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Recurring outbreaks of cholera coupled with lack of laboratory diagnostic capacity in low resource settings fuels clinicians’ reliance on clinical case definitions and highlights the importance of accurate diagnostic guidelines. While “rice-water” stool color is the hallmark predictor of cholera, few have examined the diagnostic accuracy of this assessment. This study assesses the sensitivity, specificity and positive and negative predictive value (PPV; NPV) of classifying stool color as “rice”, “clear” (i.e. watery) or “rice or clear” stool by either the patient or nurse for diagnosing cholera.
Method:
From March 2019-2020, a random sample of patients presenting to the International Centre for Diarrhoeal Diseases Research, Bangladesh with acute diarrhea who had a stool sample obtained were included in this analysis (N=2135).
Results:
Of the 1198 (56.1%) of patients that had culture growth, 641 (53.5%) were positive for Vibrio cholerae. “Rice” stool was reported by 518 (23.8%) patients and 640 (29.5%) nurses, while “clear” stool was reported by 1081 (49.8%) patients and 353 (16.3%) nurses. When observed by nurses, both “rice” (76%) and “clear” (85%) stool were reasonably specific but not very sensitive for cholera (44% and 20%, respectively). The combined “rice or clear” colored stool had the best balance of sensitivity (65%) and specificity (61%) with a PPV of 42% and NPV of 80%. When reported by patients, “rice” stool had high specificity for cholera (76%) but low sensitivity (25%), while “clear” stool had both poor sensitivity (54%) and specificity (51%).
Conclusion:
Current international guidance that recommends classifying watery (clear) stool as cholera in outbreaks may still miss many patients with culture confirmed cholera even when the stool color is observed by trained health professionals and is likely not useful at all self-reported by patients. The combination of “rice or clear” diarrhea may provide somewhat more accurate assessments.
In January 2021, the State of Louisiana approved COVID-19 vaccine distribution to elderly and immunocompromised persons. From annual hurricane planning assessments, the city of New Orleans recognized medical and transportation barriers would prevent some eligible residents from accessing vaccines at public point of dispensing (POD) sites. A new vaccine distribution system was needed for homebound individuals and their caregivers. By February, the city developed and implemented a homebound vaccination plan under the direction of New Orleans Emergency Medical Services (NOEMS) and the New Orleans Health Department. This presentation will review this vaccine distribution model and the opportunities and challenges identified in maintaining this model for future medical POD interventions.
Method:
The City of New Orleans, along with news outlets and service providers, instructed homebound residents and caregivers to self-identify their need for a homebound vaccine by calling 311 and adding their name to a centralized waitlist. NOEMS/NOHD staff would schedule appointments based on resident and provider availability and geography of their home residence. Two 2-person teams were deployed simultaneously to provide ten doses within a five-hour time frame to minimize waste. Each deployment team included one city employee with an EMS certification and one volunteer, along with a cooler, ancillary supplies, registration form, and educational sheet to complete the appointment.
Results:
350 homebound residents and caregivers were vaccinated with the COVID-19 vaccine from February 2021 to January 2022. Vaccine doses were rarely wasted due to the availability of a centralized city-wide vaccine request list.
Conclusion:
The COVID-19 pandemic exposed gaps in mass dispensing plans and procedures. This local plan, created in haste to meet community need, became a model practice for other Parishes within the State of Louisiana and nationwide. This distribution modality needs to be maintained and tested, in addition to traditional POD sites, to be utilized in future dispensing events.
This study measured the impact of virtual three-level collaboration (3LC) exercises on participants’ perceived levels of collaboration, learning, and utility (CLU) at hospitals in the southern region of Saudi Arabia. Our 3LC exercise is a tabletop training tool used to facilitate disaster education and document CLU. This model enables the practitioner to acquire new knowledge and promotes active learning.
Method:
An English version of the CLU scale, the validated Swedish survey tool, was applied to 100 health-care managers or leaders in various positions at both the operational and tactical levels after conducting the 3LC exercises.
Results:
The results show that most participants strongly agreed that the exercises focused on collaboration (r2 = 0.767) and that they had acquired new knowledge during the exercises. There was a statistically significant association between participation in the collaboration exercises and perceived learning (r2 = 0.793), as well as between perceived learning and utility (r2 = 0.811).
Conclusion:
This study confirms the feasibility of three level collaboration exercises conducted virtually. Our work also demonstrates that learning depends on collaboration practices and that collaboration exercises before crises can help to build qualities that people can apply in daily life. Collaboration elements exercised in this study contributed to perceived learning. There was a strong covariation between participation in the participants’ collaboration exercises and perceived learning and utility. The virtual three-level collaboration exercises were well received by the participants and achieved an acceptable collaboration, learning, and utility score. Although exercises were conducted virtually, they were well received by the participants and achieved a value M = 4.4 CLU score, which opens up new dimensions in collaboration simulation exercises, at least from an organizational perspective, in a world with an increasing number of disasters and public health emergencies.
During public health emergencies, like COVID-19 or natural disasters, care for the pediatric population can become fragmented. Communication between systems may be challenged due to lack of relationships or infrastructure barriers such as incompatible electronic health record (EHR) systems. This can create critical, life-threatening situations for pregnant patients, infants, and children with exposures to threats. A systems-level approach was developed to guide planning efforts to improve and enhance communication and data sharing along the spectrum of care for children during public health emergencies.
Method:
The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) gathered subject matter experts to discuss how healthcare systems and community partners could strengthen the communication within the pediatric system of care. Three primary challenges emerged: Communication, Screening and Data, and Preparedness and Planning. Action steps were identified to address these challenge areas and meet the goals of reaching diverse populations, addressing health disparities, improving collaboration between health systems and public health, implementing effective screening practices that are guided by data, and strengthening infrastructure.
Results:
As a result of the in-depth discussions a graphic was developed to help guide those working to improve the system of care in their communities by implementing the activities described above. Selected multidisciplinary state teams will test strategies to address these goals.
Conclusion:
Improving communication and data sharing in the pediatric system of care will improve care and better inform the response during public health emergencies. Building successful partnerships, such as those between health care and public health, will be critical to success. The example of the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) program, which collects and analyzes data related to public health threats, demonstrates the strength of this approach.
Chemical terrorist attacks using nerve gas require patients with immediate administration of antidote, or otherwise they will experience abnormal neurological activity, respiratory arrest, and death. When it occurs in large stadiums at mass gatherings such as the Olympics, under normal medical care systems, preventable deaths occur due to insufficient deployment of on-site auto-injectors and stockpiled antidotes in hospitals. In Japan, the government has stockpiled antidotes in confidential warehouses and deployed auto-injectors around possible terrorist sites. When a chemical attack occurs, a stockpile of antidotes go to hospitals, auto-injectors go to the site, and firefighters and police are allowed to administer auto-injectors to patients. However, few studies are conducted on pre-deployment of auto-injectors and antidotes in chemical terrorisms. Therefore, the number of pre-deployment was examined.
Method:
A single chemical attack with 750 patients was assumed. Response was divided into five steps: (1) transportation of stockpiles to hospitals, (2) transportation of auto-injectors to the site, (3) on-site use of auto-injectors, (4) transportation of patients to hospitals, and (5) patient care in hospitals. Computer estimation was used for the time required for transportation for (1), (2), and (4). Desktop exercises were conducted for on-site response time, outpatient response time, and the number of beds available at hospitals for (3) and (5). The values obtained from computer estimation and desktop exercises were imported into the simulation model to measure the number of paramedics, auto-injectors required to be deployed in advance, and the amount of stockpiles required to be delivered to hospitals.
Results:
A minimum of 80 auto-injectors and ten paramedics were required to be pre-positioned at the scene. A minimum of 100 ampules of antidote was required immediately at the nearest hospitals.
Conclusion:
The pre-deployment of auto-injectors and personnel are essential to reduce the number of deaths in the event of chemical terrorisms.
There is growing evidence that disasters may increase the risk of developing chronic diseases, including diabetes, dyslipidemia, chronic kidney disease, and cardiovascular disease. However, how much disaster exposure specifically affects chronic disease risk is unknown. This presentation introduces the study protocol for the Risk of hEalth ConditiOn AdVerse Events after disasteRs (RECOVER) Cohort Study, which addresses this gap.
Method:
The primary aim of RECOVER is to determine the extent to which disaster exposure specifically increases the risk of developing chronic disease (Aim 1). The secondary aims of the study are to determine if the nature, duration and severity of disaster exposure are risk factors for disease (Aim 2), to map mediators of post-disaster chronic disease risk (Aim 3), and to identify potential biomarkers of post-disaster chronic disease risk (Aim 4). RECOVER will recruit over 6000 adults (1:1 disaster exposed vs unexposed) in Australia to a nationally representative cohort for longitudinal follow-up. Detailed data will be obtained annually on disaster exposure, demographic, social and health factors. The primary health outcome (Aim 1) of chronic disease will be defined as new, incident diabetes, cardiovascular or respiratory disease, and will be ascertained through data linkage with the Pharmaceutical Benefits Scheme. A biomarker sub-stream will include ~1,000 participants who provide a hair and saliva sample for cortisol and epigenetic analysis.
Results:
N/A
Conclusion:
There is an urgent need for detailed individual-level data to analyze the nature of the association between disaster exposure and chronic disease. In 2020 alone, 16.8 million Australians were exposed to disasters. The frequency and severity of disasters are only expected to grow due to climate change. As the first prospective cohort study to longitudinally track individual-level disaster exposure and chronic disease outcomes, RECOVER will fill a critical evidence gap.
Unfortunately, before SARS-CoV-2, a global workforce crisis in health care had already been flagged internationally and is only expected to grow. Health care workers are the critical driving force underpinning all health systems. A skilled workforce takes years to develop, and staff shortages have enduring negative impacts on patients, patient safety, and the ability to deliver Universal Health Coverage.
Method:
A scoping literature review on health care worker mortality and morbidity resulting from SARS-CoV-2 was undertaken and included reviewing the peer-reviewed and grey literature.
Results:
Four opportunities for improving the protection of health care workers during a pandemic were identified:
1) Strengthening data collection and reporting standards of health care worker mortality and morbidity due to SARS-CoV-2
2) Improving the protection of health care workers
3) Accelerating the vaccination of health care workers against SARS-CoV-2, and
4) Addressing gender inequities in health care
These four approaches provide opportunities for improvement and are only preliminary steps in addressing the ‘perfect storm’ that the shortage of global health care workers and the ongoing SARS-CoV-2 pandemic have created.
Conclusion:
The global community has a unique opportunity to protect health care workers and improve pandemic preparedness and response. The health and socioeconomic impact of SARS-CoV-2 has been unprecedented, and health care workers have borne the brunt of this pandemic. We owe our health care workers more. Without a well-trained and adequately resourced health care workforce that is prepared to face the next pandemic, we as a global community will not be able to deliver global health care or global security at the level that is required.
Every year many concerts, festivals, public meetings and major events take place in Ireland. Depending on the nature of the event such as: location, the number of attendees, and performers–these events present varying amounts of risk. The Health Service Executive is concerned with managing risks and advocates that event organizers put comprehensive event management plans in place. Healthcare arrangements for outdoor crowd events should be specified in the Event Medical Plan section of the event management plan by the event organizer. As part of the event notification process, event organizers engage with the HSE South Emergency Management Office which in turn liaises with the various care groups across the Cork Kerry region to inform them of events that may impact their service. Historically, event organizers have informed the Emergency Management office of events in a wide variety of formats and varying levels of information.
Method:
The HSE South Emergency Management Office engaged with Cork University Hospital (Major Trauma Center) to identify the information hospitals require from various events around the region. In addition, the Emergency Management Office liaised with a subject matter expert in Mass Gatherings from Australia to discuss key indicators/data points healthcare facilities could benefit from knowing in advance of mass gathering events.
Results:
A standardized Word document template was developed as a proof of concept that lists key data that healthcare facilities have identified as important for them to be made aware of as part of the notification process. This template now lends itself to be developed into an online editable form to enable event organizers to inform the relevant healthcare facilities of mass gathering events.
Conclusion:
Health care facilities require timely and accurate information regarding mass gathering events to ensure appropriate plans and preparations are in place. A standardized notification template would assist in the preparation phase.
The Network Of practitioners For Emergency medicAl systems and cRitical care project (NO-FEAR) was funded through an innovative call from the European Commission contained in the Horizon 2020 2016-2017 work program dedicated to Safe Societies - Protecting the freedom and security of Europe and its citizens.
The call assumed that professionals from many different sectors, including medical emergency teams, had little means and time to monitor innovation and research that could be useful to them. Moreover they have little opportunity to interact with academia or industry on these issues.
The project, funded in 2018 under a Coordination and Support Action Call, brings together practitioners, academia, policymakers and the industry involved in the response to medical emergencies, crises and health threats.
Since the very beginning, NO-FEAR has mobilized the vast network created during the project, to share real-time knowledge, experiences, lessons observed and challenges.
Method:
Qualitative methodology
Results:
This article intends to present the stages of the project during its journey where the creation of a network of practitioners dedicated to medical emergency services according to the three pillars methodology set in the project and which took place during the Covid 19 pandemic constituted a space to test innovative approaches in the relationship between end user and industry, in the identification of gaps and needs in the field and in responding to them, often going beyond the mandate of the project, creating a community capable of acting at the intersection of policymaker, companies and citizens.
Conclusion:
The case of NOFEAR demonstrates how, thanks to a European project, created a network of individuals and businesses that interact and or collaborate with each other can accelerate knowledge driven and sustainable growth of multidisciplinary ecosystems able to mitigate the fragmentation of the emergency medical systems.
Radiofrequency Identification (RFID) is becoming a ubiquitous technology that provides methods of tracking and organizing complex processes, and has had previously described benefits when used in medical and clinical situations such as disaster and mass casualty incidents. However, the potential benefits of this technology have not yet been examined or applied to mass gathering events such as music festivals using the medical lens.
Method:
RFID at music festivals was observed and characterized at a Canadian multi-day festival through a combination of (1) observation of real world application of the use of RFID-enabled attendee wristbands and (2) the development of a proposed implementation framework using expert input in event medical care, public health, festival safety and event organization. Potential roles for RFID technology in enhancing attendee safety, facilitating event medical care and collaborating with other on-site services, and promoting research agendas for these unique events were explored.
Results:
Observed and theoretical roles for RFID fell into four main domains: (1) the presence of important encoded personal health data and contacts specific to individuals that would be accessible in case of an emergency, (2) the unique, anonymous identification of attendees who access (and re-access) medical as well as other services, including during handovers between these services, (3) support for any larger public health research projects aimed at understanding the behaviors and flow of attendees, including recreational substance use and related harm reduction efforts, and (4) the storage of festival-tailored data throughout the event on RFID-enabled wristbands (eg previous medical visit details, self-entered substance use history, etc).
Conclusion:
The use of RFID at music festivals has clear benefits. It allows for the dynamic access and retrieval of important data that can aid safety and support the provision of timely and tailored medical care. Security and privacy issues need consideration where attendee data is concerned.
Variations in the incidence and patterns of injuries exist between genders which may impact treatments and outcomes. The study aimed to describe the epidemiology, treatments, and outcomes based on the gender of persons presenting with injuries to an Emergency Department (ED) in Kigali, Rwanda.
Method:
This was a secondary analysis of a prospective cross-sectional study conducted in January-June 2021 at the Centre Hospitalier Universitaire de Kigali ED. Descriptive statistics were performed and variable comparisons based on binary gender self-designation (male or female) were conducted.
Results:
A total of 601 patients were included in the analysis of whom 25.6% were female and 74.4% were male. Gender differences were found in the mechanism of injury with females more likely to be injured via falls (43.5% versus 23.0%, p=0.001), while males were more likely to be in a road traffic accident (52.6% versus 39.6%, p=0.006), have stab and/or laceration (9.0% versus 2.0%, p=0.004) or have been assaulted (6.9% versus 2.6%, p=0.047). Injury severity was not significantly different between genders based on the median Kampala Trauma Score and presence of triage hypotension. For treatments females were more likely to have been transported by prehospital services (87.7% versus 72.9%, p=0.001), but were less likely to received acute ED treatments of intubation, wound care, tourniquets, blood products, thoracostomy and point-of-care ultrasound during the first six hours of care (67.5% versus. 78.1%, p=0.009). Hospital admission was significantly greater among females as compared to males, (31.2% versus 41.8%, p=0.019) but no difference in mortality was observed (2.0% versus 1.3%, p=0.568).
Conclusion:
This study provides data on differences in epidemiologic and care characteristics between males and females presenting for emergency injury care in Rwanda. These findings can inform future research and help the development of gender-centered healthcare delivery in Rwanda and other similar contexts.
The COVID-19 crisis stressed the medical system and required leaders to rise to the occasion. Some institutions were very successful while others floundered. We saw this at every level of government as well as in healthcare. Applying the principles of crisis leadership and communication (and avoiding pitfalls) will increase our readiness to respond effectively during stressful times.
Method:
Literature review and US Centers for Disease Control and Prevention guidelines.
Results:
While there is robust literature on the topics of crisis communications and leadership this training is lacking in healthcare circles. This poster aims to introduce the subject and advocate for increased training in Crisis Communications.
The US CDC has developed a freely downloadable training manual, along with tools for rapidly developing a crisis message. Furthermore, a checklist to help with the presentation and a list of communication pitfalls to avoid are included.
Conclusion:
Leaders can use these tools to prepare in advance for crisis communications, avoiding common mistakes that reduce communication effectiveness.
Mt. Ontake (3,067m), Japan's second-highest volcano, erupted without warning on September 26, 2014, leaving 58 dead and five people missing. More than 20,000 rescue workers were mobilized from all over the country. The findings on rescue operations and subsequent advances in emergency preparedness and rescuer education are presented.
Method:
After the disaster, public data was obtained from the Cabinet Office by conducting interviews. Photographs and videos were collected from the military, the police, and the Fire and Disaster Management Agency sources, as well as from local governments and the Volcano Research Institute.
Results:
The volcanic eruption received governmental disaster designation. The leading cause of death and the rescued survivors were traumatic injuries caused by sudden falling rocks. Volcanic tremors and landform upheaval were observed immediately before the eruption, but they were too short-lived to lead to evacuation. The location of the victims at the time of the eruptions seemed to be the most critical determinant of survival. What medical care could do at this point was very limited. No rescuers died, but some suffered acute mountain sickness and hypothermia. In the following year, education for rescue organizations began, and volcano information was released to the public in real-time as raw data, regardless of whether they could be understood. In 2022, shelters were constructed near the summit of Mt. Ontake.
Conclusion:
A severe volcanic eruption leaves little time for people to evacuate, and emergency medical care can play only a minor role. In Japan, where there are many volcanoes, measures are underway to support self-help to increase the possibility of saving lives for climbers and rescuers in an eruption that is difficult to predict.
Korea Institute Radiological Medical Sciences operates an emergency medical response system in case of a radiological accident or disaster. A radiation accident or disaster can affect large-scale patients and destroy medical infrastructure. However, there is currently a lack of specialized education for treating large-scale patients or high-dose exposure patients. This study aimed to evaluate the efficiency of radiological mass casualty triage education programs and present a new training method to improve the ability of 119 emergency medical teams in the event of a radiological accident or disaster.
Method:
The results of mass casualty triage for radiological events were analyzed using the audience response system and questionnaire for paramedics who participated in the radiation accident response training program. For 25 paramedics, a pre-post evaluation was conducted on two items: understanding the mass triage and understanding the radiological mass triage. The data were analyzed using the SPSS WIN 23.0 program.
Results:
Thirty simulated patient scenarios were developed with the addition of clinical symptoms of radiation exposure based on the four trauma classifications: immediate, urgent, delayed, and death. The triage results of 30 cases conducted by 119 emergency medical teams were evaluated, and the trainees were asked to respond to the level of improvement in their knowledge of triage through pre- and post-training questionnaires. As a result of the pre- and post-education questionnaire, the degree of understanding of the mass triage was 3.8 before education and 4.4 after education, showing a significant difference (p=.003/MAX=5). The pre- and post-education questionnaire results of radiological mass triage showed a difference between 2.3 before education and 4.1 after education (p=.000/MAX=5).
Conclusion:
For effective radiation medical response, 119 emergency medical teams are required to have a repetitive mass triage education program for radiological events. It is especially important to provide a radiological triage system for field application.
Head trauma is a high-risk presentation to the emergency department (ED). Preventing secondary brain injury through earlier diagnosis and intervention relies on timely access to head CT. Wexford General Hospital (WGH) ED uses NICE guidelines, which recommend specific timeframes for acquiring CT in head trauma. Following an audit demonstrating low compliance to NICE CG176 time standards in 2020 (34%), a quality improvement project was undertaken to optimize imaging pathways for head trauma.
Method:
94 head trauma CT scans were analyzed over a two-month period (June 14, 2022-August 14, 2022) from the NIMIS and IPMS databases to establish current time compliance and median wait times for CT.
Following the implementation of a head injury assessment proforma at triage to prompt earlier evaluation of high-risk head injuries, 108 head trauma CT’s were reviewed over a two-month period (August 15, 2022-October 15, 2022) to determine if these parameters improved.
Unpaired, two-tailed Mann-Whitney’s test was used to compare median wait times from triage to CT. Two-tailed Chi-square test was used to compare overall compliance rates.
Results:
Overall ED compliance to NICE time standards improved following implementation of the proforma (43% vs. 36%, p=0.401).
For CT scans that were indicated within one hour, there was a statistically significant decrease in median wait time from triage to CT (134mins vs. 186mins, p=0.046). There was also a decrease in median wait time for scans indicated within 8 hours; however, this did not reach the threshold for statistical significance (216mins vs. 275mins, p=0.230).
Conclusion:
Although there was an overall reduction in wait times for CT, this did not translate to a significant improvement in compliance rates to NICE CG176 time standards. This suggests that, despite earlier identification of these high-risk head injuries at triage, other systemic barriers to obtaining head CT are present and warrant further investigation.
The COVID-19 pandemic created a public health crisis worldwide. Mass vaccination efforts in some cases were initiated without adequate civilian manpower due to critical medical staffing shortages. The governments of many nations deployed their military assets to fill gaps in care and to initiate projects to promote vaccinations. The COVID-19 pandemic created a unique international military vaccination response to an infectious disease disaster.
This literature review highlights creative solutions, abilities utilized, projects completed, overall effectiveness, and lessons learned by the military community worldwide to support their vaccination efforts within their countries. By collating this information into a single document, the collective global experience can be better analyzed and this information utilized to develop a framework for future disaster preparedness and mitigation planning efforts.
Method:
Medline (PubMed), GoogleScholar and the JSTOR Security Studies collection were searched for English language articles from January 1, 2020 and onwards. Keywords used included civil-military coordination, military, COVID-19, vaccination, vaccine. Titles were initially screened for relevance. The abstracts were then reviewed for a decision on inclusion. Article inclusion was determined by author consensus based on relevance to the objectives. Key papers were also hand searched for additional unidentified references.
Results:
Data collection and analysis planned for completion by January 2023.
Conclusion:
The COVID-19 pandemic created a public health need for mass vaccination distribution that was assisted by militaries throughout the world. This literature search demonstrates the ways in which military resources contributed to COVID-19 vaccination efforts, including creative techniques, successes and opportunities for future improvement.
The ASEAN Leaders’ Declaration on Disaster Health Management (ALD on DHM) was adopted at the 31st Summit in Manila in 2017. The Plan of Action (POA) to implement the ALD on DHM was adopted by the ASEAN Health Ministers Meeting in 2019, with Regional Collaboration Committee on Disaster Health Management (RCCDHM) established as a primary implementing mechanism under the purview of ASEAN Health Cluster two and Senior Officials Meeting on Health Development (SOMHD) to operationalize the implementation of the POA with its priority areas and targets to be realized by 2025. The first RCCDHM Meeting was organized in-person in Bangkok in 2020. The RCCDHM is composed of two representatives from each ASEAN member state (AMS), one representative from the ASEAN Secretariat and one representative from AHA Centre, and the secretariat role for the RCCDHM is carried out by the Ministry of Public Health, Thailand. The RCCDHM Meeting decided to develop the Matrix of Detailed Activities (MDA) addressing the five priority areas of the POA-ALD on DHM.
Method:
The RCCDHM Meeting organized a core group consisting of the Philippines and Thailand to develop the MDA which identifies information on activities, expected outputs, indicators, lead country, source of support, and the timeline for achieving objectives of the POA. During the COVID-19 pandemic, online communication was applied to discuss and coordinate among the AMS.
Results:
The core group developed the draft MDA in consultation with the ASEAN Secretariat/Health Division. After a series of discussions, the RCCDHM endorsed the MDA which confirms necessary activities and commitment of AMS.
Conclusion:
The review and endorsement process for the MDA will be elevated to the higher level meetings in the ASEAN Health sector for final approval. The RCCDHM also confirmed to strengthen collaboration with other ASEAN initiatives, non-health ASEAN sectors, UN, or other international partners, and the ARCH Project.
The health system faces many challenges including the lack of personnel or resources and the overcrowding of emergency rooms. In this context, Real Time Locating Systems (RTLS) offer the possibility of improving the efficiency, safety and quality of care management. Clinical trajectories are currently very dependent on manual processes. We believe that real-time management systems that use geolocation can optimize time-dependent clinical trajectories, improve critical care and transform the health network for patients, caregivers and managers. Typically, RTLS tools require a significant investment in terms of installation, configuration, and integration.
Method:
The Nano Data Center (NDC) system developed by Humanitas Solutions is equipped with an advanced and low-cost IT infrastructure. It is self-deploying, self-configurable and allows geolocation and autonomous telecommunication with multiple interfaces (WIFI, Bluetooth, electrical). It requires a power source and operates without requiring access to technological infrastructures, which is the major difference with similar products based mainly on cloud computing and dependent on internet connectivity. We tested, as a pilot project, the deployment of the NDC system in a complex hospital environment (Centre intégré de la santé et des services sociaux de la Montérégie-Centre, Quebec, Canada) in order to demonstrate its potential use.
Results:
Using the NDC system, we were successful in establishing an autonomous communication network over several hospital floors. This innovation made it possible to support the real-time geolocalization of fictive patients and the creation of a real-time dashboard for monitoring clinical trajectories, analyzing data, and evaluating performance.
Conclusion:
The next development phases of the CHRONOS project include real-time notification and transformation of clinical trajectories into smart trajectories. The independence of the NDC system in terms of infrastructures would allow its deployment in low-resource environments, such as temporary installations or remote areas. Thus, its potential benefit in creating connected environments in disaster situations.
Distilling from the National Risk Assessment for Ireland, the Regional Working Group for Major Emergency Management Region South (Cork and Kerry) assessed threats in the region and 22 hazards were identified which were distributed over the natural, transportation, technological and civil categories. The hazards were plotted on an Interagency (Health, Police and Local Authority) Emergency Management Risk Matrix
Method:
A three-hour ‘Introduction to Emergency Management’ educational program was developed in May 2022 with the aim of introducing frontline members of the Principal Response Agencies (Health, Police and Local Authority) across the Cork and Kerry region to the concept of emergency management. As part of this educational session, participants (N = 55) were given an overview of the regional risks as identified through the risk assessment process by the Regional Working Group for Major Emergency Management. As part of a breakout session, course participants were asked to identify their perspective on ‘worst case scenario’ risks.
Results:
An analysis of the operational risks identified by members of the Principal Response Agencies (Police, Health and Local Authority) were categorized into the four risk sub-headings: natural, civil, technical and transport and compared with the strategic regional risk assessment. The differences identified based on the comparative analysis, detailed that those holding operational portfolios identified that concurrent risks, as evidenced during the Cyberattack on the Health Service Executive in May 2021 during a wave of the global pandemic in Ireland were a perceived 'greater' risk that those traditional risks identified in the regional risk assessment.
Conclusion:
This study highlights the importance of engaging operational staff when developing regional emergency management risk assessments. The requirement to consider and incorporate concurrent emergency management risks is vital to ensure that the Cork and Kerry regions are prepared for future events.
Cyberattacks continue to plague medical systems across the world with nearly 24% of all cyber breaches impacting health systems. In Fall 2021, a large, tertiary care county hospital in Indianapolis, Indiana, USA suffered a cyberattack, causing over four weeks of downtime, forcing the system to revert to paper charting and to operate without the electronic medical record (EMR) or internet. Communication in the Emergency Department is structured through the EMR system or wireless local area network (WLAN) phones, causing communication difficulties when online systems are disrupted.
Method:
In the twelve months following the breach, a series of communications-focused interviews with stakeholders including residents, faculty, nurses, and consultants were analyzed using a thematic analysis.
Results:
Through interviews, four key themes and recommendations were identified for every internet-dependent tertiary care system to establish and maintain communication links when the primary form of communication is compromised and access to internet is limited or nonexistent:
Expect systems to fail–plan ahead
Develop multilayered communication tools that are stored and structured at different sites
Notify all affected teams immediately and initiate the downtime action plan
Reassess and adapt the downtime action plan as information becomes available
Conclusion:
While every system is going to experience different struggles during cyberattacks and downtime, all hospitals can benefit from improving communication structures when the established communication pathways are no longer available. Consider cybersecurity threats in your emergency planning meetings and designate systems to protect your communication abilities during downtime.