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Primary healthcare providers (PHCPs) are uniquely positioned to evaluate and increase vulnerable patients' disaster preparedness, in that they have detailed information about their medical needs, resources, and limitations. Nevertheless, it is still unclear what their roles and services are in this field. This study aimed to review the literature on PHCPs services to prepare the vulnerable population for disasters.
Method:
MEDLINE, Scopus, and PubMed databases were searched. Inclusion criteria include peer-reviewed articles published in English with no restriction on publication date. In order to obtain a broad perspective on the subject, the study type was not limited. The retrieved articles were imported into EndNote Reference Manager to manage duplications. Then, the reference lists of retrieved articles were checked for the relevance of the title and abstract. Lastly, fulltext articles identified were inspected against the inclusion criteria. Thematic analysis was performed to consolidate the commonalities in PHCPs roles and services for disater preparedness.
Results:
From the database search, 2193 articles were retrieved and 844 duplications were eliminated. Afterwards, 1349 articles were screened based on title and abstract, 49 full-text articles were assessed for eligibility, and 22 full-text articles were included. The six themes associated with services provided by PHCPs were emerged as follows: identifying vulnerable groups and assisting them in disaster planning, providing written materials and/or recommendations; protecting vulnerable population’ records; educating staff, vulnerable clients, and their caregivers; coordinating disaster planning and response across agencies; routine assessment of disaster preparedness, and planning for evacuation.
Conclusion:
This scoping review reveals that the literature on PHCPs services to improve vulnerable populations’ disaster preparedness is limited. Consequently, there is a need for scientific research to increase the existing capabilities of PHCPs for vulnerable population disaster preparedness and identify barriers and facilitators affecting their coordination with disaster management agencies.
Gunshots and bomb blasts are important causes of injury within conflict zones and extremities are frequently affected. There is a paucity of research on the characteristics and outcomes among civilians with conflict-related extremity injuries.
Method:
We performed a prospective cohort analysis utilizing data collected during a randomized trial at two civilian hospitals in Jordan and Iraq between 2015 and 2019. Adult patients who presented within 72 hours of sustaining an extremity injury requiring surgical care were included. We used mechanism of injury (gunshot versus bomb blast) as the exposure and wound closure by day five as the primary outcome measure.
Results:
The population was predominantly young men (n=163, 94% male, median age 29 years), injured by gunshots (61%) or bomb blasts (39%). Compared to the gunshot group, participants in the bomb blast group had more concomitant injuries (32/63 [51%] vs 11/100 [11%]; p<0.001), larger wounds (median area 100 cm2 [IQR 50–145] vs 53 cm2 [IQR 25–78]; p<0.001) and more frequent infections (16/63 [25%] vs 13/100 [13%]; p=0.04). Wound closure by day five was achieved in 25% (n=16/63) of the bomb blast group and 74% (n=74/100) of the gunshot group (p<0.001). This difference remained after controlling for confounding factors (OR 4.7; 95% CI 1.6–13.7).
Conclusion:
In this first prospective cohort analysis of civilians with acute conflict-associated injuries, those with extremity wounds caused by bomb blasts had worse outcomes than those with gunshot wounds. Our findings may prove useful to inform treatment protocols for civilians in armed conflict settings.
Non-conventional terrorism (NCT) is laced with uncertainty that can foster fear and lead to unwanted public behavior. One such example is the masses of worried-well overcrowding hospitals. The purpose of this study was to explore public behavioral intentions during NCT and the effect of risk messaging in attenuating unwanted behavior.
Method:
An online intervention-based study was conducted among 1,802 adult Israeli participants. Threat perception and behavioral intent before and after exposure to hypothetical NCT scenarios were assessed stratified to the media type, exposure to rumors and fake news, and risk messaging.
Results:
Participants perceived the CBRN terrorism threat as low-medium in likelihood, and threat intrusiveness and perceived incident severity were estimated at a medium level. Nearly half (45%) of participants indicated it is highly likely that they would seek medical attention following an NCT incident. Exposure to fake news significantly increased the intention to seek medical attention (p=0.001). However, the odds of participants exposed to risk messaging reporting this intention were 0.470 (95% CI: 0.359, 0.615) times that of participants not exposed to risk messaging (χ2=30.366, p<0.001).
Conclusion:
This study shows that overcrowding hospitals by worried-well following a non-conventional terror incident can be attenuated by risk messaging. In particular, this study suggests that simple, timely, and clear risk messaging is capable of overcoming fake news that otherwise can increase unwanted behavior. Rumors and fake news have limited power to alter threat perception, but they can significantly change behavioral intent and cause unwanted behavior that could jeopardize crisis management. Rational behavior by the public during NCT can be considered an outcome of rational decision-making by crisis managers, especially risk communicators.
A dedicated primary scene landing Helicopter Emergency Medical Services (HEMS) has been in operation in Ireland since 2012. Commencing with a unique collaboration between the Irish Aer Corps and civilian Emergency Medical Services (EMS) it has expanded to include a second charity funded model in the south west of the country. Both services operate under a single governance and dispatch system and provide an Advanced Paramedic level of care to the patients they serve. There is limited published literature on prehospital care in Ireland and to date no detailed descriptive study of patients treated by HEMS in Ireland. This research describes the characteristics of the patients treated by HEMS in Ireland.
Method:
This retrospective study will investigate the data of an excess of 8000 patients responded to by HEMS (2012-2022) in the republic of Ireland. Descriptive statistics will be used to interpret patient demographics, geographical spread, receiving facilities, mechanism/etiology of disease or injury, vital trends, transportation decisions and clinical interventions and short-term clinical outcomes.
Results:
Early stage data extraction shows seasonal variation in HEMS use with increased use in the summer months. Almost twice as many male patients vs. females were treated by HEMS while the most common age profile was 55-65 yrs. Trauma presentations have increased over the past 10 years and now account for over 60% of the overall caseload. The most common medical etiology was cardiac arrest or post resuscitation care followed by STEMI Care, the most common trauma cases were from road traffic collisions followed by falls and farm accidents.
Conclusion:
This study will be the first to describe the overall characteristics of HEMS patients in Ireland over a decade of service provision. As the Irish health system continues to evolve, so must its aeromedical services.
ASEAN Leaders’ Declaration on Disaster Health Management (ALD on DHM) (2019-2025) was adopted by the ASEAN Summit in November 2017 to strengthen the DHM system at national and regional levels, and the Plan of Action (POA) to implement the ALD on DHM was endorsed by the ASEAN Health Ministers Meeting in August 2019. Knowledge Management (KM) is one of the five priority areas in the POA with the relevant targets including the regional academic network establishment, organization of regional academic conferences, publication of the ASEAN academic journal on DHM, and so forth. The ARCH Project Phase2 (ARCH2), which started in January 2022, focuses on aiming to support implementation of this POA.
Method:
The ARCH2 will support the establishment of the ASEAN Academic Network on DHM (AAN-DHM) and the ASEAN Institute for DHM (AIDHM). In addition, the ARCH2 will support the promotion of academic activities on DHM which shall be conducted under the AAN-DHM in collaboration with the AAN member institutes and AIDHM.
Results:
Terms of Reference (TOR) of AAN-DHM was endorsed by the 15th ASEAN Health Ministers Meeting in May 2022. Afterward, the National Focal Point (NFP) institutes for the AAN were nominated among all ASEAN Member States (AMS). The first meeting of representatives of the NFP was held in September 2022 to discuss several areas such as governance of the AAN-DHM, the organization plan for the ASEAN Academic Conference (AAC), and the publication plan of the ASEAN Journal. Simultaneously, the TOR of the AIDHM was prepared for further discussion of its establishment.
Conclusion:
The AAN has already been established to initiate the preparation of its academic activities. The AAC on DHM is scheduled to be held in November 2023 in Indonesia as the first regional event for accelerating academic activities toward enhancing KM on DHM in the region under the AAN-DHM.
The Dutch Multidisciplinary Guideline for Psychosocial support during Disasters and Crises (2014) contains general principles and recommendations for mental health and psychosocial support (MHPSS) to those affected by disasters, crises or other potentially traumatic events. Changes in the field of MHPSS, ‘new’ types of crises (such as social unrest and long-term crises) as well as new (scientific) knowledge have been identified. A revision of the guideline is therefore necessary to ensure that the document is in line with the current scientific evidence and practice.
Method:
The aim of the revision is to regain national consensus on the updated recommendations for providing optimal MHPSS in the event of disasters and crises. Needs and challenges identified in the national field formed the basis for the revision, together with the existing recommendations from 2014. The setup of the revised guideline is in accordance with the Dutch EBRO method [Evidence Based Guideline Development]. The knowledge input was twofold: first, a systematic literature search was conducted in PsycINFO, Ovid Medline, Embase en PTSDpubs. Further, a multidisciplinary working group was formed with representatives from the domains of practice, policy and research. A consensus process was followed to test and revise the guideline.
Results:
The literature search yielded 3,845 unique articles and 180 met the inclusion criteria. Based on the scoping review, supplemented with literature and expert knowledge, the recommendations have been updated and revised. The majority of the recommendations are still valid. They have been adapted based on current literature. Knowledge of the two new themes: ‘long-term and creeping crises’ and ‘social media’ is translated into recommendations in the field of MHPSS.
Conclusion:
The revision will lead to a more complete starting point for additional guidelines, perspective for action and protocols for specific users and applications.
Information Technology has been applied to respond to the coronavirus disease 2019 (COVID-19), which has attracted increasing attention. However, there is still no comprehensive bibliometrics study in the global publications on the application of Information Technology in COVID-19. This study aimed to investigate the current research status of Information Technology in preventing and controlling the COVID-19 pandemic.
Method:
Relevant literature published between 2020 and 2022 was downloaded from Web of Science Core Collection (WoSCC) databases. Key search terms included COVID-19, big data, artificial intelligence, internet of things, cloud computing, etc. The data elements were as follows: year, countries/territories, institutions, authors, journals, research areas and citations of publications. Statistical methods and knowledge domain maps were applied to conduct contribution and collaboration, co-occurrence and co-citation analysis using VOSviewer. COOC software was used to construct the two-mode matrix, conduct hierarchical cluster analysis of high-frequency keywords and journals, and identify keywords of bursts.
Results:
A total of 10,962 articles were retrieved. The most frequent country and institution were USA (2,423, 22.10%) and the University of California System (212, 1.934%), respectively. The research areas were included but not limited to computer science (2,198, 20.051%), engineering (1,421, 12.963%) and public environmental occupational health (1,032, 9.414%). Three research hotspots were identified: (i) Internet-based social and psychological surveys; (ii) Distance education, telecommuting and telemedicine; (iii) Artificial intelligence-assisted diagnosis of COVID-19 patients. The clustering results of a two-mode matrix showed that research had the most frequent interaction with health, social media and information technology. According to co-citation analysis, a total of four clusters of journals had been obtained (clinical medicine, medicine, computer science and engineering, and public health). The keywords of burst were computer-based learning, general public, student-centered learning, etc.
Conclusion:
Information technology has played an important role in the response to COVID-19, which belongs to the interdisciplinary field.
Tropical cyclones are common weather phenomena occurring during the summer and fall months, primarily impacting coastal areas of the eastern shore of North America and the eastern and southeastern coast of Asia. The injuries often reported in the aftermath of these storms include near drowning, orthopedic injuries, and stress-induced cardiovascular emergencies. However, in the aftermath of Hurricane Ida (August 2021), we saw (and will discuss) an unusual trend of burn injuries.
Method:
Anonymized patient data from the regional burn center was reviewed for storm-related injuries in the 30 days post-Hurricane Ida landfall. This retrospective analysis included demographics of the patient population, size of injury (reported in total body surface area [TBSA]), mechanism of injury, and length of stay.
Results:
Inclusion criteria (burn injury as a chief complaint during the 30 days following the hurricane) identified 41 patients. Of the 41 patients, (32/41 [78.0%]) were admitted for their injuries. The leading nature of the injuries included flame (25/41 [60.1%) and scald (9/41 [22.0%]). The leading cause of burn injury included generator operations (refueling, gasoline, propane, contact with hot surfaces, etc., (14/41 [34.1%]), debris management (7/41 [17.1%]), and open flame for cooking or lighting (11/41 [26.8%]). Patient ages; median of 43.0 years [0.5 to 79]) with sexual (identity being recorded as) male (32/41 [78.0%]) and (9/41 [22.0%]) female.
Conclusion:
Climate change is contributing to the increased frequency and intensity of tropical cyclones. Consequently, strategies such as generator use and reliance on alternative fuel sources for lighting, heating, and cooking, have become more widespread to cope with the temporary interruption of public utilities following a natural disaster. However, these temporary solutions have led to an increased frequency of burn and inhalation injuries. Solutions include campaigns to increase public awareness and an increased clinical readiness to receive and manage more patients with burn and inhalation injuries.
The Covid-19 pandemic strained most of the world’s health care organizations to, and sometimes beyond, their limits. To anticipate, coordinate, mobilize, and prioritize hospital resources, Sweden’s health care regions established regional medical command and control teams according to the medical major incident structure. This command structure was initially developed based on an all-hazards approach focused primarily on sudden mass casualty incidents with a relatively short time frame. Covid-19 management was active for several months with a most intense operations period during the spring of 2020. This study aimed at identifying competence needs by employing a co-creative approach with members of the staff involved in the pandemic management.
Method:
Data was collected and analyzed using a modified Delphi consensus method. The respondents were subject matter experts serving in the regional medical command and control teams during the COVID-19 pandemic. One workshop was held to gather opinions, which were included as statements in a consensus survey and answered by the participants after the first workshop. A second workshop was held to discuss statements that did not reach initial consensus in the survey and establish final consensus.
Results:
The consensus agreed statements were sorted into five themes, which constituted the collective agreement of medical command and control core abilities. The five core competence themes were: Situation report, Team organization, Co-operation, Competence management, and Analysis. The consensus agreed statements highlighted competencies needed for creating situation reports, organizing medical command and control teams, effective cross-organization co-operation, decision-making, and medical intelligence analysis.
Conclusion:
The core competencies of medical command and control identified in the present study can be used to further affirm current learning objectives and to formulate future learning objectives for education and exercises. The evaluation approach could potentially be used as a post-incident review to fine-tune an organization’s training plan.
In August 2021, Hurricane Ida struck Louisiana as a near-category five storm, bringing massive devastation to the region’s healthcare infrastructure. In its aftermath, extreme heat coincided with record COVID-19 hospitalizations in the state, leaving minimal healthcare surge capacity remaining and medically vulnerable populations unprotected. Meanwhile, sparse pre-storm evacuations exposed prominent gaps in existing medical response plans designed to serve high-risk groups. Subsequently, Louisiana rapidly established a 250-bed alternative care site (ACS) within hard-hit New Orleans. This presentation highlights key considerations in the operation of the site and discusses which patient populations are most in need of medical support following tropical weather events.
Method:
The findings of this discussion are the result of after-action reviews, brief literature reviews, and the experiences of responders during Hurricane Ida. The presentation also draws on retrospective patient chart reviews from Louisiana’s prior alternative care sites.
Results:
Following Hurricane Ida, a post-storm alternative care site was rapidly established in New Orleans in partnership with a US Disaster Medical Assistance Team (DMAT). Operationalized in less than 72-hours, this site provided inpatient care to displaced persons with major chronic medical needs (e.g. home ventilators, hemodialysis, respiratory therapies), significant mobility impairment, wound care, and psychiatric illnesses. Incorporating Louisiana’s experience with a COVID-19 alternative care site, this facility far-exceeded the typical scope of medical shelters, simultaneously lessening medical surge on already-overburdened hospitals and meeting post-storm needs in the region.
Conclusion:
Following extreme weather events in metropolitan areas, traumatic injuries and acute illness comprise a small proportion of the medical needs after the event. Accordingly, disaster medical responses must prepare to treat large numbers of chronic illness exacerbations that result from a loss of access to primary care, home health support, and auxiliary services. This approach efficiently leverages resources into lifesaving interventions and protects healthcare systems during times of high stress.
single cloud-based chart that is owned by the patient protected by the government
information uploaded by a certified care provider (or they don't get paid)
Maintained by a patient navigator who organizes information
linked to self-care directions and
tele-support clinicians
2. Disparate and rapidly changing medical treatments of variable support with evidence
Why can't we integrate all guidance into one set of current recommendations so that when you put your information into the patient's EMR, guidance pops up and you follow that.
Not only will that lead to consistency, you are essentially entering a patient into a clinical trial of sorts as this data can be reviewed later.
3. CME
Fragmented, disparate, inconsistent.
Make it a paid part of our salary making it mandatory, and consistent
4. Telemedicine
Create a Provincial or State or Regional Virtual hospital that Offers 24/7, Full hospital e-consultant services.
a. Tier one, e-Consultants support acute care issues.They help you decide regardless of where you are working the management and connect with a regional hospital bed registry so you can move your patient from your ED to a hospital with beds.
b. Tier two, e-Consultants who support in-patient rounds virtually in rural/remote settings with hospitalists. For example, an Internist could support and monitor a regional virtual ward and do rounds with in-house hospitalists on patients across the region.
C. Tier three would be the equivalent of an outpatient clinic, done virtually.
Method:
A STRONGERR website using Social Media tools will be created to determine if social media can be used to accelerate health care transformation to create a unified delivery system.
Results:
Website will be up by Dec 2022. Results April 2023.
On February 13, 2021, Winter Storm Uri hit the United States beginning in the Pacific Northwest, heading across the central US, and eventually exiting on the East coast. By February 16, roughly 73% of the continental United States had snow coverage leading to ten million households without power. To understand the disaster-related causes and circumstances of death for Winter Storm Uri, we activated media mortality surveillance to help inform preparedness and response efforts.
Method:
We searched the internet for key terms related to the winter storm, including storm name and type (e.g., winter storm), location-specific terms (e.g., state, county, city), mortality-related terms (e.g., death, mortality), cause of death (e.g., exposure, motor vehicle collision, carbon monoxide), along with other information learned from previous days (e.g., name of individual). We compiled and coded data into a standardized media mortality surveillance database and conducted descriptive statistics.
Results:
Between February 13 and March 2, 2021, the media reported 136 storm-related deaths from nine states. The winter storm had the largest impact in Texas (n=91). Of decedents with sex data available (n=91), the majority (58%) were male. For decedents with age data available (n=93), the majority (91%) were adults. Exposure to extreme temperatures (47%) was the most common cause of death, followed by blunt force trauma (15%), CO poisoning (7%), and fire (7%). Roughly one-third of deaths (34%) were indirectly related to the winter storm with motor vehicle collision (13%) representing the top indirect circumstance. Twenty-six deaths (19%) have an unknown circumstance and cause of death.
Conclusion:
This was the first time we activated media mortality surveillance for a winter storm providing timely data for public health action. Media mortality surveillance continues to be a useful tool in assessing the impact of a disaster and guiding response efforts.
National Veterinary Services of World Organization for Animal Health (WOAH) are responsible for a wide range of activities including animal health, animal welfare and veterinary public health. The WOAH European Region member countries were surveyed to determine and quantify the level of capacity to respond to natural disasters, determine the types of disasters experienced, determine their levels of education and training and identify gaps in capacity and specific needs of Member Countries for disaster response.
Method:
A web-based Qualtrics survey on Animal Welfare in Natural Disasters was conducted by Lincoln Memorial University in conjunction with the World Organization for Animal Health (OIE) Platform on Animal Welfare for Europe. The 50 question survey was distributed by email link to Member Countries points of contact provide by OIE. The survey was emailed to 53 OIE European Member Countries with reminder emails to complete. Survey results were compiled and tabulated. Only aggregate data is published and presented.
Results:
Forty-nine countries responded to the survey for a 92% completion rate. Floods, earthquakes and fire were the three most commonly encountered disasters. Fifty-two percent indicated they incorporated animal welfare into their disaster planning. Thirty-one percent indicated they had no or limited legal authority to manage animal emergencies in natural disasters. The species covered in the national response plan ranged from laboratory animals at 17% to livestock at 48%. Eighty-two percent had no or limited standard operating procedures and 73% had no training to respond to animal welfare in disasters. Budgets, trained personnel, equipment/supplies and legal authority were the most frequently identified gaps
Conclusion:
The survey demonstrated there is a wide range of European Member Countries capacity to respond to animal welfare in natural disasters. This provides the baseline for the OIE Platform for Animal Welfare Europe to provide focused and actionable support to Member Countries
The COVID-19 Pandemic negatively impacted the mental wellbeing of healthcare workers worldwide. Many organizations responded reactively to their staff needs. The novel, evidence-informed Social Support, Tracking Distress, Education and Discussion Community (STEADY) program was implemented, with senior leadership support across a large hospital. STEADY is a multi-pronged program developed to mitigate occupational stress injury in healthcare workers and first responders. This project examined the feasibility of implementing STEADY across hospital units during a pandemic.
Method:
STEADY was implemented in five acute care units and across the rehab site of a large hospital. Data was collected on the five program components (drop-in peer support groups and critical incident debriefs, psychoeducation workshops, wellness assessments, peer partnering, community-building initiatives). Most peer support groups were facilitated by the program manager trained in peer support and one of six clinical staff.
Results:
The program was iteratively adapted to meet the needs of target units/groups. More than 300 sessions were run in ~one year, for an average of ~1.15 sessions per unit per week. With flexible adaptation to the mode of facilitation, ~75% of planned workshops and ~85% of peer support sessions were run. Three critical incident stress debriefs were held. The formal partnering program was offered via e-mail with minimal uptake. Ninety-five wellness assessments were completed by target end-users, with 36 personalized responses sent. Gratitude trees were posted in each unit for community-building. Eight target unit staff completed formal peer support facilitation training. Twenty additional groups across the organization requested STEADY programming support and ten requested gratitude trees.
Conclusion:
Results indicate that most components of the STEADY program were feasible to implement in hospital units during the pandemic. On-site, interactive programming was most engaging for end-users. Leadership support and flexible, continuous adaption by program leaders were identified as facilitators to program implementation and uptake.
Molecular assay for diagnosing and detecting SARS-COV-2 is an essential tool in pandemic management, allowing for early informed decision-making. Worldwide, the gold standard for testing SARS-COV-2 includes real-time reverse transcription-polymerase chain reaction assay (RT-PCR). The Cepheid Xpert-Xpress was authorized for emergency diagnosis of SARS-COV-2. This platform demonstrated various advantages, including faster results, due to a decreased turnaround time, and decreased contamination risk. However, inconclusive results often leave clinicians uncertain regarding individual patient management decisions. Often leading to more confusion than answers.
The aim of this literature review includes the following:
identify the frequency and clinical implications of inconclusive results for SARS-COV-2 diagnosis utilizing GeneXpert assay
whether inconclusive results should be interpreted as negative
assessing the reliability of the GeneXpert platform to diagnose SARS-COV-2
Method:
A narrative literature review was conducted with eight critically appraised articles which met the inclusion criteria.
After the initial data collection, the SANRA Framework was implemented to aid in the sorting and filtering of data. The analysis of data was conducted with a critical appraisal tool.
Results:
The GeneXpert SARS-COV-2 assay demonstrated high sensitivity and specificity. Studies indicated that inconclusive results associated with a high cycle-threshold value (CT-value) of more than thirty-five on the Cepheid Xpert Xpress were associated with a decreased viral load and, thus, decreased infectivity. However, numerous factors influence the CT-value, such as specimen integrity. Thus, results must not be interpreted in isolation.
Conclusion:
This narrative literature review demonstrated the need for institutions to assist clinicians with decision-making regarding inconclusive results. A flow diagram grading a patient’s risk of having SARS-COV-2 with an inconclusive result could be of immense value. The flow diagram should incorporate the current epidemiology in the area, patient symptomology and risk and duration of exposure.
People with hearing disabilities (PwHDs) often do not receive the warnings sent out to the general community during emergencies. Our goal was to identify the obstacles preventing PwHDs from accessing vital information in routine circumstances and during general emergencies.
Method:
This study was conducted from November 2018 through July 2020. We used a mixed-methods approach. The qualitative portion consisted of a standardized, open-ended interview with 19 PwHDs from various socio-economic backgrounds, religions, areas of residence and levels of hearing disability about coping with emergency situations in Israel. Grounded theory was used for analysis of the findings. The quantitative portion consisted of a cross-sectional survey of 288 PwHDs focused on perceptions of their self-efficacy in dealing with emergencies, methods of communication and accessibility of services. Using the Qualtrics survey platform with Israel sign language videoclips that included subtitles in straightforward Hebrew increased the participation. The statistical analysis was conducted using SPSS ver.23.
Results:
Most respondents explained that their responses differed depending on whether the emergency is collective or personal.
1. Collective emergencies: Events such as earthquakes or wars that affect everyone. Most solutions provided to the general population are not accessible to or suitable for PwHDs.
2. Private emergencies: PwHDs often encounter personal emergencies such as difficulty asking for help on the street, the inability to contact call centers or the difficulty in obtaining accessible information from organizations.
Conclusion:
The distinction between types of emergencies requires the development of different resources for dealing with routine issues and public emergencies. The latter affect PwHDs less than private emergencies. Standards of accessibility must be established for places providing services both during the day and at night, such as emergency rooms, telephone service centers, clinics, etc. These standards are the basis that which will allow for PWHDs to communicate independently.
In Japan, the response to COVID-19 has been a disaster response. In May 2021, the number of patients requiring hospitalization increased rapidly in Sapporo City, Hokkaido. Almost all medical institutions and clinics were overcrowded, and patients were forced to wait at home. Sapporo City requested a response from the Japan Disaster Medical Assistance Team (DMAT).
Method:
DMAT collaborated with the Sapporo City Public Health Center to set up a patient waiting station (The Temporary Medical Facility for Hospitalization Waiting) utilizing an unused hotel. DMAT placed the patient under medical care, provided oxygen therapy and other procedures, and coordinated hospitalization referrals. DMAT also organized a doctor home response system for patients who need emergency hospitalization and those who have returned home from The Hospital Waiting Stations.
Results:
64% of the patients were admitted to hospitals, 27% back to their homes, 9% were sent to residential care facilities, and 1% were sent to welfare facilities. The doctor home response system was able to redirect 52% of patients requiring emergency hospitalization.
Conclusion:
For the rapidly increasing number of patients with COVID-19, DMAT established a temporary medical facility and home visit system and was able to minimize the number of preventable deaths.
Healthcare workers (HCWs) are at increased risk of burnout, post-traumatic stress injury and suicide, compared to the public. Long-lasting increases in HCW distress are reported following pandemics. Such occupational stress can negatively impact individuals, organizations, and the overall healthcare system. Understanding HCW distress and needs can inform the development of resources to mitigate negative outcomes. Staff wellness data was gathered from a large academic health center during the COVID-19 pandemic, as part of a quality improvement project seeking to support staff wellbeing. Longitudinal trends of distress and preferences related to support were shared with leadership.
Method:
Monthly wellness assessments were sent to hospital staff via email. Assessments included screens for burnout, anxiety, depression and posttraumatic stress, questions regarding types of resources accessed, and open-ended questions regarding staff needs. Surveys were voluntary and confidential. Participants could provide their email to receive tailored resources based on individual results. Survey data was analyzed longitudinally to identify trends of distress over time.
Results:
A total of 2,518 wellness assessments were completed from April 2020-July 2021. An average of ~167 (range 17 – 946) HCWs responded per month and 638 staff provided their email addresses to receive a response; 497 of these completed assessments multiple times. The proportion of positive screens were, on average, 44%, 29%, 31% and 53%, for anxiety, depression, post-traumatic stress and burnout, respectively. Anxiety and post-traumatic stress scores decreased from April-August, then increased from September. The most reported source of support accessed was family/friends; ~40% of responders had not accessed formal mental health support.
Conclusion:
When COVID-19 cases decreased and stay-at-home mandates were lifted, HCW distress was reduced. Burnout trended upwards through the pandemic. Peer/family support remained favored compared to formal mental health support, suggesting the importance to HCW of social support. HCW reported a preference for convenient access to supportive resources.
In recent years, unmanned aerial vehicles (UAVs) have been increasingly used for medical surveillance purposes in mass gathering events. No studies have investigated the reliability of live video transmission from UAVs for accurate identification of distressed race participants in need of medical attention. During the 2022 Montreal marathon, the aim of this study was to determine the proportion of data collection time during which live medical surveillance UAV video feed was successfully transmitted and considered of sufficient quality to identify acute illness.
Method:
Four UAVs equipped with high resolution cameras were deployed at two predefined high-risk areas for medical incidents located within the last 800m of the race. The video footage was transmitted in real-time during four consecutive hours to a remote viewing station where four research assistants monitored it on large screens. Interruptions in live feed transmission and moments with inadequate field of view on runners were documented.
Results:
On September 25, 2022, 8,577 athletes registered in the Montreal marathon and half marathon. Out of the eight hours of video footage analyzed (four hours per high-risk area), 91.7% represented uninterrupted live video feed with an adequate view of the runners passing through the high-risk areas. The total interruption time was 22 minutes and 19 seconds, and the field of view was considered inadequate for a total of 17 minutes and 33 seconds. Active surveillance of drone-captured footage allowed identification of two race participants in need of medical attention. Appropriate resources were dispatched, and UAV repositioning allowed for real-time viewing of the medical response.
Conclusion:
Live video transmission from UAVs for medical surveillance of runners passing through higher-risk segments of a marathon race for four consecutive hours is feasible. Live feed interruptions and segments with an inadequate field of view could be minimized through practice and additional equipment redundancy.
Historically, the child care industry has been unprepared for emergencies. A previous study identified gaps in Michigan’s child care programs’ emergency plans. Study objectives were to reassess programs’ preparedness plans after the introduction of state-mandated emergency plans and to examine the effect of the COVID-19 pandemic on programs’ operations.
Method:
A 29-question survey was sent to ~500 child care programs across Michigan in 2020 to assess emergency plans and response to COVID-19. Data were analyzed using descriptive statistics and qualitative methods.
Results:
Overall, 346 programs (70%) responded. Most (92%) reported having a written plan, but one-third reported having no infectious outbreak plan pre-pandemic. One-third of programs lacked plans for special needs children (vs. 40% in 2014); 62% lacked plans for child reunification (vs. 60% in 2014); 46% reported staff received no preparedness training. COVID-19 impacted programs substantially: 59% closed, 20% decreased capacity, and 27% changed disinfecting protocols. Several themes related to the pandemic’s effect on programs were identified: 1) changes in learning 2) changes in socialization 3) increased family burden 4) financial challenges 5) lack of guidance.
Conclusion:
Significant preparedness gaps remain among Michigan’s child care programs, suggesting the need for increased support and the addition of emergency preparedness to programs’ quality ratings.