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RCHIS is an Electronic Medical Record (EMR) and Health Information System (HIS) that has been purpose-built for use by Red Cross Red Crescent (RCRC) Emergency Response Units (ERUs), which are the equivalent of Type 1 (fixed and mobile) and Type 2 facilities in the Emergency Medical Teams (EMT) classification.
Method:
A three day in-person super user training was held with 13 participants: 9 first aid volunteers, 2 nurses and 2 medical doctors. Seven of the delegates had experience using an EMR. These super users served as trainers for staff at the pilot.
The pilot occurred with the Portuguese Red Cross (PRC) for the Peregrinação de Fátima, where 200,000 people were in attendance. The PRC was part of a wider coordination cell with the civil defense authority, who required live reporting from the three Type 1 fixed clinics PRC had set up.
Results:
In total there were 77 user accounts, of which, 243 patients were consulted with and either discharged or referred throughout the four day pilot.
The delegates shared feedback directly and through a survey. 88% stated that RCHIS was ‘very easy’ to use with the majority of delegates requiring less than 20 minutes of training to be using the application and inputting patient data related to their user role. Additionally, after their training 95% of delegates stated they had sufficient training to use RCHIS to its full extent. Informal feedback from delegates was hugely positive, indicating that it was improving patient care and also continuity of care when a patient returned the next day.
The civil defense authorities were able to utilize the real-time reporting to assist in their operational response. The application was well received by the wider civil defense authority.
Conclusion:
The first RCHIS pilot was very successful from both a technical and organizational perspective.
Business continuity planning (BCP) ensures that critical healthcare operations are not interrupted and are recovered quickly, in the event of a disaster. BCP has an important role in avoiding adverse health impacts, particularly in long-term care settings. The purpose of this study is to conduct a literature review and comparison of the U.S. and Japanese BCP in long-term care to identify and compare challenges and desirable approaches in each country to support older adults.
Method:
We systematically searched PubMed, CINAHL, Japan Medical Abstracts Society and EMBASE databases, gray literature, and conducted a hand search of high-impact journals for studies published between 2000 and 2022 that assessed BCP in the United States and Japan.
Results:
From the literature, a challenge identified in the U.S. is the limited coordination within and across regions and between healthcare institutions and long-term care settings. The advantages are that an established structure of planning, training and evaluation is in place, with evidence from recent disasters showing net positive effects. In Japan, a significant challenge is that, despite an emphasis on continuity in the provision of medical care and welfare to individuals, cooperation between BCP at healthcare institutions and BCP at long-term care facilities is underdeveloped. The advantage is that BCP at medical institutions is incorporated into the national healthcare plan in Japan, making it easy to design BCP protocols and plans according to local needs.
Conclusion:
Future research should focus on two points. 1) In the U.S., there is a need for evaluation of BCP cooperation and coordination among healthcare networks, especially in long-term care settings. 2) In Japan, it is necessary to promote BCP in healthcare sectors and accumulate training and evaluation across the fields of medical institutions and long-term care facilities.
The COVID-19 pandemic also raged in Fukushima Prefecture, Japan. Moreover, it forced a response to the medical crisis just as much as the disaster. After the Great East Japan Earthquake, disaster response system development progressed in Fukushima Prefecture. The relationship between the DMAT and the Prefectural Medical Health and Welfare Department was becoming more assertive.
Method:
However, as the disaster response members became fixed, there was an urgent need to develop new young human resources.
Results:
Meanwhile, flood damage caused by Typhoon No. 24 occurred in September 2018. It was the first time since the Great East Japan Earthquake that a disaster countermeasures headquarters was set up within the prefectural office. In that response, we discovered young talents. Furthermore, they nurtured in response to the medical crisis caused by the COVID-19 pandemic.
Conclusion:
In recent years, the main elements of disaster response required support for continuing medical care and securing public health. Unfortunately, however, these things are insufficient both as medical education and as postgraduate education. Therefore, few human resources are interested in disaster medicine and taking action. In addition, it is also a fact that, like surgical operations, if disasters are not responded to, they will not come to fruition. The response to this pandemic is genuinely an opportunity for human resource development. Taking advantage of this crisis to develop new human resources can be a blessing.
Workplace violence within the ambulance services is a serious problem. A prevalence of up to 8.5% of all ambulance missions has previously been reported. Prior research used a retrospective design and the knowledge of risk factors for workplace violence is weak. Therefore, the aim of the current study was to measure the prevalence of workplace violence within the ambulance service in a Swedish region.
Method:
This was a prospective cohort study using data from all ambulance missions in a region in Sweden during one year. The data was analyzed with descriptive and analytic statistics using SPSS.
Results:
Data was collected from 28,648 ambulance missions. A total of 209 unique workplace violence incidents were reported, corresponding to a prevalence of 0.7%. Seventy-three of all incidents reported physical violence and 161 verbal threats, where some of the incidents included both physical and verbal violence. The most common risk factors for workplace violence were: the perpetrator was under the influence of alcohol or drugs (70.5%), mental illness (60.5%) and communication problems (15.3%). The perpetrator was most often a man (n=68%) between 18 and 29 years of age. Co-variation between the risk factors was high. No significant differences in the occurrence of workplace violence could be seen in relation to time of the year, weekday, or time of day.
Conclusion:
The prevalence of workplace violence was one of the lowest reported. An understanding of risk factors could be used within the ambulance service and dispatch centers to identify situations with an increased risk of workplace violence and mitigate the risk of such incidents.
Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies need specific hospital preparedness and resource availability.
Preparing to evaluate and manage victims from CBRN exposure events in one aspect of hospital preparedness, is often underestimated. Specific skills and capabilities are required to manage these events. Emergency department (ED) and hospital staff need adequate training to provide safe and effective care.
Method:
The Hospital Complex of Valtellina and Alto Lario (with three hospitals), in consideration of the geographic location amid mountains, far from urban hospital centers, decided to develop an intensive training program for the hospital emergency staff. Firstly, it was based on an eight-hour initial training program, using a combined civilian military approach that included hazard recognition, substance identification, site safety, response roles, PPE use, and decontamination procedures. The CBRN Operational Unit (for prevention of chemical-biological-radiological-nuclear risks) of the 1st Territorial Unit of the Auxiliary Military Corps of the Order of Malta Italy led such training session showing that a military approach to CBRN threats can be used with civilian and military competencies and tools in managing specific hazardous events hospital first responders may face.
Results:
A drill exercise was performed on a radiological fall-out incident to test the hospital’s emergency response staff preparedness. Hospital management and decontamination procedures were analyzed to treat victims as well as first responders and to train hospital staff with few resources available.
Conclusion:
Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. Skills and competencies of military personnel can be a resource in these kinds of events to train civilian personnel who are not normally acquainted to or confident to manage this kind of CBRN events, and can represent a new model and challenge of interagency cooperation in the disaster management of complex emergencies involving hazardous materials.
Hemipelvectomy occurs seldom, yet it is a serious injury. Hemipelvectomy following trauma is associated with high incidence of morbidity and mortality. Successful management requires early recognition with a multi-speciality approach and meticulous surgical technique.
Method:
Retrospective data from hospital records of the Level-1 Trauma Center, between December 2011 through September 2022 was obtained. Clinical details including mechanism of injury, trauma scoring, associated injuries, hemodynamic status, surgical procedures, wound complications, ICU stays, hospital stay, prosthesis application, and their outcome were analyzed. Patients were followed up physically in OPD or telephonically.
Results:
Total footfall 615,274 patients with 16,786 admissions in trauma surgery, 1,299 amputations and 13 hemipelvectomy patients during the study period of ten years. Seven were in shock on presentation, of which, four were non responders and three responded to initial resuscitation. Seven patients had associated Genitourinary injuries, four had anorectal involvement, five had vascular injuries and six had associated extremity injuries. Six patients underwent hemipelvectomy in the primary surgery and seven ended up in hemipelvectomy on consecutive surgeries. Multiple surgeries were required for all the patients both for control of local sepsis and adequate soft tissue cover. Eight of thirteen patients developed wound infections, and related sepsis, one survived a covid infection and three had MODS. Four out of thirteen patients died and of the nine survivors, prosthesis is being used by three patients, two returned to work without prosthesis and two lost to follow up.
Conclusion:
With a multidisciplinary and dedicated team approach, we can expect favorable outcomes in post-trauma hemipelvectomy patients.
Children are often disproportionately impacted by disasters, and yet pediatric specific considerations are not properly emphasized during disaster planning and training, resulting in the desperate needs of children falling through the cracks during disasters. Children differ from adults developmentally, physiologically, and psychologically, and are more vulnerable to negative long-term medical, social, and behavioral outcomes. Additionally, children lack autonomy and rely on adults to gain access to the healthcare system and other resources. Despite the distinctions between adults and children, time and curricula for pediatric disaster training is insufficient, and workforce capacity and competency to plan for and respond to the disaster related needs of children are inadequate; this is especially true for both physicians and other healthcare responders who do not complete a specific pediatric residency. Our study seeks to determine the key core competencies of pediatric disaster medicine that should be included in the training of responders.
Method:
A systematic gray literature review of existing pediatric disaster medicine curricula was performed, from which a list of the most commonly present key core competencies was created.
Results:
Data collection and analysis is expected to be completed by April 2023 and will yield a ranked list of core competencies.
Conclusion:
There is a need for improved pediatric disaster training that addresses the specific considerations of children; this is especially true for non-pediatricians who may be treating children following a disaster. The gray literature review will identify key components of pediatric disaster medicine, which should be applied to all such training curricula to ensure that the care of children who suffer during and after disasters is equitable across the globe.
In the Netherlands several additional facilities and working methods are created to strengthen the effectiveness and capacity of the regular daily health care during large incidents and disasters. One system is called GGB (Large-scale medical assistance). The daily healthcare is organized in 25 safety-regions, which are far too small to handle big incidents. GGB provides in organizing assistance between regions, increasing the effectiveness of ambulance care, the deployment of other emergency services and volunteers, and coordination of this all. GGB is developed to deal with an incident with 250 injuries. This method was investigated to determine value.
Method:
Based on a standard questionnaire, key persons of ambulance care, trauma care, Red Cross and Offices of Public Health and Safety per safety region were asked about their experiences with GGB. (125 forms)
Subsequently, the regional outcomes for each discipline were evaluated in a national conferences (four conferences). To conclude, an interdisciplinary national meeting was held to bring the results together. The authors developed the questionnaires, supervised the research process, and presented the results to the authorities.
Results:
Results indicated that the working methods for scaled-up care is useful and should be continued. The extra financial costs outweigh the gained strength. The cooperation between professionals and volunteers also receives a lot of support. Proposals have been made for further improvements, in particular concerning cooperation between organizations. Bottlenecks have also been identified in the collaboration between health care, fire services and community care.
Conclusion:
In the perception of the care providers there is added value and cost-effectiveness. This is important for the support of the system. As a next step, the authors want to focus on measuring the actual effectiveness. For that, we want to be able to compare systems in several countries. The presentation ends with a call to do so.
Japan DMAT and US DMAT have been conducting several tabletop exercises to prepare for major earthquake disasters in Japan. Japan is predicting overwhelming disasters on Japanese soil soon, which needs efficient and optimum use of resources in medical assistance, including additional support from the US. The Japanese government established a large-scale Earthquake/Tsunami Disaster Emergency Response protocol in 2020. However, this protocol does not include any standard operation procedure (SOP) to receive an international medical team. The purpose of this study is to establish the SOP of receiving medical assistance from US-DMAT based on the WHO International Emergency Team (EMT) initiative through tabletop exercises.
Method:
Collaborated with the Office of the Administration for Strategic Preparedness and Response (ASPR) of the United States Health and Human Services, tabletop exercises assuming that a large-scale earthquake occurred during the hosting of the 2025 Osaka Expo was conducted utilizing an online meeting system.
Results:
A provisional SOP was composed. Even though Japan had several disaster medical assistance collaborations with US DMAT and is well-familiarized with the Classification and Minimum Standards for Emergency Medical Teams", many issues need to be prepared to accept US DMAT.
Conclusion:
Numerous procedures need to be conducted to receive US DMAT assistance during a large-scale earthquake in Japan. With this SOP, receiving US medical team assistance will be conducted promptly, eventually saving many lives. This SOP can be modified for other international teams' acceptance in Japan. It could reference other countries seeking to have SOP for receiving international medical team assistance shortly.
In the context of COVID-19 outcomes, global data has deduced a gender bias towards severe disease among males. The aim of this study is to compare morbidity and mortality during two years of the COVID-19 pandemic in female and male patients with COVID-19, as well as to assess length of stay, health seeking behavior time after positive diagnosis, and vaccination differences.
Method:
A retrospective-archive study was conducted in Israel from March 1st (patient zero cases) to March 1st, 2022 (two consecutive years). Data were obtained from the Israeli Ministry of Health's (MOH) open COVID-19 database.
Results:
The findings indicate female infections are 1.12 times more likely, across almost all age groups, apart from the youngest (0-19) age groups. Despite this, the relative risk of severe illness, intubation and mortality is higher among men. In addition, our findings indicate that the mean number of days taken by unvaccinated men from positive diagnosis to hospital admission was greater than among unvaccinated women among the deceased population.
Conclusion:
Targeted approaches including risk communication which take into consideration sex and gender and the intersecting factors are necessary to engage in the fight against COVID-19 for ensuring the most effective and equitable pandemic response.
Interventions that mitigate hazard exposures offer the most efficient means of reducing disaster mortality. However, such interventions require an evidence base that describes the relationship between hazard exposure dynamics and health risk. Medical practitioners have long used patient specific hazard exposure assessments to determine acute and chronic disease risk and align medical treatment and care. This study compared patient-specific hazard exposure data collected from people seeking healthcare during seven different natural hazard disaster events and compared the minimum patient data set standards recommended at the time.
Method:
Patient data collection forms used by primary and secondary health care providers during emergency health and medical responses to seven natural hazard disasters were reviewed. Data fields relating to potential exposure characteristics were recorded and compared to patient data fields used by health services prior to the disaster event. A literature review of definitions of disaster ‘exposure’ adopted by UN disaster management agencies were compared with the health and medical sector.
Results:
Only the SARS-CoV-2 disaster consistently assessed and recorded details about patient exposure characteristics. Patient hazard exposure data was typically limited to the time of onset of symptoms and duration relative to hazard impact. Little qualitative or quantitative assessment of the magnitude of exposure to any hazard was included, or patient-environmental data. While variables of hazard and vulnerability were extensively studied, and discussed in scholarly and industry literature, the concept of exposure received comparably little attention.
Conclusion:
Building an evidence base to correlate hazard and environmental exposure characteristics with patient health effects must be prioritized, especially for cohorts vulnerable from physiological or co-morbid factors. Such advances can be made through simple inclusions in minimum patient dataset recommendations. Understanding hazard-exposure dynamics are vital for advancing emergency health responses toward early intervention and health protection from future hazards that threaten functioning of whole health systems.
Disaster and emergency management planning has an essential role to ensure that hospitals can continue to function in disaster response situations. However, there are several gaps for safe hospital policies and implementations between national and provincial/district level. The Special Region of Yogyakarta, as one of the provinces with high disaster risk in Indonesia, initiated a study to identify local policies needed for safe hospitals.
Method:
Focus Group Discussion (FGD) series were conducted with several hospitals representing private, public, academic, and military hospitals located in the first ring of Mount Merapi, an active volcano located on the border between Yogyakarta and Central Java Province. The FGD participants consisted of the Hospital Disaster Plan team, hospital task force of COVID-19, emergency department and hospital management team. Three FGD were carried out with different topics of discussion in each session. The topics were hospital experiences in implementing Hospital Disaster Plans during COVID-19, hospital incident command, coordination and networking. In addition, they also conducted advocacy and public consultation
Results:
The study that involved 12 hospitals and 40 persons, resulting in 11 specific additional policies for Yogyakarta safe hospital which include; six additional Standard Operating Procedure (SOP) in terms of donation management, volunteers’ recruitment and cost claim; one initiated Memorandum of Understanding (MoU) for surge capacity; conducting functional exercise rather than full scale ritual simulation with management scenario, as well as develop two plans for cyber-attack and business continuity plan.
Conclusion:
The pocketbook of Yogyakarta’s safe hospital will be useful for more than 70 hospitals in implementing and developing their hospital disaster plan, improving coordination among hospitals in the disaster phase, as well as a lesson-learned process for other regions to develop their local-based safe hospital policies.
Neonatal resuscitations are challenging to any mixed ED with rotating medical staff. Covid-19 decimated nursing numbers and reduced training to a standstill. New doctors and nurses find pediatric resuscitations (simulations and in real cases) challenging as there are complex algorithms/calculations as well as preparing and operating systems such as a Drager ResuscitaireR.
Training rotating or new staff for rare complex resuscitations can be time and resource consuming with little yield.
We describe our experience of applying incremental measures after almost every simulation to improve team performance and knowledge.
Method:
This is an ongoing audit of simulations and cases for neonatal / infant resuscitations using our pediatric bay and Drager ResuscitaireR system. Our main aim was to improve:
Two ED consultants ran “in-situ” simulations and recorded gaps/errors (including feedback in debrief). Any measures deemed fixable were implemented ASAP. Improvement was made if error was not repeated in subsequent two independent simulations.
Results:
Audits of five real cases and fifteen simulations revealed gaps (e.g. dose miscalculations, equipment unfamiliarity) which were corrected by simple measures after each discovery. These include:
1. Neonatal resuscitation checklist with steps to setup the Resuscitaire
2. Weight-based resuscitation cards / pre-made packs of equipment instead of manual calculations
3. Position markers for "ideal" ResuscitaireR ventilator settings
4. Step by step ResuscitaireR numbered markers on machine
We found improvements in knowledge gaps, task accomplishment rates, staff satisfaction, appreciation of deficits and in-situ simulation uptake. More gaps are found and resolved at every simulation.
Conclusion:
A Human Factors approach with incremental adjustments and simple improvements with each simulation led to better team task accomplishment in complex preparation and resuscitation.
Future strategic pressures in the Indo-Pacific region will present major policy and strategic challenges driven by rapidly increasing populations, resource depletion and contests, and forced adaptation to a changing climate. While regional countries remain likely to continue on a high growth trajectory, there is growing concern that nations will face difficulty to sustain economic gains in the face of strategic resource depletion and availability, population growth, and increasingly frequent extreme weather events. This mismatch could result in strategic miscalculation and reformulation, driving CBRN proliferation choices that fall outside of historical norms or standards. Such societal stressors are already occurring in the region and themselves may suddenly impact on health and social systems in unpredictable and complex ways.
Method:
Three tabletop exercises called the Boxwood Scenarios were conducted utilizing the Avalanche TTX system, including participants from key intelligence, military, and academic experts. Participants were invited to a Delphi study examining positive and negative drivers, shaping factors, motivators, and consequences of CBRNE proliferation in the Indo-Pacific region. Two rounds of result review were conducted by the group. These results underwent a systematic mixed methods analysis (quantitative and qualitative methods) and interpretation.
Results:
Climate change, demographic and geopolitical pressures were highlighted as key to future potential CBRN proliferation risks, with this nexus resulting in major proliferation concerns as early as 2040. Proliferation decisions driven by, and occurring in parallel to, climate and demographic pressures were identified as of major concern. Such decisions would have profound multi-layered social, health and broader implications for Indo-Pacific countries with declining determinants of national power.
Conclusion:
Climate change and demographic and geopolitical pressures could drive future Indo-Pacific CBRN proliferation. The consequences to human populations, the viability of ongoing international disaster risk reduction and capacity-building efforts, and the increased future risk of major CBRN events cannot be overstated.
Management of outbreaks rely on hospitals’ health information technology (IT) to electronically share data to public health systems. Studies show that half of non-federal hospitals reported a lack of capacity to exchange information with public health agencies, placing a variable burden on institutions to meet the government mandated reporting requirements. This study aims to contrast the impact of COVID-19 reporting requirements across two New York City institutions with disparate health IT capabilities.
Method:
A retrospective, qualitative study contrasting the impact of reporting requirements on a small independent hospital (SIH) with 198 staffed beds and a large, networked hospital (LNH) with eleven campuses during the COVID-19 pandemic. Researchers conducted 51 interviews with hospital leadership, clinical directors, and infection control personnel. Interviews were transcribed and coded using qualitative analysis software.
Results:
The LNH had a 50-person analytic team that handled reporting tasks, a centralized data warehouse that was automatically updated, electronically generated reports with universal access, and limited burden of clinical staff. The SIH had no dedicated analytic team. Seventeen departments were utilized to handle reporting tasks with no centralized place to share electronic data, limited capacity to create automatically updated reports, a daily manual information gathering processes, and significant need of clinical staff to collect data. Both SIH and LNH faced challenges associated with the distribution of responsibilities and resources with pressure to report in a timely fashion. However, the burden on the SIH was so onerous that it significantly impeded routine hospital work and patient care.
Conclusion:
The disparity in health IT capabilities highlights significant institutional inequities and variability in response during a pandemic. The findings have implications for how government and other regulatory bodies may adjust policies to equitably meet public health needs and not unfairly burden small hospitals.
Civilians constitute a significant wartime target, and trauma accounts for most of their injuries. Air raid sirens have long been used to alert civilians of incoming attacks and have since expanded to warn of natural disasters. Sirens are known to cause significant emotional distress and physiological changes. Injuries inflicted from trauma during a run for shelter have yet to be described in the medical literature.
Method:
During the recent Israel-Gaza conflict of May 2021, most of Israel's population experienced rocket warning sirens. We collected all adult patients arriving at a major tertiary medical center emergency department (ED), attesting to having suffered their injury while running for shelter. Clinical and demographic data were retrieved and analyzed.
Results:
A total of 48 patients were identified, with a mean age of 59.6±20.0. Ten (21%) patients were admitted, and their mean length of stay was 4.4±3.7 days. Women had a higher probability of being hospitalized (42.9% vs. 5.9%, p=0.04), and those hospitalized tended to be older (68.8±16.4 vs. 54.8±20.8, p=0.06). Extremity injuries were most common (50%), before head trauma (29%), and torso injuries (25%). Most patients (38/48, 79.2%) were discharged from the ED, and the rest were hospitalized for observation or surgery. One patient died from a head injury.
Conclusion:
This study implies that injuries while running for shelter were the most significant cause of physical injury to Israeli civilians during the Israel-Gaza 2021 conflict. Warning siren injuries should be given appropriate attention from prevention by directed media campaigns to post-conflict reimbursement.
More than 7.8 million people fled Ukraine since the invasion of Russia and are registered as refugees in Europe (as of November 1, 2022). Almost 89,000 of them are registered to the Netherlands (as of November 3, 2022). It is expected that this number will rise. Appropriate and accessible Mental Health and Psychosocial Support (MHPSS) is essential for conflict survivors to address psychological harm from traumatic events and distress both during the escape and after, while trying to adjust to an unfamiliar place. Receiving countries have the obligation to provide MHPSS as part of their international commitment to the right to health. This is recognized in the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of Persons with Disabilities (CRPD). Nevertheless, the Netherlands is failing to honor this commitment with fragmented services that do not seem to fit support needs. The longer it takes to put a comprehensive approach in place, the greater the damage to the refugees will be. This interactive session aims to shed light on practical challenges and opportunities for the implementation of appropriate, accessible and integrated MHPSS. What is needed to go from a fragmented to an integrated approach?
Method:
Being active as advisors in the field of Disaster Health and MHPSS in the Netherlands, the presenters review their experienced challenges thereafter opportunities and good practices are explored together with the participants.
Results:
Experienced challenges include complexity, fragmented organization, lack of ownership and inadequate access to knowledge and information about support needs.
Conclusion:
More is needed to meet the commitment to the right of health and to provide adequate MHPSS to refugees in the Netherlands and beyond. International exchange and learning can help us to understand and overcome implementation challenges.
The COVID-19 pandemic and the countermeasures taken form a threat to the physical and mental health of the population, especially for more vulnerable groups. In this study, which is part of the Integrated Health Monitor COVID-19, the impact of the COVID-19 pandemic on the healthcare use of the Dutch population and specific vulnerable groups was examined.
Method:
In this study two data-sources were combined. The first consists of electronic patient records of general practices (GP) participating in the Nivel Primary Care Database. These records are representative of the Dutch population and provide insight into acute complaints, chronic conditions, medication prescriptions and primary care use. For the current study, primary care use in pre-COVID years (2018 and 2019) was compared to that in 2021. This data was coupled with microdata from Statistics Netherlands, containing such information as socio-economic status and migration background. Analyses were conducted using longitudinal mixed-effects regression models.
Results:
Results show that risk factors play a role in the utilization of primary care. Women and those with a low household income visited the GP more often for mental complaints. Individuals with a migrant background visited the GP more often for coughing, fatigue, and social problems. Those with pre-existing chronic physical conditions were seen less often by their GP for shortness of breath. Among those with pre-existing mental problems GPs more often registered shortness of breath, yet less problems with access to care or social problems.
Conclusion:
Combining GP registry data with relevant background data has deepened our understanding of changes in health problems and healthcare use among the general population during the COVID-19 pandemic. This study provides insight into how specific vulnerable groups are affected more strongly, and emphasizes the importance of monitoring these groups during a health crisis.
The KIRAMS establishes radiological emergency institutions and provides training for emergency medical agents. However, because of the uniqueness of radioactive accidents, the current training program has a limitation in the realistic description. Therefore, training programs based on virtual augmented reality technology that can describe radiological emergencies are required. In this study, the contents of practical training for decontamination of radiation-contaminated patients as a part of radiation disaster prevention personnel training using VR simulator are developed.
Method:
Environments and devices required for treating patients with complex radiation damage are made visible using VR simulator to enable practical training of techniques and practices that will be required in actual radiation emergencies or training. The VR decontamination training content uses three Point tracking techniques to calculate the location of the head-mounted display device and the hand to visualize the movements. Additionally, Universal Render Pipeline technology was used to develop realistic visualizations of situations.
Results:
In this study, VR decontamination treatment practice content was developed, which allows a single trainee to go through the entire treatment process of treating radiation-contaminated patients. The radiation-exposed patient’s treatment process is composed of nine subprocesses, including wearing personal protective equipment, obtaining samples from openings, taking measurements, cleaning contaminated injuries, and so on. A checklist user interface was used to enable trainees to check their progress. The trainee can practice patient treatment with a controller while using VR decontamination treatment content. Additional functions such as narration, sound effects, animation, and so on were added to high educational effects.
Conclusion:
In this study, VR decontamination treatment content was developed using VR training simulator to practice the treatment of radiation-contaminated patients. The results of this study will contribute to fostering the workforce response to radiation through efficient education using a VR training simulator, as well as promoting the use of radiation safety regulations.
Gallstone ileus is a rare cause of intestinal obstruction. It commonly affects older patients with significant medical conditions. This disease has a high mortality rate (12-17%), hence should be an important diagnosis to consider, especially as the geriatric population grows worldwide.
Method: Case Report:
84-year old gentleman, with diabetes and ischemic heart disease, presented with diarrhea, vomiting and fever for one day. He was febrile, tachycardic and hypotensive. There was lower abdominal tenderness with guarding. Labs done revealed metabolic acidosis with a raised lactate along with raised inflammatory markers. Impression was intra-abdominal sepsis, with a need to rule out mesenteric ischemia. He underwent CTAP which revealed gallstone ileus. The gallbladder was collapsed and pneumobilia was present in keeping with fistulation. Dilated small bowel loops were present with a transition point at the distal jejunum or proximal ileum, where there are two gallstones. Patient underwent exploratory laparotomy. There was an obstructing large gallstone 100cm from the DJ flexure. After removal of gallstone and decompression, the bowel was pink with areas of bruising. Patient was hypotensive intra-operatively likely contributed by septic shower, requiring dual vasopressors. He was transferred to the ICU post-operatively and developed cardiogenic shock with type 2 respiratory failure precipitated by sepsis. He demised on Day 2 post-operatively.
Results:
Gallstone ileus is caused by intestinal impaction of a gallstone that has migrated through a cholecystoenteric fistula. The classic radiologic sign of gallstone ileus is Rigler's triad. This is only picked up 15% of the time on plain abdominal x-rays. Early CT scans can reveal Rigler triad up to 80% of the time. Surgical management remains the cornerstone of treatment.
Conclusion:
Gallstone ileus remains a diagnostic challenge as patients present with non-specific signs and symptoms. It is prudent for emergency physicians to consider this disease in elderly patients who present with small bowel obstruction.