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Urban communities are under constant threat of numerous potential disasters, including cyanide exposure events. Exposure can occur in settings such as structure fires, industrial accidents, or even intentional acts of terrorism. The typical treatment modality for cyanide toxicity employs the antidote, hydroxocobalamin. While studies regarding antidote availability have been conducted in Korea and Hong Kong, a literature search did not reveal any such studies in any part of New York City.
The borough of Brooklyn has a population of 2.57 million people. In the setting of a mass casualty incident (MCI) involving cyanide toxicity, such as a large structural fire or a chemical attack, it is uncertain of the region's capability to provide hydroxocobalamin. The objective of this study is to assess the stockpile of hydroxocobalamin across acute care hospitals in Brooklyn.
The amount of hydroxocobalamin required to treat a cyanide-related MCI was based on recommendations from the 2018 US Expert Consensus Guidelines for Stockpiling Antidotes. Ten grams of hydroxocobalamin are needed for each 100-kg patient. Theoretically, a minimum of 50 grams of hydroxocobalamin would be required for a mass casualty incident (5 patients).
Method:
Fifteen acute care hospitals within Brooklyn were identified as potential treatment sites for cyanide exposure. Each site’s emergency manager was sent a survey identifying hydroxocobalamin availability in both their pharmacy and their emergency department.
Results:
All 15 hospitals responded to the survey. Two of the 15 hospitals had at least 50g of hydroxocobalamin in their inventory, however, no hospital had 50g stored in their emergency department. The median amount of hydroxocobalamin stored was 20g or two doses.
Conclusion:
Should a mass casualty incident involving cyanide exposure occur, only two hospitals in the borough of Brooklyn would be prepared to treat five or more patients presenting to their hospital.
Accurate triage is crucial for pediatric patients because their physiological differences make them more vulnerable to traumatic injury and mortality. However, pediatric trauma patients are challenging for EMS personnel for several reasons including infrequent clinical encounters and inadequate training. Despite the need for increased training, little is known about EMS readiness to perform triage and lifesaving interventions during pediatric mass casualty incidents (MCIs). Simulation skills assessment correlates with EMS performance in the field and can be used to determine MCI readiness.Pediatric patients are often omitted from MCI training and protocols. Feedback from EMS clinicians who participate in pediatric MCI simulations may be useful for educators seeking to optimize pediatric mass shooting triage training.
Method:
This was an observational study assessing EMS clinician accuracy in triaging eight children and two adults in a mass shooting simulation involving intimate partner violence (IPV) set at a private residence. Participating EMS clinicians were attendees of continuing education classes at Yale New Haven Health Centers for EMS. Participants worked in pairs, and triage decisions were documented during the simulation with an evaluation tool and video recording. After the simulation, pairs completed the demographic survey and completed a semi-structured debriefing. Facilitator prompts included correct triage level for each patient, the role IPV plays in mass shootings, and the participants feedback. Recordings of the debriefings were transcribed and analyzed using grounded theory. During the evaluation process, the major themes will be identified and coded. The transcriptions will be re-evaluated and any additional sub-themes will be identified and coded.
Results:
As of November 2022, eight paramedics have participated with more sessions scheduled for spring 2023. A preliminary review indicates potential themes will fall under the categories of simulation implementation and clinical approach to triage.
Conclusion:
These findings may assist EMS agencies with their pediatric MCI training and response.
Targeted Automobile Ramming Mass Casualty attacks (TARMAC) have occurred worldwide since 2010. The dramatic increase in incidence warrants special attention to the unique pattern of injury associated with such attacks as they are unlike any other type of intentional trauma. This study characterizes the resulting injuries from the 2017 Charlottesville, Virginia TARMAC attack.
Method:
Patient records of victims were identified and analyzed for injuries, demographics, and surgical needs. The data were evaluated for patterns.
Results:
Nineteen TARMAC victims were treated in the UVAHS Emergency Department. Most were female (68%). Average age was 29.4 years (range 13 – 72 years). Data showed seven ICU admissions, four standard admissions, and seven discharges. There was one fatality and the specific injury data was unavailable. Most injuries were orthopedic: lower extremity fractures (n=7) [2 open], upper extremity fractures (n=7), axial skeleton fractures (n=6), and a facial fracture (n=1). Arterial injuries required interventional radiology (n=1) or observation (n=2). Organ injuries included a Grade 1 spleen laceration (n=1) and pneumomediastinum (n=1). six victims required one or more operative interventions during admission: emergent procedures (n=6) and delayed procedures (n=4). In the Emergency Department, two bony reductions were performed, five lacerations were repaired, and one thoracotomy was performed. Injury Severity Scores were calculated (mean=11.5; median 6; range 1-75).
Conclusion:
Due to the mechanism of injury, TARMAC attacks inflict a unique wounding pattern. Intentional mass blunt trauma is previously unknown to emergency medicine. Vehicle variables including weight, speed, and bumper height affect the injury location and severity. This vehicle, a low-height sports car, inflicted primarily lower extremity injuries. Mortality rates have been higher in attacks involving taller, heavier vehicles, as seen in France, Germany, and Sweden. Analysis of victim data from TARMAC attacks will help emergency medicine physicians, surgeons, and disaster medicine specialists to prepare, train, and mitigate against this increasingly frequent tactic.
Disaster management and emergency preparedness relies on the collaboration, communication, and expertise of a multidisciplinary team. Skills in preparation, communication, and management of disasters are core competencies of an emergency physician. To learn the principles of disaster management, simulations are critical as mass casualty/rapid surge events seldom occur. The COVID-19 pandemic resulted in the cancellation of in-person events. In response to these restrictions, the University of Toronto, EM Program developed a successful virtual interprofessional mass casualty simulation.
Method:
The novel online simulation event was piloted in 2021 and ran for three-hours. The exercise focused on developing soft skills (e.g., communication, team-work, and debriefing) and hard skills (e.g., triage, casualty distribution, and activation of plans). Groups were composed of members of each post-graduate year to facilitate near-peer learning. A total of six groups were formed: Adult, Children, Community Hospitals, EMS, Government, and Media. Each Team used multiple communication tools (i.e., Whatsapp groups, Zoom breakout rooms, Shared Google Documents) to swiftly pivot and manage a mass casualty event. Post-exercise debriefing and anonymous evaluations were gathered.
Results:
A total of 28-residents (nine PGY1, ten PGY2, and eight PGY3 learners) and 11-staff observers participated (25-respondents). Nineteen participants rated the simulation exercise as excellent and six as “very good”. Twenty participants rated the workshop as “very useful” and five as “useful”. Positive feedback centered around content applicability, exercise creativity, level of engagement, and learning value. Constructive feedback included the need for more pre-exercise orientation time, increasing disaster management time, and inviting allied-health staff.
Conclusion:
There is a clear need for EM residents to learn and develop skills related to disaster management and emergency preparedness. This exercise showed that disaster management and emergency preparedness competencies can be learned in a virtual format. This virtual format has encouraged its continuation and further inspired the curation of a four-year program.
Pharmacists have been recognized as essential healthcare professionals during the COVID-19 pandemic. However, evidence of the challenges that were faced by the profession and the way pharmacists adapted their roles throughout the pandemic are largely unknown. This study aimed to describe the impact of COVID-19 on pharmacy practice around the world.
Method:
A cross-sectional online questionnaire with pharmacists who provided direct patient care during the pandemic. Pharmacists were recruited through social media with assistance from national/international pharmacy organizations. The questionnaire was divided into three sections; 1) demographics, 2) pharmacists’ roles/services during the pandemic, and 3) practice challenges. The questionnaire was adapted from the established, piloted, and published INSPIRE Canadian Survey. The data were analyzed using SPSS 28. Descriptive statistics were used to report frequencies and percentages.
Results:
A total of 505 pharmacists practicing in 25 countries consented and completed the questionnaire. Only 26.4% (132/500) of participants were engaged with local disaster and public health agencies during the pandemic to coordinate pandemic response. The most common role that pharmacists undertook was responding to drug information requests (89.4%, 448/501), followed by allaying patients' fears/anxieties about COVID-19 (82.7%, 413/499), educating the public on reducing the spread of COVID-19 (81.3%, 409/503), and addressing misinformation on COVID-19 treatments/vaccinations (79.1%, 397/502). The most common services provided by pharmacists were performing medication reviews (78.5%, 391/498) and managing and/or monitoring patients’ chronic diseases (72.3%, 362/501). Almost half of the participants reported administering COVID-19 vaccines (44.9%, 225/501). The most common challenge that pharmacists encountered was increased stress level (82.2%, 415/505), followed by medication shortages (72.3%, 360/505).
Conclusion:
Despite the unprecedented nature of the COVID-19 pandemic and the various challenges associated with it, pharmacists around the world adapted their roles and services to continue to meet the needs of their patients and be their safe-haven for ongoing care.
In general, models for thermal effects of nuclear weapons are not as well developed as models for blast and radiation effects, yet casualties resulting from fires and burns in a nuclear detonation would significantly impact civil defense and emergency healthcare. Previous studies have conducted in-depth analysis of the various atmospheric conditions that affect the thermal radiation transmissivity. However, such models have yet to consider the role that buildings play in the urban environment to estimate the casualties from the thermal effect more accurately.
Method:
A three-dimensional model of the area within a three-mile radius of the detonation site in Atlanta, Georgia, USA was created in Blender. To represent the thermal energy resulting from a 15 kiloton, near-surface burst, a point light was created with a power of 96,725 gigawatts and a radius of 81 meters. Using the Cycles render engine, the resulting light/shadow was orthographically captured directly above the scene.
Results:
The rendered model demonstrated the attenuating effects of the built, urban environment. Nearly half (46.82%) of the pixels in the resulting raster were black, or regions that were not exposed to any thermal energy. Slightly less than a quarter (22.32%) of the pixels were white or light gray, or regions that received mostly direct thermal energy. The remaining regions (30.86% of the pixels) were dark gray, or regions that were initially in shadow from the thermal pulse but received thermal energy via reflection from nearby buildings.
Conclusion:
As the thermal pulse travels at the speed of light, it arrives at a location before the blast wave. As such, the built urban environment offers protection from the thermal energy released during a nuclear detonation. Future studies that incorporate this thermal model may more accurately determine the quantity and geospatial distribution of burn casualties in the aftermath of a nuclear detonation.
Globally, nurses play pivotal roles in epidemic and emergency response. Nurses’ actions include supporting and informing surveillance and detection, dispensing live-saving medical countermeasures, implementing prevention and response interventions, providing direct care for patients, educating patients and the public, providing health systems leadership, and counseling community members. Despite these roles, there exist gaps in how countries train and prepare their nursing workforce for these health threats.
Method:
To help address this gap, the Johns Hopkins Center for Health Security has developed an International Resource Center for Pandemic and Disaster Nursing. We have established an international working group to provide input on the goals and mission of the center, website development and functionality, and advocacy efforts. This working group has met four times over the course of the last year. We have also met with several organizations involved in nursing and epidemic and disaster preparedness and response, including the World Health Organization and the International Council of Nurses (ICN), to identify ways to align our work with other ongoing efforts.
Results:
Presently, we have developed a static website that provides access to evidence-based, open-source trainings and educational resources applicable to pandemic and disaster nursing. The website also provides listings of upcoming webinars, guest blog posts, trainings, and conferences relevant to disaster and pandemic nursing. The website will be launched in early 2023.
Conclusion:
The long-term vision for this center is to expand beyond a static website and create a vibrant and fully staffed virtual center. This center would be the first of its kind dedicated to developing the resources, technical assistance, partnerships, and advocacy efforts needed to build and support a global nursing workforce that is prepared for outbreaks and disasters. It would build on the existing wealth of expertise within the working group and forge lasting connections between disaster nurse experts across the globe.
In Korea, there are various medical and industrial researchers who use radiation as part of their research. But radiation can cause extensive long-term damage in case of an accident. Therefore, national-level policy and training for the response workforce have been established for a professional response. Since 2002, the KIRAMS has been providing emergency medical response education based on the five mandatory contents (including legislation, protection measures, and emergency medicine).
Method:
The training content can be divided into theoretical and practical courses. Early education included theoretical courses on cases of accidents and their effects on the human body, as well as practical courses on treatment for contaminated patients. The current education program offers group practice using a HPS and mobile learning. As for the future of national radiation emergency education, the paradigm of education will change with the fourth industrial revolution, the advancement of the IT industry, and the advent of the ‘untact’ era. Therefore, research and development on XR technology–based educational content that can overcome reality’s constraints, is being conducted. Simulation-based education courses to increase effectiveness and immersion will be implemented.
Results:
Currently, there are approximately 900 radiation emergency medical personnel, and more than 30 new and supplementary education contents are provided each year to improve their proficiency and response abilities. Approximately eight types of content using XR technology will be developed and tested (2021-2023) before being implemented in actual education programs (2024). Advancements in education reflecting special conditions, such as COVID-19, and technological advancements will continue indefinitely.
Conclusion:
Efforts are ongoing to improve the educational content and to train excellent radiation emergency medical personnel. With the implementation of XR technologies and new education trends, the future of national Korean radiation emergency medical education is expected to advance and diversify, and further improvements in the educational content can be expected.
Chemical exposures can cause direct and indirect injuries to responding medical personnel. Therefore, hospital healthcare providers should be provided with disaster response training that includes identification of chemical hazards, establishment of the hazard zone, personal protective equipment use, decontamination, and chemical injury antidote use. This study evaluates the educational effectiveness of the chemical-mass casualty incident response education module (C-MCIREM) for hospital healthcare providers.
Method:
This was a retrospective quasi-experimental study. Subjects were hospital providers who enrolled in the C-MCIREM program between May 1, 2021, and July 26, 2022. Subjects were hospital providers from Bucheon, Mokpo, Iksan, Jeonju, and Dae-gu cities in South Korea. Subjects completed pre, post, and three-month knowledge retention and self-assessments of readiness tests, as well as evaluations on tabletop exercises (TTX), and a satisfaction survey (11-point Likert) after the course. The instructors scored teamwork measures via standardized evaluations on TTX throughout the course. The K-paired Sample Friedman test was used to compare samples.
Results:
127 respondents were enrolled. The median knowledge score rose from 51/100 (39, 66) to 85.5/100 (73.75, 90) with a median retention score of 74/100 (64, 88) (p<0.001). Participants felt their readiness to respond increased in all facets (all p<0.001) on the post and retention test for the MCI situation. All three hospital teams showed significant increases in teamwork between the median of the 1st and 4th TTX as 27/100 (23.5, 29) and 69/100 (66.75, 69.5) (p<0.05). Participants were overall satisfied (9.1/10 SD 1.13) and would recommend the training to others (9.15/10 SD 1.2).
Conclusion:
C-MCIREM participants had high satisfaction with a significant increase and persistence in knowledge, improved teamwork, and self-assessed readiness to respond to a chemical mass casualty incident.
In 2019, the World Health Organization published the Health Emergency and Disaster Risk Management (H-EDRM) framework, detailing how all actors in the health system can contribute to reducing negative health outcomes of emergencies and disasters, including mass casualty incidents (MCI). The H-EDRM framework’s whole-of-health-system approach stresses the need for each level of healthcare systems to be involved in all phases of the disaster cycle, particularly preparedness and response. This approach highlights the critical role that lower levels of care, including primary healthcare, can play during MCI, demonstrating the need to integrate these into countries’ disaster plans. Nevertheless, countries’ disaster management plans have historically focused on hospitals and few recommendations exist for how to practically proceed with such an integration. This study explores what has been published on the topic of reverse triage (RT), namely the process used by healthcare workers (HCWs) to determine which patients can safely be discharged to lower levels of care, resulting in increased surge capacity at hospitals. The objective of this work is to collect evidence around existing criteria, tools or referral pathways used by HCWs during MCI, ultimately integrating lower levels of care in MCI management.
Method:
A systematic literature review was performed and a total of 12 studies were analyzed.
Results:
Literature focusing on RT towards lower levels of care during MCI is scant and limited to few case studies. There is no standardized tool or guidelines for how to perform RT and existing referral pathways are described in only isolated case studies.
Conclusion:
Published evidence on RT criteria is limited. The results of the current review can serve as groundwork upon which to design further research studies. It can be used to help devise strategies and policies for the integration of lower levels of care during MCI.
The impact of a heat wave on body temperature of patients being admitted to the emergency department (ED) and of patients that were already hospitalized was investigated. This can provide insight into measures or infrastructural adjustments that still need to be made.
Method:
A retrospective study comparing the measured body temperature of patients admitted to the ED and patients already hospitalized during a heat wave from August 11-13, 2020 versus a period in which no heat wave, no manifest presence of COVID-19, and no other endemism was present (October 10 and October 20, 2019, and November 5, 2019) was conducted. Two groups were created per period: morning and afternoon measurements.
Results:
Comparing the heat wave to the control period, no statistical difference was observed in morning temperature measurements at the ED. In the afternoon temperature measurements at the ED, however, a statistically significant difference (p < 0.01) was measured. Afternoon measurements during the control period showed a mean of 36.842 °C, whereas the measurements during the heat wave showed a mean body temperature of 37.191 °C. For hospitalized patients, a statistical difference (p < 0.01) was measured in both morning and afternoon temperature measurements. The control period showed a mean morning body temperature of 36.629 °C and a mean afternoon body temperature of 36.7154 °C, as opposed to the heat wave mean body temperatures in the morning (36.698 °C) and afternoon (36.7937 °C).
Conclusion:
This study emphasizes the rise in body temperature during a heat wave, independently of other factors that influence body temperature. Hospitals should focus on preventive measures, such as air conditioning and providing good temperature control. Further research is needed.
The past three years have included multiple Public Health Emergencies of International Concern (PHEIC) and dramatically impacted all facets of Emergency Medical Response. During this time, simultaneous crises have demonstrated the value of the non-traditional responder in mitigating complex incidents. Current geopolitical climate has proliferated nuclear power and increases the necessity for readiness and awareness for radiological incidents. These are complex incidents a responder may face and requires even the lowest skilled practitioner to be fully engaged before special operations intervention.
Limited research exists to determine whether current emergency medical services (EMS) training supplies the competency necessary to ensure safety of the prehospital provider during a radiological incident. Forthcoming research will investigate the effectiveness of this current training within the United States.
Method:
Survey data will be collected from multiple providers across the United States to evaluate their confidence level on two primary objectives during a radiological incident: competency of personal protective equipment donning and doffing, and management of contaminated patients.
Data analyses of survey responses help drive future proposed educational activities that will be compliant with best practices set forth by organizations such as the United States Department of Health and Human Services Radiation Emergency Medical Management (REMM), the National Fire Protection Agency (NFPA), and Radiation Emergency Assistance Center/ Training Site (REAC/TS).
Results:
Data will be collected by survey responses to evaluate a diverse range of EMS services. Details such as skill level, type of EMS service, catchment of communities served, and their impressions upon the training will be analyzed.
Conclusion:
This is an ongoing project that will embrace the perspectives of the diverse group of delegates of WADEM throughout and become enriched through the organization's wealth of knowledge. Gaps highlighted during roll-out of this research can also be used to address logistics, doctrine, and policy shortfalls.
The war in Ukraine has not only led to complex emergencies and humanitarian crises but also other severe consequences, such as the chemical industry disaster. The chemical industry is one of the principal sectors of Ukraine’s economy, and it is estimated that Ukraine has a total volume of hazardous chemical accumulation of more than 5.1 billion tons. An attack on chemical industrial facilities will lead to catastrophic consequences. This thesis aims to study the disaster risk of chemical industrial facilities and its consequences on public health and the environment during complex emergencies in Ukraine.
Method:
Observational cross-sectional risk assessment method was utilized to assess hazard, vulnerability, and exposure of the chemical industry in Donetsk Oblast, Luhansk Oblast, Kherson Oblast, Zaporizka Oblast, and Kharkiv Oblast, Ukraine. Data on chemical factories in Eastern Ukraine was collected on Google Maps and Google Earth in May 2022. Lastly, the semi-quantitative risk assessment method was utilized to describe the risk from the perspective of consequences for life and health, the environment, property, and speed of development.
Results:
Chemical industry disaster risks in Ukraine during complex emergencies in Donetsk Oblast, Luhansk Oblast, Kherson Oblast, Zaporizka Oblast, and Kharkiv Oblast are high in terms of likelihood and consequences to life and health, environment, property, and speed of development.
Conclusion:
This risk assessment enables potential chemical disaster risks in Ukraine during complex emergencies to be understood and communicated by the local community, the first responder, and till policy makers. Therefore, enable a whole-of-society approach involving risk management, disaster preparedness, and response. Further detailed risk assessment on the type of chemical and their hazards should be conducted once the situation permits.
Helicopter Emergency Medical Services (HEMS) have formed an integral component of the Irish healthcare system for the past decade, yet the factors leading its commencement, its evolutions over this time, the current model of service delivery have not been widely published.
Aeromedical service provision may vary significantly from country to country and may also vary regionally within countries. Health systems necessities, capacity and maturity, the level of state, corporate, private or community investment and capacity of the contracted service provider are all factors that influence the service provision.
Method:
This research provides a descriptive analysis of the historic factors leading to the implementation of HEMS during an era of healthcare reform, its key evolutions and current model of service delivery.
Results:
Health system reform in a time of global financial recession led to a unique collaboration between the Irish Defense Forces and civilian Emergency Medical Systems (EMS) to provide a sustainable foundation of primary scene landing Helicopter Emergency Medical Services for the Irish state. This sharing of professional knowledge, logistics and operational experience lead to many further system reforms and will inform future aeromedical service provision.
Conclusion:
Over the past decade the Irish health system has undergone significant reconfiguration and centralization of services, leading to increased demands on emergency medical ground and aeromedical services. Future advancements in aeromedical service provision require an innate understanding of the current model.
This research will add to the knowledge base and inform policy makers and support decision making surrounding Helicopter Emergency Medical Services reform and enhanced service provision in the Irish state.
As a part of a primary intervention, Emergency Medical Services (EMS) may leave a patient at the scene. This decision is made in partnership with the dispatching center. The prognosis of these patients is often unknown. The aim of our study was to assess the outcomes of non-transported EMS patients.
Method:
It was a descriptive, prospective study conducted over a two-year-period. We included all alive non-transported EMS patients from the site of intervention after a primary mission of the EMS team based on a medical decision. The prognosis was assessed by unexpected events (UE) defined by death, second EMS call, urgent consultation or hospitalization/surgery within seven days. We considered two groups: a group with UME (UME+) and a group with good evolution (UE-).
Results:
We included 97 patients. The average age was 56±19 years. Seventeen patients (17,5%) had no medical histories. Hypoglycemia was observed in 43% of patients. Thirty-four patients (35%) had an UE. These UEs were distributed as the following: ten consulted a private doctor, ten consulted their family physician, seven called the EMS, three visited the emergency department and four died. There were no significant differences in demographic, anamnestic characteristics between two groups. Psychiatric pathology was more common in the UE- group(28% vs. 9%; p=0.0037). Intravenous injections were more common in the UE+ group (64% vs 39% ; p=0,019). Among the four deaths, three were unexpected.
Conclusion:
One-third of non-transported EMS patients had UE. Unexpected death was rare (one patient). Setting-up a system for these patients including scores and algorithms, and a post-EMS compulsory visit in collaboration with family physicians could be beneficial.
A disaster involving significant casualties in a populated area demands the rapid development of a field hospital with personnel specialized in Disaster Medicine. In this scenario, the clinical response of Emergency Medical Teams should be guided by the knowledge of how the medical needs of the population change after the disaster itself. In order to reduce the loss of life and prevent long-term disability, it is essential to have the right tools to treat critical patients. In fact, disasters cause a variety of conditions ranging from minor to life-threatening injuries requiring admission to Intensive Care Unit (ICU).
Method:
A systematic review was carried out and electronic healthcare databases were searched using terms such as “Disaster” or “Flood” or “Storm” or “Earthquake” or “Mass Casualty Incidents” and “Intensive Care Unit” or “Intensive Care” or “Health Impact”. Articles that met the search criteria, published in the last 15 years in the English language, were analyzed and summarized. The objective of the review was to identify the main health problems following disasters and, in particular, the diseases that may require intensive care in order to assess the need to include ICU in the minimum technical standard for Emergency Medical Teams type 2.
Results:
The review included 12 studies identified as relevant and significant for our purpose. Health problems were sorted for disaster type and severity of the injury. The review demonstrates that health problems after a disaster are different depending on disaster type, but in all the scenarios there are diseases that potentially may require timely intensive care.
Conclusion:
The presence of an ICU within an Emergency Medical Team type 2 (according to WHO EMT classification) is an essential part of disaster management plans as ICU plays an irreplaceable role in saving lives and in reducing the health impact of a disaster.
Hospitals around the world need to be safe and prepared to face disasters, being these man-made or caused by natural hazards. The Hospital Safety Index (HSI) is a tool developed by the World Health Organization (WHO) that allows access to the level of preparedness of hospitals; it is the most widely used instrument of its kind. Although the HSI is frequently used by hospitals and healthcare facilities around the world, scientific literature on its application in real life is scarce and qualitative studies are absent. By adopting a qualitative methodology, this study aims to investigate the use of the HSI to assess disaster preparedness in hospitals and healthcare facilities, identify challenges and facilitators of the HSI use, and devise recommendations for future adaptations of the tool.
Method:
A retrospective qualitative study employing semi-structured online interviews was conducted to gather opinions and perspectives of professionals using the HSI to assess disaster preparedness. Participants were recruited by contacting via email the authors of scientific publications on the use of the HSI.
Results:
In total, nine people from three different countries (Serbia, Sri Lanka, and Indonesia) and having different professional backgrounds agreed to participate in this study. They shared the reasons for their choice of using the HSI, against other tools, as well as the steps taken before and during data collection. Strengths and weaknesses of the HSI were identified and authors reported the challenges they encountered in the preparatory phase and during data collection. Modifications of the tool and recommendations for the future were proposed targeting both researchers and hospital managers.
Conclusion:
As far as the authors know, this is the first qualitative study examining the methodological implications of using the HSI and providing practical recommendations that can advance the HSI tool and foster its use for disaster preparedness assessments worldwide.
The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects’ objectives, the NIGHTINGALE consortium adapted the Translational Science (TS) process. The aim of this study is to perform the first TS (T1) phase PRISMA scoping review to extract data that will be used to guide the creation of the initial evidence-based second TS phase (T2) modified Delphi statements for a subsequent study.
Method:
The consortium was divided into three work groups (WGs) MCI triage, Prehospital Life Support and Damage Control (PHLSDC) and Prehospital Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping review with a common research strategy sharing MCI related search terms and then terms specific for each WG. Final included articles went through data extraction based on identified themes and sub-themes from PH MCI response literature to be used to create the future statements.
Results:
The initial search yielded 925 total references to be considered for a title and abstract review (PH Triage 311, PHLSDC 329, PHP 285), then 483 articles for a full reference review (MCI Triage 111, PHLSDC 216, PHP 156) and 155 articles for the database extraction process (MCI Triage 27, PHLSDC 38, PHP 90).
Conclusion:
The progression of the study of prehospital MCI response enabled NIGHTINGALE partners to methodically obtain information that will contribute to each WG’s creation of initial T2 modified Delphi statements.
The Ministry of Health, Labor, and Welfare of Japan have suggested local governments establish Health, Medical, and Welfare Coordination Headquarters at the time of disaster. Gathering and processing information is one of the key functions of the headquarters. The study aims to clarify the required functions of information for the headquarters.
Method:
A series of interview surveys and observations were conducted, including for local governments and experts in disaster response. The contents were analyzed and required standard functions and procedures had been extracted.
Results:
The most important aspect of information gathering is its use in decision-making in matching needs and demands with resources. Needs and demands are based on damage and situation of the casualties. Resources can be categorized into human, material, financial, and informational. Because the headquarters have to process much information, it is important to clarify the objective and strategy of disaster response. The headquarters gather various quantitative and qualitative information using information and communication technology, telephone, meeting and other methods. Qualitative information can be categorized as: expected, surprising (unexpected), and unusual (rare) contents. For expected contents, quantification or estimation of needs from information in normal time or limited information immediately after the disaster and displaying or further analyzing by geographic information systems is useful. By surprising contents or case reports, additional responses or strategies will need to be reviewed.
Conclusion:
The procedure, including information gathering and decision-making, follows the OODA (observe, orient, decide, act) loop. According to our mail survey of all 47 prefectural local governments in 2019, 89% were planning to establish the headquarters. However, only 36% had prepared a manual. Using the results of this study, a standard strategic manual for the operations of the headquarters is being developed and brushed up.
The transition to residency is a challenging time in the medical trainee’s career. In addition to learning and implementing knowledge specific to emergency medicine, logistics and system nuances can initially impede a learner’s ability to begin the process of mastering their profession. In an attempt to ameliorate this transition to residency an orientation was created to introduce concepts of local ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits.
Method:
Interns were given a pre-workshop survey on comfort level (1-5 Likert) of ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits. They rotated through four workshop stations in small groups. The first was an ultrasound workshop showcasing our commonly used ultrasound and how we capture images and videos into our medical system for review. The next was institution specific protocols for medical and trauma resuscitation using simulation. Third was a workshop on how to navigate our electronic medical record with simple overviews of documentation and order entry. Lastly, they went through arterial and central line kits to familiarize themselves with the contents. A post-workshop survey was given.
Results:
Comfort with ultrasound documentation pre-workshop mean was 4.0 with a post-workshop mean of 4.45 (p=0.068). Comfort with resuscitation pre-workshop mean of 2.91 increased to 3.91 (p=0.008). Electronic medical record documentation comfort rose from a mean of 3.5 to 4.27 (p=0.007). Comfort navigating procedural kits increased to a mean of 4.09 from 3 (p=0.002).
Conclusion:
There was a statistically significant increase in comfort level with ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits after completion of the workshops. Only ultrasound documentation had a p value less than 0.05. It can be reasonably deduced that focusing on institutionally specific aspects of workflow can help interns expedite their education by familiarizing them with these nuances prior to their first shift.