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Exposure to toxic fumes from an industrial chemical fire may not only lead to airway burns and inhalational injury but also toxic exposure via the transdermal route.
Method:
A 45-year-old gentleman presented with dyspnea two hours after a ten-minute exposure to toxic fumes while fighting an industrial chemical fire without personal protective equipment. He reported voice hoarseness and chest tightness. Nasoendoscopy demonstrated paranasal sinus soot and significant upper airway edema. Awake fiber-optic intubation was performed for prophylactic airway protection in the Burns ICU but bronchoscopy did not reveal any inhalational burns.
However, the patient developed worsening lactic acidosis (serum lactate 2.8mmol/L to 8.1mmol/L with pH 7.28) within 12 hours post-exposure. Carboxyhemoglobin was 0.9%. Toxicology was consulted for suspicions of transdermal HAZMAT contamination, in particular cyanide given the profound lactic acidosis. The patient was given two doses of hydroxocobalamin and brought to the Hospital Decontamination Unit for de-gowning and thorough wash-down. The chemical scan meter showed high levels (352IU) of an unknown chemical on his skin pre-decontamination, which could not be detected post-decontamination. Lactate improved to 5.0mmol/L within two hours post-decontamination while acidosis resolved at eight hours post-decontamination. The patient was extubated and discharged without sequelae.
Results:
To our knowledge, no other human cases of transdermal cyanide poisoning have been reported. Cyanide interferes with mitochondrial oxidative phosphorylation pathways to cause toxicity and death if untreated. However, its effects via transdermal exposure are often delayed compared to exposure via more conventional inhalational routes. This makes recognition difficult and compounds the challenge of long turnaround time for blood cyanide tests. Increased transdermal absorption is possible through intact skin if moistened by sweat.
Conclusion:
The potential for transdermal HAZMAT absorption from exposure to toxic fumes is underrecognized. It is crucial to maintain vigilance given the challenges in diagnosing transdermal cyanide toxicity and importance of initiating treatment early.
Collecting real-time individual health data of all disaster-affected populations is usually considered impossible. The University of Kochi's team and its partners conceived a novel health assessment system named "Community Oriented Approach for Comprehensive Healthcare in Emergency Situations (COACHES)." It collects individual health data anonymously and records such data in a cloud-based database. The system runs on any personal mobile device by scanning a personal identification code (QR code). It is expected that anyone on site with qualifications in healthcare will run this system as a volunteer to ensure data reliability. The COACHES app development is in process, and its prototype is currently available. This study aimed to assess how people react to the novel system and see the feasibility of installation in Japan.
Method:
Two focus group interviews (FGI) were conducted in a small coastal village in western Japan. The village anticipates severe damages with days of isolation once a large-scale earthquake followed by a tsunami hits the area. The first FGI was held with nine purposively recruited participants. The second FGI was held one month after and included seven of the first FGI participants with one of the absent participants providing a written response. FGI was for one-hour each, with discussion following the system demonstration. The voice data during the FGI were recorded and analyzed. The research was approved by the University of Kochi IRB.
Results:
Some showed intense interest in the system, whereas concerns such as the privacy violation for using personal devices, the availability of healthcare personnel, or a fear that anonymous data collection may delay identifying a person in need of assistance.
Conclusion:
Further studies are proposed, particularly in recruiting volunteers, data storage in case of technical damage, and how to make people with limited IT literacy comfortable using the new system.
On February 24, 2021, a large explosion and fire occurred in an industrial estate in Singapore. Eight casualties with major burns were conveyed to the emergency department (ED) at Singapore General Hospital, the designated regional Burns Centre. This article details the events and recommendations arising from this multiple casualty incident.
Method:
An After-Action Review (AAR) was conducted to examine the prehospital notification process, casualty triage & tagging, medical management, manpower and resource allocation, and command-and-control structure.
Results:
All eight casualties were conveyed by the national Emergency Medical Services (EMS) and arrived within a 46-minute window. The first three suffered 90% full-thickness burns and inhalational injuries and were intubated. The remaining five suffered between 37% to 64% burns, with three requiring intubations as well.
Four major areas were identified for improvement:
Firstly, there was scant information from EMS regarding total casualty count. There was also inadequate knowledge of mass burns triage protocols in the ED. Thus, resources were heavily utilized for the first three casualties - all of whom were later deemed unsalvageable, given palliative care and demised.
Secondly, casualty identities were initially unknown. They were tagged with similar-looking ten-digit serial numbers, resulting in a near-miss event involving mislabelled blood tubes.
Thirdly, there was unfamiliarity with the incident response plan for a multiple casualty incident of this scale. This contributed to lack of situational oversight and inconsistent leadership direction from various stakeholders with resulting conflicting instructions.
Fourthly, routine trauma computed tomography pan-scans for all casualties caused delayed reporting by Radiology and created a bottleneck in casualty disposition.
A multi-disciplinary workgroup comprising Emergency, Trauma, Burns and Intensive Care departments outlined several recommendations based on the AAR findings. Drills were strongly recommended to resume following a hiatus due to COVID-19.
Conclusion:
AARs help provide invaluable insights. Response plans should be refined together with relevant stakeholders.
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.
Disaster medicine education is a huge challenge, but essential to disaster preparedness. While natural disasters have always been a part of world events, recent large-scale natural and man-made disasters have drawn attention to disaster medicine. As a consequence, medical schools in many parts of the world have begun to incorporate disaster-related topics into their curricula. However, in the territory of the former USSR, disaster medicine has just begun its development, and at the moment it is represented only in a couple countries, including Kazakhstan.
Method:
Data collection was performed using a database search through the Ministry of Education and Ministry of Healthcare of the Republic of Kazakhstan, Uzbekistan, Kyrgyzstan, Russian Federation, Belarus, and Ukraine. Disaster Medicine curricula on different education levels, including bachelor, graduate, and postgraduate levels were reviewed and analyzed.
Results:
Even though Kazakhstan is the ninth largest country in the world, education in the field of disaster medicine is currently represented only in one medical university in the country: specialists in disaster and emergency medicine are trained in residency and master's programs. In the Republics of Uzbekistan and Kyrgyzstan, education in the disaster medicine field is not provided, but there are electives for bachelor students. The Federal Center for Disaster Medicine, located in Moscow, offers doctors advanced training in disaster medicine, also disaster medicine education is provided at the bachelor and residency levels all over the Russian Federation. In Ukraine, at the moment, there is no training of specialists in disaster medicine, while in Belarus there are curricula at all levels of education.
Conclusion:
Despite the fact that our life is impossible without catastrophes, most of the post-soviet countries are not having educational programs in disaster medicine. Using international experience could be beneficial so that every country will be prepared to face any disaster both locally and globally.
Low/middle-income countries (LMIC) in Africa face unique, systemic challenges in medical education. Africa faces a shortage of medical schools; only one school serves 24 countries. 11 countries have no medical school. Residency programs are few. The effect of this shortage is far-reaching. Africa has 3.5% of the world’s health workforce and 1.7% of the world’s physicians, yet 27% of the global disease burden. COVID-19 created further resource constraints, especially in emergency medicine (EM). Non-clinical physician functions such as student and resident education suffered. In Rwanda, we implemented a pre-recorded, remote teaching model to substitute in-person instruction. This study evaluates whether remote teaching is received positively by EM learners and whether it is a viable alternative during times of limited in-person availability.
Method:
28 lectures were recorded by American EM faculty. The recordings were presented to Rwandan EM residents within their standard didactic curriculum. Lecturers were available in real time via Zoom. Topics were chosen by Rwandan faculty based on curricular needs. Program evaluation followed the Kirkpatrick framework. Attendees completed a post-lecture Likert-scale survey assessing the first Kirkpatrick level related to satisfaction, lecture and learning method quality, and suitability. Qualitative and free-response data was also collected.
Results:
Responses were analyzed with descriptive statistics using means and standard deviations. The mean response range across questions was 3.6-4.3 (1 = worst, 5 = best); the standard deviation range was 0.4-1.6, indicating an overall positive result. Qualitative feedback, which reached saturation, did not indicate significant dissatisfaction with the quality or suitability. Points for improvement included lecturer accents and rate of speech.
Conclusion:
When in-person lecturers are unavailable, pre-recorded and remote instructional methods may be a suitable substitute. Future directions may include piloting the project with a multinational cohort or in LMICs with greater technological or resource limitations, and assessing higher Kirkpatrick framework objectives.
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.
Emergencies provide opportunities for deep systemic intra-action and after-action reviews, followed by changes and adaptations that are aimed at enhancing resilience against future health emergencies. One of the most prevalent lessons learned from the COVID-19 pandemic is the need to intensify the investment in the health workforce. Diverse groups of health workers have brought their expertise from the benches to patients’ beds, and the desks of the decision-makers.
Method:
Match skill mix of health staff with the needed level of care: those with mild diseases can be cared for by basic nursing staff. Critical patients require advanced skilled nursing that is familiarized with advanced technologies such as ECMO, and use “out-of-the-box” thinking.
Developing the capabilities of the communities and civil society organizations to respond to emergencies. Cooperation agreements with partners that are not involved in medical care during “regular days” should be set before emergencies strike.
Formulate civil-military-police cooperation as well as the Good Samaritan Law is an important legal instrument to allow for humanitarian aid from within and outside the country.
Results:
Matching the skill mix of the health staff with the needed level of care for basic nursing for minor patients as well as advanced nursing for critical patients, while using “out of the box “ thinking to develop a high level of knowledge is important to maintain quality care during emergencies.
Conclusion:
The COVID-19 pandemic and other emergencies provide us with the opportunity to switch from bouncing back to bouncing forward, and from just coping to anticipating and transforming. Investing in the health workforce would enhance preparedness and readiness so that emergencies will not turn into disasters and crises. The presentation will highlight some of the new approaches and methods applied during the COVID-19 outbreak, as well as those applied in countries that are faced with wars and military conflicts.
Although prehospital emergency care in a civilian versus military context may differ in terms of working conditions and injuries, in both contexts the exposure to stressful and extreme events are present. Besides the continuous reports of post-traumatic stress symptoms, an alarming increase of burnout and suicide in (emergency) physicians is recognized as well. However, most of the research on this topic is either retrospective or peri-recovery, which might have an impact on the availability of information with regard to causes and underlying processes. Hence, in the current study, we conducted an in-depth study of well-functioning emergency caretakers, studying their profile while including their perspective on both their professional and personal context and the interconnectedness with their operational performance.
Method:
We used a mixed method approach, combining the results of a quantitative questionnaire and a thematic analysis of 23 in-depth semi-structured interviews to gain additional qualitative information. We interviewed well-functioning and operating prehospital emergency professionals, recruited in three different settings, i.e., a military hospital, a military Special Operations Surgical Team, and a civilian hospital in the capital city.
Results:
The quantitative part showed a preference for task-oriented coping. However, the interviews broadened this result, showing how the personnel are continuously seeking to find a balance between emotional connection and disconnection. Several risk-factors for mental injury were detected and the support and recognition from both the personal and professional environment showed to be crucial in finding a balance between job passion and the sacrifice of one's personal life.
Conclusion:
The interviews showed that a variety of interrelated underlying professional and personal factors are related with how emergency personnel perceive and cope with stress events. A systemic approach to prevent mental health problems is highly recommended.
Health Organizations (HOs) worldwide are vital to any nation’s capacity to withstand crises. The COVID-19 pandemic increased the HOs’ awareness of the importance of Organizational Resilience to ensure Operational Continuity during crises.
This study aimed to identify the main elements affecting HOs’ resilience, to enable their application in long-term processes of capacity building.
Method:
A cross-sectional study examining the level of organizational resilience in HOs was performed, in a general hospital (group A) and one region of Emergency Medical Services–EMS (group B). A structured questionnaire, consisting of 29 items, was developed, validated, and subsequently used to assess organizational resilience. The questionnaire encompassed: ethos, organizational culture, leadership and human capital, situational awareness, adaptability, organizational performance, and learning ability.
Results:
The respondents included 225 participants from the hospital and 214 from the EMS. Both HOs presented a high level of organizational resilience (average score among hospital and EMS personnel was 3.79 versus 3.91 respectively).
In a multivariate linear regression test, the factors found to predict the organizational resilience (in both organizations) were education (academic/non-academic), gender (male/female), and two age groups (20-30 & 31-40).
These factors explained 11% of the organizational resilience. Other factors such as profession or seniority at work, were found to be non-significant.
Conclusion:
As the operational continuity of health organizations is vital during crises, the developed evaluation tool contributes to the capacity of managers and policymakers to continuously monitor the level of organizational resilience. In line with the factors identified as predictors of organizational resilience, health managers should focus on educational interventions to increase their organization’s resilience. It is recommended that follow-up studies be initiated to examine additional variables that may predict the level of organizational resilience.
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.
The mission of the medical department in the Home Front Command is to support the preparedness of Israel’s health system for emergencies, both in day-to-day routine and during wartime. This is achieved by practicing emergency scenarios in all general hospitals, including biological, chemical, and radiological mass-casualty events.
Method:
Implementing an annual drill plan in all general hospitals and practicing emergency scenarios, including non-conventional events such as mass toxicological events and radiological mass casualty events.
Results:
The presentation describes the hospital radiological and chemical mass casualty event doctrine and the drills performed in hospitals to achieve better preparedness.
Conclusion:
The drills conducted in the general hospitals in Israel enable better preparation for CBRN emergency scenarios.
In November 2022, a group of eleven Irish doctors traveled to St. Joseph’s Hospital, Nyabondo, Kenya with Global Emergency Care Skills (GECS), an Irish NGO. The group delivered a training course to healthcare staff in the hospital, in advance of the scheduled opening of a regional Major Trauma Center on site. This course incorporated didactic lectures, skills stations and simulated clinical scenarios and covered commonly encountered emergency presentations in low and middle income countries (LMICs).
Method:
A qualitative study was conducted using a free text questionnaire with faculty, exploring their experiences of education in a resource-limited environment. Responses were interpreted by performing thematic analysis to identify recurring themes.
Results:
All eleven faculty members completed the survey in full. An interrogation of the responses identified commonalities across the majority of faculty members. The main themes encountered were increased recognition of the lack of postgraduate training in LMICs, the challenge of devising material appropriate to a resource-limited setting, a growth in confidence and individual teaching ability, and a reaffirmation of the effectiveness of simulation teaching in medical education.
Conclusion:
This survey demonstrates the significant impact of teaching such a course on faculty members. Despite the challenges encountered, faculty members strongly felt that simulation training offered significant benefits. Survey respondents noted that moulage could be adapted to suit the needs of course participants without compromising on educational goals. In the absence of formal postgraduate education in LMICs, external agencies continue to play an important role in the delivery of structured training programs.
Violence against healthcare workers (HCWs) and lack of public trust threatens the foundation of the physician-patient relationship in Trinidad. The primary aim of this study was to determine the prevalence of violence against Trinbagonian HCWs in the public sector. Secondary objectives included determining risk factors for violence and mistrust between the public and providers.
Method:
A cross-sectional analysis of 434 Trinbagonian HCWs in the public sector was conducted using a modified World Health Organization (WHO) data collection tool, distributed via social media and administrative emails, and snowballed for two months. Fifteen semi-structured interviews were conducted regarding trust in the healthcare system with patients selected from various communities.
Results:
Of the 434 respondents, 45.2% experienced violence and 75.8% witnessed violence against HCWs in the past 2 years. Verbal abuse (41.5%) was most common. Perpetrators were patients (42.2%) and patients’ relatives (35.5%). Chi-square analysis highlighted that HCWs with the highest probability of being abused were aged 25-39 (63.8%), had 2-5 years of work experience (24.9%), specialized in emergency & internal medicine (48.6%), and cared for psychiatric & physically disabled patients (p-value <0.001). HCWs believed the threat of violence negatively impacted their performance (64.5%), and further action was necessary for mitigation (86.4%). Patients interviewed doubted physicians' altruism, competence (80%) and honesty (53.3%), expressed mistrust in their physician (46.7%), and cited poor infrastructure/management (66.7%) and dissatisfaction with care (60.0%) as factors that contributed to violence.
Conclusion:
Analysis revealed that violence against Trinbagonian HCWs in the public sector deteriorated patient experience and adversely affected psychological well-being, efficiency, and job satisfaction. Results suggested mistrust of HCWs by the population. Interventions should be instituted to support at-risk HCWs and educate the public to avoid recurrence.
Helicopter emergency medical services (HEMS) personnel provide on-scene trauma care to patients with high mortality risk. The HEMS work context is characterized by an exceptionally high exposure to critical incidents, emotionally demanding patient encounters, and having to perform under pressure with limited resources. The aim of this study was to further our understanding of the factors underlying HEMS personnel wellbeing given their challenging work context.
Method:
Sixteen semi-structured interviews were conducted with HEMS personnel from a University Hospital in The Netherlands. Interview topics included work context, personal characteristics, coping, work engagement, and psychosocial support. To analyze the data, a generic qualitative research approach was used inspired by grounded theory, including open, axial and selective coding.
Results:
The analysis revealed ten categories that provide insight into factors underlying the wellbeing of HEMS personnel and their work context: team and collaboration, coping, procedures, informal peer support, organizational support and follow-up care, drives and motivations, attitudes, other stressors, potentially traumatic events, and emotional impact. The findings show that HEMS personnel are highly motivated and have a strong team mentality. Various factors are important to their wellbeing, such as job resources and social support. The HEMS work can have an emotional impact but HEMS personnel use various coping strategies to deal with this. The perceived need for organizational support and follow-up care is low among participants.
Conclusion:
This study identifies factors and strategies that support the wellbeing of HEMS personnel. It also provides insight into the HEMS work culture and help-seeking behavior in this population. The findings may be beneficial to understand and support employee wellbeing in other emergency services work contexts as well.
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.
The concept of disaster related internal displacement is typically seen as something that occurs in low-income countries and is rarely considered in the setting of high-income countries. This leads to a paucity of data to support contextually appropriate best practices to address displacement. This research, funded by the Australian government, explores the lived experiences of those faced with forced displacement from disasters in high-income countries and aims to improve outcomes for this vulnerable cohort.
Method:
The first phase of the research, guided by a broad-based Steering Group, included a rapid literature review and thematic analysis of peer-reviewed literature of disaster related, internal displacement in high-income countries, including Australia.
Results:
The peer reviewed literature review identified only 12 papers that met the inclusion criteria. The literature from Australia and other developed countries indicated that internal displacement is a prominent feature of disaster impacts and that needs are complex, dynamic and diverse. Common themes of need were revealed: the need for the development of an evolving displacement policy framework to support human rights; the co-creation, coordination and provision of timely and flexible support services, and on-going data collection and sharing. No displacement, specific frameworks, measurable thresholds, or central data registries exist at federal or state government levels in Australia to support these needs.
Conclusion:
Inclusive policies, practices, and resources are required in Australia to support assets of displaced people and address their unmet needs in disasters, which also remain largely unmet in other high-income countries. Australia can learn from all countries faced with the challenges of managing displacement and also share its own experiences. Furthermore, it is recommended that WADEM consider extending its current Position Statement relating to Refugees and Internally Displaced Persons to include high-income countries based on the findings of our study and other sources.
Access to palliative care, and more specifically the alleviation of avoidable physical and psychosocial suffering is increasingly recognized as necessary in humanitarian response. Palliative approaches to care can meet the needs of patients for whom curative treatment may not be the aim, not just at the very end of life but also more broadly. Humanitarian organizations and sectoral initiatives have taken steps to develop guidance and policies to support integration of palliative care. However, it is still sometimes regarded as unfeasible or aspirational in crisis contexts; particularly where care for persons with life threatening conditions or injuries is logistically, legally, and ethically challenging. We present a synthesis of findings from five qualitative sub-studies within a R2HC-funded research program on palliative care provision in humanitarian crises that sought to better understand the ethical and practical dimensions of humanitarian organizations integrating palliative care into emergency responses.
Method:
A multi-disciplinary, multi-national team conducted an exploratory mixed-methods study and presented findings from semi-structured interviews with international and local health care providers, patients, and families that explored experiences of palliative care in different humanitarian responses: protracted refugee crisis (Rwanda n=17), acute refugee crises (Jordan and Bangladesh n=20), a public health emergency (Guinea n=16), and natural disasters (various countries n =17)
Results:
Four themes emerged from descriptions of the struggles and successes of applying palliative care in humanitarian settings: 1) justification and integration of palliative care into humanitarian response, 2) contextualizing palliative care approaches to crisis settings, 3) the importance of being attentive to the ‘situatedness of dying’, and 4) the need for retaining a holistic approach to care. The findings are discussed relation to the ideals embraced in palliative care and corresponding humanitarian values.
Conclusion:
Though challenging, palliative care in humanitarian response is essential for responding to avoidable pain and suffering consistent with humanitarian principles.
The Tokyo 2020 Games were held without spectators in the fifth wave of the COVID-19 pandemic after one-year postponement. From all over the world, approximately 11,000 Olympians and 4,400 Paralympians participated in the games. As one of the designated medical institutions, Tokyo Medical and Dental University Hospital provided emergency medical care for the personnel referred by medical staff at the venues or the Olympic Village clinics. On the other hand, it played a central role in treatment and care for COVID-19 patients in the Tokyo metropolitan area. The aim of this study was to review the emergency medical care system of the hospital as a designated hospital for the Tokyo 2020 Games and discuss the measures for future large-scale international events.
Method:
A retrospective analysis of persons involved in the Games who visited our emergency department by request was conducted. COVID-19 patients who were admitted were also analyzed. The study period was from July 13 to August 11 for the Olympics and from August 17 to September 11 for the Paralympics, respectively in 2021. The data was derived from electronic health records from the hospital.
Results:
The total number of ED visits was 38 during the period. One patient was hospitalized, and another patient was transferred. Twenty-one (55%) were athletes, seven (18%) were staff members, and ten (26%) were others. The reason for the visit was medical disease in 23 (61%) and surgical disease in 15 (39%). There was one COVID-19 positive patient. The number of COVID-19 inpatients was 124.
Conclusion:
Emergency medical care was provided for the persons involved in the Tokyo 2020 Games in cooperation with all the staff at the hospital. The COVID-19 pandemic ‘disaster’ may have had some impact on our hospital’s role as the designated medical institution.
The COVID-19 pandemic has impacted populations internationally, through infections and consequences of infections, and by the countermeasures to prevent the spread of the coronavirus. Concerns exist surrounding the impact of the COVID-19 pandemic on the mental health of youths in the Netherlands. Consequently, we studied quarterly trends and risk factors of suicidal ideation among Dutch youths from September 2021 onwards.
Method:
The Network GOR-COVID-19, a research group consisting of different organizations, monitors the effect of the COVID-19 pandemic on population health. As one element of this monitoring, quarterly data collections have been undertaken since September 2021 from a panel of youths (12 – 25 years of age) representative of the Dutch population. Online questionnaires collect data on self-reported health and wellbeing. We analyzed a selection of demographic, social activity, and mental health variables as potential risk factors for self-reported suicidal ideation in the previous three months. We assessed trends, performed longitudinal analyses, and conducted logistic and random forest regressions per quarterly round of data collection. Analyses were weighted for age, sex, educational level, and province where appropriate.
Results:
Approximately 4,500 youths participated in each quarterly questionnaire, with some participating more than once. Results showed substantial increases in self-reported suicidal ideation during and immediately after the third lockdown in the Netherlands in December 2021, rising from 9% to 17%, then slowly decreasing to 16% in May/June 2022, and to 13% in September 2022. In all multivariable analyses variables relating to mental health were indicated as risk factors. The strongest associations were seen in those experiencing mental health complaints and loneliness. Demographic variables were not strongly associated with suicidal ideation.
Conclusion:
The monitoring conducted by The Network GOR-COVID-19 enables the tracking of trends in the impact of the COVID-19 pandemic on the mental health of Dutch youths in The Netherlands.