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Emergency Medical Teams (EMT) training is moving towards competency training. Although there exist a few systematic reviews regarding the competency training, there has been little investigation on how the competencies can be effectively translated into the EMT personnel’s training.
In a humanitarian organization in Hong Kong, a competency matrix for EMT volunteers was developed in 2018. The organization relies on a steady base of volunteers to perform its services. With these competencies, volunteers can be encouraged to undertake a multitude of available trainings to fit with the needs of the organization, or for their own personal benefit.
Method:
The aim of the study is to recommend methods to improve uptake of the competency matrix among volunteers of the organization. A mixed methods study was completed, encompassing literature search, a quantitative questionnaire and qualitative one-to-one semi-structured interviews.
The Behavior Change Wheel and the Capability-Opportunity-Motivation-Behavior (COM-B) interactive system were used to guide the research rationale and to frame the questions asked to investigate perceptions regarding the competency matrix.
Results:
Data collected from the questionnaire and interviews were collated and organized into the corresponding Theoretical Domains Framework as specified from the Behavior Change Wheel, and the respective intervention functions and policy categories were lined up accordingly. Analysis of data identified a series of key factors influencing the potential incorporation of the competency matrix among volunteers. Data collected from volunteers largely agree with and is supported by the literature on adult training, volunteer management and specifically on EMT training.
Conclusion:
Although EMT training is moving towards competency-based training, research publications on how to effectively deliver competency-based training, and on the effectiveness of various didactic methods within EMT training are scarce. This calls for more research to be done in the area of competency-based training of EMT.
Blended learning has been proven to support the teaching of various concepts across disciplines. This study aims to investigate the impact of the traditional blended teaching mode (self-study online and face-to-face consultation) on the undergraduate’s learning of disaster skills, and compared with face-to-face consultation, explore the influence of new mode (tutoring manipulation online) on the acquisition and forgetting of knowledge in disaster medicine based on the blended learning.
Method:
A prospective cohort study method was used. The two semesters in a school year adopted different blended teaching models for 8 weeks. In the first term, students conducted disaster theoretical knowledge before class through an Online Course created by our team. In class, teachers guided training about response and preparedness (face-to-face consultation). Due to the outbreak of Covid-19, a new training model was adopted (tutoring manipulation online) in the second term. Three knowledge tests were conducted before class, after class, and six months after the end of the term. An accuracy rate difference was defined between the second and first as correct improvement rate (CIR), and the difference between the second and third as forgetting rate (FR).
Results:
Seventy-five students were included in the traditional group, and 64 students were included in the new group. The three results in traditional group were (0.38±0.11) %, (0.65±0.11) %, (0.56±0.13) %,and (0.49±0.15) %, (0.71±0.13) %, (0.60±0.12) % in new group. The mean scores after 6 months on both groups were lower than at the end of the term (Ptraditional <0.001, Pnew =0.010). The new group had a higher accuracy rate on all tests than the traditional group (P <0.01).
Conclusion:
Traditional blended learning models can improve students’ performance in disaster training and deepen knowledge memory. The new blended model may replace the traditional model for disaster training during the Covid-19 pandemic.
The COVID-19 pandemic inspired social changes that promote outdoor activities including eating at restaurants, which may linger in a world hyperfocused on disease transmission prevention, increasing the vulnerabilities to vehicle-based terrorism. Vehicle ramming attacks started to transition from a relatively rare method of attack to one of the most lethal forms of terrorism prior to the emergence of COVID-19.
Method:
This study aims to provide a historical analysis of the terrorism-based attacks using vehicles between 1970 and 2019 by retrospectively searching the Global Terrorism Database for terror events that used a vehicle as a means of attack–a methodology suggested by Tin et al.
Results:
257 recorded terror attacks involved some type of vehicle between 1970 and 2019. The attacks resulted in 808 fatalities and 1715 injuries when excluding the September 11 attacks. 76 events occurred in the West Bank and Gaza Strip, 25 in the USA, 16 in Israel, and 14 in the UK. Of the 257 terror incidents, 71% (183) occurred within the last 6-year span of inquiry.
Conclusion:
By 2016, vehicle attacks were the most lethal form of attack comprising just over half of all terrorism-related deaths in that year. Large gatherings such as festivals, sporting events, and now outdoor seating at restaurants, leave a number of people highly vulnerable to vehicle ramming attacks depending on established countermeasures. The increased prevalence of outdoor activities and gatherings in a post-COVID-19 world will further expose large numbers of people to the potential vulnerabilities of vehicle-based terrorism. The scale of the casualties from a vehicle-based terror attack can overwhelm traditional resources and strain the abilities of the healthcare sector. Counterterrorism and disaster medicine specialists are crucial players in educating first responders and emergency medicine providers, allowing them to adequately prepare for an evolving threat in a world devastated by COVID-19.
Cumulative disasters have been shown to influence mental and physical health in both responders and victims, with studies showing associations in rates of depression and Post Traumatic Stress Disorder. Systemic problems that impact patient care such as limited resources, overcrowding of emergency rooms, and staffing shortages can be morally challenging for healthcare workers. Andrew Jameton, in 1984 defined Moral Distress (MD) as the inability of a moral agent to act according to his or her core values and perceived obligations due to internal and external constraints. Unresolved MD can create significant long-term debilitating physical and mental damage. Emergency medical providers on the island of Grand Bahama had the unique experience of responding to both the aftermath of Hurricane Dorian and the Covid-19 Pandemic. The aim of this study is to determine the prevalence of Moral Distress (MD) in Accident & Emergency (A&E) Physicians, Nurses, and Emergency Medical Service (EMS) staff at the Rand Memorial Hospital (RMH) in the Bahamas.
Method:
This is a descriptive, qualitative, prospective cross-sectional study, utilizing a three-part survey sent to participants. Sociodemographic information, Hurricane Dorian & Covid-19 experiences, and responses to a validated modified Moral Distress Scale will be collected and uploaded to a secure, encrypted data management program. The data will be analyzed using the most current IBM SPSS statistical analysis package. Descriptive and Inferential statistics will be used to determine the impact of Hurricane Dorian & Covid-19 on MD and its associated sociodemographic factors.
Results:
Data collection and analysis are planned for completion by March 1, 2023.
Conclusion:
Addressing the causes of Moral Distress early can help improve healthcare systems’ resiliency by ensuring a healthy and supported workforce equipped with the resources to respond to future disasters.
Crisis collaboration exercises are perceived as developing and testing cross-sectoral team integration, preparedness efforts, and response. However, the general problem is that crisis collaboration exercises may tend to produce results with limited usefulness in actual crisis work. The purpose of this quantitative, non-experimental, survey-based study was to examine to what extent there was a statistically significant relationship between participation in Norwegian maritime crisis collaboration exercises and the perceived levels of learning and usefulness in an actual crisis. The scope was limited to relevant public, military, and non-governmental exercise participants.
Method:
Surveys were electronically distributed among participants in three 2016 Norwegian maritime crisis collaboration exercises. The data collection instrument was the Collaboration, Learning, and Utility scale (Berlin & Carlström, 2015). The CLU-Scale is specially designed to measure collaboration exercise participants' perceived levels of learning and utility. The scope was limited to relevant public and non-governmental exercise participants including health, law enforcement, and military stakeholders.
The effects of collaboration, learning, and usefulness were tested in two bivariate regression analyses, where the first tested the relationship between collaboration and learning, and the second tested the relationship between learning and usefulness. To measure the linear dependence between the variables, Pearson’s r was calculated. The coefficients of determination (r2) were calculated to determine what proportions of the variance in the dependent variables could be considered predictable from the independent variables.
Results:
The joint collaborative characteristics predicted 27% (r2 = 0.27) of the learning variance, which meant that the remaining 73% of the predicted variance was unaccounted for. The perceived learning items predicted 34% (r2 = 0.34) of the usefulness variance.
Conclusion:
This study found a moderately strong statistically significant relationship between participation in Norwegian maritime crisis collaboration exercises and perceived levels of learning and usefulness. More focus on collaboration learning techniques in exercise planning and evaluation is recommended.
Clinicians with knowledge, skills and attitudes required in austere environments better serve their patients regardless of setting. Few opportunities traditionally exist for medical students to learn about wilderness, disaster medicine, or environmental illness. Events related to climate, disasters, and COVID-19 reinforce the need for physicians to develop tools for practice in resource-limited settings. We created a medical student elective which delivered core content related to wilderness medicine, environmental illness and disaster preparedness and response, along with overarching skills including improvisation, teamwork, and resource allocation.
Method:
Content experts partnered with educational design specialists to create a new student experience. We identified key impact areas using an analysis of courses at peer institutions, informal surveys, and published literature. Learning objectives were informed by relevant skills and content, as well as the cross-cutting goal of teaching students to perform in resource-limited settings.
A four-week curriculum was conceptualized, including lectures, workshops and skill sessions, synchronous and asynchronous online experiences, and a five-day backcountry trip focusing on in situ simulation and skills training. The course was offered in May 2021 and May 2022. Students completed post-course surveys regarding the utility of course elements, as well as teaching effectiveness.
Results:
Overall satisfaction was 3.64/4.00. Self-reported competence increased in the domains of diagnosis and pathophysiology, treatment, teamwork, and resource management and improvisation. Qualitative data suggested that students are generally under-exposed to wilderness, environmental and disaster content. Self-reported helpfulness of learning activities was greatest for small-group outdoor workshops, and least for large teleconference-based sessions.
Conclusion:
Strengths included interactive coursework reflecting teamwork, open access learning modules, and rubric-based assessment structures. Limitations include pandemic-related restrictions in group activities as well as limited objective measurements of knowledge and skills. Future goals include increasing in-person learning, dissemination of the curriculum to larger groups of learning, and development of reproducible performance measures.
While the importance of pharmacists' involvement in disaster management is becoming increasingly recognized in the literature, there are few mechanisms by which pharmacists can prepare themselves for emergencies. This project aimed to determine the effectiveness of a disaster tabletop exercise (TTX) in preparing pharmacy staff for disasters.
Method:
A TTX was held at the American Society of Health-System Pharmacists Summer Meeting which was held in Phoenix, Arizona in June 2022. The workshop incorporated an evolving emergency scenario in which participants worked through activities pertaining to the mitigation, preparedness, response, and recovery cycle. The scenario involved a hypothetical storm and landside scenario across fictional towns in Arizona, US. Workshop attendees worked in small groups on one of two provided hospital profiles. The attendees were invited to complete a pre-post survey assessing their perceptions of disaster management including perceived preparedness. This survey was previously developed, piloted, and published. The paper surveys were collected at the end of the workshop and inputted into RedCap. Data were descriptively summarized using SPSS, and pre-post survey results were compared using appropriate statistical tests.
Results:
The workshop was attended by 40 pharmacy personnel and 31 completed the survey. All participants agreed that the exercise was well structured, realistic, allowed them to test their response plans and systems, and helped improve their understanding of their role and function in disaster response. After the workshop, participants' perceptions of their ability to prevent, respond, and recover from a disaster all significantly improved (p=0.004, 0.013, and 0.013 respectively). However, perceptions of their preparedness for a disaster did not significantly change (p=0.197).
Conclusion:
This study adds to the evidence of the effectiveness in training and preparing the pharmacy workforce. The TTX improved the understanding and perceived capabilities of pharmacy personnel in responding and recovering from emergencies.
As health care professionals and family members, we know that many patients died alone in healthcare settings during the first six months of the COVID-19 pandemic. An extensive literature review confirms this as well, and concludes that visiting restrictions during the pandemic had negative impacts on patients and their loved ones.
There is a right to not die alone contained in the Dying Patient’s Bill of Rights; however, it happened time and time again during the early months of this pandemic when countless people in long-term care settings and hospitals were reported to be isolated during their final hours of life. No one should die alone! What can we learn from this experience to try to minimize this from happening during the next pandemic?
Method:
This study will explore the state of the literature on the status and impact of visitor restrictions during the COVID-19 pandemic, in conjunction with a survey of a defined sample of practicing registered nurses in the United States. This study seeks to respond to the primary research question of how patients’/family members’ end-of-life needs can be met in a pandemic when hospital visitation is severely limited or non-existent? There are for (4) related sub-questions concerning effective direct and indirect methods of family presence.
Results:
The literature concludes that countless people were isolated without family presence during their final hours of life during the first six months of COVID-19. The initial survey process is currently underway, with the identification and analysis of recommendations for improvement in early 2023.
Conclusion:
The goal of this study is to develop best practices for meeting the end-of-life needs of hospitalized patients and their loved ones during a pandemic, so that to the extent possible, no one dies alone.
The Japan Disaster Relief Search and Rescue Team (the JDR Rescue Team) Medical Unit consists of EMT (emergency medical team) registered doctors and nurses who provide health care and medical advice to rescue operations. The JDR Medical Unit began 20 years ago when they voluntarily participated in rescue training and is characterized by volunteers who belong to different hospitals across the country. As a result, there were problems due to varied skills, and motivation. Until 2017, all applicants were recruited and trained as provisionally registered members, but only about 30% of them became fully registered members.
Method:
Since 2018, we have fundamentally changed our personnel training methods, establishing three main pillars. The first is a screening process based on work experience, expertise, and motivation; the second is dedicated guidance through training, textbooks, online study sessions, and training; and finally, we have created abundant training opportunities and visualized the growth process through a ladder to keep them motivated and goal-oriented at all times. Specific trainers are defined as task force members and they analyze each scene of the deployment practically and reflect on training. The task force also receives training abroad and absorbs good practice from other teams.
Results:
After changing the personnel training methods, the number of participants who dropped out of the training program was significantly reduced, and approximately 90% of the participants became fully registered members. The team members are more motivated and the team's capabilities have improved, leading to IER (INSARAG External Reclassification) certification as a heavy team twice.
Conclusion:
By selecting experienced and capable members and providing them with sufficient guidance and abundant training opportunities, we succeeded in improving the efficiency and capacity of human resource development. Ideally, victims are handed over to EMTs as patients for the future goal.
In the event of a major event or disaster, the intensive care unit (ICU) should be able to offer an adapted and proportional response, within a limited time frame, to the influx of patients who can benefit from the technical facilities of the University Hospitals of Geneva. We developed an innovative approach to ICU care aimed to guarantee continuity by protecting healthcare staff from excessive fatigue and by tailoring the care provided from individualized care to the best care for the most people.
Method:
A modified organizational and systematic investigation method (MINOS, Paries - 2013) was used to elaborate an ICU security model; threats to activity shut down were identified and their prevention, recovery, and mitigation were planned. These actions were updated following the evolution of the crisis. Crew resources management (CRM) and bedside simulations were used in the implementation phase.
Results:
The ICU security model pillars were staff protection and patient management; the identified threats to activity continuity were lack of human resources, activity overload, medical errors, pressure sores and healthcare acquired infections; they were evaluated at intermediate or high risk to patients’ safety. The prioritized care plan was developed to control, recover, and mitigate these threats. It consisted in: adaptable level of ICU care, modular organization by cell, huddles, matrix for activities prioritization and controlled delegation method. Before implementation, 55 nurses and 46 doctors were trained by CRM courses and simulations. The pilot phase was deployed in one cell, from December 2021 to January 2022; 67 patients were admitted in the period; 13 adaptations to the original plan were introduced. No critical safety issues were reported.
Conclusion:
The prioritized care could be an adapted and proportional ICU response to a major event allowing the continuity of the activity while protecting staff from overload. Further tests are needed.
As the COVID-19 pandemic started, the NO-FEAR project shifted to real-time experience sharing to improve response to an unknown new threat. The lessons observed during more than 20 webinars were collected and analyzed at the end of 2019 to identify those relevant for future preparedness and response to another outbreak or new threats.
Method:
A questionnaire using a 0-4 Likert scale was distributed to the wider NO-FEAR community, where they were asked to identify the relevance of the item for future preparedness. Later the results were discussed by the consortium and put for feedback in a large meeting in Madrid in March 2022. The 78 observations were clustered into five categories: 1) The human factor (23) 2) Knowledge sharing, cooperation and coordination (11) 3) Equipment and supplies (15) 4) Standard Operating Procedures (SOP) (20) 5) PPE (9).
Results:
The Top-rated observations were the following:
The human factor: 2.3 need for updated, trustful information sharing with personnel (e.g. regarding treatment protocols, PPE, updates, etc.) to allow them a comprehensive understanding of the situation (3.73).
Personal Protective Equipment (PPE): 6.1 need for PPE stockpile management, considering transportation, storage space, and risk of throwing away out-of-date PPE (3.63).
Equipment and supplies: 4.3 need for solutions to increase equipment and beds capacity (3.56).
The human factor: 2.22 need for management of fake news and mitigation of violent incidents against healthcare personnel (3.56).
Knowledge sharing, cooperation and coordination: 3.5 need to collect data, needs, gaps, and lessons in preparation for future outbreaks (3.56).
Better integrating health care into crisis management structures was highlighted during the Madrid conference.
Conclusion:
NO-FEAR highlighted the importance of real-time international real-time knowledge sharing in a crisis, the need to better address the needs of the personnel during a long-term crisis, and better integrate health into crisis management structures
A widely acknowledged aspect of emergency preparedness is hospital-wide staff education. Maintaining interest in hospital emergency preparedness among hospital staff is challenging. A hospital-wide education process involving a robust lecture and hands on donning and doffing sessions followed by periodic disaster drills has been recently undertaken as a quality improvement process.
Method:
A prospective pre- and post-test study of 256 hospital staff were given a six-hour training course in comprehensive Hospital Incident Command Systems (HICS), Hazmat (Hazardous Materials), and CBRNE (Chemical, Biological, Radiation, Nuclear, and Explosive) events. The same pre and post-test were given to all participants that contained questions to assess emergency preparedness knowledge.
Results:
256 registrars within seven months (two classes per month) completed training with pre and post-tests. The average class size was 18.3 (range= 14 to 26 registrars). 3 of 256 (1.1 % 95% confidence interval) registrars achieved the pass mark of 70% in the pre-test survey and 230 (89.8 %) registrars achieved the pass mark in the post-test (χ2-test P < 0.001) with an absolute increase in the pass rate of 84%.
Conclusion:
This finding justifies Emergency Preparedness Training at our institution, showing a marked improvement in staff knowledge of HICS and CBRNE management. This study should encourage continuous widespread use of Emergency Preparedness training in hospital Emergency Preparedness.
Vulnerable populations were the most impacted by the COVID-19 pandemic. This included those with underlying health conditions, self-employed, low-income, people with limited access to health care, and the elderly. To capture these lessons and identify resilience actions, the Health Emergency and Disaster Risk Management (Health EDRM) Framework was used to guide the application of the Public Health System Resilience Scorecard (Scorecard).
Method:
This study was conducted in Australia, Bangladesh, Japan, Slovenia, Turkey, and the United States. Participants included emergency professionals, doctors, nurses, environmental health specialists, researchers, and government officials. The Scorecard was used to rank the level of preparedness from 0-5 (5 the highest) for the public health system resilience indicators. Following the individual workshops, recommendations were collated and interpreted to develop consolidated priority actions.
Results:
The priority actions related to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. To address surge capacity issues, determining whether existing disaster structures have the capacity to provide support for hospitals during patient surges. This could include services that enable telehealth and primary health care to support hospitals during a crisis. Mental health services at the local government level should be evaluated and awareness of ecosystem risks in urban and rural areas needs to increase. Strategies for achieving reciprocal trust are required to enable uptake of public health information, and the extent at which pre-existing chronic health issues are likely to exacerbate needs to be understood and addressed.
Conclusion:
This study revealed several areas for strengthening public health system resilience. Priority actions relate to addressing needs relating to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. This serves as a framework for transforming public health systems to become more adaptive, flexible, and focused on enabling societies to function at the highest possible level when responding to a disaster or pandemics.
In a climate where natural disasters are becoming progressively more frequent and severe, there is a greater need for healthcare resilience. Hospital pharmacists are important healthcare responders during disasters, but little is known about how prepared pharmacists are to fill roles in disasters or how prepared pharmacy departments are to support their response. The aim of this study was to determine the disaster preparedness of pharmacists and pharmacy departments in a Metropolitan Health Service in Australia and investigate any relationship between the two.
Method:
This research utilized two surveys to determine the individual preparedness of registered pharmacists within the eligible hospitals and the preparedness of pharmacy departments (this information was obtained through the Directors of Pharmacy).
Results:
In total, 68 individual pharmacists participated in the study. It was found that individuals were moderately prepared (preparedness score 19.98). Interventions, such as education, improved individual preparedness scores, though these had poor uptake, where only 17.4% (n=12/68) of participants had received disaster education or training. Individual preparedness was unaffected by facility preparedness and provision of comprehensive resources.
The preparedness of hospital pharmacy departments was generally low, where two hospitals were rated as ‘somewhat prepared’, due to the presence of a mostly comprehensive plan and a moderate engagement in activities that contributed to preparedness. The third hospital was ‘poorly prepared’, as it did not have a disaster plan and had low engagement in preparedness activities.
Conclusion:
This study shows that a substantial improvement in pharmacy preparedness is required to achieve healthcare resilience and quality patient outcomes in disaster aftermath–further reinforcing the need for national and pharmacy-specific guidance, complemented by standardized preparedness interventions such as education and training. There is also a glaring disconnect between the preparedness of pharmacy facilities and their workforce, which demonstrates a culture of disaster preparedness.
The National Ambulance Service (NAS) must transport patients with acute psychiatric needs to their nearest emergency department for assessment. Wexford General Hospital (WGH) does not have on-site medical psychiatric services after hours, in-patient psychiatric beds, or dedicated psychiatric doctors. Patients requiring formal acute psychiatric assessment and/or admission after ED review need to be transferred 60-80 km to other healthcare facilities.
Aimed to assess average ED stays of psychiatric patients and determine what degree transfer time contributed to their total time would help to determine what delay there was to providing acute psychiatric care due to the lack of after hours/on-site services.
Method:
Data was collected from the iPMS system. A total of 125 patients presented with primary psychiatric complaints between January 1, 2021 and December 31, 2021 and required onward transfer for acute psychiatric assessment or admission. Patients were excluded if less than 18 years or had been admitted to another WGH service before transfer. There are no existing guidelines in the National Clinical Program for Psychiatry or NICE guidelines for acute psychiatric patient transfer times or ED stays.
Results:
The average WGH ED attendance time was 15h 27min (range 0h08min and 19h22min). The longest interval contributing to overall time was Transfer Booked to Transfer Time (average 3h 27min). The time from Psychiatric Referral to Transfer accounted for 30% (on average) of patients’ attendance time.
Conclusion:
There are significant delays in accessing acute psychiatric care due to the absence of Ambulance Service Bypass Protocols to transport patients to the most appropriate rather than the nearest ED. Proposed Trauma bypass system changes offer unique opportunities to review such inequity of access to acute psychiatric services.
In recent years, Japan has been hit by a number of natural disasters including the Great East Japan Earthquake, the Kumamoto Earthquake, the heavy rains in western Japan, and the heavy rains in Kumamoto to name a few. In each of these events, a number of hospitals located within the disaster areas were damaged and ceased to function, leading to difficulties in providing regional medical care. This presentation examines the effectiveness of mobile medical containers in handling such situations in the future.
Method:
This study organizes lessons learned from past disasters as well as the merits of and challenges facing current mobile medical containers while looking into the future.
Results:
When the Great East Japan Earthquake occurred, assembly-and-installation type temporary health clinics were constructed, but due to the numerous Japanese laws and regulations, it took almost three months for these to be delivered. On the other hand, current mobile medical containers are already in use in countries such as Tonga and Senegal and have the following advantages: (1) High mobility and easy installation, (2) Expandability as necessary, and (3) Durability for long-term use.
Conclusion:
Despite challenges such as clarification of legal handling, electricity, water supply and drainage, we consider mobile medical containers to be effective alternative medical facilities in the event of disasters.
Strengthening national disaster management legislation and policy is critical for preventing and reducing catastrophic health effects from the growing threat of natural hazard disasters. Although evaluations of the effectiveness of legal and policy instruments are rarely published, similar approaches continue to be applied universally by governments to align their response to disaster impacts. This study analyzed and contrasted the effect of disaster legislation and policy on the emergency health and medical response to six complex natural hazard disasters, including typhoon, earthquake, flood, smoke haze, thunderstorm asthma and the COVID-19 pandemic.
Method:
The study applied qualitative multi-case study methodology and used a standardized program logic model to synthesize and analyze the effect of national disaster legislation and policy on emergency health and medical responses. Events were case-bounded by date, more than 9,000 casualties, and local emergency responses provided health and medical care.
Results:
Four themes emerged critical to health system response. Where legislation and policy provided clear separation of powers, systems delineated roles and responsibilities, provided clarity and process for assessment, resource acquisition, and operational mandates. Policies that created dedicated local networks and included non-health related organizations, accelerated coordination of crucial health functions for rapid mobilization and prioritization for affected populations. In all but one case, the hazard was closely monitored, already affected communities, and catastrophic risk to life understood, before the declaration and statutory powers were invoked.
Conclusion:
Using ‘declarations’ as the legal instrument to initiate ‘whole of government’ resources in disasters requires urgent review, especially where advanced hazard monitoring systems exist. Disaster and emergency health policy should support action orientated toward exposure mitigation, inclusion of non-traditional health actors and partnership building. International policy mechanisms are required to address emerging health threats not locally prioritized and advance regional cooperation agreements when the impact of hazards harm populations outside geographic boundaries.
In September 2020, severe wildfires in Oregon (USA) came dangerously close to Hospital A. The entire county was under evacuation orders. The Neonatal Intensive Care Unit (NICU) at Hospital A needed to evacuate patients to other areas for safety, however the characteristics of premature and critically ill neonates required a specialized transport team. This presentation outlines a case study of how the Pediatric and Neonatal Transport team (PANDA), based at Oregon Health and Science University (Portland, Oregon, USA), responded to evacuate neonatal and infant patients to other metro area NICUs during the wildfires.
Method:
Case study.
Results:
During a six-hour period, both PANDA transport teams on shift were activated to complete back-to-back transports of neonates and infants by ground ambulance to fire safe locations. Each patient was transported by a PANDA Registered Nurse and PANDA Respiratory Therapist, with an Emergency Medical Technician who drove the ambulance and Medical Control available by phone. The PANDA team normally operates in non-disaster settings. This was the first time PANDA was activated to evacuate patients from a hospital during a disaster. This presentation will discuss lessons learned and implications for future practice.
Conclusion:
Wildfire frequency and severity is predicted to increase due to climate change. Evacuation of premature and critically ill neonates requires a specialized transport team due to patient size, weight, and other considerations. Specialized transport teams should develop disaster evacuation workflows and resources, and regularly practice for these events. There is also a need for trauma-informed care in the post-evacuation setting to transport staff and parents of patients who were unable to travel with their child during transport. A full team pre-transport risk assessment is crucial in these circumstances.
A mass hospital evacuation occurred in Taiwan in 2021 due to the clustered COVID-19 infection in Hospitals. To maintain essential services with limited manpower, 74 patients are triaged and evacuated to 12 hospitals in 6 cities in 16 hrs for further treatment.
Method:
All patients were evaluated by physicians for discharge. The patients who still needed hospitalization were classified into three groups according to the risk of infection1. The high-risk group of patients were cared for by infected staff directly; the moderate-risk group were patients admitted to the same ward but didn’t receive care from infected staff. The low-risk group were patients avoiding infection outbreak. Only the low-risk group patients were transferred, excluding patients with unstable vital signs, hospice, and prison. Command Center of HICS of TGH set up a transfer execution team to handle this task.
Results:
There were 74 patients transferred, including 56 from internal medicine and 18 from the surgery ward. Most of the transfers are concentrated within 16 hours. These patients were transferred to 12 emergency hospitals in 6 cities. The average transport time was 1.5 hours and the longest was about 3 hours due to the distance and traffic.The 17 private ambulances and 11 Fire Department ambulances were dispatched and transferred 60 patients. In addition, there were 14 patients evacuated by small buses. No mortality or COVID-19 infection had been reported within 3 days after this mass evacuation, only one patient had been intubated after one hour of arrival to hospital due to condition deterioration.
Conclusion:
A hospital evacuation is a complicated process, especially during a pandemic. All infection control measures create difficulties in the patient transfer process. Well-prepared evacuation plans, regular drills, well-trained personnel, an organized command system, and regional cooperation are the keys to mass evacuation in a disaster.
Proper packing technique is crucial to minimize blood loss and successfully stop fatal junctional (axilla, groin, and neck) bleedings. Several medical simulators and mannequins are used to teach techniques for manual pressure and wound packing. Live tissue training (LTT) using animal models represents a high-fidelity simulator, but the number of times massive hemorrhage can be practiced is limited due to cumulative blood loss of the animal. Moreover, the animal’s potent coagulation limits the reuse of injuries. The study aimed at creating and validating a reproducible and repeatable exsanguination simulator to be used for high-volume training.
Method:
This study was approved by the regional animal ethics committee (Dnr 17953-2020). All animals were fully anesthetized throughout the duration of experiments. A repeatable exsanguination simulator using live tissue (RESULT) was created using commonly available materials to add reproducible junctional bleedings in an LTT context. A canister of porcine or bovine blood is connected to a standard gravity infusion set with roll clamp and pump chamber removed and added to a 100 cm 3-way stopcock connected to a 60 ml syringe. The free end of tubing is surgically inserted into the hind leg of a pig and placed inside a 5 cm long and 5 cm deep wound cavity. The simulator was evaluated with instructors controlling the rate of bleeding using the syringe while training participants packed the wound.
Results:
According to the instructors, participants benefited from the additional training made possible by using RESULT. Instructors received direct feedback on applied manual pressure and packing through the resistance of the syringe plunger. Moreover, participants found the increased number of repetitions beneficial to their training. The animals had no change in status from the multiple bleeding interventions.
Conclusion:
Both participants and instructors found the novel bleeding model useful for high-volume training in stopping massive junctional bleeding.