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The number of deaths from natural disasters that have occurred in Japan since 1989 is in the order of (1) the Great East Japan Earthquake, (2) the Great Hanshin-Awaji Earthquake, and (3) the Kumamoto Earthquake, but the ratio of related deaths to the total number of deaths was highest for the Kumamoto earthquake.
Method:
In the case of the Kumamoto earthquake, an inland earthquake of the same scale as the Great Hanshin-Awaji Earthquake, direct deaths due to the earthquake were suppressed, but related deaths are thought to have increased due to the effects of evacuation life and other factors. According to a report by Kumamoto Prefecture, the majority of direct deaths from the Kumamoto earthquake were caused by trauma such as excessive pressure or asphyxiation. As for related deaths, most of the victims were aged 60 years or older, more than 80% of them had pre-existing medical conditions, and respiratory and circulatory system diseases were the most common causes of death.
Results:
A survey of victims transported by ambulance from evacuation centers to medical institutions after the Kumamoto earthquake showed that a large number of victims were transported in the acute phase after the disaster. The reasons for transport are diverse injuries and illnesses, including trauma from falls, dyspnea, impaired consciousness, and fever, suggesting that stress from the earthquake and problems in the living environment of the evacuation centers had an impact on the deterioration of health conditions.
Conclusion:
It is important to identify issues and consider countermeasures based on past experiences in order to prevent health hazards in evacuation centers.
Children are frequently victims of disasters. However, gaps remain in disaster planning for pediatric patients. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty incidents that involve large numbers of children.
On April 26, 2018, the NYC PDC conducted a first in NY, full-scale exercise with the NYC Fire Department (FDNY) testing evacuation, patient tracking, communications, and emergency response of the Obstetrics, Newborn and Neonatal units at a NYC based hospital. The goal of the exercise was to evaluate current Ob/Newborn/Neonatal plans and assess the hospital’s ability to evacuate patients.
Method:
The exercise planning process included a review of existing OB / Newborn / Neonatal plans, four group planning meetings, as well as, targeted specific area meetings and plan revisions. The exercise incorporated scenario-driven, operations-based activities, which challenged participants to employ the facility's existing evacuation plans during an emergency.
Results:
The Exercise assessed the following: Communication, Emergency Operation Plans, Evacuation, Patient Tracking, Supplies and Staffing. Internal and external evaluators rated exercise performance on a scale from 1-4. Evaluators completed an exercise evaluation guide based on the Master Scenario Event List.
An After Action Report was written based on the information from the exercise evaluation guides, participant feedback forms, hot-wash session, and after action review meeting. Strengths included the meaningful improvement of plans before the exercise (including the fire department) and the overall meeting of exercise objectives.
Conclusion:
Lessons learned included: addressing gaps in effective internal and external communications, adequate supplies of space, staff, equipment needed for vertical evacuations; providing staging and alternate care sites with sufficient patient care and electrical-power resources. The lessons learned are being utilized to improve existing hospital plans to prepare for future full-scale exercise and or real-time events.
Emergency services organizations routinely undertake internal quality improvement activities following training and operational activities. One form of a quality improvement activity is the After Action Review (AAR). An AAR is a facilitator-led post-event review where data is collected from individuals and groups of individuals using either surveys, focus group-like meetings, or individual interviews. Data is collected using a semi-structured data collection tool which is usually customized to the specific tasks being reviewed and the priorities and goals of the organization. The quality of AARs has been noted to vary significantly across organizations with reporting biases and differences between exercise or real event AARs and biases introduced by utilization of internal rather than external evaluators, and limited justification for data selection and collection rationales. The Australian Capital Territory Emergency Services Agency (ACT ESA) has identified that interoperability and integration between internal ACT ESA sub-agencies and externally with other agencies is a key problem. The aim of this study was to identify specific areas of consistent interoperability concern through the examination of historical AARs.
Method:
In this qualitative study a Framework Analysis of historical AAR text documents was conducted, following the standard five step process. This was followed by detailed thematic analysis in aggregate and examined longitudinally, with emergent themes undergoing further analysis.
Results:
AARs relating to major emergency response and training activities 2016-2022 were examined. There was a substantial variation in quality, level of detail, completeness and structure across the different AAR documents. Consistent themes emerging from the data highlighted concerns regarding inter-agency culture, uncertainty when conducting joint activities and its impact on decision making, logistics concerns, resourcing and breakdown of shared understanding and communication between teams.
Conclusion:
Despite a centralized command structure, historical AAR analysis shows ACT ESA has had persistent operationally impacting interoperability and integration problems within the organization and with external agencies.
Particular skills are critical when participating in trauma response. Engagement and practice with these skills can help build staff confidence, however, ensuring competency across all staff can prove challenging. Establishing a training utilizing skill stations can positively affect staff experience and confidence measures on predetermined dates to capture all team members is a way to ensure confidence in skills vital for patient care in ED settings. Execution of the “skill station” exercises at measured intervals demonstrated improved confidence in trauma skills by ED staff. Exercises with specific skill-oriented practicum offer low-cost, dynamic training opportunities. Improving confidence and competence in critical trauma-related clinical skills directly improves patient outcomes.
Method:
Six trauma skill stations were created, aimed at specific skill-based practices. These measured skill competencies include arterial line setup, rapid blood infuser use, defibrillator use, chest tube management, pelvic binder application, and tourniquet application. Competency was reached when participants could effectively perform the skills through teach-back technique.
Results:
Qualitative feedback demonstrated that nurses felt more confident responding to a patient needing trauma interventions in an ED setting. Nursing staff were more engaged with trauma skills in their scope. All participants were able to appropriately and adequately teach-back the skill with 100% accuracy. Improved knowledge retention will be measured in future training sessions.
Pre and post-tests could be utilized to demonstrate more dynamic results. This measurement tool will be utilized in the formal training process moving forward to capture baseline and improvement data more objectively.
Conclusion:
This low-cost and highly efficient method of strengthening novice nurses’ trauma skills competency and confidence can be utilized across various skills and departments. More confident nurses show improved readiness to respond to a patient in need of trauma interventions.
Foot injuries are a common patient presentation at music festivals, and are resource-intensive patient encounters by virtue of their comparative volume. There are no published accounts devoted to these ubiquitous, typical, predictable festival injuries leading to presentation to on-site medical services for treatment.
Method:
A retrospective chart review was performed of visits to medical services for first aid or medical care involving feet at a multi-day music festival in Canada. Data extracted included demographics, injury characteristics, and type of footwear. Encounters were classified as initial or repeat visits, and repeat visits were assessed for having had previous dressings applied.
Results:
Over the five day festival period, foot care visits accounted for 416 of 1129 (37%) patient presentations for minor care. Most common injuries were blisters (51%), ankle sprains (10%), lacerations (8%), abrasions (6%), and bug bites (6%). Footwear was reported as shoes (28%), shoes and socks (28%), flip-flops (19%), sandals (28%) and bare feet only (5%). The most common blister sites were toes (48%) and the posterior heel (17%). 12% of cases were repeat visits, and 50% of repeat visits were for dressings failure.
Conclusion:
Foot injuries make up a significant portion of presentations, and often re-presentations, to medical services at music festivals. Preparation for these common injuries should include (1) a dedicated and purposeful bandage selection and supply, (2) provider training in best foot care practices, including bombproof, danceable dressings, and (3) educational resources to inform attendees of risks and provide preventative upstream measures that might allow them to avoid injury.
Whether it is COVID in New York, chemicals in Syria, or a radiological exposure from a dirty bomb or nuclear detonation, trauma is increasingly mixed with CBRN. Decontamination, isolation, and newer treatments all impact the patient as well as the physician. Military physicians regularly plan for these patients, but the civilian world has not. Civilian CBRN training has been spotty, at best. Our recent experience with COVID and the current threats of nuclear attack, emphasize the need to integrate CBRN exposure into our trauma treatment plans, both to help our patients and to protect the caregivers.
Method:
Literature review and US Department of Health and Human Services Guidelines.
Results:
A template for patient flow and treatment priorities is presented along with just-in-time references. Triage guidelines for trauma patients with Acute Radiation Syndrome (ARS) are also provided.
Conclusion:
Civilian preparation for managing the CBRN contaminated trauma patient starts with a mental model of treatment priorities and self-protection strategies. Just-in-time treatment references can provide additional support and confidence.
Public health agencies’ ability to monitor outbreaks requires government mandated reporting from healthcare institutions, with consequences for noncompliance. This study aims to characterize the burden on acute care hospitals from government reporting requirements during COVID-19 pandemic.
Method:
A retrospective study over a 14-month period (April 27th, 2020 to June 10th, 2021) during the COVID-19 pandemic examining the log of changes and requirements of the Health and Human Services (HHS) Teletracking, an online system for hospital reporting. We interviewed 33 individuals including hospital leadership, clinical directors, and infection control personnel in a New York City (NYC) small independent hospital (SIH).
Results:
During the study period, reporting requirements increased from five daily reports to 29 daily reports across eleven different agencies, all with separate reporting systems. Reporting schedules varied from several times a day to intermittently. Typically, new reporting requirements were conveyed to institutional contacts at 8 AM with a required deadline of 1 PM the same day. The continuous changes reportedly made it difficult to develop stable data gathering and workflow processes. There was a reported lack of clarity around new data elements’ definitions and different agencies employed different variables for the same measure. There were hospital penalties for missing deadlines, leading to clinical staff being diverted from patient care to meet reporting needs.
Conclusion:
The study shows significant reporting barriers and diversion of resources away from the frontline to supply data collection during disasters. There is significant redundancy in reporting agencies and in reporting systems, each with different reporting frequencies, and variable definitions of data elements. The public health needs of a disaster response would be better served with a more coordinated, efficient system to share information without further straining the healthcare system.
Tribhuvan University Teaching Hospital (TUTH) is a tertiary care hospital in Kathmandu. The emergency department sees between 130 to 140 cases per day. These patients get initial evaluation and basic investigation for acute emergency management and treatment. Those requiring further treatment are then admitted to the department of General Practice for post emergency care which acts as an observation ward. This step allows for the patients to be observed on a short-term basis and permits patient monitoring and/or treatment for an initial 24-48 hour period and up to a maximum of five days. These steps allow for focused follow up, improved efficiency and minimizes inappropriate admissions to other hospital inpatient wards. This paper evaluates functionality, admission criteria, patient categorization and subspeciality referral to specialty patient care, discharge criteria and cost effectiveness.
Method:
A descriptive observational study was carried out of the patients admitted to the observational ward between 2020-2021.
Results:
Most articles suggest these wards improve patient satisfaction and clinical care, decrease length of stay, reduce unnecessary inpatient hospital admissions and are useful in fever under evaluations, COPD, poisoning, pneumonia, mild head injuries, high sugar, hypertension, gastroenteritis etc. Around 14% of patients were sent to the observation ward after acute emergency care. 84% were discharged from observation ward with a mean stay of three days and were followed up in community care or GP OPD. Nine percent were admitted to hospital wards, and 7% transferred to yellow/red area emergencies for derange vitals.
Conclusion:
Observation wards seem to have advantages, excluding those who will inevitably need longer treatment, reduces cost savings and unnecessary burden of hospital admission.
The Emergency Medical Team (EMT) Strategic Advisory Group of the WHO has endorsed the EMT Minimum Data Set (MDS) Daily Reporting Form in 2017 and the revised EMT Minimum Standards of the WHO suggests EMTs report it regularly in case national reporting forms are not available.
Method:
This study searched and listed previous use cases of the MDS by reviewing published papers including gray literature and interviews with national authorities, organizations, and experts.
Results:
In 2019, the MDS had been activated for the first time in Mozambique during international scale response at the tropical cyclone Idai; also in Japan it was used at the typhoon Faxai/Hagibis response; further in the Independent State of Samoa during the measles outbreak. In 2020, the MDS was used during a COVID-19 mega-cluster incident on the Diamond Princess Cruise Ship in Japan, the tropical cyclone Harold in Vanuatu and the Kumamoto Heavy Rain in Japan. In 2021, the one was used during the Izuyama landslide response in Japan; and the typhoon Rai response in the Philippines. In 2022, it was used during the cyclone Batsirai response in Madagascar; and in Moldova, Poland, and Ukraine to respond to the armed conflict situation in Ukraine.
Many countries are preparing to use the form; in 2022 the Association of SouthEast Asian Nations (ASEAN) has officially endorsed the form as a regional standard form for EMT daily reporting. Military partners also were testing the form, in 2019 forces from eight nations at the 39th Cobra Gold 20 in Thailand used the form for training purposes.
Conclusion:
The MDS was used in at least 14 emergencies in nine countries. Mozambique and Japan have published academic literature using the MDS. The use of MDS would strengthen Health Emergency and Disaster Risk Management (H-EDRM) in a data-based manner.
At mass casualty incidents (MCIs) medical needs exceed available resources, requiring prioritization of response efforts and materials. Principles of triage have evolved since the 18th century into several modern-day algorithms that sort casualties into priority groups based on clinical parameters. It is unclear, however, if such algorithms are effective and practical during real-world MCIs. This analysis reviews the literature on use and efficacy of prehospital MCI triage algorithms.
Method:
The MEDLINE, Scopus, and Google Scholar databases were searched for peer-reviewed and grey literature on prehospital MCI medical response. Articles discussing MCI triage concepts, triage at MCIs, or algorithm efficacy were included. Articles were excluded if they described law enforcement, ethical, psychological or epidemiological perspectives without detailing the medical response.
Results:
Frequently-cited MCI triage algorithms include START (Simple Triage & Rapid Treatment); Triage Sieve; CareFlight; SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport); and RAMP (Rapid Assessment of Mentation & Pulse). They differ in the physiologic parameters assessed, inclusion of numerical measurements, and number of triage categories. Surveyed providers were less likely to have performed full triage at MCIs (16%) than in training (69%), and more likely to have performed no triage (29% vs. 1%). In retrospective trauma registry analyses, algorithms were generally poorly predictive of the need for life-saving interventions (13-58% sensitive, 72-97% specific) in one study, and variably predictive of critical injury (45-85% sensitive, 86-96% specific) in another. The Glasgow Coma Scale motor component was associated with critical injury (73% sensitive, 96% specific if <6); other physiologic variables had sensitivities under 40%. In prospective studies, algorithms were accurate for 36-52% of adults and 56-59% of children. Some suggest clinician judgment may be similarly effective.
Conclusion:
Multiple algorithms exist for MCI triage, but they are infrequently utilized and may be inaccurate. Simpler, more realistic, scalable, and widely accepted response systems need to be instituted.
Industrial disasters can have a myriad of repercussions ranging from acute deaths, injuries, and long-term adverse health impacts on nearby populations to political fallout and environmental damage. This is a descriptive epidemiological analysis of industrial disasters occurring between 1995 and 2021 which may provide useful insight for health care systems and disaster medicine specialists to better prevent and mitigate the effects of future industrial disasters.
Method:
Data was collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all industrial disasters occurring between January 1, 1995, and December 31, 2021.
Results:
1,054 industrial disasters were recorded from 1995 to 2021. The majority of these disasters occurred in Asia (720, 68.3%), with 131 (12.4%) in Africa, 107 (10.2%) in Europe, 94 (8.9%) in the Americas, and 2 (0.2%) in Oceania. Half of these disasters were explosions (533, 50.6%), 147 (13.9%) were collapses, 143 (13.6%) were fires, 46 (4.4%) were chemical spills, 41 (3.9%) were gas leaks, and 34 (3.2%) were poisonings. There were 6 (0.6%) oil spills and 3 (0.3%) radiation events.
Conclusion:
A total of 29,708 deaths and 57,605 injuries were recorded as a result of industrial disasters and they remain a significant contributor to the healthcare risks of both workers and regional communities. The need for specialized emergency response training, the potential devastation of an industrial accident, and the vulnerability of critical infrastructure as terror targets highlight the need to better understand the potential immediate and long-term consequences of such events and to improve healthcare responses in the future.
An adequate Mass-Casualty Incident (MCI) triage system is essential to provide the best possible health care to the greatest number of affected people and to optimize the management of the available resources in the context of a MCI.
Method:
In February 2022, Disaster Medicine Service 118 of Regione Piemonte adopted a new 5-color code-MCI triage system and Emergency Medical System (EMS) personnel was trained through a 3-hours-distance learning course. 515 medical doctors and nurses attended the course and completed the final test (triaging of 50 computer-based simulated patients/cases). Their performance was compared to intended triage designations. We collected the data and conducted a descriptive observational study.
Results:
A total of 25.750 evaluations were carried out: 1.030 white cases, 6.180 green cases, 6.180 yellow cases, 9.270 red cases and 3,090 black cases. Overall triage accuracy was 89,63%. The overall errors were 2.671 (10.37%). Concerning the type of error, there were 1.415 cases under-triaged (5.5%) and 1.256 cases over- triaged (4.88%). Based on color-code, the highest rate of error was in green cases (3.48%), while black patients showed the highest accuracy rate (0.32%). Based on type, the most frequent error was under-triage of red patients, while the less frequent was over-triage of black patients.
Conclusion:
The results of the final test performed by EMS personnel showed the accuracy rates of triage using new 5-color code-MCI triage systems of Regione Piemonte to be in range with data reported in the literature. A study limitation is the fact that the data analyzed are derived from online testing performed in no-time limited and no-stress conditions. Another potential limitation is the distance learning which doesn’t allow a discussion with the teacher or a request for clarification. For this reason, we would plan a future study defining the efficacy of the didactic methodology in comparison with face-to-face courses.
Teaching and becoming culturally competent are concepts that have and continue to evolve partly due to the language being used such as culturally competent, culturally sensitive, and cultural humility. With such an influx of ethnically diverse populations, nurses need to become competent in the care of patients from many cultural backgrounds. Faculty must first be culturally competent to provide this pedagogy for nursing students. This paper explores and analyzes the cultural competence of Baccalaureate Nursing Faculty in the United States.
Method:
This study was conducted using a quantitative, descriptive approach among baccalaureate nursing faculty. The Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) tool was used for this study. The survey was sent to 70 randomly selected baccalaureate nursing program Deans and/or Associate Deans listed on a public web site. The sample was purposely chosen to represent at least one program from each of the 50 states across the United States.
Results:
Ninety-four responses were received. Of the 94 responses, 37 surveys were incomplete, leaving a sample size of 57. An analysis was completed on the 57 completed surveys. Limitations include the length of the survey (60 questions) as the authors found that some participants did not answer all the questions. Although faculty rated themselves high regarding being able to identify cultural biases, faculty highlighted the need for more education on culture.
Conclusion:
Faculty appear to be culturally aware and recognize the need for more education to achieve a culturally competent skill set. With the increase in the influx of immigrants from all over the world, the population of the United States is changing. Cultural competence needs to be included in curricula to ensure that patients are advocated for and respected.
Although hyperbaric oxygen therapy is required in disasters or emergency situations, barotrauma, which is the most common complication, continues to occur. If barotrauma occurs during hyperbaric oxygen treatment, treatment is stopped, and there is no proper preventive method for this. Therefore, the authors evaluated the degree of barotrauma prevention by applying a tympanometry-based anti-barotrauma device (ABT).
Method:
The candidates of the clinical trial are adults between the ages of 18 and 65 who correspond to academic indications for hyperbaric oxygen therapy. In a prospective parallel design, the candidates were placed in the test group and control group. Simple randomization and one-sided blinding were applied. The medical staff directly observed the severity of middle ear barotrauma through a video otoscope. The number of treatment interruptions and completions along with findings from the otoscope observation (Grade 0~5) such as level of ear pain (pain scale value) were collected at three university hospitals.
Results:
When ABT was applied, it was possible to prevent barotrauma earlier than the traditional medical observation. However, since the application of ABT requires the patient's voluntary cooperation, it is difficult to prevent barotrauma if a patient has reduced consciousness or is unable to follow the instructions of the medical staff.
Conclusion:
Applying ABT is an appropriate method for early detection of barotrauma. However, in order to be applicable to patients with reduced consciousness or difficulty in cooperation, an automatic intrinsic pressure reduction system should be developed.
Global disasters have increased over the last century, with growing numbers of people affected. In the Middle East and North Africa, natural disasters have tripled since the 1980s. Education and training for disaster preparedness for healthcare providers can help reduce vulnerability to disasters by improving their knowledge and response effectiveness. Physicians working in the emergency department are integral members of the response to those incidents. Currently, no studies describe how much training or experience in disaster preparedness exists for physicians working in the emergency departments in Kuwait. However, comparable studies in different regions have illustrated the importance of researching this field. This paper aims to assess the disaster preparedness levels of emergency department physicians in Kuwait.
Method:
An online survey will be sent to the physicians working in the emergency departments of the seven general hospitals in Kuwait. This survey consists of four domains:
1) Demographics: personal and professional characteristics of participants.
2) Education and training: exploring the involvement of participants in prior formal training courses or exercises in disaster preparedness.
3) Experience: assessing the involvement of participants in the mitigation or response to previous disasters.
4) Knowledge and perception: participant awareness of local hospital plans and systems as well as their attitudes and opinions about disaster preparedness.
Results:
Data collection and analysis are planned for completion by March 31, 2023.
Conclusion:
The needs assessment is essential to developing educational curriculums for any discipline. In disaster medicine, tailoring the training curriculum is especially important because learners might not have experience in the field due to the high acuity and low frequency of disasters. The results can be used to develop a roadmap for Emergency Physician training in disaster preparedness in Kuwait. In addition, the approach adopted in this paper can be used to assess further disciplines for disaster preparedness.
International humanitarian aid is crucial in disasters but must be needs-driven and coordinated with requests from local authorities. We identify disaster and population factors associated with international aid appeal during disasters and hence guide preparation by international humanitarian aid providers.
Method:
In this retrospective database analysis, we searched the Emergency Events Database for all disasters from 1995 to 2015. Disasters with and without international aid appeals were compared by location, duration, type of disaster, deaths, number of people affected, and total estimated damage. Logistic regression was used to examine the association of each factor with international aid appeal.
Results:
Of 13,961 disasters recorded from 1995 to 2015, 168 (1.2%) involved international aid appeals. Aid appeals were more likely to be triggered by disasters which killed more people (OR 1.29 [95% confidence interval (CI) 1.02-1.64] log10 persons), affected more people (OR 1.85 [95%CI 1.57-2.18] / log10 persons), and occurred in Africa (OR 1.67 [95%CI 1.06-2.62). Earthquakes (OR 4.07 [95%CI 2.16-7.67]), volcanic activity (OR 6.23 [95%CI 2.50-15.53]), and insect infestations (OR 12.14 [95%CI 3.05-48.35]) were more likely to trigger international aid appeals. International aid appeals were less likely to be triggered by disasters which occurred in Asia (OR 0.46 [95%CI 0.29-0.73]) and which were transport accidents (OR 0.12 [95%CI 0.02-0.89]).
Conclusion:
International aid appeal during disasters was associated with greater magnitude of damage, disasters in Africa, and specific types of disasters such as earthquakes, volcanic activity, and insect infestations. Humanitarian aid providers can focus preparation on these identified factors.
In the United States, 840,000 children are reported missing annually. While no concise data is available on the incidence from healthcare facilities, infant and child abductions and elopement events pose a high risk to infants and hospital staff. Following an update on the missing child and missing infant policy at a tertiary care hospital in New York, the hospital’s emergency preparedness team conducted a full-scale hospital drill. The drill included input and participation from administration, nursing, hospital police, and the pediatric department.
Method:
New updates in the policy which had not been tested before were evaluated during this drill, including plain language verbiage to activate a code, the process of alerting hospital police of the missing pediatric patient, hospital police response, and the response of hospital staff in their work areas. Inpatient pediatric wards, the emergency department, and outpatient clinics were given teaching about the new policy and their responsibilities in the event of a missing child or infant. Evaluators were pre-selected and placed throughout the hospital. Afterward, controllers de-briefed with each of the evaluators as well as with hospital personnel in areas that did not receive teaching on the policy.
Results:
The areas that did not receive in-person training on the policy update wanted to assist but did not know how to respond and did not follow protocol for securing their areas. Furthermore, areas of the hospital were identified where the overhead paging system did not work as well as gaps in hospital police staffing to cover key hospital exit points.
Conclusion:
This drill revealed that all hospital personnel need dedicated and personalized training on policy updates highlighting their roles in response, communication lines need to be tested, and plans to address concurrent clinical emergencies need to be formulated.
Despite Spanish experience in counterterrorism, jihadism means new modus operandi, based on active mass casualty incidents, involving new injury patterns as mass bleeding ones. Therefore, the environment is completely different to first responders' structure. This change forced the revision of the tactical response model, led by the Spanish Association for Emergency Medicine's Tactical Care Secretary, who provides a discussion forum to its members, reaching a joint framework document, IBERO, adapted to Spanish tactical emergency capabilities.
Method:
Methodology was based on three parameters:
1) Literature revision, selecting three sources: Books and academic papers, TCCC and TECC guidelines, and Hartford Consensus, and AARs from the main active incidents with similarities to jihadist ones.
2) Formation of discussion groups: Threat definition, tactile response, and prehospital care, triage and evacuation systems.
3) A final group formed by representatives of each discussion group wrote the final document.
Results:
The protocol defines a staged plan of action, adapted to Spanish legislation and institutions, following the acronym IBERO:
1) Information: threat intelligence and information transmitted to responders from the incident location and dispatchers.
2) Block the threat by perimeter, zonification and suppression of the threat.
3) Escalation of resources. Definition of areas of action according to direct threat, indirect threat and safe areas of action.
4) Response and Rescue. Extrication to safe areas, including different stages of triage and protection against secondary attacks.
5) Order and evacuation. Access to other emergency services, and psychological first aid.
Conclusion:
The document proves the need for a coordinating framework of the Spanish emergency system to be fully adapted to these new threats. The discussion groups have identified the need for regular training on threat identification, zonification setting, mass bleeding control, extrication, and evacuation techniques during hostile situations. To achieve this goal, realistic training is mandatory.
COVID-19 conforms to key baseline characteristics of disaster which is defined as “a situation or event that overwhelms local capacity, necessitating a request for national or international level of assistance.” Many countries faced shortages of health workforce, maldistribution, misalignment of needs and skills of healthcare workers.
The research goal is to identify the country responses on the shortage of workforce, their best practices and the lessons learned that may help to better handle any similar crisis in the future.
Method:
The scoping review was conducted in four electronic academic databases, namely, Medline, Web of Science, EBSCO, and TRIP and 24 scientific articles were reviewed. This study is funded by the World Health Organization Centre for Health Development (WKC-HEDRM-K21001).
Results:
The main strategies implemented were a financial coordination mechanism, relaxing standards/rule, redeployment, recruiting volunteers, fast tracking medical students, and using other resources in the workforce such as: the recruitment of inactive healthcare workers, returnees whose registration has lapsed within the last 1-2 years and integration of internationally educated health professionals. All these strategies demonstrated advantages like establishing mutual support across nations, organizations, motivating healthcare workers, lessening the workload of healthcare workers, and creating a new staff model for the next pandemic. If a pandemic lasts longer, financial support mechanisms are no longer feasible and longer working hours result in burnout. Managing volunteers, including supervision of their safety and allocation to the area in need, required hard effort and high-level coordination, especially when a needs assessment is unavailable. Another problem was the absence of an available list of resources, including volunteers and retired medical personnel.
Conclusion:
To date, countries have not yet determined clear policies on how to ensure the sustainability and resilience of the workforce during major health shocks. A follow-up study investigating the strategies implemented is needed.
In 2018 Sierra Leone, a country highly prone to disasters, launched its first National Emergency Medical Service (NEMS) aiming to strengthen the provision of essential health services to the population with the long-term goal of creating a resilient health system able to effectively respond to and recover from emergencies. The Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), together with the Italian NGO Doctors with Africa (CUAMM), under the supervision of the Ministry of Health and Sanitation (MoHS), developed a prehospital Disaster Training Package (DTP) delivered to all NEMS personnel to boost the prehospital management of mass-casualty incidents (MCIs) and outbreaks.
Method:
The DTP was designed following the six-step approach to curriculum and training development with the ultimate goal of creating a workforce comprising qualified emergency responders with specific professional competencies to respond to outbreaks and MCIs. The DTP included a first phase in which NEMS local trainers underwent a training-of-trainers (ToT) course, enabling them to deliver cascade trainings to 16 district ambulance supervisors, 441 paramedics, 441 ambulance drivers, and 36 operators working in the NEMS operation center.
Results:
Starting on July 19, 2021, the ToT course was delivered to the seven national trainers. All trainers successfully passed the final examination and achieved high scores in the practical sessions, demonstrating active participation, commitment to the project, and good awareness. Following the ToT course, the series of cascade trainings started on August 2, 2021, delivered by the just-trained national trainers under the direct supervision of the two training managers.
Conclusion:
The NEMS’ DTP is the very first Disaster Medicine training course delivered to prehospital healthcare providers in Sierra Leone. The authors believe that the provision of the DTP to all NEMS personnel has the potential to improve Disaster Medicine culture among health professionals in the Country.