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Mass casualty incident (MCI) management was usually taught by lectures and then tested by exercises. However, the lecture may not be interesting and tabletop exercise (TTx) may not adequately engage participants, especially senior medical students. To solve these two problems, we think that a TTx using 3D models can be a good teaching method of MCI management for medical students.
Method:
A TTx of MCI in the emergency room (ER) was designed for senior medical students based on five core capabilities of MCI management: incident management system, event recognition and initiation of response, patient triage, surge capacity and capability, and recovery and demobilization. 3D models containing miniatures of the ER, hospital staff, patients, and other personnel were used in the TTx. No lecture was conducted before or during the exercise. Students needed to discuss how to respond to events in the incident and show their responses using the 3D models, and the instructor facilitated the discussion and gave feedback right after the students’ decision.
Knowledge of each core capability was tested by four multiple-choice questions. The interest in learning disaster medicine and willingness to participate in MCI management were evaluated by questionnaire, along with quantitative feedback to the exercise. The same test and questionnaire were conducted before and after the TTx.
Results:
From September 2018 to May 2022, 326 students completed both pre- and post-exercise evaluations. The test scores of all five core capabilities, levels of interest, and willingness increased significantly after the exercise. Students thought the exercise was interesting and a good learning tool. Most students wanted to be notified of further training.
Conclusion:
A tabletop exercise using 3D models is an effective way to teach senior medical students MCI management and disaster medicine while increasing their interest in learning and willingness to participate.
Following humanitarian crises (e.g. armed conflict), reliable population health metrics are vital to establish health needs and priorities. However, the challenges associated with accurate health information and research in conflict zones are well documented. Often working within conflict settings are authorities and non-government organizations (NGOs) who frequently collect data under the context of operations. This operational data is a potentially untapped source of hard-to-reach data that could be utilized to provide a better insight into conflict affected populations. The Hard to Reach Data (HaRD) framework highlights the process of identifying and engaging with these stakeholders collaboratively to develop research capacity.
Method:
The HaRD framework was developed from literature searches of health and social sciences databases. The framework which provides a structure to gain access to data in hard-to-reach settings was applied to humanitarian mine action to identify and collect existing but underutilized data.
Results:
Guided by the HaRD framework we compiled the world’s first global casualty dataset for casualties of landmines and explosive remnants of war. The framework provided a structured approach to identify and engage with key stakeholders. An adaptive approach was needed for stakeholder engagement with trust building and transparency important factors in developing a collaborative partnership. Appropriate communication of research findings is important to ensure reciprocity.
Conclusion:
The HaRD framework can identify potential data sources and guide access in hard-to-reach data settings. Operational data is often available but hidden; a systematic approach to identifying and engaging with stakeholders can assist in developing successful research partnerships between academia and humanitarian organizations.
The COVID-19 pandemic provided a unique opportunity for the United States National Guard (NG) to assist in an infectious disease disaster. This study aims to interpret data from NG situation reports (SITREPS) given to the National Guard Bureau (NGB) by each state national guard headquarters regarding their relief efforts from April to June 2020. This is the first published study about NG disaster relief utilizing quantitative data provided by the US military.
Method:
The SITREPS of all 50 states, the District of Columbia, Guam, Puerto Rico, and the US Virgin Islands are available for the dates of April 10, May 6, May 16, and June 3, 2020 through a NG website that requires government level access. These were examined to evaluate and analyze the activities directed by each state NG headquarters as part of COVID-19 response efforts. No other dates were available for analysis.
Results:
During the COVID-19 pandemic, the NG primarily provided security, tested for COVID-19, ran COVID-19 shelters, assisted foodbanks, delivered meals, provided transportation services, aided mortuaries, supported protective equipment warehouses, and deployed medical personnel to cover hospital shortages. They provided services to children, homeless persons, residents of skilled nursing facilities, and Native Americans living on tribal lands. Service members (SM) sewed masks, provided translation services, and cooked in prison kitchens. All state NGs participated in COVID-19 relief to varying degrees. Numerical data about the services provided such as quantity was rare but is included as available.
Conclusion:
The United States National Guard provided a wide variety of services through activation of its service men and women that impacted COVID-19 response throughout all states and territories. This elucidation of the uses of the National Guard should be considered during future governmental disaster preparedness planning efforts, and can be extrapolated to international military disaster relief.
The WHO Health Emergency and Disaster Risk Management (H-EDRM) Research Network has identified that health data collection during health emergencies and disasters is a key element to enable proper coordination and timely response, and research priorities of the network.
Method:
Focus group discussion was performed to identify key challenges which hinder accomplishment of the data collection.
Results:
It was concluded that the issue faces significant challenges including; (1) Access: Logistic issues including safety, transport and communication did not allow experts such as epidemiologists to access onsite and relevant stakeholders. It is also challenging for local public health stakeholders to accept new experts during emergencies. (2) Tools: forms or tools that are concise and operational to be accepted by frontline responders should be provided. (3) Standardization: to set standard forms or tools and its operational mechanism is essential to collect health data, otherwise collected data will be partial and fragmented. (4) Governance: overall governance of procedure and data ownership must be clarified before its implication administratively and legally. These should be endorsed by local health authorities. (5) Ethical procedure: Obtaining informed consent and conducting timely procedures is difficult. Contextually, health data collection during emergencies and disasters in many cases is inappropriate. (6) Operation: Collected data should contribute to ongoing operation in a timely manner. The discussion also found the standard tool of the WHO; the Emergency Medical Teams Minimum Data Set, which has been already used in more than ten countries and has been providing leading examples for this topic.
Conclusion:
Further research to fulfill the identified challenges and gaps will facilitate the collection and strengthen the health emergency and disaster risk management.
Handover is of big value in preserving continuity of the medical services chain when managing patients. Simulation is well accepted as a good learning method to acquire non-technical skills. Actual studies dealing with this issue are performed on paramedics. Studies involving physicians are rare and usually focus on interviews or questionnaires describing practical situations.
The aim of our study was to evaluate the utility of simulation in enhancing the quality of handover between both pre-hospital and intra-hospital physicians.
Method:
We conducted a prospective pre-test/post-test study in a regional Emergency Medical System (EMS) on the handover topic.
We included voluntary physicians who signed participation consent. The study was designed as a three-step project: theoretical training with pre-test and post-test, 1st simulation session, 2nd simulation session with post-test. The two simulation sessions were evaluated according to a specific score. We evaluated the progression of knowledge (tests means) and skills (percentages of good answers): before and after theoretical training and before and after simulation sessions.
Results:
Sixteen EMS physicians were enrolled. Thirteen were under 40 years old and ten were emergency medicine physician specialists. Theoretical training made progression in means and percentage good answers (post-test 1 vs. pré-test : 9.5±3.3 vs 6.9±2 ; p=0.008 et 22 vs. 10% ; p=0,001 respectively). Progression of means after simulation was noticed (2nd session vs. 1st session) (16.3±0.9 vs. 12.3±2.5 ; p<0.001). Simulation enhanced significant quality of handover. Means and percentage of good answers in tests was better after simulation sessions (post-test 2 vs. post-test 1 vs. pre-test : 10.7±2.8 vs. 9.5±3.3 vs. 6.9±2 ; p=0.01 et 29% vs. 22% vs. 10% ; p<0.001 respectively).
Conclusion:
Our study showed the utility of simulation in enhancing handover between pre-hospital and intra-hospital physicians. Simulation as an active learning method, combined with theoretical training, can improve knowledge and enhance skills.
The Israeli health system had a critical role in leading the response to the COVID-19 pandemic facing a wide-range of challenges following the length and the unique characteristics of this health emergency. This study evaluated the weaknesses and strengths of the different parts of the system, relying on WHO building blocks to promote better coping with large-scale health emergencies.
Method:
The experiences of 13 high-level senior experts in the Israeli health system who directly managed COVID-19 were examined, using in-depth semi-structured interviews conducted during 2021. Critical and snowball sampling were used to select participants. Interviews were recorded and transcribed. Data analysis was conducted using ATLS.TI 22 software and reviewed by peers. The interviews were analyzed using the thematic analysis method. A theme expresses a broad central idea that tends to appear and reoccur in the analytical material in different forms of expression. Specifications and ideas were discussed among the researchers while engaging in repeated rereading of the transcriptions until saturation was achieved with the final themes.
Results:
The role of the Ministry of Health in integrating the health response and importance of spokespersons providing professional information increase trust as a crucial role of community health services in emergencies having political tensions reflected in the medical response. The Israeli Health system differ from hospital systems abroad by the relationships between preparedness during routine and emergency response. The importance of trust was highlighted.
Conclusion:
The study demonstrates a deep understanding of the way the Israeli health system dealt with the pandemic, revealing needs, resources, weaknesses and strengths. The results offer a rare opportunity to learn how integration of service-delivery can be improved within the health system in all levels. These lessons should be translated to advance better handling of future emergencies.
Penetrating trauma is a highly visible issue in history, social media, and politics. Crime statistics showed increasing numbers of violations of the law banning assault weapons in Germany. Although these injuries have historically been rare in Germany, we have noticed increasing numbers in our hospital. Studies focusing on these injuries of penetrating trauma are lacking, hence a distinct therapy algorithm is missing.
Method:
All penetrating injuries proximal to the wrist and ankle in the years 2016-2021 were analyzed in a retrospective survey. Isolated injuries of hand and foot were excluded. Data were gathered from the clinical information system and the protocol of the emergency medical services. For further analysis we identified three distinct groups: Patients who acquired the injury by an accident (ACCIDENT), self-inflicted (SELF-HARM) or by crime (ASSAULT). The groups were compared using MicroSoft Excel® and Sigma plot® (Jandel, San Rafael, CA).
Results:
A total of 961 cases were identified. The analysis showed an increasing number of cases with penetrating injuries from 2016 until 2019. Furthermore, major differences between the groups were revealed. The assault victims (ASSAULT n=117) were mostly male (91%) and non-German (52%). They were more likely to be accompanied by the police (13%), to be intoxicated, to require hospital admission (also to critical care) and to require surgery as compared to the cases of the ACCIDENT (n=484) and SELF-HARM (n=360) group. The SELF-HARM group cases were predominantly female, younger and had psychiatric comorbidities.
Conclusion:
The cause of penetrating trauma injury is important and can provide information crucial to the management of the patient. The emergency treatment of assault victims is challenging due to the particular circumstances of these cases. Optimal preparation and anticipation of the accident and emergency staff are necessary to deal with these patients. In summary, assault victims had more serious injuries than the other groups.
Emergency Medicine (EM) physicians are crucial members of the disaster medical response. In Singapore, the EM residency program spans five years, with junior residents (JRs) progressing to senior residents (SRs) in three years after passing the MRCEM exam or its local equivalent. This study aims to assess the knowledge, attitudes and perceptions toward disaster medicine among EM residents in Singapore.
Method:
A cross-sectional study was performed for 90 EM residents for the academic year 2020/2021. A self-administered, 44-item online questionnaire based on the Emergency Preparedness Information Questionnaire (EPIQ) was delivered via GoogleForms™. This assessed familiarity through 10 dimensions, with a minimal score of one and a maximal score of five. The survey also included questions on attitudes towards emergency preparedness and preferred learning methods. Data was collected from May 2020 to November 2020, and analyzed with SPSS.
Results:
The response rate was 41%. Of these, 75% were JRs and 25% SRs. The overall mean familiarity with disaster preparedness was 2.43 ± 0.90. There was no statistically significant difference of overall mean familiarity between JRs and SRs. Overall, they fared best in the dimension on isolation & quarantine with a mean score of 2.91 ±1.05 and worst in the dimension on psychological issues with a mean score of 2.34 ±0.95.
Residents felt that disaster medicine was relevant to their practice with a mean score of 4.22 ± 0.98. They also felt that it was necessary to learn more about it, with a mean score of 4.16 ±0.90. The highest ranked preferred learning method was workshop/simulation training (45.5%), followed by lectures (23.4%).
Conclusion:
EM Residents have a poor overall familiarity with emergency preparedness, however, they recognized its importance and relevance. The preferred formats of learning were simulation/workshop training. More must be done to improve the overall competency of EM residents in disaster medical response.
The COVID-19 pandemic had a devastating impact on long-term care in Canada, exacerbating an existing crisis of staff shortages, inadequate infrastructure and funding, into a disaster. In response, the province of Ontario enacted emergency legislation and requested federal government support, resulting in the deployment of personnel from the Canadian Armed Forces and acute care hospitals into long-term care homes across the province. This exploratory study aims to develop a rich description of the long-term care context during the pandemic, deployed personnel's perspectives on providing care in the context, and identification of lessons learned while working during the pandemic.
Method:
Descriptive exploratory design with demographic questionnaire and semi-structured interviews will be used to understand the background and perspective of deployed personnel and managers on working in long-term care during the pandemic. Thematic analysis will be used to analyze the transcripts, organize codes, and identify and describe major themes. Findings will also be compared with disaster literature to understand how the perspectives of deployed personnel compare with existing disaster research.
Results:
21 interviews were initially conducted. Analysis of these interviews identified key challenges experienced by those deployed, including human resources, leadership and accountability, and policies and regulations. Perspectives and strategies for overcoming these challenges were also shared.
Conclusion:
The scale, duration, and context of the redeployment of personnel into long-term is unprecedented and has seen little research. This exploratory study shares the experiences of personnel who deployed into long-term care and helps identify lessons learned from overcoming challenges in the disaster context. These findings will be able to inform future disaster research and how to better prepare responders in the future.
Considerations for patient and staff safety are critical during an encounter with an individual who is potentially contaminated by hazardous materials in the hospital setting. Decontamination training for all team members may be ideal, however, there are significant barriers precluding implementation including time-spent, associated costs, and staffing limitations. Studies demonstrate that immediate recognition of potential contaminants and removal of clothing mitigates risks with a best-estimated 85% hazard reduction. Initial risk-reducing best practices like focused training and resources, allow for more adequate decontamination response and improve team training gaps with potential first receivers throughout the hospital setting.
Method:
A two-step process was implemented to address a training disparity including a deployment of high-impact resources and the installment of these resources at high-risk locations. First, a slide deck with focused education to both clinical and non-clinical staff was developed from the established decontamination team training program. The focus of this training was to introduce the concept of RAIN (Recognition, Avoidance, Isolation, and Notification). This education highlights how to safely remove potentially contaminated clothing and contain the materials. RAIN kits were created with the items necessary to safely accomplish this while prioritizing patient privacy and safety to patient and staff. The kits included instructions, privacy kits, thermal blankets, and trauma shears. Next, the RAIN kits were deployed at pre-identified locations where potentially contaminated patients may present.
Results:
Qualitative improvement in staff satisfaction was noted after the implementation of the abridged, high-impact RAIN kits. The pre-deployed kits at critical high-likelihood locations throughout the hospital created a more accessible model with improved ease of use and effectiveness, reducing current gaps in training. Limitations should be considered when implementing a high-acuity, low-frequency program to clinical and non-clinical staff with support from leadership.
Conclusion:
Focused education and pre-deployed kits empower staff to respond in hospital settings for potentially contaminated patients.
Hospital waste in the United States (US) generates 7,000 tonnes of waste daily. During the pandemic, hospitals had to increase the amount of personal protective equipment (PPE) worn by healthcare providers. The aim of this study was to compare pre and present COVID-19 waste generation amounts in comparison with hospital census and PPE purchased.
Method:
This research examined the solid waste generated at a level II trauma center from January 2018-December 2021. Data examined included: the amount of solid waste generated, monthly patient census, COVID-19 census, policy changes, and the amount of purchased PPE pre and during the pandemic.
Results:
PPE product numbers purchased varied with a noticeable increase in mask and gown ordering. The number of admitted COVID-19 patients peaked at 46. Hospital waste tonnage fluctuated but did not show a statistically significant change.
Conclusion:
The COVID-19 pandemic has caused hospitals to increase their PPE posture to help safeguard its employees and patients. In our hospital setting, the use of PPE increased and overall hospital census decreased. This has profound implications for not only the hospital’s revenue, but also with less census volume, there was curiously the same amount of hospital waste generated. This work needs to be continued in other healthcare PPE heavy settings, to better understand the downstream consequences of infectious diseases on responsible hospital waste management and environmental sustainability.
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.
Emergency nurses’ views on their roles, challenges, and preparedness in the context of armed conflict are necessary to capture in-depth insights into healthcare needs. They can identify the required education and training for emergency nurses and provide evidence of the situations of care in the context of armed conflicts. Unfortunately, the evidence about these factors in the context of armed conflict is scant.
Method:
A semi-structured interview with 23 participants was conducted using qualitative content analysis. The study was conducted in Saudi border hospitals that are shared with Yemen. The COREQ guideline for reporting qualitative research was followed.
Results:
The emergency nurses’ roles in hospitals in the context of armed conflict discussed clinical nurses’ and head nurses’ roles. The main challenges that emergency nurses faced include poor orientation, access blocks, and communication barriers. Various perspectives about the preparation, including education, training, and strategies for preparing emergency nurses, were identified. The most striking findings in these settings were the diversity of armed conflict injuries, clinical profile, triage of mass causality, trauma care, surge capacity, orientation, communication, and strategies for preparing nurses.
Conclusion:
This study provided an estimate of the scope of ED nurses' roles, and how they were prepared across a range of hospitals in the armed conflict areas and therefore a snapshot of their experiences significant to be an informative resource for these settings. This study has provided essential implications for preparedness and planning. Given the large number of preparational courses being undertaken by ED nurses in these settings, the choice of the required education and training must be planned accordingly considering the clinical profile of patients in armed conflict areas, trauma care, triage of mass causality, surge capacity, safety and security, communication, policies, and law.
Internationally, COVID-19 has impacted populations because of both infections and measures to prevent the spread of the virus. The pandemic's long-term social and psychological effects on the Dutch population were studied.
Method:
The GOR-COVID-19 health monitor1 includes quarterly measurements among youth (12- to 24-year-olds) and adult (25 and older) panels. The measurements of June and September 2022 included the open-ended question, ‘In your life at this moment, do you still feel the effects of the corona pandemic from the last 2.5 years?’ The first author qualitatively analyzed the responses (7.171 in total) through descriptive coding. A team member did a co-coder reliability check.
Results:
In the questionnaire, various people name positive effects of the pandemic, such as being able to spend time alone or feeling more confident. However, many respondents describe how the pandemic negatively affected their social life, mental health, personal development, financial situation, and perception of society. People who experienced life transitions show vulnerability to social isolation while working and learning online because they missed the opportunity to establish a new social network. Among them are young people who started secondary school, university, or their first job during the pandemic. The youth also often describe having difficulty with social interaction, feeling they have ‘unlearned’ to be in large groups or interact with strangers. Older generations, in contrast, comment on their own continued cautiousness.
Conclusion:
After years of pandemic, fear of contamination and social distancing measures have impacted society and individuals. The findings raise the question, ‘How will the experience of a pandemic continue to shape society and, in particular, what will be the lasting effects on the social networks and mental health of generation Z?’
1 See Integrated GOR-COVID-19 health monitor and The Dutch GOR-Covid-19 health monitor, both in the European Journal of Public Health (2022) 32:3.
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 structures
advice to the Organizing Committee and Government departments
advice on COVID-19 including testing policy
staff/stakeholder preparation through exercising/training
increased staff numbers and skill mix able to adapt
budget
operational response structure
plans in place and tested for a health protection response in the event of an incident
other mass gatherings reviewed for transferable learning enhanced surveillance systems
Results:
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.
Children, who comprise 25% of the US population, are frequently victims of disasters and have special needs during these events. To prepare NYC for a large-scale Pediatric Disaster, NYCPDC has worked with an increasing number of providers that initially included only a small number of hospitals and agencies. Through a cooperative team approach, stakeholders now include local public health, emergency management and emergency medical services, 28 hospitals, community-based providers, and the Medical Reserve Corps.
Method:
The NYCPDC utilized an inclusive iterative process model whereby a desired plan was achieved by stakeholders reviewing the literature and current practice through repeated discussion and consensus building. NYCPDC used this model in developing a comprehensive regional pediatric disaster plan.
Results:
The plan included disaster scene triage (adapted for pediatric use) to transport (with prioritization) to surge and evacuation. Additionally, site-specific plans utilizing guidelines and templates now include Pediatric Long-Term Care Facilities, Hospital Pediatric Departments including Pediatric and Neonatal Intensive Care Services and Outpatient/Urgent Care Centers. A force multiplier course in critical care for non-intensivists has been provided. An extensive Pediatric Exercise program has been used to develop, operationalize and revise plans based on lessons learned. This initially included pediatric tabletop, functional and full-scale exercises at individual hospitals leading to citywide exercises at 13 and subsequently all 28 hospitals caring for children.
Conclusion:
The NYCPDC has comprehensively planned for the special needs of children during disasters utilizing a pediatric coalition based regional approach that matches pediatric resources to needs to provide best outcomes.
The NYCPDC has responded to real time events (H1N1, Haiti Earthquake, Superstorm Sandy, Ebola), and participated in local (NYC boroughs and executive leadership) and nationwide coalitions (including the National Pediatric Disaster Coalition). The NYCPDC has had the opportunity to present their Pediatric Disaster Planning and Response efforts at local, national and International conferences.
Migration and forced displacement are reshaping the globe today. More people are being displaced by conflicts and natural disasters than ever before, and climate change is playing a pivotal role as a contributing factor for migration and conflict.
While there is a growing literature regarding provision of care for migrants in hosting countries there is no evidence on the use of the surge capacity model to support preparedness, readiness, and response to migration crisis by local health services, or medical teams.
Method:
A scoping review with a narrative summary relevant to disaster medicine, looking at two major migration routes (Central/Eastern Mediterranean and South/Central America) was performed to determine if the surge capacity model has been applied by medical teams responding to migration crises, and how this has affected the adaptation of health services.
Results:
Preliminary analysis demonstrates variations on the use of the term “surge capacity”, and the imperative need to better define its application when preparing to or responding to any type of disaster, here specifically migration crisis. Thus far, there is no evidence on the use of the surge capacity model for the conformation of national/international medical teams when responding to this type of crises, and its relation to the adaptation of health services. This is particularly relevant, as the surge capacity model can support building and/or strengthening the capacity and capability of national and international medical teams.
Conclusion:
There is an imperative need to design a conceptual framework based on the surge capacity model for the conformation of fit-for-purpose medical teams, that ensures preparedness, readiness, and appropriate response to migration crises guaranteeing adaptation of health services depending on context needs, and that defines skills and competencies of the responders. Additionally, this provides a conducive platform for operational research activities to foster evidence coming from the field.
The pandemic of COVID-19 in the northeastern part of Thailand established the response mechanism to COVID-19.
Method:
This study aimed to explore the PHER model of the COVID-19 pandemic in three provinces located in northeastern Thailand. The target group was 78 people who were responsible for COVID-19 response from the sub-district, district, and provincial levels. The data was collected through in-depth and group interviews following the non-structure interview guide and data was analyzed by content analysis.
Results:
Two levels of the PHER model were: 1) The response of the provincial level related to national and global situations. The provincial’s measure of the COVID-19 response was run by the Provincial Communicable Disease Committee (PCDC) and followed by the COVID-19 Epidemic Administrative Center (CEAC). The core team was a public health subcommittee who ran the Emergency Operation Center (EOC) and COVID-19 pandemic. The PCDC launched the provincial measure, risk communication response to COVID-19, and issues of the pandemic from CEAC and EOC. 2) The response inside the provincial level two components of the structure were the PCDC and the PEOC and the district EOC. They composed the Situation Analysis Team (SAT) and Joint Investigation Team (JIT), which was an operation to surveillance, investigation, real-time situation and reported to PEOC and PCDC as the issues of measures decision. Thailand’s identity of the PHER model was the village and sub-district on behalf of the Communicable Disease Control Unit (CDCU) and Community COVID-19 Respond Teams (CCRTs) in which members were Health Volunteer (HV), Village’s leader, and Local organization. Core activities were screening the risky group and surveillance: Home or Local quarantine and Home isolation (HI) or community isolation (CI) of rehabilitation from Covid-19 post treatment.
Conclusion:
The strengthening of PHER depended on the CCRTs and CDCU which supported the PEOC and PCDC to prevent and control Covid-19.
Compassion, calming down and providing aid are common ways of helping people in need soon after traumatic events. However, such forms of help were seldom tested and other research suggests that active coping may have more positive long-term effects. The SIX C's model was created to provide simple and effective evidence-based Psychological First Aid guidelines that help shift the person from helpless into active and effective activation in a very short time. The model emphasizes the need for cognitive communication as well as effective activation in contrast to the previous concepts of calming and emotional communication
Method:
This retrospective cross-sectional study examined empirically the SIX C's Model's basic concepts. We checked the association between whether people received activating versus more passive forms of aid during crises, their self-efficacy and post-traumatic stress disorder (PTSD) symptoms. 428 participants completed scales on the type of aid received during past traumatic events including activating aid (encouraging active and effective responses) versus passive aid (receiving compassion, calming down and general aid), as well as their current general self-efficacy (GSE) and PTSD symptoms
Results:
Results revealed that passive aid was not related to PTSD while activating aid correlated inversely with PTSD. Importantly, both resilience and GSE emerged as mediators and moderators between activating aid and PTSD. The moderation showed that receiving activating aid was associated with less PTSD only in people low on resilience or GSE
Conclusion:
The study revealed a major role for self-efficacy in protecting people from PTSD. Self-efficacy not only statistically mediated the relationship between active aid and PTSD but also moderated this relationship. The findings underline the importance of encouraging the person to act effectively during the event and to maintain cognitive communication. This type of aid leads to increased self-efficacy and contributes to the reduction of risk for PTSD.
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.