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The trauma care system in Ireland is being re-configured to have major trauma centers for severe injuries and other sites for less severe injuries. This is to ensure patients are brought quickly to the most appropriate hospital to manage their injuries. The National Ambulance Service (NAS) electronic Patient Care Record (ePCR) records what happens to patients before they reach the hospital and the Major Trauma Audit (MTA) captures data on patients’ hospital treatment. These datasets are currently separate and if they could be joined, they would inform important decisions on which hospitals to take patients. This study aims to investigate joining these datasets to create a seamless database of the patient journey from roadside to recovery.
Method:
Proof of Concept–The ePCR and MTA datasets will be linked on a once-off basis. The combined anonymized dataset will then be analyzed to identify pre-hospital characteristics that determine the need to bypass smaller hospitals and bring patients to a larger major trauma center or trauma unit.
Stakeholder input for ongoing dataset combination and utilization–A stakeholder consultation process will explore the best way to make a GDPR-compliant combination of datasets on an on-going basis, including geo-location data and the inclusion of patient reported outcome measures. This will incorporate the requirements of the Data Protection Commissioner, National Office of Clinical Audit, patients, clinicians, NAS, HSE and other stakeholders.
Geospatial implications of major trauma services–Once ongoing data combination is approved, we will determine geospatial implications of the trauma network for prehospital care configuration and the patient journey.
Results:
Study results will inform prehospital service configuration to ensure safe and equitable patient management.
Conclusion:
The data arising from this study will capture the full trauma patient journey. This data is essential to inform policy and practice for trauma care in Ireland.
Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU ®,TR-DGU) and Israel (Israeli National Trauma Registry,INTR) in a retrospective analysis.
Method:
Patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, pre-hospital care, hospital treatment, and outcome were compared.
Results:
Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic accidents were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 versus 20), more patients were treated in an intensive care unit (92% versus 32%), and mortality was higher(19.4% versus 9.5%) as well.
Conclusion:
Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most likely, this was caused by different recruitment strategies of both registries like trauma team activation and the need for intensive care in TR- DGU. More detailed analyses are needed to uncover similarities and differences between both trauma systems.
A scoping review of the literature available on landmines in Egypt and their resultant disaster impact (human losses, material losses, economic losses and environmental losses) on the Bedouin communities inhabiting contaminated regions and on Egypt is presented. A narrative approach is taken to map the data extracted from the available literature to: the domains of losses; evidence of external assistance; and progress, revealing the widespread impacts of the hazard of landmine contamination.
Method:
The review question was mapped based on the JBI and the Arksey and O’Malley Frameworks with reference to Aromataris and Munn (2020), and Peters (2022). The research question was identified starting with the search strategy, and is broken down using PCC as recommended for Scoping Reviews (Peters, 2022).
Searches of scientific literature were conducted using multiple databases, further searches of search engines, social media and of grey literature were conducted. The search results were then screened over two stages to determine their relevance. Data was then extracted using the PRISMA-ScR checklist before being tabulated and charted.
Results:
The data collated evidently shows human losses manifest as mortality, physical disability, psychological trauma, financial instability and social impacts; while material losses include blocks to considerable areas of the country’s landmass suitable for urban housing, agricultural and touristic potential, as well as mineral, and oil and gas reserves; economic losses include impedance to development, lost revenues and deterrence from investment; environmental losses comprise extensive contamination of Egypt’s land.
Conclusion:
Evidence of external assistance being sought and provided is ample, signifying the overwhelm of Egypt’s coping capacity; rather, positive steps to de-mine the land and provide mine risk education and survivor assistance are beneficial in risk reduction. While landmine contamination is not classically considered to carry a disaster risk, this study proposes it does.
The COVID-19 pandemic has underlined the international priority to systemically operationalise resilience in the face of increasing prevalence of complex and cascading hazards. This concept paper identifies the components of a resilient society, establishing the usefulness and usability of the application of ‘resilience’, and proposes the characteristics used by a resilient system.
Method:
Through the review of case-based examples and previously published concept papers, this paper underwent a concept analysis to understand and qualify the characteristics of a resilient community. Through extensive research and critical analysis of disaster risk responses both effective and not, the authors condensed the literature to identify the key components of a resilient society.
Results:
To respond to this evolving landscape of disaster risk, community and governmental responses should be collaborative in order to be successful and sustainable to increase resilience across communities, societies and networks. To unpick the complexity of how communities and governments might promote resilience effectively, we explore whether community and social capital are useful resources to create and sustain resilient approaches to disaster risk reduction and management. We consider that by exploring how social capital links, bridges and bonds actors within a system are qualitative key facets of a resilient community. A resilient system is the product of trust and collaboration between asset-based networks of bonded and bridged communities and risk and support-based networks of bonded and bridged organizations.
Conclusion:
By evaluating the usefulness and usability of the concept, we consider that a resilient system is an iterative learning process, asset based, trusting across power and resource gradients and is best built before or even if essential during a crisis. Noting that resilience is a dynamic process which requires integrated collaboration and continual adjustment to develop a sustainable framework, we consider that social characteristics of a resilient system are useful, useable and should be used.
Cold exposure generally has a negative effect on tasks that rely on finger dexterity. It is not known if cold exposure will affect medical laypeople’s ability to perform first aid for life-threatening bleedings, specifically tourniquet application. This study investigates the effect of cold exposure on medical laypeople’s tourniquet application ability.
Method:
Twenty-nine adult medical laypersons received brief tourniquet application training and then completed a tourniquet application test in a baseline condition and three partial cold immersion conditions where their hands were immersed in nearly 0°C water. The three cold immersion conditions were 16°C, 12°C, and 8°C hand-skin temperature. Tourniquet application quality was measured using a procedural checklist. Time until bleeding control was also measured.
Results:
The results show that cold exposure significantly increases the time to bleeding control, F(3, 84) = 5.42, p < .01, η2 = .05. Planned contrasts revealed a significant increase in time between baseline and 8°C hand-skin temperature (M baseline = 65.5s, SD = 17.0; M 8°C = 76.9s, SD = 19.6), t(28) = 3.77, p < .01, r = 0.38. No effect was found on the procedural application quality, F(3, 84) = 2.21, p = .09.
Conclusion:
Cold exposure can decrease the chance of survival for the injured person when a medical layperson provides first aid for life-threatening bleedings due to increased application time. The results can also be used when educating medical laypeople in first aid for life-threatening bleedings as it provides evidence of specific effects from a stressor that is common in regions with cold climate. Future research should be aimed at exploring possible mitigation strategies such as tourniquet design or rewarming procedures and investigating if a similar effect exists for prehospital professionals.
Medical and paramedical staff endure a psychological toll of burn-out as part of the heavy personal consequences of their work, with an immeasurable increase during the Covid-19 pandemic outbreak. In Israel, there is an added stress of the highly unstable political situation, including war and racial-riots with direct hits of missiles leading to mass casualty events. Members often had to stay in the hospitals for days as the roads home were blocked. Wolfson Medical Center (WMC) is a medium size, level II hospital in the center of Israel. It serves a complex population, most from low to medium socioeconomic status, and a large population of displaced persons. The responsibilities of the staff weigh heavy, leading to psychological trauma, with clear signs of anxiety, depression and suicide.Israel Trauma Coalition (ITC) is a non-profit organization collaborating with over 40 organizations to create a continuum of care in psycho-trauma, response and preparedness.
Method:
ITC has initiated a Resilience-Trustees program, establishing a strong and active group within the organization, with adequate representation from each department and profession. Training the team to identify a colleague in distress, to respond adequately and to refer to professional help as needed. The program has started implementation in various hospitals in Israel, including WMC.
Results:
The expected results of this program is a change in the organization's culture of discourse and daily interaction so as to promote resilience and mutual trust and to help cope favorably with crisis situations. The actual results will be shown through a case study of the WMC team of Resilience Trustees, in accordance with the steps of the program (resilience in the original team, then the overall staff).
Conclusion:
This initiative will promote awareness and acceptance of mental, personal and team difficulties, as well as reduce risks of secondary traumatization, burnout and other disorders.
The occurrence of mass casualty incidents is increasing globally. Training is an essential cornerstone in achieving disaster preparedness, yet studies show that medical first responders perceive their level of readiness to face disaster incidents as inadequate. As real-world disaster training exercises can be characterized as resource-intensive in terms of cost and time, virtual training environments have been highlighted as a potential alternative to mass casualty incident training. In order to increase the preparedness of medical first responders, a deeper understanding of their requirements in the context of disaster training exercises is needed.
Method:
Individual, contextual interviews were conducted with a total of 26 medical first responders from four European emergency service organizations: Hellenic Rescue Team (Greece), Summa 112 (Spain), Sanitätspolizei Bern (Switzerland), and Johanniter Österreich (Austria). The interviews were analyzed using qualitative content analysis.
Results:
The preliminary results indicate that real-world disaster training exercises have limitations regarding realism. The participants described a need to train in an environment that accurately represents what they might face amidst a real-world incident site. This included the recreation of potential environmental dangers that had to be taken into consideration before approaching the incident site. The participants also highlighted the importance of realistic representations of injuries and reactions from the victims during training. The limited possibilities to provide a realistic training environment that corresponds to the set requirements lead to the participants feeling less prepared to face a real-world mass casualty incident.
Conclusion:
Medical first responders’ need for increased realism in real-world disaster training exercises deserves attention. Training solutions that could potentially increase the level of preparedness needs to be taken into consideration. How the degree of realism in Virtual or Mixed Reality based training platforms affects the perception of preparedness among medical first responders warrant further research.
The pandemic brought to the fore the importance of maritime transport as an essential sector for the continued delivery of critical supplies and global trade in times of crisis. Timely vaccination of seafarers secures their health and enables the chain of infection to be broken with the international propagation of the virus via maritime traffic. As part of the COVID-19 vaccination program, the Health Service Executive in conjunction with the Port of Cork company developed a unique pathway for seafarers to access COVID-19 vaccinations once they arrived in Cork.
Method:
An Excel template was developed by HSE and Port of Cork that would capture key information for seafarers to avail of vaccinations. Once data was captured by the ship's Captain, it was sent to the shipping agent and reviewed by the HSE South Emergency Management Office. Once the data was validated it was sent to the vaccination center so that the seafarer's details could be entered onto the system. Once confirmed, travel arrangements were made from the vessel to the vaccination clinic ensuring a safe staffing level remained on the vessel.
Results:
A total of 84 seafarers registered for the seafarer's vaccination program. 70 of these seafarers received one or more doses in Cork City Hall Vaccination Centre with the remainder having received one dose in pharmacies in Cork City.
Conclusion:
This joint initiative developed by the HSE Emergency Management Office and the Port of Cork, the first seafarer's COVID-19 vaccination program in Ireland, ensured seafarers were allowed to avail of a COVID-19 vaccination when they arrived at the Port of Cork. This highlights the requirement for future vaccination programs to consider and incorporate the requirements of seafarers acknowledging the essential role they play in the global supply chain.
The risk internationally of terrorist attacks and other mass trauma incites societies to strengthen the planning and implementation of psychosocial care. Prior findings have documented that psychosocial care responses, especially long-term follow-up, differ substantially between countries. With the aim to strengthen future psychosocial care responses and research, this presentation describes the models for psychosocial care and research activities following terrorist attacks in European countries.
Method:
Pre- and post-attack policy documents and reports addressing the psychosocial care responses to terrorist attacks were identified, and research on the mental health of affected individuals and psychosocial care provision was reviewed.
Results:
Although several aspects of the acute psychosocial care responses to terrorist attacks were similar across countries, there were substantial differences as to if and how long-term follow-up interventions were planned and implemented. There were also major differences in whether or not monitoring of and research on the psychosocial care responses were conducted, and existing research had important limitations.
Conclusion:
In order to strengthen the public health responses to future terrorist attacks and other mass casualty incidents, there is need for more standardized registration of affected individuals, as well as international models for monitoring their health and longitudinal research on the countries’ psychosocial care provision. During the presentation, it will be discussed how monitoring and research can be improved in this context.
To determine if lockdown measures related to the COVID-19 pandemic changed the frequency and epidemiology of geriatric patient emergency medical service (EMS) facilitated visits to the emergency department (ED) in Hamilton, Ontario, Canada.
Method:
A retrospective chart review was conducted comparing ED presentations of patients over 65 years of age presenting to two academic hospitals in Hamilton, Ontario via EMS between March 17, 2020, and July 15, 2020 (the first wave of the COVID-19 pandemic) to March 17, 2019, and July 15, 2019 (pre-pandemic).
Results:
Total EMS facilitated geriatric ED number of visits decreased by 17.3% during the first wave of COVID-19 in 2020, relative to the same seasonal time frame in 2019 (March 17- July 15). Visits were more dramatically decreased in the first 8 weeks after the pandemic was declared but then recovered to pre-pandemic levels thereafter. More geriatric patients visiting the ED via EMS were admitted during the initial stages of the COVID-19 pandemic, relative to 2019. However, the acuity and epidemiology of visits remained the same during the first wave of the COVID-19 pandemic, relative to 2019.
Conclusion:
Lockdown measures during the first wave of the COVID-19 pandemic coincided with decreased geriatric EMS ED visits in the initial two months after the pandemic was declared. Visit numbers recovered as the first wave ended. The epidemiology, as well as the overall acuity, did not change.
Demand for prehospital emergency services has been increasing worldwide. Significant challenges exist in meeting response times in rural environments when faced with surges in demand related to weather events or sustained demand surge such as the pandemic environment. Significant pressure also exists in the hospital environment receiving such large volumes of patients with short duration handovers to allow prehospital assets return to their primary roles. The aim of this study is to determine trends for ambulance presentations in a rural emergency department over seven years with absolute numbers and percentage of overall attendances.
Method:
A retrospective analysis of anonymized electronic registration data on the iPMS system from initiation in 2014 to 2022 including total registration numbers, presentation by ambulance, and handover times. Excel is used to record and examine data.
Results:
ED attendances rose from 29,236 in 2014 to 43,184 in 2021 with total ambulance presentations ranging from 4,859 in 2014 (16.62% of attendances), maxing in 2019 at 10,326 out of total attendances of 42,637 (24.22% of attendances).Lowest monthly ambulance presentations occurred in April 2014 (441 or 15.82% of 2788 attendances) and maximal monthly presentations was 1,023 in May 2022 (23.38% of 4376 attendances). Lowest percentage of attendances arriving by ambulance occurred in May 2014 with 14.97% (468) out of 3,127 ED presentations. Highest percentage of attendances arriving by ambulance occurred in January 2021 with 33.67% (875) of 2,599 ED presentations which was during the lockdown phase of COVID in Ireland.
Conclusion:
Overall total numbers of patients arriving by ambulance has been steadily increasing for years but numbers (and percentages) dramatically increased during COVID and this has been sustained in the POST Lockdown pandemic phase. Strategies are required to manage demand, increase turnaround and educate the public on appropriate use of prehospital emergency services.
Leaving a viable public health legacy and sustainable improvements in health infrastructure and capacity should be key for mass gatherings (MGs). Legacy includes improvements in health systems, health behaviors and delivering future MGs. Legacy planning and evaluation should be considered early in planning however, they are often neglected due to lack of funding to support, embed learning and maintain a sustainable legacy, and often favored over the event running smoothly.
Building on the Public Health for Mass Gatherings: Key Considerations (KC2) (2015), an updated literature review will identify new evidence for evaluating MGs and their legacy. This review will inform the development of updated resources to reflect the changing global health landscape and learning from MGs hosted during COVID-19, which can inform ways of better embedding legacy and evaluation in planning and post-event.
Method:
A systematic literature review methodology will be used. Electronic databases will be searched for relevant publications and grey literature of a wide range of MGs globally, focusing on evaluations, MG legacies, and impacts. Searches for specific technical areas e.g., surveillance, will also take place.
Results:
The literature review undertaken to develop the KC2 chapter identified limited publications. The increased interest in this field, should lead to an improved evidence base while recognizing evidence for long-term evaluation and legacy impact may still be more restricted due to the challenges of undertaking these studies. Recent literature will likely reflect work undertaken to deliver MGs during COVID-19, which will be included to identify good practice and transferable learning.
Conclusion:
Key findings of the review will be published, and the evidence base will be used to update the evaluation and legacy chapter of the KC2. There are also plans to develop a MG evaluation and legacy tool that will be applicable beyond the major high-profile funded events.
There are only two medical practitioners who are genuinely generalists. The confirmed generalist is the one who has been trained and credentialed to perform prenatal care, deliver babies and perform c-sections, take care of young children, perform simple surgeries, perform palliative care, and hold a patient's hand and hug the family after the death of a loved one. In the human world, that medical provider is a family practice physician. In the animal world, that provider is the veterinarian, who cares for all species that are not human and covers their medical needs, from preventive care to surgical needs, dentistry to dermatology, internal medicine to cardiology. As such, veterinarians are indeed generalist medical providers. In disasters, veterinarians are often pushed aside by their human medical counterparts. In doing so, there are a lot of learning opportunities missed on both sides.
Method:
A literature review was conducted.
Results:
n/a
Conclusion:
In learning the skills that are unique and overlapping, physicians and veterinarians will be better able to respond to disasters anywhere and will be positioned to help the displaced and injured get better so they may return to normalcy as quickly as possible. It is time that disaster teams and planning sessions stop being siloed and think about how medical generalists can team up and work together.
Sierra Leone, one of the countries with the highest maternal and perinatal mortality in the world, launched its first National Emergency Medical Service (NEMS) in 2018. We carried out a countrywide assessment to analyze NEMS operational times for obstetric emergencies with access to timely essential surgery within 2 hours. Moreover, we evaluated the relationship between operational times and maternal and perinatal mortality.
Method:
We collected prehospital data of 6,387 obstetric emergency referrals from primary health units to hospital facilities between June 2019 and May 2020 and we estimated the proportion of referrals with a prehospital time (PT) within 2 hours. The association between PT and mortality was investigated using Poisson regression models for binary data.
Results:
At the national level, the proportion of emergency obstetric referrals with a PT within 2 hours was 58.5% (95% CI 56.9% to 60.1%) during the rainy season and 61.4% (95% CI 59.5% to 63.2%) during the dry season. Results were substantially different between districts, with the capital city of Freetown reporting more than 90% of referrals within the benchmark and some rural districts less than 40%. Risk of maternal death at 60, 120, and 180 min of PT was 1.8%, 3.8%, and 4.3%, respectively. Corresponding figures for perinatal mortality were 16%, 18%, and 25%.
Conclusion:
NEMS operational times for obstetric emergencies in Sierra Leone vary greatly and referral transports in rural areas struggle to reach essential surgery within two hours. Maternal and perinatal risk of death increased concurrently with operational times, even beyond the two-hour target, therefore, any reduction of the time to reach the hospital may translate into improved patient outcomes.
The first cases of COVID-19 arrived in Israel in March 2020. In Israel, the first known cases were Israeli patients diagnosed with COVID-19 aboard the Diamond Princess which were repatriated.
Shortly later, additional cases were found in increasing numbers constituting the "first wave". The high number of patients put significant strain on Israeli hospitals. The initial wave was later followed by additional surges in the number of patients further straining the system. At the peak, hospitals with a total bed capacity of 800 had 135 covid-19 patients with 21 of them requiring ventilatory support.
Method:
Daily and weekly multidisciplinary meetings were held and daily reports were composed. Following each wave, lessons learned and recommendations for improved preparedness were formulated. The following results and conclusion sections summarize some of the main insights and recommendations.
Results:
The main challenges in Beilinson hospital during the "first wave" were a shortage of personal protective equipment (PPE) and how to best utilize the existing supplies, uncertainty regarding infectiveness, best management practices and uncertainty regarding the expected magnitude and duration of the pandemic. In retrospect, the major insights were the need for a flexible and divisible ED to safely care for changing loads of suspected and verified COVID-19 patients as well as COVID-19 negative patients. Increasing the in-hospital stockpile of PPE as well as the regional and national stockpile and creating local production capacities. The importance of the daily multidisciplinary managerial meeting was to improve situational awareness and allow improved decision making. Staff briefing occurred on a daily basis and during times of high uncertainty at the beginning of every shift.
Conclusion:
Performing structured and frequent debriefing and analysis to achieve clinical and operational insights is crucial for improved short-term performance as well as improving preparedness for future challenges.
Hospitals experiencing a COVID-19 outbreak are in a similar situation to those affected by natural disasters, with a breakdown in command and coordination, shortage of personnel and supplies, and increased stress among staff. In Japan, when a COVID-19 outbreak occurs, the first step is for the hospital or health center to respond. However, if the local authorities are unable to respond, the Ministry of Health, Labour and Welfare dispatch Disaster Medicine Assistance Team (DMAT) by request of the local government to facilitate early recovery. This study will examine the effectiveness of early phase support by DMAT.
Method:
Patients and healthcare workers in 31 hospitals supported by DMAT after an outbreak occurred between April 2020 and January 2021 were included in the study. Attack rate and case fatality rate for patients and the attack rate for healthcare workers were analyzed for each of the two groups: those that started support less than ten days after the first positive case and those that started support more than ten days after the first positive case.
Results:
For hospitals that started support in less than ten days, the attack rate was 27.9%, the case fatality rate was 17.4% for patients, and the attack rate for healthcare workers was 9.7%. For hospitals that took more than ten days to start support, the attack rate was 44.8%, the case fatality rate was 23.1% for patients, and the attack rate for healthcare workers was 14.3%. The attack rate (p<0.001) and case fatality rate (p=0.011) for patients and attack rate for healthcare workers (p<0.001) were significantly lower in hospitals that started support in less than ten days.
Conclusion:
Early intervention of DMAT support using natural disaster support techniques for hospitals experiencing an outbreak reduced the attack rate and case fatality rate for patients and healthcare workers.
Due to climate change, many countries are exploring nuclear power as a clean, sustainable, and alternative energy source. However, radiophobia stemming from a history of major accidents at nuclear power plants (most recently Fukushima Daiichi) inhibits the expansion of this industry. In an unlikely event of a large-scale accident, the risks posed to humans are minimal when mitigation measures are followed. This includes appropriate Personal Protective Equipment (PPE) for first responders, and medical professionals responding to these emergencies. An examination of the PPE recommendations for these scenarios will highlight best practices for minimizing exposures, and the effects of radiation.
Method:
A systematic literature review will provide a historical baseline of the PPE worn during previous nuclear power plant events. Additionally, current recommendations for PPE levels in response to these emergencies will be explored. Five databases will be utilized for this study, including PubMed, Web of Science, and SCOPUS.
Results:
Many studies examine different types of nuclear radiological exposures, but few focus on nuclear power plant scenarios. More than 5,000 articles emerged from a preliminary survey of the five databases. However, less than 1% of them satisfied the extraction criteria, and reviewed PPE for nuclear power plant accidents. Medical responders caring for “exposed” individuals who present at Emergency Departments have minimal exposure once they’re decontaminated, and everyday PPE is maintained. However, data on PPE recommendations for on-site response remains unexplored. Airtight suits and full-face respirators emerged as industry gold standard for protection, but a closer examination of these types of suits, and responders' self-efficacy utilizing the gear would clarify their actual protective qualities.
Conclusion:
While nuclear power plant accidents do not occur often, many remain fearful of their impact. Maintaining proper PPE (including respiratory habiliment) for event responders is one way to minimize the adverse health effects of these nuclear radiological exposures.
Mass casualty incidents (MCI) overwhelm existing resources in the emergency department. The existing method to recall staff in an MCI is text notification through the hospital call center. This study aims to assess the effectiveness of a novel method to recall senior emergency physicians during an MCI.
Method:
For this method, upon notification of a MCI, the senior physician on duty will start call tree activation based on four different senior physician job grades. He/she will call the first physician for each grade, who takes over calling and activating the remaining physicians in the same grade with a maximum of two attempts. Each physician receiving the activation call then texts an acknowledgement and estimated time of arrival at the department in the group chat. An unannounced, simulated MCI event was conducted at 02:00 and 14:00 on a weekday. Effectiveness was determined by the proportion of senior physicians available within 60 minutes of activation.
Results:
For the 02:00 activation, three of the 25 senior physicians were on clinical duty in the hospital while nine were contactable within 15 minutes and thirteen after 30 minutes. Eleven were able to return to the hospital in 60 minutes or less and one beyond 60 minutes. Nine were local but unable to return and one was overseas.
For the 14:00 activation, four of the 25 senior physicians were on clinical duty in the hospital while 15 were contactable within 15 minutes and six after 30 minutes. Nine were able to return to the hospital in 60 minutes or less and four beyond 60 minutes. Three were local but unable to return and five were overseas.
Conclusion:
This method can achieve rapid manpower augmentation with more than half the staff present in the hospital within 60 minutes. Drills involving physical recall should be performed to further test this workflow.
The COVID-19 pandemic presented obstacles to Emergency Medical Teams (EMT) deployment, including concern of exposure to COVID-19 and travel restriction in many areas of the world. Recognizing these challenges, EMTs sought alternatives to physical deployment, such as virtual deployment. However, concerns have been raised regarding access to internet in aid recipient countries, as well as patient privacy and data leakage in general due to insecure internet connections and intentional data hacking. There is limited literature, and no internationally agreed set of criteria, on the evaluation of deployment including the recipient countries’ ministries of health’s opinion on the deployments. In order to compare alternative deployment modalities, a set of criteria to evaluate an EMT deployment must be established.
Method:
The research will identify a set of criteria that can be used to evaluate a deployment; to identify the possible alternative modalities to traditional physical deployment; and to explore perceptions of acceptability and ability to meet the goals of international humanitarian assistance. A stakeholder analysis will be conducted to identify the key informants and relevant stakeholders, and the Delphi Approach will be utilized to seek experts’ opinions and reach consensus.
Results:
This research will help to establish a set of criteria for evaluating deployments, and to identify the alternative deployment modalities, the advantages, and disadvantages, and to evaluate each alternative modality, with the hopes of guiding EMTs to plan their future deployments, as well as to provide alternatives should there be further restrictions in the future.
Conclusion:
At this moment, this research is at the planning stage and ethical approval has not yet been sought. Should this abstract be accepted, ethical approval will have been obtained, and data collection will have just started in May. The presentation will include a summary of relevant literature, the methods, and any preliminary results.
Subcutaneous adipose tissue (SAT) and bony thorax will deform and conduct driving force during cardiac arrest (CA). The association between short-term prognosis and deformation of adult thorax for patients acquired return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR) was unclear.
Method:
Clinical records and CT images were collected from eligible patients admitted to the hospital who received CPR and achieved sustained ROSC from May 31st, 2019 to June 30, 2021. The patients were divided into different groups according to discharge outcome, then into three subgroups according to the ventilation mode before and after CPR. After that, patients with the same ventilation mode before and after CPR are combined and analyzed.
Results:
Records from 1663 patients were reviewed. After selection, 70 patients were included into this study. Significantly thicker posterior SAT post-compression was found at the 7/8/10/11 spinous process plane in patients with favorable neurological outcome (p<0.05). For patients receiving same kind of respiratory support before and after CPR, significantly thicker posterior SAT pre-compression at the 6/7/8/9/10/11 spinous plane and thicker posterior SAT post-compression at the 7/8/9/10/11/12 spinous plane (p<0.05). For patients without mechanical ventilation before or after CPR, significantly thicker posterior SAT post-compression was found at the 10/11 spinous plane in patients with favorable neurological outcome (p<0.05). For patients receiving mechanical ventilation before or after CPR, thicker posterior SAT post-compression was found at the 10/11/12 spinous plane was associated with favorable neurological outcome. No difference was found in the bony thorax within a different vertebral plane after subgroup analysis (p>0.05).
Conclusion:
Thicker posterior SAT and greater SAT depth difference after compression was associated with favorable neurological outcome at the discharge of patients who obtained ROSC after CA. A shorter duration of chest compression (<6 minutes) doesn’t cause calculable changes in patients’ bony thorax in patients who obtained ROSC after CA.