ko Ara , Oh Yigyeong , Kwak Hyemin , Jung Eui Yup 
Published: November 2022

Background/Introduction:The Korea Disaster Relief Team (KDRT) was established in 2008 to systemize Korea’s overseas medical emergency response. Following multiple international deployments since 2008, KDRT embarked on its journey to achieve WHO Emergency Medical Team (EMT) Global Classification in 2017.Objectives:To outline the key success factors in KDRT’s work to reach classification as a Type 1 Fixed EMT.Method/Description:As the Korean government dispatches KDRT, a multi-agency collaboration is essential to respond to overseas disasters. To this end, KDRT leveraged a formal collaborative approach, assigning specific roles for EMT development and deployment to several national agencies: The Republic of Korea Ministry of Foreign Affairs, the Ministry of Health and Welfare, the Ministry of National Defense, the Korea International Cooperation Agency, Korea’s National Medical Center, and the Korea Foundation for International Healthcare. This network prepared KDRT for WHO EMT Verification and developing Standard Operation Procedures for the EMT Type 1. Based on this SOP, KDRT repeated simulations for each element to strengthening capabilities and enable deployment ensuring strong coordination with national and international partners in response.Results/Outcomes:After initiating KDRT’s journey towards EMT classification 2017, KDRT formalized cooperation with multiple agencies, and codified these roles and responsibilities in formal/published SOPs. Finally, the KDRT was verified by WHO in June 2022.Conclusion:This study provides a process within the operating system limited to the Republic of Korea, the country of the KDRT. However, it also can be used as a collaborative reference case in the EMT development and verification process.
Health Care Systems on the Brink of Failure – The Impact of War on the Pattern of Emergency Health Care Visits by Ukrainian Refugees in Poland
Authors: Goniewicz Krzysztof , Hertelendy Attila J. , Khorram-Manesh Amir 
Published: November 2022

Background/Introduction:One of the most severe outcomes of the Ukraine war has been the systematic destruction of communities resulting in mass migration of people to Poland. Millions of affected people have arrived in Poland as war refugees requiring medical attention from a fragile health care system overburdened by the COVID-19 pandemic. This study assesses ED utilization in Polish hospitals by Ukrainian refugees.Objectives:To assess the impact of Ukrainian refugees on ED utilization in Poland.Method/Description:Demographic data, chief presenting complaints, diagnosis, and the level of care needed were registered. Bivariate and multivariate logistic regression analysis were performed to yield odds ratios (OR) with a 95% confidence interval.Results/Outcomes:At the time of investigation, there were 4,000 Ukrainian refugees admitted to Polish hospitals, of which more than half were children. Results are forthcoming.Conclusion:Although COVID-19 pandemic highlighted the insufficiency of the Polish health care system, resulting in delayed treatment for many patients, the current mass migration from Ukraine emphasizes the lack of a proper organization for crisis management in Poland. Facing an unprecedented and historic challenge, the Polish health care system, operating at the limit of its capacity, is stretched beyond capacity resulting in excess mortality, which exceeded 200,000 deaths during the pandemic. The impact was directly due to the pandemic or the delay in treating other diseases such as cardiovascular diseases and cancer. Inconsistency in medical decision making, lack of proper recommendations from the authorities, and organizational insufficiency requires a renewed focus on adaptive capacity and long-term solutions that promote systems resiliency.
Emergency Medical Teams (EMT) Education and Training – Improving Disaster Preparedness with the Portuguese Emergency Medical Team (PT EMT) E-Learning Course
Authors: Ladeira Luis Manuel , Cardoso Ivo Manuel , Correia Ana Margarida , Rato Fátima 
Published: November 2022

Background/Introduction:EMT’s training is considered of high importance for disaster preparedness and response. The PT EMT, joined the TEAMS 3.0 Consortium, seeking to develop a universal training program for EMTs.Objectives:The purpose of this study is to evaluate the effectiveness of the PT EMT E-learning Course in preparing trainees for disaster during their EMT initial training.Method/Description:The analyzed data were collected through the application of a final questionnaire, which aimed to assess the effectiveness of the topics covered and the self-perception of disaster preparedness. A total of 31 trainees attended the E-learning Course, but only 25 answers were collected.Results/Outcomes:The results showed that 92% of the trainees considered as the most important themes three areas: (1) Disaster and Humanitarian Principles; (2) Safety & Self-Protection; and (3) Disaster Logistics. The overall mean score was 4.52 points (SD = 0.770) out of five for the importance of this training for the performance of their mission roles and 4.48 points (SD = 0.770) in the contribution of these contents to their individual development. After completing this E-learning module, 88% consider themselves better prepared to disaster response and to attend the practical module of the initial training program.Conclusion:The PT EMT E-learning Course, preceding the practical TEAMS 3.0 course, proved to be effective in the preparation of trainees for the practical training, but especially, it adds a huge variety of important knowledge, solidifying their preparedness for disaster response.The development of common training bases for EMTs, with both modules, will improve the disaster preparedness and response.
Opportunity Cost Analysis for Emergency Medical Teams: A Tool for Policy Making Support
Authors: Negrette Juan Carlos 
Published: November 2022

Background/Introduction:To some planners, allocating resources for emergency response may look unnecessary if not wasteful. Low-probability events can be perceived as unlikely, and for that reason, not worth considering within the regular planning structure. This is almost a dictum when planners must operate in a low-resource setting, where competition for available resources favors an approach that focuses in addressing pressing, not eventual needs.Objectives:Understanding this context, it is also important for planners to consider the importance of systemic resiliency, implicit in the early utilization of Emergency Medical Teams for disasters mitigation, and for that reason, as necessary instruments to reduce impact - in terms of lives lost - and cost - financial and social - of medical emergencies that result from natural and man-made disasters.Method/Description:Conducting an adverted DALYs cost analysis of a recent disaster is an instrument that could help policy, decision makers, and planners in general gain greater visualization of the potential social and financial costs reduction associated to the implementation of EMTs and, as a corollary, acknowledge the importance of preparation for necessary systemic resilience and its impact in equity and societal well-being.Results/Outcomes:Initial analysis shows that preparation for early responses by EMTs to mitigate disasters can result in lower costs while reducing overall mortality and morbidity and potentially favoring faster systemic recovery.Conclusion:The approach utilized requires improvement and expanded discussion with experts and beneficiaries will most likely result in its refinement and advancement.
Predicting the Demand for Medical Care in Disaster-Affected Areas using the Minimum Data Set and Machine Learning
Authors: Igarashi Yutaka , Kubo Tatsuhiko , Toyokuni Yoshiki , Yokobori Shoji , Koido Yuichi 
Published: November 2022

Background/Introduction:The Minimum Data Set (MDS) has allowed governments of disaster-affected countries to collect, examine, and evaluate standardized medical data from Emergency Medical Teams in real-time. However, little study has been conducted on the use of MDS data to predict health care needs.Objectives:This research proposes an outlook on the use of machine learning and MDS data to predict the need for medical care in disaster-affected areas.Method/Description:The characteristics of the data collected by MDS and the optimal machine learning model were discussed.Results/Outcomes:The primary causes of disease after disasters are trauma (MDS Nos. 4–8), which frequently occurs immediately after a disaster, and infectious diseases (MDS Nos. 9–18), which can increase due to decreasing hygiene conditions. Furthermore, certain infectious diseases can spread quickly because of living in congested evacuation centers, and early detection is crucial.Therefore, predicting the need for medical care in a disaster area is complicated and requires a combination of many machine-learning models. Data-driven methods are mostly linear approaches and cannot capture the dynamics of infectious disease transmission. Additionally, statistical models depend heavily on assumptions, making real-time infection prediction challenging. Thus, deep learning is employed to model without losing the temporal component.Conclusion:Real-time prediction of health care needs using machine learning and MDS can be useful to policymakers by enabling them to better deploy and allocate health care resources, which is useful to patients and front-line health care providers. More detailed predictions for regions and diseases are also anticipated.