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Traumatic injury from road traffic accidents is a major cause of morbidity and mortality in Rwanda. Basic first aid training can help bystanders to provide prehospital care. The objective of this study was to determine the impact of Stop the Bleed (STB) hemorrhage control training on participant knowledge, attitudes, and practices regarding bleeding control.
Method:
A total of 64 participants from two community organizations (Healthy People Rwanda and the Rwandan Emergency Care Association) were provided with training in STB. The course included a didactic presentation and skills session where participants could practice skills. A KAP (Knowledge, Attitudes, Practices) survey was provided to participants before training, immediately after training, three months, and six months post-training.
Results:
Immediately after training, participant knowledge of bleeding control techniques improved across 5 of 7 questions, including correct tourniquet placement (98% vs 85%) and the correct order of steps to take when treating bleeding (63% vs 9%). There was also a significant increase in confidence across six measures: identifying life-threatening bleeding, applying a tourniquet, applying direct pressure, wound packing, treating severe active bleeding, and teaching bleeding control techniques to others (p<0.001). After three months, 100% (n = 21) of participants reported using at least one skill from the course, and 95.24% (n = 20) reported using at least one piece of equipment provided during the course. After six months, 93.33% (28 of 30) of participants reported using at least one skill from the course, and 86.67% (26 of 30) reported using at least one piece of equipment provided during the course. Notably, 17 participants reported using the tourniquet they had received by six months post-training.
Conclusion:
This study found that STB training increased participant knowledge of bleeding control techniques and confidence in performing techniques for bleeding control. All participants reported using skills learned from the course.
Urolithiasis prevalence is approximately 15-20%, the third most common urological presentation to emergency departments (ED). In the ED, renal stones are usually diagnosed by clinical presentation, but imaging modalities play a role in confirmation and exclusion of hydronephrosis. 85% of stones are calcium oxalate/calcium phosphate, which are radio opaque, and 15% are radiolucent uric acid or cysteine stones. Non-contrast CT scans have 95% and 97% sensitivity and specificity rates, while x-rays have 57% and 76% respectively. In Wexford General Hospital, radiology prefers plain film x-rays prior to CT scans in assessing kidney stones.
Method:
The aim of this study was to assess the sensitivity of x-rays in patients undergoing low dose non-contrast CT for kidney stones and to apply this information to clinical practice. A retrospective audit was conducted using NIMIS/PACS from December 1, 2021-March 31,2022. All patients who underwent CT KUBS for evaluation of renal stones were included, and CT KUB findings were compared with initial x-ray findings.
Results:
A CT KUB was performed on 56 patients to assess renal stones, and 29 patients had renal stones. Among 29 patients, 21 had x-rays and CT scans performed, and 12 had x-ray findings that indicated renal stones, indicating 57% sensitivity. The study found 36 patients had x-rays for renal stones, but no CT scan was scheduled for 15 patients who might have undiagnosed radiolucent stones.
Conclusion:
Radiological imaging plays a central role in the management of suspected renal stones. CT KUB is a useful tool for evaluating patients with radio-opaque kidney stones as well as detecting radiolucent stones and renal pathologies that can be missed with plain radiographs. Low-dose CT KUB is recommended as a first-line investigation for renal stone patients to reduce radiation risks and unnecessary abdominal x-rays while assisting clinicians in accurately diagnosing patients and excluding other possible causes.
As populations worldwide are experiencing more frequent and intense weather and climate extremes, many professionals of the WADEM community are at the frontline of managing compounding and cascading impacts on physical and mental health. Vulnerable, isolated, and marginalized people are the most affected by climate and weather threats. The elderly and children faced 3.7 billion more life-threatening heatwave days in 2021 than annually in 1986-2005 increasing the need for emergency care on a large scale.
Method:
The World Health Organization (WHO) and World Meteorological Organization (WMO), together with partners from health agencies, climate services, academia and other sectors are collaborating to accelerate the use of climate, weather and environmental science and services for better health protection. A selection of key resources and tools will be highlighted that can be used by the WADEM community to better understand, anticipate, and manage health risks from extreme weather and climate.
Results:
Participants will learn about the new WHO-WMO ClimaHealth Portal, a global knowledge and action hub with huge potential for facilitating learning and action to better protect health from climate risks. Tools and resources include the Global Heat Health Information Network (GHHIN) Checklist and Technical Brief for improved heatwave preparedness and response in the context of COVID-19, and a new WHO Guidance Document on Measuring the Climate Resilience of Health Systems providing a framework and indicators for assessing and protecting health systems from climate threats.
Conclusion:
As extreme weather intensifies, integrated climate-informed services for the health sector including multi-hazard early warning systems and action plans, as well as strengthened partnerships between the health community and hydrometeorological services are indispensable to further restrict adverse health impacts. Accelerating the uptake and upscale of existing tools and resources is urgently needed to meet the increasing health and societal challenges caused by climate change and weather extremes.
The Australian Capital Territory Emergency Services Agency (ESA) has experienced a significantly increased burden of training and most significantly recurrent major emergency response events correlated with increased bushfire and extreme weather events since 2019. ACT ESA is required to provide comprehensive pre-hospital paramedic, firefighting, and emergency response support to the population of the Australian Capital Territory on a day-by-day basis (business as usual) but also surge to meet extraordinary demand. Historically, operational roles and functional areas within ACT ESA have worked largely autonomously under business-as-usual conditions. Under crisis or disaster conditions, these sub-agencies are required to work harmoniously together and alongside external agencies such as Australian Defense Force and Australian Federal Police. ACT ESA have identified that interoperability and integration between internal ACT ESA sub-agencies and externally with other agencies is a key problem. From 2023-2027 ACT ESA has committed to a program of organizational change to address this problem.
Method:
An organizational change plan focusing on improving interoperability and integration was developed using the Generalized Method for Measuring Interoperability and Continuous Quality Improvement frameworks. A comprehensive framework for measuring organizational change and the effectiveness of interventions across multiple workplace domains, based on Kirkpatrick’s approach, was developed through a co-design process between academia and the ACT ESA.
Results:
The ACT ESA change management framework, research, and implementation plan is presented here, alongside the results of preliminary stakeholder and professional engagement activities providing early feedback, adjustment and evolution.
Conclusion:
The ACT ESA is in a unique position within the Australian emergency response landscape having a much greater degree of centralized command, control, and coordination. Despite this advantage, it has identified interoperability both within the organization and with key partnering organizations as a problem. This study outlines how the ESA is approaching organizational change by applying systematic implementation and change management approaches.
Amid the escalating nuclear arms race in the latter half of the 20th century, civil defense preparedness drills, commonly known as “Duck-and-Cover” drills, were practiced throughout classrooms in the United States. Since then, education and preparedness measures have been largely replaced by fire evacuation and active shooter drills. This study endeavored to understand the likely actions that members of the public may take in the event of a nuclear detonation in the 21st century.
Method:
Scenarios for 5 kiloton and 100 kiloton near-surface nuclear detonations were modeled using the Hazard Prediction Assessment and Capability (HPAC) software. A video was created animating the models with a voiceover that explained the initial effects of a nuclear detonation. Using the Qualtrics platform, a survey was created in which the order of behavior-based questions and the video was randomized. Lucid distributed the survey to a representative sample of the American public.
Results:
Among 3,087 participants, only 921 (30%) indicated their confidence in knowing what to do in the event of a nuclear detonation in their city. Participants were most likely to listen to the radio, hide in an interior room, and seal windows or doors. Two thirds indicated they would “duck and cover” (n = 2034, 66%), an action that ranked below helping others (n = 2183, 71%) and wearing a mask (n = 2174, 70%). Study participants who indicated their likely behaviors after watching the video were significantly more likely to listen to the radio (p = 0.044) than those who answered such questions before watching the video.
Conclusion:
The results of this study suggest there remains a need for emergency preparedness education for members of the public in the United States. As the threat of a nuclear detonation grows, educational methods such as video explanations may increase the preparedness of the American public.
To understand the role of medical providers in general and the radiology community in the prevention, management, and aftermath of a radiological or nuclear event.
Method:
Using a power point presentation, the author will describe in detail the role diagnostic medical imagers can play in responding to the radiological or nuclear MASCAL events.
Results:
The purpose is to educate the civilian radiology audience about their role amidst the changing nature of current nuclear threats and asymmetric and hybrid warfare in urban settings. It is very likely that in the future the civilian radiology community may be involved and respond to a nuclear crisis or a radiation accident or its aftermath before the military gets involved because it will most likely be initially a MASCAL event in a civilian setting, not immediately under the purview of the military.
Conclusion:
Radiologists and nuclear medicine physicians will play a very critical and central role in the event of a nuclear detonation or a radiation dispersal device detonation due to their inherent knowledge of the principles of radiation, contamination, exposure and radiation protection.
Improved understanding of pediatric emergency preparedness can ensure the safety of children during disaster events, a population that is often overlooked.1 2 One method to minimize disparities is to increase the pediatric preparedness workforce by providing education to trainees about the foundations of this field.
Method:
A pediatric emergency preparedness curriculum was created as part of an elective prehospital track within a pediatric emergency medicine fellowship program at a quaternary pediatric hospital.
Results:
The curriculum focuses on three domains: education, research, and administration. The trainee is required to participate in local and regional educational opportunities. Locally, trainees create and facilitate at least one tabletop exercise about a preparedness topic of their choice. They also attend regional and state-wide preparedness drills to foster better understanding of integrated system processes. Additional educational opportunities involve the creation of asynchronous learning modules for their division and development of just-in-time resources for disaster events. For research, they have the opportunity to pursue an original project in the field and participate in other research activities with the track director. The administration domain prepares the trainee to be a leader in the field. Trainees are active participants within the emergency department’s preparedness committee and during hospital-wide preparedness meetings. These meetings develop protocols and policies as well as educational initiatives. Fellows are also encouraged to join national collaborative preparedness efforts through the American Academy of Pediatrics and the EMSC innovation and Improvement Center (EIIC).
Conclusion:
This curriculum provides an introduction to and continued education about disaster preparedness to pediatric emergency fellows early in their career. Completion of the sub-track fosters future leaders in the disaster medicine field. In the future, this curriculum can be adopted by other medical training programs to expand understanding of pediatric preparedness concepts.
Electronic dance music festivals (EDMF) are a unique subset of music mass gatherings. Besides the already more significant burden on in-event health services (IEHS) that comes with these festivals, EDMF are also known for their illicit drug use, with their attendees at high risk for illegal drug use.
Method:
Encounter data from all patients seen and treated by IEHS at an annual outdoor multi-day EDMF (focused on hardstyle dance music) in August 2019 were analyzed. Based on the chief complaint, and medical and nursing notes, a list was consolidated into 31 reasons for the consultation of IEHS. The most common reasons for consulting IEHS were analyzed.
Results:
This outdoor hardstyle dance event had 30,000 attendees, of which 580 visited IEHS. This resulted in a patient presentation rate of 19.3/1,000 attendees. Four were transported to the hospital (transport to hospital rate: 0.13/1,000 attendees). The most prevalent reason to consult IEHS were lacerations and abrasions (9.66%), sprains (9.48%), and headaches (7.59%). Only 4.83% of all patients (n = 12) presented with adverse effects of illicit drug use. Of interest is that twelve patients with intoxications (42.86% of all intoxicated patients) were initially triaged as life-threatening, mainly due to obstructed airways. Only one of these twelve needed endotracheal intubation and was transported to the hospital. All other intoxicated patients returned to the event. No direct relationship between gender and the chief complaint was found.
Conclusion:
Besides typical patient presentations, illicit drug use with its adverse effects can seriously impact IEHS. These results confirm the need for highly trained (Advanced life support level) IEHS at EDMF. Competent IEHS can mitigate the burden of these events on regular EMS.
Advances in technology can drastically improve the ability of providers to care for survivors of a disaster. Research into new applications of technology in the Disaster Medicine space, and dissemination of new technological achievements are vital to saving lives. This presentation discusses several recently proven technologies in the field of disaster medicine which deserve further dissemination, as well as promising technologies currently being studied.
Method:
An overview of the current uses and upcoming research on several technologies will be definitive in future disaster responses.
Results:
Unmanned Aerial Vehicles (UAVs) and Telemedicine have been well studied and are proven game changers in field disaster response. Artificial intelligence continues to be studied and aid real-time, strategic and tactical decision making in the field. Virtual reality simulation has now advanced to be a feasible, cost effective and effective method of training disaster responders as well as for training the lay public in disaster risk reduction. Artificial Intelligence is also being studied for uses in the hospital and in all forms of Emergency Management, and is likely to be intricately tied to the future of the field.
Conclusion:
As new technologies are developed, it is important for Disaster medicine practitioners to consider how they can be applied to the field. Advocating for applying new technologies to disaster medicine, and for dissemination of proven technologies is a vital part of advancing the field of disaster preparedness and response.
Reusing PPE is not recommended but was common during COVID-19 pandemic. Limited guidance on proper PPE use and its reuse heightened the hazards to health care worker (HCW) safety. Emerging data on PPE use suggests that most HCWs were contaminated by donning and doffing of PPE while adhering to standards of care.
Method:
A prospective observational study was conducted to understand HCW behaviors in donning, doffing, and reusing PPE. Emergency Department physicians and nurses were video-recorded donning, doffing, and reusing PPE within a simulated acute care environment. Participants performed five donning and doffing PPE procedures. PPE kit included gown, face shields, and N95 respirator masks. Participants had access to disposable gloves and hand sanitizer. Recordings were reviewed and coded independently by two trained coders based on checklist of key behaviors. Agreement between coders was high (81.9%). All participants reported completing PPE training.
Results:
28 videos of participants capturing 278 procedures were reviewed. None of the participants followed the CDC’s order for donning across five scenarios. Majority of participants failed to perform hand hygiene before donning or re-donning PPE or when doffing PPE. For contaminant spread risk, 92.85% (n=26) touched patient-facing side of PPE during re-donning and/or doffing PPE (M= 3.75, SD= 2.37, Median = 4; 0-9 times). The most common area of self-contamination was hands (n= 111 across all participants in 5 donning/doffing sequences). Touching patient-facing side of PPE was more likely to occur during donning than doffing (70.5% vs. 20.1% of sequences).
Conclusion:
The study found wide variation in PPE donning/doffing practices among HCW in violation of CDC guidance. This first study to review PPE reuse through a human factors lens, identifyied deviant behaviors that contribute to HCW self-contamination. Efforts are needed to redesign PPE and develop effective ways to train staff using PPE equipment safely.
Hospitals are subject to internal and external threats which could necessitate an evacuation. Such evacuation needs deliberate surge and collaboration, particularly collaborative use of community capacities to handle affected patients, personnel, devices, and hospital structures using consensus systems. Therefore, it is crucial to identify hospital evacuation procedures’ flaws and assess the possibility of implementing measures using community resources. This study aimed to explore Thai hospitals’ current evacuation readiness and preparation regarding surge capacity and collaboration according to the Flexible Surge Capacity concept.
Method:
The previously used hospital evacuation questionnaire was adopted. It contained relevant questions about hospital evacuations’ responses and preparedness encompassing surge capacity and collaborative elements and an open-ended question to collect possible perspectives/comments.
Results:
The findings indicate glitches in evacuation protocols and triage systems and inadequacies in surge planning and multi-agency collaboration. Additionally, it was evident that hospitals had limited information about communities' capabilities and limited collaboration with other public and private organizations.
Conclusion:
Although implementing the measures for concept integration to hospital evacuation is challenging, pragmatic research exploring planning for community engagement according to the flexible surge capacity to build a concrete hospital evacuation plan would enhance hospital readiness and its generalizations. The latter needs to be tested in simulation exercises.
In Tohoku, the northeastern part of the main island of Japan, students entered medical school following the Great East Japan earthquake that occurred on March 11, 2011. Such students wished to volunteer at the time of disaster, however, the undergraduate medical curriculum was inadequate to enable the practice of disaster medicine. Thus, the Tohoku Disaster Medical Assistance Student (DMAS) holds workshops for undergraduate students to acquire disaster medicine knowledge.
Method:
Tohoku DMAS offers Peer Learning Education. In the DMAS course, students learned disaster medicine through lectures and simulations under the supervision of disaster medicine experts. The workshops vary in length between 3–8 hours. Tohoku DMAS’s goal is to support disaster management headquarters and shelters. Students are expected to provide logistical support that includes recounting the chronology of events at disaster management headquarters and helping with managing evacuation shelters.
Results:
According to the activity reports and roster of the course, there were only three students initially when the course was formed in 2018, however, the group continued to grow, and 165 students currently belong to the Tohoku DMAS. Those students include medical students, nursing students, and paramedics students at various universities and colleges. The DMAS has held 30 training sessions since 2018. The total number of training participants was 1,308. The DMAS has held tabletop simulation exercises and lectures on various topics such as shelter management, disaster triage, and nuclear disasters. Furthermore, some members have participated in emergency drills for each prefecture. The current challenge of the program was obtaining adequate insurance coverage for students and financial support during the activity at the disaster scene.
Conclusion:
The DMAS plays a role in disaster medicine education for undergraduate medical students in the Tohoku region. The program continues to grow and faces opportunities and challenges.
Uncomplicated acute alcohol intoxication (UAAI) requiring medical management is common at some mass gathering events. Most of the mass gathering literature reporting on medical management involving UAAI are single case studies. The common clinical practice for UAAI at mass gatherings reported in the literature involves intravenous fluids and antiemetics. However, emergency department evidence suggests that administration of intravenous fluids does not enhance patient outcomes, and in some cases extends emergency department length of stay and costs.
Method:
Using a retrospective cohort design of routinely collected data over a nine-year period (2010-2013 and 2016-2020), this study was set at an annual end-of-year ‘schoolies’ youth mass gathering event. The primary study aim was to determine the intravenous fluid management practices of UAAI at this event. Secondary study outcomes included patient demographic, clinical characteristics, and patient outcomes. Data were analyzed using time series and descriptive statistics. Ethical approval was obtained.
Results:
In total, 378 patients were identified with UAAI at the event over the nine-year period. The median patient age was 17 years (IQR: 17-18), with 47.2% (n=179) being male. Overall, the median length of stay was 74 minutes (IQR: 40 – 144). Only 7.9% (n=30) patients received intravenous cannulation and 6.3% (n=24) patients received intravenous fluids. Proportionately, the use of intravenous fluids for the management of UAAI decreased over the study years [2010, 28.6%; 2011, 32.1%; 2012, 15.6%; 2013, 6.3%; 2016, 2.6%; 2017, 0%; 2018, 1.8%; 2019, 0%; 2020, 0%].
Conclusion:
Some mass gathering events have a higher incidence of UAAI presentations. This is particularly true for those mass gathering events with young adults and at music festivals. Knowledge translation from the emergency department context regarding UAAI clinical management could be applied to the mass gathering event setting. This clinical management should include a conservative approach to the management of UAAI.
There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes that add value in a medical disaster situation. Some studies suggest that not only technical skills are needed, but also non-technical skills. However, little is known about the actual demands and skills needed to manage a medical disaster situation. Therefore, this scoping review aimed to identify core competencies required for the disaster medicine response.
Method:
A scoping review using the Arksey & O´Malley framework (1) was used. Structured searchers in the databases PuBMed, CINAHL full plus, Web of Science, PsychInfo and Scopus was conducted. Thereafter, data was structured and analyzed. Inclusion criteria were (1) original papers published in English during the last ten years, (2) covering any aspect of competence or skills needed to respond to a disaster situation. (3) Both qualitative and quantitative studies were included. Exclusion criteria were (1) reviews, editorial texts or similar, (2) papers focusing on the care of single patients.
(1) Arksey H, O’Malley L. Scoping Studies: Towards a methodological framework. Int. J. Social Research Methodology. 2005;8(1):19-32.
The 2018 Hokkaido earthquake caused a power outage in all of Hokkaido. In Japan, several hospitals have generators for outages. However, when electricity is lost, several hospitals are disrupted because they are accustomed to having a stable power supply on a daily basis. This study describes the efforts of a hospital that were not accustomed to disaster response to evaluate and implement power-loss countermeasures. The purpose of this study is to measure the usefulness of hospital power-loss countermeasures.
Method:
1) Classification of Japan’s existing power-loss countermeasures.
2) Hospital evaluation of the classified power-loss measures.
3) Confirmation of the usefulness of the hospital’s power-loss countermeasures.
Results:
Power-loss countermeasures were classified into four categories. 1.) Equipment enhancement: this measure is expensive but can prevent loss of power, 2.) Purchase of goods: this measure is inexpensive and alternative power is available, 3.) Manual creation, and 4.) Training. Training measures can help smoothen the hospital’s response after a loss of power. A hospital evaluated whether those measures were appropriate for that hospital. As a result, some of the measures were immediately put into practice.
Conclusion:
This hospital was not accustomed to disaster response, and at first, they did not seem to know where to apply countermeasures. However, after implementing the measures, the hospital announced within its organization that the next step was training. It became clear that by presenting specific measures and evaluation methods, the hospital could create good practices. In the future, web-based evaluation methods should be developed so that all hospitals in Japan can work on measures to counteract power loss.
On August 29, 2021 Hurricane Ida struck New Orleans with Category 4 winds. While the most severe weather occurred during a 24-hr period on August 29, the city suffered significant damage to telecommunication systems, medical facilities, and infrastructure for several weeks afterward. At the height of the storm, multiple events affected routine deployment of EMS, including damage to transmission lines causing interruption of the 911 system, and suspension of ambulance travel for safety when the winds exceeded 50 mph. These factors, as well as pre-storm preparations, affected utilization of EMS by residents and thus a “peri-hurricane” period was examined to determine the overall effect of Hurricane Ida on New Orleans EMS operations.
Method:
Run sheets for calls to NOEMS between August 26-September 9, 2021 were analyzed to assess the most frequently reported medical complaint just prior to and after the hurricane. Run sheets were also evaluated to determine average time from call to arrival on scene, time to arrival at patient (“response time”), and time from leaving scene to arrival at destination (“transport time”). To account for the atypical period during which EMS response was suspended due to wind, both mean and median times were calculated. Data was compared to a control period of Aug 26-Sept 9, 2022.
Results:
During the study period, 1,971 calls were received, with trauma and respiratory the most common complaints. The mean call-to-arrival time was one hour, although the median time was 15 minutes. Response time was 34 minutes compared to 21 minutes in 2022, and median response time was comparable to the control period. Transport time mean and median were 12.3 and 11.3 minutes, also similar to 2022.
Conclusion:
Despite citywide infrastructure failures and suspension of operations for over 12 hours during landfall, multiple mitigation strategies enabled NOEMS to quickly resume operations and minimize impact on patient care times.
The Delphi technique is a unique survey method that involves an iterative process to gain consensus when consensus is challenging to establish and is widely used in Disaster Medicine research. Participants typically rate a variety of statements using a specified rating scale. The survey is repeated for several rounds, and at each round statements that do not reach a predefined level of consensus are advanced to the next round while giving the participants information about the responses of other participants for their comparison. The final statements are then ranked in order of the average rating. The statistical methods to analyze Delphi studies are not well described. This study investigates the use of a 1 to 7 linear rating scale along with parametric summary statistics for assessment of consensus and ranking of statements.
Method:
A study set of 9297 individual ratings on the 1 to 7 scale were obtained from previously performed Delphi studies and used to create 490,000 simulated Delphi ratings with various numbers of participants.
Results:
While the overall distribution of ratings was strongly left skewed the sampling distribution was near normally distributed for studies with five or more participants. The average difference between the standard deviation and interquartile range was -0.26/7. The overall risk of falsely concluding consensus using the standard deviation as a summary statistic was 7.3% when compared to using the interquartile range. The average difference between mean and median was -0.20/7. The risk of falsely ranking the statements by a value of 0.5 or more was near zero for all sample sizes when the mean was compared to the median.
Conclusion:
This study suggests that the use of the 1 to 7 linear rating scale in combination with the parametric summary statistics of standard deviation and mean is a valid method to analyze ratings from Delphi studies.
Disasters occur globally and can impact emergency department (ED) services. Chemical, biological, radiological, and nuclear (CBRN) events have different characteristics in terms of onset and duration when compared to other disasters, such as wildfires, floods, and hurricanes. It is important to have an understanding of the impact of CBRN events on EDs to inform disaster preparedness. The purpose of this paper is to identify peer-reviewed published literature that describes the impact on EDs from CBRN events.
Method:
An integrative literature methodology was used, guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) Guidelines. MEDLINE, PsycINFO, CINAHL, Pubmed, and Scopus were searched using terms relating to CBRN events and EDs. Papers were included if they focused on the impact of real-world CBRN event(s). Information from each included paper was extracted into a table, including author(s), CBRN event characteristics, ED response characteristics, patient presentation characteristics, and outcome characteristics.
Results:
Of the 15,982 studies that were identified from the database searches, 4,012 were duplicates and 11,696 were irrelevant at the title and abstract screening stage. Therefore, 274 were screened at the full-text stage resulting in 44 studies for inclusion. Included papers were mostly from the United States of America (n=22/44, 50%), followed by Turkey (n=4/44, 9.1%). Most of the events were chemical (n=36/44, 81.9%), with Chlorine (n=9/36, 25%) being the most frequently reported chemical agent. Between 1 and 5,500 people [M=54, IQR: 22-253] presented to EDs because of CBRN events.
Conclusion:
Emergency departments assess and manage patients who present following CBRN events. Of these patients, the majority do not require hospital admission, suggesting that the ED is integral in the health response to CBRN events. As such, EDs should be adequately prepared, from a resource and process perspective to assess, manage and discharge large numbers of CBRN-related patients.
During the COVID-19 pandemic, consideration was given to co-ventilating multiple patients on a single ventilator. Prior work had shown that this procedure was possible by ventilating four adult-size sheep for twenty-four hours, and other groups had performed this maneuver during dire circumstances. However, no investigation had examined the safety regarding cross-contamination. The purpose of our studies was to investigate if an infection could spread between individuals who were being co-ventilated.
Method:
Four sterile two-liter anesthesia bags were connected to a sterilized ventilator circuit to simulate the co-ventilated patients’ “lungs.” The circuit utilized Heat and Moisture Exchange filters and bacterial/viral filters, which were strategically inserted to prevent the transmission of infectious droplets. Serratia marcescens was inoculated into “lung” number one. The circuit was then run for 24 hours, after which each “lung” and three additional points in the circuit were cultured to see if S. marcescens had spread. These cultures were examined at 24 and 48 hours to assess for cross-contamination. This entire procedure was performed a total of four times.
Results:
S. marcescens was not identified in lungs two, three, or four or the three additional sampling sites on the expiratory limb of the tubing at 24 and 48 hours in all four trials.
Conclusion:
Cross-contamination between co-ventilated patients did not occur within 24 hours utilizing the described ventilator circuit configuration.
International health partnerships have often been characterized by wealthier countries or organizations pushing resources and money into projects in countries with different needs. This can be new technologies, building facilities, and/or training personnel. Often this has been assessed in the amount of money spent. In recent years more focus has been put on synergy effects in involved organizations. Hence the change from aid to partnerships. A previous study focused on the subjective perception of the workforce regarding clinical skills, management skills, communication & teamwork, etc. (Jones et al., 2013). This paper focuses on defining learning goals and using a model by Patzauer (2022) as a complement to traditional partnership evaluation measures.
Method:
Seven team members from a health partnership participated in a project for implementing ambulance service treatment guidelines through training of the partner's ambulance personnel and instructors. The training took place during one week in the partnership country. All Swedish participants were nurses actively working as ambulance personnel or had previously worked in ambulances. Before the training week the participants answered a questionnaire with open questions about their personal learning goals and expectations for the training week. At the end of the week, after having trained ambulance personnel, they answered another questionnaire with open questions addressing what they had learned.
Results:
Analysis of the responses showed that the participants expected to acquire both personal and clinical skills. Afterwards, they had improved language skills, self-efficacy, and becoming better instructors.
Conclusion:
The model of using learning goals as an integral part of evaluating health care partnerships provides knowledge that is useful both in terms of assessing the project, and also as input to participants' managers showing clinical and organizational benefits. Including personal learning goals as a part of partnership projects' evaluation, provide useful knowledge about benefits and experiences that improves the organizations.