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Since 1900, disasters in the Northern Triangle of Central America—Guatemala, Honduras, and El Salvador—have caused over one-hundred-thousand deaths, affected millions of people, and caused billions of dollars of damages. As climate change causes increasingly frequent severe weather events, the catastrophic effects of disasters are likely to contribute to poverty and political and economic instability in the region leading to greater levels of migration out of the Northern Triangle.
Method:
This study provides a descriptive analysis of all disasters recorded in the EM-DAT database affecting Guatemala, Honduras, and El Salvador between 1900-2022. Disasters are analyzed by frequency, severity, financial cost, distribution by country, burden of death, affected and financial cost by country, and type of disasters most prevalent in each country. These trends are then graphed over the time period of the database.
Results:
EM-DAT records 359 disasters in the Northern Triangle between 1900 and 2022. Meteorologic events (floods and storms) were the most common types of disaster (44%), followed by transport accidents (13%). Meteorologic events and earthquakes were the most severe, as measured by deaths (62% of total deaths caused by disasters), people affected (60%), and financial cost (86%). Guatemala had the greatest number of disasters (45%), deaths (68%), and affected people (52%). The financial costs of the disasters were evenly distributed between the three countries.
Conclusion:
Meteorologic disasters are the most common and most severe type of disaster in the Northern Triangle. Earthquakes and transport accidents are also common. As climate change causes more severe storms in the region, disasters are likely to increase in severity as well. Governments and aid organizations should develop disaster preparedness and mitigation strategies to lessen the catastrophic effects of these coming disasters. Missing data in the EM-DAT dataset limits the conclusions of this study to general trends
Asia is one of the regions most affected by natural disasters such as major typhoons. In Japan, recovery from natural disasters is said to take more than 10 years, and local government officials are primarily responsible for this recovery. In this study, we investigated the effectiveness of the me-fullness® smartphone application in maintaining the well-being of local government employees involved in recovery efforts.
Method:
We conducted a survey of 35 employees of the town of Shichigahama, one of the areas affected by the 2011 Great East Japan Earthquake. The Chalder Fatigue Scale (CFS), Athens Insomnia Scale (AIS), and Depression, Anxiety and Stress Scale–21 Items (DASS-21) were used as survey instruments. 22 of the 35 employees used the me-fullness application on their smartphones for one month. During the month the application was in use, there was a heavy rain warning and an election for the House of Counselors, which the Shichigahama town employees had to cope with in parallel with the recovery from the Great East Japan Earthquake.
Results:
The percentage of insomnia indicated by an AIS score of four or higher was 53.5% (7/13) before and 30.8% (4/13) after the use of the me-fullness application. The percentage of stress was 38.5% (5/13) before and 7.7% (1/13) after the use of the me-fullness application.
Conclusion:
This study showed that the me-fullness® application could improve the sleep and stress of local government employees and maintain their well-being for a long time during the recovery efforts.
Non-coordinated support during disasters has negative effects on affected communities and people. From the 2004 Indian Ocean Tsunami, the United Nations introduced a cluster approach to avoid gaps and duplication of aid. Japan's disaster coordination of support for health and medical care was organized after the 2017 Kumamoto earthquake. The Ministry of Health, Labour and Welfare (MHLW) announced and issued the notice that the prefectures need to establish a system related to health and medical activities in the event of a large-scale disaster. In July 2022, welfare content was added. This study investigated the current status of health sector organizational coordination among health, medical, and welfare responders during 2022 the Large-Scale Earthquake National Exercise (LSENE).
Method:
The 2022 LSENE was conducted on October 1, 2022 with participation from the Disaster Medical Assistant Team (DMAT) and responders from each prefecture's health and welfare divisions and organizations. Each responder's exercise log sheet and the exercise controller's evaluation were reviewed.
Results:
Even though there was a notice from the MHLW, organized coordination was conducted only by several medical and health teams. DMAT is the only team with a system to dispatch teams from non-affected prefectures and coordinate well to allocate teams. Some other health and welfare organizations did not have a dispatching system. They had difficulty sending teams to affected areas, especially due to a lack of a systematic response system, training, coordination headquarters, and information sharing. It was suggested that information sharing and coordination among responders is necessary, although information gathering and request judgments related to dispatch coordination are different for each organization.
Conclusion:
In order to smoothly coordinate support teams for health, medical, and welfare in the event of a disaster, it is necessary not only to improve the coordination headquarters for health, medical, and welfare but also to verify its operation through training.
Road traffic injuries (RTIs) are the largest individual contributor to the global burden of injury and were among the five leading causes of global disability-adjusted life years (DALYs) in 2016. In regions with limited emergency medical services, training lay first responders (LFRs) has been shown to increase availability of prehospital care for RTIs, but sustainable mechanisms to scale these programs remain unstudied.
Method:
Using a training of trainers (TOT) model, a six-hour LFR training program was launched in Lagos, Nigeria. The course was taught in a hybrid fashion with primary didactics over Zoom and practical in-person breakout sessions. Thirty TOTs proceeded to train 350 transportation providers as LFRs over one month. A previously validated, 23 question, pre-/post- assessment was administered digitally to assess knowledge acquisition. Participants responded to five-point Likert survey assessing instruction quality and post-course confidence.
Results:
TOTs scored a median of 56.5% (IQR: 43.5%, 71.7%) and 91.3% (IQR: 88.0%, 95.7%) on the pre- and post-assessments, respectively, with bleeding control scores increasing most (+69.4%). Course trainees scored a median of 34.8% (IQR: 26.0%, 43.5%) and 73.9% (IQR: 65.2%, 82.6%) on the pre- and post-assessments, respectively, with airway and breathing increasing most (+48.6%). All score increases were statistically significant with p<0.001 and did not differ by trainer. Participants rated confidence 5/5 (IQR: 5,5) in first aid skills and 5/5 (IQR: 4,5) in emergency transportation, increasing from pre-course confidences of 3/5 (IQR: 3,4) and 4/5 (IQR: 3,5), respectively (p<0.001). Participants rated the quality of education content and TOT instructors to be 5/5 (IQR:5,5).
Conclusion:
This is the first time the efficacy of digital instruction for first responder trainers in LMICs has been investigated and demonstrates knowledge acquisition equivalent to that of prior in-person courses. Future work will examine the cost-effectiveness of the training of LFRs and the effect of LFRs on trauma outcomes.
The Merriam-Webster Dictionary describes culture as “the customary beliefs, social forms, and material traits of a racial, religious, or social group.” Also noted are: “the characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time.” Much has been written about the impact of culture on disaster risk and response. However, the issues are complex and multifactorial.
Method:
The author/presenter extensively reviewed current qualitative and quantitative literature regarding the impact of culture on disaster phases of mitigation, preparedness, response, and recovery.
Results:
There are over a thousand publications on the issue of culture and disaster. While it is clear culture plays a role in the phases of disaster management, there continues to be debate as to the weight which should be placed on culture, or whether it can be seen as separate from other elements which significantly impact phases of disaster, including political, economic, technologic, geophysical, etc.
Conclusion:
With subject matter expertise based on lived and academic experience, the presenter plans to utilize a tabletop format to engage small groups in discussion of the above concepts as well as their experiences relating to catastrophes and cultures. The hope is that this format will spur further translational research interest.
The consequences of missed lower-limb deep vein thromboses (DVT) can be life-threatening. Similarly, inappropriate treatment with anticoagulation in low-risk patients carries a significant risk of harm. Early diagnosis and appropriate treatment with anticoagulation rely on timely ultrasound access. The National Institute for Health and Care Excellence (NICE) recommends timeframes for ultrasound acquisition based on Well’s score and D-dimer value.
If rapid ultrasound (Point of care Ultrasound POCUS in our context) demonstrates no features of DVT, it is safe to arrange follow-up scan within eight days without empiric anticoagulation. If, however, no bedside ultrasound is performed, anticoagulation is commenced until a formal scan excludes DVT. NG158 recommends this scan be performed within 24 hours. This audit investigated our compliance with NG158 time standards at Wexford General Hospital (WGH) emergency department (ED).
Method:
Electronic records for patients undergoing formal ultrasound for suspected DVT between 08/01/2022-10/13/2022 were reviewed using the hospital’s databases. Charts were reviewed to determine if POCUS was performed. In total, 42 records met selection criteria. Audit Committee governance review was obtained. Fisher’s exact test was used to compare compliance rates between those that underwent bedside ultrasound and those that did not.
Results:
Overall compliance with NG158 was 40.5%. Compliance rates for those offered bedside ultrasound were significantly higher than those that weren’t (58.3% vs. 16.7% p<0.0106). The mean waiting time for a radiology department ultrasound is six days, 12 hours, and 16 minutes.
Conclusion:
Overall compliance is low, and delays to obtaining formal ultrasound are long. We observed that compliance rates for those who underwent bedside ultrasound were significantly higher than for those who did not. This suggests that bedside ultrasound is under-utilized in our ED. Training more staff to perform bedside scans would alleviate current delays to ultrasound diagnosis and reduce risks associated with empiric anticoagulation.
Endovascular procedures in emergencies like the implantation of tubes for a life support system are increasing. Guidewires are the essential basis for the regularly used Seldinger Technique. We present a novel concept that may further optimize the safety and efficacy of guidewire handling and navigation during endovascular procedures.
Method:
Using specifically designed luminescent particles, a novel, clinical-grade coating protocol was created to develop a new luminescent guidewire. Different prototypes were designed and tested for their luminescent capacity following a short exposure to any light-source. Chemical-analysis, hemocompatibility, hemolysis and cytotoxicity testing of the new guidewire was performed. The usability of the new prototype was compared to regular guidewires by application into needles, catheters and tubes which are used during percutaneous procedures.
Results:
The engineered guidewires demonstrated a luminescent capacity of at least 20 minutes after less than ten seconds of exposure to a light source. Chemical analysis, cytotoxicity, hemolysis, and hemocompatibility indicated a biocompatibility profile of the guidewire. Good usability, safe and rapid handling was demonstrated when simulating endovascular procedures. Under dimmed-light conditions, the luminescent guidewire demonstrated substantially enhanced visibility when compared to the standard-of-care.
Conclusion:
We present a new, luminescent guidewire that may enhance the safety and efficacy of endovascular procedures, especially where light conditions are suboptimal or for emergency situations when procedures have to be as fast and efficient as possible.
Mass casualty incidents result in mass casualties at short notice and stress healthcare systems. Research shows the critical potential role laypersons have by providing time critical intervention, on-scene, while awaiting arrival of emergency services, thus reducing mortality.
This study aims to demonstrate the attitudes of laypersons to responding to mass casualty incidents in Singapore.
Method:
Laypersons were invited to participate in a pilot course aimed at training laypersons principles and interventions for mass casualty incidents. This was developed by the Disaster Volunteer Corps of Singapore General Hospital Department of Emergency Medicine. Respondents were invited to answer a questionnaire which aimed to explore knowledge and prior experiences, willingness, attitudes, and readiness. Descriptive statistics were analyzed, and free-text responses were categorized into various headings by theme.
Results:
A total of 29/30 course enrollees responded to the questionnaire. Twenty (69%) participants were female. The median age was 50 years old (IQR 35-56.5). Most of the participants were employed (82.7%) and were Singapore Citizens (89.7%).
65.5% had no previous experience with first aid, and none had experience with MCIs. Understanding of mass casualty incidents was poorly understood, 1.42/5 (±0.56).
Respondents were most willing to assist in conventional disasters as compared to other types. Competency in voluntary role and altruism were the most important motivators as compared to compensation which was the least.
Overall, there is a high understanding that Singapore is at risk of disasters but most respondents do not have emergency plans in place for disaster situations.
Conclusion:
This study shows that while laypersons are willing, most do not have the knowledge or experience to respond to mass casualty incidents. This mirrors previous studies in Singapore relating to attitudes and knowledge of laypersons to CPR and AED.
More research and intervention is needed into the attitudes and willingness of members of public and mass casualty incidents.
This study aims to analyze and describe terrorism-related attacks in East Asia from 1970 to 2020. This descriptive analysis of terrorist attacks in East Asia will help first responders, emergency medical services (EMS), hospital-based medical providers, and policymakers establish a more refined hazard vulnerability assessment framework and develop a counter-terrorism medicine (CTM) mitigation, preparedness, response, and recovery plan.
Method:
This descriptive observational study draws data from the Global Terrorism Database (GTD) from January 1, 1970, to December 31, 2020. Epidemiology outcomes included primary weapon type, primary target type, the country where the incident occurred, and the number of total deaths and injuries collected. Data from 2021 was not yet available at the time of this study. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.
Results:
There were 779 terrorism-related events in East Asia from 1970 to 2020. In total, the attacks resulted in 1,123 deaths and 9,061 persons injured. The greatest number of attacks (371; 47.63%) occurred in Japan and the second most occurred in China (268; 34.4%). Explosives were the most used primary weapon type (308; 39.54%) in the region, followed by incendiary devices (260; 33.38%). Terrorist attacks drastically diminished from their peak of 92 in 1990, but there were additional peaks of 88 in 1996, 18 in 2000, 20 in 2008, and 36 attacks in 2014.
Conclusion:
A total of 779 terrorist attacks occurred from 1970 to 2020 in East Asia, resulting in 1,123 deaths and 9,061 injuries. Of those, 82.03% of attacks occurred in Japan and China. Terrorist attacks drastically diminished since their peak in 1996, but there is an overall uptrend in attacks since 1999.
During the COVID-19 pandemic, it became difficult to conduct face-to-face training and practice for disaster medial education. As an alternative to this, it was proposed to build a metaverse world using virtual and augmented reality(XR) technology and implement disaster training education within it. Therefore, the authors investigated the process and effects.
Method:
The authors conducted training of healthcare workers through software implementing a metaverse called MediBase and NurseBase, which was created for doctors and nurses in hospitals to respond to disasters such as COVID-19. The trainees were given a practical orientation after basic theoretical education, attached a VR headset, and performed a medical response to a virtual disaster according to their judgment, and the records and debriefing were organized and analyzed.
Results:
The satisfaction of trainees with education reached a maximum of 88%. Even in the part where the correct choice was made in the theoretical evaluation, the time was delayed or the wrong choice or behavior appeared in the metaverse practical education and training.
Conclusion:
In disaster situations that cannot be implemented identically to reality and most disaster education and training that cannot target actual patients, metaverse-based disaster medical education and training is expected to become a more effective alternative in the future.
Mass gathering events (MGE), organized or unplanned, can attract sufficient attendees to strain the planning and response resources of the host community, state, or nation, thereby delaying the response to emergencies. MGEs also have the potential to cause a mass casualty incident. But MGE can also lead to improvements in the organization of local emergency medical services or public health that form the legacy of that MGE. Emergency medical teams (EMTs) could be deployed to ensure health security as a surge in MGE. But these EMTs should be built on guiding principles and core standards. However, to the best of our knowledge, there are no standards on medical planning and response during any type of MGE (e.g., sports, religious, or festivals).
Method:
A systematic review was performed in accordance with current guidelines, using six databases, namely Medline (via the PubMed interface), Scopus, Embase, Cochrane Library, ScienceDirect, and CINAHL, as well as literature sourced by Google Scholar and The Journal of Prehospital and Disaster Medicine. Studies published on minimum standards or medical planning and response during MGE from 2002-2022, written in English, were selected and assessed for eligibility by two reviewers.
Results:
From a total of 20,159 articles, 138 were screened, and 32 were assessed for eligibility. Two were only abstracts, and the others did not contain any description of minimal standards available for medical planning or response in different types of MGE.
Conclusion:
No studies were found that describe any form of standards for medical planning and the response of emergency medical teams in different types of mass gathering events (e.g., sports, religious, festivals). There is a need for minimum standards for emergency medical teams deploying as a surge in mass gathering events.
The absence of clinical information in the aftermath of disasters in resource-constrained environments costs lives. fEMR– fast Electronic Medical Records–is a medical records system designed for mobile clinics and has proven useful in post-disaster settings. While the original version of the system was developed for areas without access to the Internet, a new version of this system was developed in 2019 to accommodate regions with connectivity.
Method:
We reviewed the design, implementation, and usage of fEMR from June 2014 to October 2022. We used logged data of the number of users, patient encounters, and the circumstances of each deployment. We compared usage between the original fEMR system and fEMR-on-chain.
Results:
The original fEMR system was created in an iterative process by students in Computer Science classes at three different American universities. The system creates a closed intranet signal to which clinicians connect their own device to access the software. The hardware is transported to the medical team in a carry-on suitcase prior to deployment. All data are stored on a laptop that acts as a server. The online version, fEMR On-Chain, was developed under a grant, but is sustained in development through academic partnerships. Both versions are designed so that the provider can complete an encounter with as few clicks as possible and with as little input as necessary to identify patients.The original fEMR system has been deployed to mobile clinics worldwide since 2014. The system has about 14,181 patients and 16,021 clinical encounters from 12 different countries. fEMR On-Chain has been deployed to refugee and migrant settings since 2019, containing about 18,000 patients and 22,000 encounters in two different countries.
Conclusion:
Successive versions of the fEMR system have been used in a variety of conditions and settings, with usage accelerating since 2019 in refugee and migrant health centers.
Health and medical disciplines have traditionally preferred experimental and quasi-experimental methods to evaluate interventions. More recently, mathematical modeling was used to test intervention efficacy in the SARS-CoV-2 pandemic. The challenge for disaster researchers is neither approach suits examining phenomena about emergency health responses in disasters. This study applied an alternative methodology to examine questions of how and why emergency health and medical responses reduced mortality during six different natural hazard disaster events.
Method:
The case study methodology is orientated by the researcher’s perspective and ‘not assigned a fixed ontological, epistemological or methodological position’. This flexibility allows alignment of the researcher’s worldview with the methodology best fitting the research problem and its context, such as post-positivism. Qualitative case study design carefully links five key design elements and sequences, including research questions, propositions, a unit of analysis, data collection, and data analysis.
Results:
Six holistic single case studies described how and why the emergency health response reduced mortality risk of people affected by different disasters. An evidenced-based theoretical emergency health program logic model compared and contrasted inputs, activities, outputs, and outcomes between theoretical and actual responses. Rival explanations were tested before data collection for each single case and applied to challenge the logic model. Each case applied four strategies to increase the validity and reliability of the holistic single case study findings.
Conclusion:
Qualitative case study methodology provides a robust and flexible framework to examine complex questions about emergency health and medical responses, including questions about events, processes, activities, performance, and outcomes. The methodology is equally suited to real-time or retrospective studies. The strength of the approach is the high compatibility for examining phenomena within the context they occur, and linking program logic, data collection, and data analysis methods to the specific question being investigated.
At the beginning of the COVID-19 pandemic, Italian emergency departments (EDs) had to hastily implement current surge response plans or create new ones. The objectives of this study are to quantitatively assess ED performance improvements between selected non-pandemic and pandemic periods at Sant’Anna hospital in Como, Italy, and to relate these to adopted and adapted surge response actions.
Method:
The average length of stay (LOS), time-to-physician initial assessment (TPIA) and left-without-being seen (LWBS) rates were calculated during two ED periods prior to the pandemic and then three periods during the pandemic in the COVID ED (C-ED) dedicated to treat COVID patients, and the COVID-free ED (NC-ED) dedicated to treat all other patients. Then quantitative data analysis based on hypothesis testing was performed.
A qualitative theme and subtheme data analysis based on the Hospital Surge Preparedness and Response Index (HSPRI) was performed on baseline strategies before each pandemic period and on the actions implemented in the subsequent period.
Results:
The LOS increased across all periods, while the TPIA decreased in the first two pandemic periods in comparison to pre-pandemic periods. The NC-ED LOS was lower than the C-ED LOS, and the C-ED TPIA was lower than the NC-ED TPIA in all three pandemic periods. The LWBS decreased between pre-pandemic and pandemic periods, with an increasing trend towards pre-pandemic levels in the last pandemic period. Of the 20 action items listed in the HSPRI, six were implemented in the first pandemic period, eight in the second and one in the third.
Conclusion:
The LOS, TPIA and LWBS rates are useful indicators to rapidly obtain an overview of ED performance but failed to provide an exhaustive assessment because ED performance depends on countless external and internal variables. Close collaboration of ED leaders with other healthcare agencies is critical to respond to a pandemic surge.
In 2014, the residency program adopted a new chief resident model. Multiple other programs had adopted a similar style of having all final-year residents have a “chief” role. Chief residents are meant to be leaders in the residency, have a direct influence on the program, and serve as liaisons with other department chiefs.
Method:
Prior to 2014, the program had three chief residents a year: one Admin, one Academic, and one Recruitment. They were chosen using a vote amongst residents/faculty, with the ultimate decision made by the residency leadership. Many other residents were interested, and often qualified, but were ultimately not chosen. In 2014, the all-chief model was adopted. Each PGY-3 would have a responsibility. The goal was to give each a leadership opportunity, and a tangible product as they transition to fellowships or new jobs. The residents were allowed to pick their position, with some influence by residency leadership. Residents were encouraged to create new roles which aligned with their personal interests or career goals. Examples included Medical Director Chief, U/S chief, PEM chief and Wellness Chief.
Results:
Some residents thrived when given responsibility, while others did not. Some could not manage more responsibility: there was a clear disparity in the effort. At the start of this, all residents’ total shifts/month decreased equally. This created some controversy when the workload was not equal. The alteration of details, requirements, and expectations occurred every year in an attempt to correct the failures.
Conclusion:
Ultimately, the all-chief model was a failure. The program reverted to a traditional chief model, allowing only those the residency leadership felt could manage chief responsibilities to have a role. Those not doing a chief role were given additional shifts and those with less added work were given only a partial shift reduction.
A Hazard Definition and Classification Review conducted by the UN Office for Disaster Risk Reduction (UNDRR) and International Science Council (ISC) resulted in publication of Hazard Information Profiles (HIPs). The HIPs provide groundwork for developing a statistical framework enabling better understanding of the true burden of hazards globally. Furthermore, standardized data is critical for effective monitoring of the Sendai Framework, Sustainable Development Goals, and Paris Agreement on Climate Change.
Following the publication of the HIPs, governments and National Statistical Offices (NSOs) have been encouraged to review their systems for classifying, monitoring and reporting on disaster risk reduction with the aim to gradually implement the HIPs in databases and reporting systems.
The aim of the pilot is to provide statistical feedback on the applicability of the reviewed hazard classification and its HIPs.
Method:
The DRS pilot utilizes mixed-qualitative methods:
Global stakeholder workshops
Literature review to understand the gaps and good practice
Utilizing snowball methodology to cascade a survey to DRS international experts.
Country-level expert focus-groups.
In-country pilots (with Low, Middle, and High-income countries).
Delphi Methodology with expert stakeholders to hone recommendations
Results:
596 responses to the survey from across 38 countries and 90 papers were identified for literature review. Survey initially sent to 120 stakeholders, and snowball methodology increased survey reach, particularly to Global South colleagues. Expert stakeholder and country-level focus groups identified a series of good practices and recommendations enabling step-change towards a standardized global statistical framework. Delphi methodology to refine recommendations is underway.
Conclusion:
The DRS pilot has raised global awareness of the importance of using the HIPs in developing a robust statistical framework with usable disaster-related statistics. This will enable greater accuracy of data contributing to Sendai Framework targets A-D. Results of the pilot being used to inform the Office of National Statistics-UKHSA-Wellcome collaboration on developing Standards for Official Statistics on Climate-Health Interactions in Africa.
The ambiguity of the command system is still the main challenge during the activation of health cluster coordination. It begins with the unclear division of tasks, communication channels that are not yet optimal, and do not have an alternative plan. This study reported the management of health cluster coordination posts during the disaster of Mount Semeru Eruption, in December 2021.
Method:
This study was a case study of qualitative research methods, data collection was carried out by observing the health cluster operation of Lumajang District Health Office (DHO) and supported by an analysis of health cluster activation policy reviews.
Results:
Resources to manage health clusters were limited due to a lack of staff knowledge in health cluster management. Therefore, the head of the Lumajang DHO appointed the Office Secretary as the health cluster coordinator. The Head of Referrals Health Services is the emergency medical team focal person and the Head of Health Promotion is the spokesperson. East Java Provincial Health Office, Ministry of Health, and Disaster Task Force of Faculty of Medicine UGM assisted in the management of health cluster post operations. Then, assisting was concerned with the most fundamental thing in facilitating health clusters such as establishing an organizational structure based on the incident command system approach as well as mapping the capacity of existing health resources on the field to visualize the geographical situation of health service capacity and emergency medical teams distribution.
Conclusion:
Although located in prone and high-risk or periodically eruption areas, the staff still have a low capacity in disaster health management. Thus, capacity building in the pre-disaster phase is highly required in the management of health clusters and emergency medical team coordination by the mandate of the Ministry of Health Regulation.
Healthcare provision depends on reliable infrastructure to power equipment, and provide water for medication and sanitation. Attacks on infrastructure limiting such functions can have a profound and prolonged influence on the delivery of care.
Method:
A retrospective analysis of the Global Terrorism Database (GTD) was performed of all attacks occurring between 1970-2020. Data was filtered using the internal database search function for all events where the primary target was “Utilities”, “Food or Water Supply” and “Telecommunications.” For the purposes of this study the subtype “Food Supply” was excluded. Events were collated based on year, country, region, numbers killed and wounded.
Results:
The GTD listed 7,813 attacks on infrastructure with 6,280 attacks targeting utilities leading to 1,917 persons directly killed and 1,377 wounded. In total there were 1,265 attacks targeting telecommunications causing 205 direct deaths and 510 wounded. Lastly, 268 attacks targeted the water supply with 318 directly killed and 261 wounded. Regionally, South America had the most attacks with 2,236, followed by Central America and the Caribbean with 1,390. Based on infrastructure type, the most attacks on utilities occurred in El Salvador (1,061), the most attacks on telecommunications were in India (140) and Peru (46) had the most attacks on its water supply.
Conclusion:
The regions with the highest number of total attacks targeting infrastructure have historically been in South America, with more attacks against power and utilities than other infrastructure. The numbers of persons directly killed and wounded in these attacks were lower than those with other target types. However, the true impacts these attacks have on lack of health care delivery are not accounted for in these numbers. By understanding the pattern and scope of these attacks, Counter-Terrorism Medicine initiatives can be created to target harden healthcare-related infrastructure.
During a mass casualty incident (MCI), activating resources for response and equitable patient distribution is paramount. The Regional Hospital Coordination Center (RHCC) of a large US city lacked an objective tool readily available to manage patient distribution to area hospitals during an MCI. In a hospital-rich community, spreading the patient distribution throughout the region decreases the impact to one hospital. A tool was needed to equitably distribute patients across the healthcare system without added burden or demand to the hospitals nearest the MCI.
Method:
This tool was developed using Excel and regional hospital capability information including trauma or burn center status, pediatric designation, etc. These capabilities and geographic distances from the MCI were the driving factors of the tool development.
The city has several high-visibility, large event locations. These locations were added into the tool and can be selected as MCI origin points. From here, the tool organizes hospitals by distance from the designated point. Since the formulas were programmed into the tool, it can be easily and quickly adapted to any MCI in the area and reflect relevant resources and limitations.
Results:
Equitable patient distribution to area hospitals during an MCI is a best practice. Advance preparation is key to ensuring quick response and effective utilization of resources. Having a custom tool pre-programmed with relevant, regional hospital capabilities expedited this process and streamlined patient distribution efforts and, ultimately, improved emergency care coordination and patient outcomes.
Conclusion:
During a Mass Casualty Incident, distributing patients equitably across the healthcare system without added burden to the hospitals nearest the event is critical. Having a custom tool pre-programmed with regional hospital capabilities expedites and streamlines patient distribution efforts, ultimately improving emergency care coordination and patient outcomes.
Russia invaded Ukraine in February 2022, leading to significant preventable death across Defense forces and communities. When appropriate and adequate training has been provided, the use of point of injury (POI) care guidelines as exhibited by tactical combat casualty care (TCCC) and the implementation of damage control resuscitation (DCR) and damage control surgery (DCS) can reduce preventable morbidity and mortality in the far foreword environment.
Background: Russia invaded Ukraine in 2014 exacting a heavy increase in preventable morbidity and mortality on the battlefield. Multiple global health engagement strategies by allied forces and health partners have focused on prehospital medicine. The most recent iteration of violence has seen a comprehensive invasion with the use of multi-domain battle and conventional weapons systems across nearly every state in Ukraine. These conventional weapon systems deployed by Russian forces exact a heavy lethality on all communities.
Method:
This report uses anecdotal data from undisclosed locations in Eastern Ukraine from the tactical evacuation care, Role 1, Role 2 to the Role 3 echelons of care as reported.
Results:
Appropriate application of combat application tourniquets (CATs), pressure dressings, access to tranexamic acid (TXA), antibiotics, basics of TCCC care and DCR/DCS, including access to blood as early as possible, save lives.
Conclusion:
Rapid access to tactical evacuation care and initiation of DCR/DCS from Role 1 to Role 2 has good effect. The Ukrainian armed forces have pushed damage control Resuscitation and Surgery as far forward as Role 1, which may require a paradigm shift within the NATO military medical standards and preparations for a peer conflict.
Adequate TCCC, DCR and DCS training in the form of global health engagement have anecdotal success in the reduction of morbidity and mortality and in providing force health and medical readiness across NATO nations and partner forces such as Ukraine.