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With the Covid-19 pandemic impacting the world at such a quick rate and with many unknown variables and dangers, there was an immediate need for ethical guidance to ensure those in many different healthcare settings such as researchers and other professionals could perform ethically in this new and complex situation. This study aims to take existing research on those ethical guidance documents in the UK/Ireland and compare them with those from the United States.
Method:
This study used a qualitative systematic review methodology with thematic synthesis to analyze the included ethics-related guidance documents, as defined in this review, published in the UK and Ireland between March 2020 and March 2022. The search included a general search in Google Scholar and a targeted search on the websites of the relevant professional bodies and public health authorities in the three countries. The ethical principles in these documents were analyzed using the constant comparative method (CCM).
Results:
In the UK and ROI review, 44 guidance documents met the inclusion and exclusion criteria, and 11 main ethical principles were identified, which were then categorized under two main themes: respect and duty. The 11 main ethical principles were: fairness, honesty, minimizing harm, proportionality, responsibility, autonomy, respect, informed decision-making, community, the duty of care and reciprocity.
In the US review, 270 documents were found from searching several public health United States government bodies. Of these documents, 50 were deemed to be Covid-19 ethical guidance, each ethical principle was tallied from every document and compared with the results from the UK/Ireland study.
Conclusion:
There were remarkable similarities in some ethical principles prioritized in the Covid-19 pandemic ethical guidelines across the Atlantic Ocean. However, there were differences in the interpretations and frequencies in which these principles were used across different regions.
Disaster medicine aims to prevent and respond to devastating events. Health professionals need to understand their role in disaster management to effectively respond when disasters occur. The aim of the study is to assess the knowledge level, preparedness, and the training gaps regarding disaster medicine among health professionals and medical students/interns in Makkah (Mecca) city.
Method:
This is an online-based cross-sectional study design conducted in Makkah City. Physicians, nurses, and medical students/interns were included. Continuous variables were reported as means and confidence intervals. While categorical variables were reported as frequencies and percentages. Data were analyzed by Chi-square and Anova test as appropriate.
Results:
Of the 651 participants, the mean age was 27.69 (95% CI 28.13 to 27.24) with 360 (55.30%) participants being males. The mean average score of disaster medicine knowledge was 7.90 (95% CI 8.29-7.51) for medical students/interns, 8.12 (95% CI 8.77-7.47) for nurses, and 4.85 (95% CI 5.21-4.49) for physicians (P <0.0001). The majority of participants selected first-aid skills and triage and evacuation as crucial aspects to be covered in learning disaster medicine, 406 (62.4%) and 373 (57.3%) respectively.
Conclusion:
In this study, the level of knowledge regarding disaster management is average among the healthcare population. Certain aspects of disaster medicine are needed to be focused on such as first-aid skills and triage and evacuation. Incorporating disaster medicine as part of training programs is a demand.
The Battle of Mosul (2016-2017) involved asymmetric warfare and excess civilian causalities. Emergency Management Centre (EMC) was a designated trauma center for the battle, located 80 km from Mosul. Exploratory laparotomy outcomes in local hospitals are poorly studied compared to military hospitals. Improving response to complex emergencies requires better contextual understanding.
Method:
Prehospital and hospital data were collected from all patients undergoing exploratory laparotomy at EMC during the battle. Data were collected and validated by EMC’s chief surgeon. New Injury Severity Scores (NISS) were calculated from operative data.
Results:
Seventy-three patients were included. 22 (30.1%) were children; 40 (54.8%) were non-combatant adults. 51 (69%) were male. Bullets caused 74.0% of injuries. Children had prolonged time from injury to first laparotomy compared to adults (600 vs 208 minutes, p<0.05). Median hospital length of stay (LOS) was six days (IQR 4-10; children 16.4 days vs adults 8.6 days, p=0.05). Median NISS was 18 (IQR 12-27). NISS were significantly higher for women (28.5 vs 19.8), children (28.8 vs 20), and re-laparotomy (32.0 vs 19.0) compared to men, adults, and primary laparotomy, respectively. In univariate and multivariate analysis, NISS was associated with hospital, but not ICU, LOS (p<0.01). Twelve patients were re-laparotomies after surgery elsewhere: ten (83.3%) were for failed repairs or missed injuries. Median time to re-operation was 5.5 days (IQR 1-8). Re-operations had longer ICU (4.5 vs 2.9, p<0.01) and hospital stays (20.7 vs 7.6, p<0.01). Three (4%) patients died; two of which were re-laparotomies.
Conclusion:
During the battle, civilians and combatants had similar injury mechanisms and outcomes. Children had a long time to present and LOS. Low mortality likely reflects high prehospital mortality. Prolonged times to admission suggest the need for improved hospital transport. Re-operation was associated with increased complications and LOS. NISS demonstrated predictive value for hospitals, but not ICU, or LOS.
Children represent 25% of the population, have special needs, and are often over-represented in disasters. The New York City Pediatric Disaster Coalition (NYC PDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve pediatric disaster preparedness and response. PDC worked with a network of pediatric intensivists to create the Pediatric Intensive-Care Response Team (PIRT). PIRT consists of volunteer pediatric intensivists that currently practice in New York City.
Method:
Secondary transport may be requested by hospitals due to a mismatch of resources to needs for patients requiring critical and/or subspecialty care. The team is activated when a disaster involves a significant number of pediatric patients. In the proposed plan, the PIRT physician on-call will triage/prioritize the patients based on acuity and need for services and relay the necessary information to the transport agency. PIRT is designated to provide subject matter expertise and resources during real-world events. PIRT maintains a 24/7 on-call schedule with backup. The PIRT system was tested in four call-down communications drills and a tabletop exercise for prioritization of pediatric mass casualty victims.
Results:
The call-down drills demonstrated the ability to contact the on-call and backup physicians by email or text within 20 minutes and others within one hour. In the tabletop, PIRT members were given 15 patient profiles based on a scenario and asked to prioritize patients based on their injuries/medical needs. This was accomplished in less than 30 minutes, followed by a review and discussion of the rank order. A number of lessons learned were identified and will be presented.
Conclusion:
The NYCPDC has developed and tested a PIRT that is available 24/7 to prioritize patients for secondary transport and offer subject matter expertise during pediatric mass casualty events. This model can be utilized to enhance pediatric disaster preparedness.
The Russian invasion of Ukraine began on February 24, 2022. UNHCR reported, as of April 6th, more than 4.3 million refugees have fled Ukraine, with 401,704 refugees arriving in the Republic of Moldova, around 100,000 of whom have remained in the country. JICA investigated whether Moldova's healthcare needs were burdened by accepting a large number of Ukrainian refugees, and examined the way to support them.
Method:
JICA dispatched the 3rd team as a survey team. The 2nd team consisted of two medical doctors, one nurse/midwife, one clinical engineer (CE), one Japan DMAT logistician, and two JICA staff. The dispatch period was three weeks when five major hospitals were visited in the capital, evaluating the current situation and the need for support for the future.
Results:
As of April 6, 2022, 3,853 people were staying in refugee accommodation centers, while the rest lived in ordinary Moldovan families. Evacuees, like Moldovan citizens, were covered by health insurance, and evacuees had access to medical care. Medical institutions were not overwhelmed by medical needs due to the Ukraine crisis. There was no epidemic of infectious diseases even at evacuation centers. However, since there was no system to share emergency information between hospitals, we held a disaster medical seminar to introduce the current situation of disaster support in Japan and supporting EMTCC.
Conclusion:
As a survey team, not only doctors but also nurses, midwives, and CEs surveyed, making it easier to understand the specific medical needs at medical facilities. Most of the evacuees stayed in ordinary Moldovan homes, and it is possible that avoiding a crowded environment at the evacuation shelters prevented the epidemic of infectious diseases.
In October 2021, Hillel Yaffe, MC, suffered a ransomware attack which shutdown most hospital computer systems, including patient EMR, pharmacy, communications, administration and backup systems. Staff were left in a state of “cyber-shock” without access to essential information for maintaining safety, quality and continuity of care. The aim of this presentation is to share the hospitals' experience and insights of this cyber-attack, outlining preparedness and response strategies.
Method:
This attack required a multifaceted emergency response strategy, including:
Immediate response activated according to specific pre-prepared emergency scenario action lists
Leadership decision making in real time under conditions of uncertainty
Identifying the extent of systems affected
Establishing alternative communication across the organization
Distributing real-time status updates and proactive guidelines, based on pre-existing emergency preparedness protocols
Finding alternative access to patient health histories
Adaptation and distribution of alternative hardcopy versions of patient evaluation and documentation normally done by EMR
Distribution of instruction materials for staff via alternative communication, ensuring quick and correct adoption of alternative protocols
Special emphasis on patient safety, risk management, quality and continuity of care
Recognition, support and resilience-building for staff facing uncertainty and unprecedented conditions
Results:
Required preparations include pre-prepared standing orders and procedures, exercises and simulations. Advanced preparation of alternative documentation and care protocols will enable uninterrupted, safe, high-quality patient care. Familiarity with pen-and-paper documentation may minimize shock and disorientation from “digital withdrawal”, especially among younger workers lacking manual documentation experience. Staff members should also be instructed in maintaining “digital hygiene”, such as using strong passwords and awareness about cyber-security threats.
Conclusion:
Hospitals must prepare for potential cyber-attacks and EMR/digital system shutdowns. Cyber-attack should be treated by organizations as an emergency event, and they should prepare incident response and contingency plans, to assure business continuity and quick disaster recovery.
After officer-involved shootings, rapid delivery of emergency medical care is critical but may be delayed due to scene safety concerns. The purpose of this study was to describe medical care rendered by law enforcement officers (LEO) after lethal force incidents.
Method:
Retrospective analysis of open-source video footage of officer-involved shootings (OIS) occurring between 2/15/2013 and 12/31/2020. Frequency and nature of care provided, time until LEO and emergency medical services (EMS) care, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board.
Results:
342 videos were included in the final analysis. LEOs rendered care in 172 (50.3%) incidents. The average elapsed time from the time of injury to LEO-provided care was 155.8 + 198.8 seconds. Hemorrhage control was the most common intervention performed. An average of 214.2 seconds elapsed between LEO care and EMS arrival. No mortality difference was identified between LEO vs EMS care (p = 0.1631). Subjects with truncal wounds were more likely to die than those with extremity wounds (p < 0.00001).
Conclusion:
LEO rendered medical care in half of all OIS incidents, initiating care on average 3.5 minutes prior to EMS arrival. Although no significant mortality difference was noted for LEO versus EMS care, this finding must be interpreted cautiously, as specific interventions, such as extremity hemorrhage control, may have impacted select patients. Future studies are needed to determine optimal LEO care for these patients.
Information sharing during disasters tends to be confusing. We started the trial operation of a digital whiteboard (DWB) as a communication tool during disasters in 2019 and fully introduced it in 2022. The DWB is a large tablet that allows interactive communication in close to real-time in remote locations through Wi-Fi.
Method:
To verify the usefulness of the system, DWBs were placed at triage posts in severely, moderately, and mildly damaged areas during a 2022 disaster drill responding to mass casualties to facilitate the sharing of patient information between Disaster Response Headquarters and each treatment area. In each treatment area, doctors, nurses and paramedics completed a standard form to share information about each patient. Information collected included the triage tag number, patient name, age, gender, type of injury or disease, and description of the treatment.
Results:
Six DWBs were remotely shared, with the triage post noting the number of patients passing through each severity level, and each treatment area noting the treatment status of each patient. The Disaster Response Headquarters replied with the results of adjustments such as hospitalization ward and time to start surgery. The descriptions were reflected in the remotely shared DWBs in about one second. Text conversations through the DWBs were also seen. In the post-event survey, some said that the smooth sharing of information led to quick decisions. Compared to conventional radios, DWBs have the advantage of allowing communication through text, which allows more detailed and accurate patient information to be communicated quickly. The results suggest the survival rate can be improved by assisting early medical intervention or rapid entry of patients into operating rooms. The next goal is to use DWBs for medical coordination among disaster base hospitals.
Conclusion:
DWBs are effective for the rapid and accurate sharing of patient information during disasters.
The critical role that nurses and midwives undertake during disasters has received significant attention in recent years. Nurses globally have faced multiple disasters, often occurring within months of each other and even overlapping. Within the past decade, on a global scale, nurses and midwives have experienced two Public Health Emergencies of International Concern (PHEIC) (SARS-CoV-2 and Monkeypox), the devastating and ongoing conflict in Ukraine and an unprecedented number of international natural hazards that have impacted them personally and professionally.
Method:
A discussion with frontline nurses and midwives provided insight into the challenges of delivering health care during disasters.
Results:
The results revealed that while there is some information available about disaster care and the role nurses play, there is minimal information about how nurses and midwives are personally affected by disasters impacting their own communities. Disaster nursing is a relatively new area of health care practice and is rarely taught at an undergraduate or workplace level.
Three opportunities for improving/acknowledging the critical role of nurses and midwives during disasters include:
1) Acknowledging that the involvement of nurses and midwives is critical to any disaster response
2) Promoting the importance of a nursing voice within the emergency management sector
3) Structural reforms be urgently adopted to address workforce sustainability including addressing gender inequality
4) These three approaches form only a part of the reform required to address the key roles that nurses and midwives perform during disasters.
Conclusion:
The ongoing pandemic has placed severe stress on an already overstretched nursing workforce, now is the right time to empower and support our nurses. In all aspects of emergency and disaster management nurses and midwives are at the frontline. Greater acknowledgement of the value nurses bring and the sacrifices they make in serving their communities will strengthen nurses’ commitment and resolve in tackling future crises.
The world is facing the devastating impact a biological event can have on human health, economies, and political stability. COVID-19 has revealed that national governments and the international community are woefully unprepared to respond to pandemics—underscoring our shared vulnerability to future catastrophic biological threats that could meet or exceed the severe consequences of the current pandemic. This study examines potential threats related to deliberate Russian military use and misuse of the tools of modern biology or an accident caused by a CBRN event evolving rapidly in the highly volatile political environment in and around Ukraine and other conflicts.
Method:
A participatory foresight, co-creative, future and transformation-oriented methodology was used to structure a transformative model for a disciplined exploration of scenarios to confront complex challenges and facilitate improved outcomes. Foresight helps to evaluate current policy priorities and potential new policy directions; see how the impact of possible policy decisions may combine with other developments; inform, support and link policy-making in and across a range of sectors; identify future directions, emerging technologies, new societal demands and challenges; and anticipate future developments, disruptive events, risks and opportunities.
Results:
The study found that the “mitigation scenarios” are based on the “Confront, Regulate, Overcome” metamodel combined with the “Security, Rescue, Care” response modalities. These require the cooperation/coordination of law enforcement forces along with military forces, fire departments and civil security resources, hospital and first-line responder teams, in order to appropriately address populations, assets and territories issues elicited by the identified threat, which drives key decision makers’ tasks at the strategic level.
Conclusion:
The participatory foresight exercise demonstrated gaps in national and international biosecurity and pandemic preparedness architectures highlighted by the challenges of the Ukraine war—exploring opportunities for better cooperation to improve prevention and response capabilities for high-consequence biological events, and generate actionable recommendations for the international community.
The COVID-19 pandemic public health strategy to reduce community transmission in Australia included unprecedented use of quarantine facilities to separate those at risk and those with the infection from the rest of the community. No standardized approach to quarantine facilities existed resulting in different models of care emerging across the country. The Northern Territory Howard Springs Quarantine Facility was a large-scale quarantine and isolation operation which hosted over 33,000 domestic and international arrivals with zero COVID-19 transmission recorded from residents to staff for the duration of its operation. The facility was deemed the gold standard model of care and the aim of this project was to distill the important elements of that model of care into an evidence-based tool kit for future use as an open access, online resource. The toolkit was a result of intense data and information analysis including resident, staff and leadership surveys, policies and procedures and results of audits of the facility during its operation.
Method:
This project to develop an online, open access evidence-based toolkit forms part of the Translational Research to Improve Health Outcomes project funded by the Australian Government’s Medical Research Future Fund. The methodology included mixed methods with an underpinning grounded theory approach to analyze de-identified audit data and information from the quarantine and isolation facility operational period. Staff and leadership team surveys were conducted to explore experiences of site functions and infrastructure. A (non-experimental) descriptive design allowed collation and statistical analysis of information recognizing the variables in the data and information.
Results:
The toolbox includes a resident centered quarantine care model, infection, prevention and control strategies for health professionals and non-health staff, quarantine communication model and presentation of core challenges (rapid recruitment, environmental factors, workforce resilience).
Conclusion:
The resulting online web resource presents evidence-based core strategies and resources for implementation in future pandemics.
Sri Lanka has been divided into 26 districts. These 26 districts are Colombo, Gampaha, Kalutara, Galle, Matara, Hambanthota, Trincomalee, Batticaloa, Ampara, Jaffna, Mullaitivu, Kilinochchi, Mannar, Vavuniya, Kandy, Matale, Nuwara Eliya, Anuradhapura, Polonnaruwa, Rathnapura, Kegalle, Badulla, Monaragala, Puttalam and Kurunegala. Ten key natural disasters have been identified in Sri Lanka as important to develop response capacity. These natural disasters are coastal erosion, cyclones, droughts, earthquakes, epidemics, floods, forest fires, landslides, lightning and tsunamis. Five battalions of the Sri Lanka Army Medical Corps (SLAMC) have been established in various parts of Sri Lanka. These battalions are named 1 SLAMC, 2(V) SLAMC, 3 SLAMC, 4 SLAMC and 5 SLAMC. The Army Hospital, Army Base Hospitals (ABH), and Medical Reception Stations have been located in various parts of Sri Lanka
Method:
Each battalion and hospital have Emergency Medical Teams (EMTs) for response to disasters. An EMT consists of: one medical officer, two nurses, two nursing assistants and one ambulance with a driver. There are two EMTs in each battalion and each ABH. The Army hospital has three EMTs.
Results:
1 SLAMC is responsible for responding to disasters in Colombo, Gampaha, Kalutara, Galle, Matara, Rathnapura, Kegalle, Kurunegala and Puttalam. 2(V) SLAMC is responsible for responding to disasters in Hambanthota, Kandy, Matale, Nuwara Eliya, Badulla and Monaragala. 3 SLAMC will respond to disasters in Anuradhapura, Vavuniya, Mannar and Mullaitivu. 4 SLAMC will respond to disasters in Jaffna and Kilinochchi dis. 5 SLAMC is responsible for disasters arising in Polonnaruwa, Trincomalee, Batticaloa and Ampara. When disasters happen in adjacent districts, hospitals will respond to those disasters.
Conclusion:
EMTs will be deployed to the disaster site as soon as possible and do treatments for casualties by staying seven days. The number of EMTs depends on the magnitude of the disaster.
Some incidents require early deployment of emergency department personnel not designated as disaster medical assistance team (DMAT). Although not as trained as DMAT members, they should be aware of basic disaster response concepts and knowledge. Educating disaster readiness to every healthcare staff in emergency departments would be ideal but it is very costly in both time and expense. To overcome this problem, we tried to evaluate the effectiveness of teaching basic concept and knowledge to non-designated personnel in a short-session and measure the effect.
Method:
This study is a before-and-after comparison study. From July 2020 to July 2022, a two-hour education was given to volunteers among doctors, nurses, paramedics and administrative staff working in emergency departments across four hospitals in Korea. Educational sessions consisted of basic disaster concept, pre-deployment DMAT preparations, initial actions required on incident site, key elements of incident response (command, control, safety, communication), and triage. Attendees were given a pretest before the session and another test after the session. Chi-square test and Wilcoxon rank test were used to compare the results.
Results:
Total of 105 volunteers participated in the study. Participants were mostly nurses (62.9%) followed by paramedics (23.8%). Overall knowledge level reported to be increased, including knowledge regarding DMAT deployment (29.5% to 93.3%, p<0.001), DMAT personnel (26.7% to 94.3%, p<0.001), DMAT-designated equipment (23.8% to 60.0%, p<0.001), initial response (27.6% to 69.5%, p<0.001) and patient transport priority (74.3% to 94.3%, p<0.001). Questions testing triage and rate of participants answering every question showed improvement with post-test median score of 67% and rate of 1.0% to post-test median score of 100% and rate of 35.2%, respectively (both p<0.001).
Conclusion:
Educating non-DMAT personnel in emergency departments with a short session showed significant improvement in basic knowledge of disaster response. It may help institutions with limited resources.
The paper provides the perspective of emergency managers within a healthcare service, using a multi-agency framework to coordinate a regional response to COVID 19. While health services play a role in the planning, response and recovery to major emergencies they are rarely the lead in coordinating the response. The exploration of existing research through Pauchant and Mitroff Onion Theory is combined with the challenges and experiences faced by emergency managers during the COVID 19 response in Ireland. The research mirrors the experience of emergency managers that preparedness and relationship building are key to quickly establishing a response. However the experience of emergency managers was that although shared situational awareness is critical a flexible system framework is required, particularly in a prolonged pandemic situation. A hierarchical command and control system can negatively impact on strong local relationships and problem solving capability. The experience of emergency mangers concurs with research that the development of a learning organization is pivotal in information preparedness before and during the response and recovery phase. The challenges of implementing lessons learned across a national health service can be challenging especially during an extended response phase.
Method:
A deductive manifest analysis approach was adopted to carry out a qualitative thematic content analysis of exercise reports and emergency debrief reports.
Results:
Research Questions
Lessons learned in the five years prior to COVID 19 enhanced the response to the pandemic emergency–yes there are several examples of how lessons learned can improve response to seemingly unrelated emergencies.
The principals of the MEM Framework in Ireland are applicable to a pandemic emergency–yes but this is dependent on local arrangements and relationships to allow flexibility in the implementation of the framework.
Conclusion:
Regular training and exercising as well as a debriefing of exercises and real emergencies enhances preparedness for emergencies.
Belize has no formal prehospital emergency medical system, leaving the majority of acutely sick and injured persons overwhelmingly dependent on private transport. To address this issue, a collaboration of public and non-profit partners worked with the Belize National Fire Service to implement the country's first formal prehospital emergency medical service using novel communications technologies. With new resources and vehicles already donated to the fire service, the collaboration focused specifically on the communications component of the response system, specifically to improve the handling of incoming requests for emergency assistance from the public, as well as to improve the process of dispatching prehospital personnel using readily-available mobile technologies.
Method:
Working with the Belize National Fire Service, program partners implemented the country's first emergency communications center, trained new dispatchers, field-tested the dispatch technology through intensive training sessions, and launched the system in the capital district of Cayo.
Results:
Launched in June 2022, the program has thus far achieved the following outcomes:
Active Dispatchers: 26
Active Responders: 104
Emergencies Dispatched: 156
Average Scene Response Time: 7m45s
Conclusion:
Over the past year, partner NGOs Trek Medics and Empact Northwest have worked collaboratively to implement a first-ever centralized emergency dispatch system for the Belize National Fire Service, using a novel cloud-based dispatch software running on readily-available mobile phones and mobile. In addition to drastic improvements in response performance, satisfaction among system managers and response personnel is high, with plans currently underway to scale the program nationally.
Disasters and humanitarian crises can have a tremendous impact on the mental health and psychosocial well-being of affected populations. Reliable and practical evidence-informed mental health and psychosocial support (MHPSS) guidelines are indispensable for policy and practice to address the mental health impact. Our objective was to review the quality of available guidelines and to explore similarities and differences in content.
Method:
The review was conducted in two steps. Firstly, MHPSS guidelines, frameworks, manuals and toolkits were selected via a systematic literature review as well as a search in the grey literature. A total of 13 MHPSS guidelines were assessed independently by 3–5 raters using the Appraisal of Guidelines for Research and Evaluation–Health Systems (AGREE-HS) instrument. Secondly, we analyzed the content of the highest-ranking guidelines.
Results:
Guideline quality scores varied substantially, ranging between 21.3 and 67.6 (range 0–100, M= 45.4), with four guidelines scoring above midpoint (50). Overall, guidelines scored highest (on a 1–7 scale) on topic (M = 5.3) and recommendations (M = 4.2), while implementability (M = 2.7) is arguably the area where most of the progress is to be made. The four guidelines proved largely similar, overlapping or at least complementary in their MHPSS definitions, stated purpose of the guidelines, user and target groups, terminology, and models used. Many recommended MHPSS measures and interventions were found in all of the guidelines and could be categorized. The guidelines stress the importance of monitoring needs and problems, evaluating the effect of service delivery, deliberate implementation and preparation, and investments in proper conditions and effective coordination across professions, agencies, and sectors.
Conclusion:
The MHPSS knowledge base embedded in guidelines is rich and contains invaluable content for disaster risk reduction. Although application contexts differ geographically, available guidelines should allow policymakers and practitioners globally to plan, implement, and evaluate MHPSS actions.
In Japan, victims of large-scale disasters are usually identified by non-objective means. In the case of the 2011 Great East Japan Earthquake, ~90% of the bodies were identified based on nonobjective means such as facial features or belongings, which resulted in misidentification. At present, the situation remains the same. However, according to global standards, a method referred to as “disaster victim identification” (DVI; individual identification of disaster victims) is recommended by the International Criminal Police Organization; in this method, a multidisciplinary investigation team integrates objective information such as dental charts and DNA. Furthermore, recently, there has been a movement to employ postmortem computed tomography (CT) for personal identification, and radiologists are expected to be included in the DVI team.
Method:
In the Department of Legal Medicine of Chiba University in Japan, individual identification via CT or magnetic resonance imaging was conducted in forensic autopsy cases of unknown identities when there was an assumed person for the body and the antemortem image of the person could be acquired. Two certified radiologists interpreted and compared the antemortem CT with the postmortem CT taken prior to autopsy and assessed whether the two images were compatible to indicate the same person.
Results:
A total of 20 cases were judged. In all cases, two images were compatible, indicating the same person. Image-based identification was particularly useful when dental findings or fingerprints were unavailable for comparison and there were no family members available for DNA testing.
Conclusion:
In the future, this method will be applied to large-scale disasters.
In March of 2022, the Washington Post reported that the: “Deadliest war isn’t in Ukraine, it’s in Ethiopia.” Current death toll estimates are around 600,000: 50,000-100,000 (warfare); 150,000-200,000 (starvation), and 100,000 (lack of medical treatment). Due to increasing civil unrest, a mixed-methods study began at the University of Gondar Hospital in Gondar, Ethiopia. Between 2018-2022, the estimated (daily average) of patients was reported to have quadrupled, from 100 to 400. The global research team implemented 12 new systemic revisions in overcrowding, triage nursing praxes, and resuscitations. Patient data from 521 hospital records was evaluated, as well as resource allocation(s) in staffing, equipment, and training.
Method:
The study’s inclusion criteria for A&E data included all patients who sought emergency care at UoG Teaching Hospital’s Emergency Department between May 13, 2018, and June 29, 2018, primarily during the normal daytime working hours between 9am and 2pm, as nighttime security and road travel were deemed less secure for data collectors.
Results:
After the 12-benchmark implementation, there was an approximate 15%-25% decrease in direct-from-triage ‘Red’ patient admission; congestion dropped 50%-70%; and the occurrences of successful resuscitations increased. The study revealed that over 75% of patients presented with symptoms indicative of illness(es), and 24.4% presented with trauma (remaining psychiatric). Of the trauma cases, approximately 28.3% were ‘intentional’ injuries. The patients’ mean TEWS triage score was 3.294, with a standard deviation from the mean of 1.9938.
Conclusion:
The overall prevalence of patients necessitating surgical evaluation, the elevated use of triage discriminators due to space, equipment, and staff concerns, and the predominant use of ‘Yellow Zone’ services–all pointed to the vital need for resource re-allocation(s), stricter ECCN adherences to TEWS triage indices, as well as future Mass Casualty Planning, Triage, and Response, and Mass Casualty Medical Operations training.
Contact tracing is a core public health tool used to interrupt the transmission of pathogens, including SARS-CoV-2. To increase the effectiveness of contact tracing, Greek health authorities used an electronic platform to aid traditional manual contact tracing to track individuals who have come in close contact with identified COVID-19 patients.
Method:
Contact tracing was implemented from the beginning of the pandemic in Greece. The aim was to identify and quarantine all the contacts of confirmed cases. The electronic database was designed following all the security protocols and national regulations on the use and protection of personal data. To assess factors associated with infectivity and susceptibility to infection in this analysis, we used contact tracing data with a sampling date between October 1 to December 9, 2020.
Results:
During the sampling period, 29,385 laboratory-confirmed SARS-CoV-2 cases and 64,608 traced contacts were identified. A median number of two persons were traced per index case. The secondary attack rate was 17.4% (95% CI: 17.0-17.8). Contacts aged 0–11 and 12–17 years were less susceptible to infection than adults 65 years or older (odds ratio (OR) [95% CI]: 0.28 [0.26–0.32] and 0.44 [0.40–0.49], respectively). Index cases aged 65 years or older were more likely to infect their contacts than other adults or children/adolescents.
Conclusion:
Contact tracing is a key strategy to interrupt chains of transmission and to promote early diagnosis. The data collected in this process could be used to estimate epidemiological parameters of interest and to better understand factors associated with infection and susceptibility to infection. Precautions are necessary for individuals 65 or older as they have higher infectivity and susceptibility in contact with their peers.
Due to the high number of road traffic accidents with acute injuries and fatalities–particularly in Mass Casualty Incidents (MCI) in low-resource urban sub-Saharan African cities–research was undertaken to create an evidence-based algorithm that could be used to assess and geospatially link EMS needs in Kumasi, Ghana, to trauma resources. Our examination showed that non-MCI fatalities was approximately 2.5%, however, MCI fatalities were found to be 1.8 times higher–at 4.3%, indicating significant opportunities in the planning, preparedness, care, and transport among MCI patient management.
Therefore, several studies (funded through Fulbright-Fogarty and Fulbright Specialist programs), supported the development of the A-E-M-S (Assess-EOP-Map-Simulate) Medical Mass Casualty Algorithm that began networking accident ‘hotspots’ to existing trauma-level capabilities and surge capacity competencies in eight specified Kumasi hospitals. This low-cost response model promises to be an innovative alternative to long-term infrastructure development and high-priced resource distributions. Use of GIS and UAV drones allowed response systems to geospatially locate, classify, shift, and/or augment resources as needed in conjunction with hotspots.
Method:
Sample sizes were averaged at 295 for all patients' ages, with only a sample size of 292 for adults at 95% confidence intervals, and a standard deviation of 0.5. A total of 300 road-traffic accident victims were collected at KATH A&E in February-May, 2017, utilizing handheld devices by four researchers 24/7 daily.
Results:
Our examination showed that non-MCI fatalities were approximately 2.5%, however, MCI fatalities were found to be 1.8 times higher–at 4.3%, indicating significant opportunities in the planning, preparedness, care, and transport among MCI patient management.
Conclusion:
To date–and in partnership with Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Ghana Medical Council, Health Services, National Disaster Management Organization, and others–over 306 Ghanaian healthcare providers from 80 different facilities have been trained in the AEMS program.