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Jakarta and Semarang are predicted to be engulfed by seawater by 2050, based on evidence by the Copernicus Sentinel-6 satellite. The current sinking rate is reaching almost 20 cm annually in both coastal cities, as reported at the World Economic Conference in May 2022, due to climate change, rising sea levels and excess groundwater extraction leading to land subsidence. Therefore, the objective of this study is to analyze the sinking of both coastal cities of Jakarta and Semarang, using indicators of vulnerability, exposure, and impact by 2050.
Method:
The YEW Disaster Severity Index (DSI) was used to analyze the impact, vulnerability, and exposure attributed to sinking. Data were obtained from real-time Google, Copernicus Sentinel-6 satellite, and triangulated with United Nations Office for Disaster Risk Reduction, World bank Data, Government of Indonesia Central Bureau of Statistics, as well as reputable journals.
Results:
The impact analysis on the sinking of Jakarta and Semarang, calculated in April 2022, using the YEW DSI, scored a High DSI impact of 6.03 and a Moderate DSI impact of 5.76, for each town respectively. Jakarta and Semarang also scored more than 100% baseline ability to cope on the YEW DSI indicators, which accounted for five vulnerability indicators and one exposure indicator of a total 13 million population affected. By 2050, both cities will be 5.6 meters below sea-level, with a constant current sinking of 20 cm per year.
Conclusion:
At present, vulnerability and exposure of the affected population account for a total of 13 million in both coastal cities. The analysis showed the inability to cope within local capacity, indicating a response is needed. The future of Jakarta and Semarang is in the hands of local, national, and global decisions and policymakers, in mitigating its impact through forest land conservation, adaptation, and relocation of the affected population.
Pediatric disaster science is critical to provide data and discovery to guide evidence-based preparedness, response, mitigation and recovery to best serve children, families and society. With the increasing frequency, severity and global scope of disasters, there is now an unprecedented imperative and opportunity to build a sustained pediatric disaster science workforce and infrastructure. The expertise, perspective and collaboration of the international, multidisciplinary community, including WADEM members, is integral to supporting effective, efficient, ethical, high quality pediatric disaster science and its implementation.
Method:
A landmark Pediatric Disaster Science Symposium was convened in-person/virtually by the US National Academies of Science Engineering and Medicine in August 2022. Forty-eight pediatric disaster focused invited speakers, collectively representing government, non-governmental organizations, academia and community attended, and online. Attendees were polled during the two-day meeting to assign priority ratings to the topics discussed.
Results:
Symposium topics included the importance, history and scope of pediatric disaster science, and research across the disaster management cycle. Research considerations specific to children included medical and psychosocial vulnerabilities and manifestations; ethics and protections; protocol development and deployment; research tools; and data collection/integration. Scientific methodology topics addressed pediatric considerations for basic science, surveillance, clinical trials, applied sciences, community-engaged research, dissemination and implementation. Infrastructure needs described leveraging disaster centers, research networks, disaster response teams, government agencies and professional societies integratively across disciplines. Building a sustainable workforce, including training and engaging pediatric scientists with disaster-focused/disaster-relevant research, funding streams, regulation and advocacy were also discussed. Research priority ratings yielded preliminary data to inform pediatric disaster science priorities.
Conclusion:
The meeting provided insights that can further guide discussions among global disaster experts and scientists, including WADEM members, to prioritize, build and scale sustainable pediatric disaster science that yields evidence-based strategies, plans, resources, and actions that improve disaster preparedness, response, mitigation, and recovery for children, families and societies worldwide.
Terrorism remains a major threat and concern in many countries around the world. Children represent approximately 30% of the world population and in the event of a terrorist attack can either be primary targets, to include the possibility of abduction, or unintended victims. Children are unique in their vulnerabilities and therefore, require special consideration.
Method:
This study is a semi-quantitative epidemiological analysis of all terrorism-related pediatric fatalities and injuries sustained between 1970-2019. Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). Summaries of events including search terms associated with children were individually reviewed and those describing the deaths, injuries, or abduction of children were tallied.
Results:
Of the over 200,000 terror events, 2,302 events met inclusion criteria. This represented 1.14% of total events which involved death, injury, or abduction of children. Of 2,032 events a total of 2,275 pediatric fatal injuries (FI) were recorded, as well as 2,280 pediatric non-fatal injuries (NFI). The most common weapons used in all attacks involving the pediatric population were explosives (1539[66.8%]), firearms (543 [23.5%]), other (169 [7.3%]) and melee (83 [3.6%]). 275 of the 2,032 were related to abductions, with 71 cases involving the abduction of ten children or more.
Conclusion:
Pediatric casualties in terrorist events represent a small proportion of overall victims, however, they have unique vulnerabilities, and when directly impacted by terrorism, can have long term physical and psychosocial sequelae, as well as a devastating emotional impact on the community.
The Irish Paramedicine Education and Research Network (IPERN) is dedicated to collaboratively building research culture and research capacity for out-of-hospital care in Ireland and internationally. IPERN is led by an inter-professional team of paramedics, nurses, doctors, allied health professionals and scientists. IPERN supports clinicians to bridge the theory-practice gap through involvement in research training, knowledge generation, knowledge translation, evidence implementation, policy setting, research partnerships, co-production and research leadership. The aim of this study is to quantitatively describe the activity of IPERN in the first two years of it’s foundation (2021-2022).
Method:
This is an observational study and data was collected prospectively throughout 2021 and 2022. Data on event attendance was collated via the Event management software EventBrite and supplemented with minutes from IPERN Committee meetings. Data analysis was performed in Microsoft Excel and comprised descriptive statistics.
Results:
The IPERN Team comprises 14 inter-professional members of whom nine (64%) are paramedics. To date IPERN has launched seven special interest groups; Medical, Trauma, Pediatrics, Mental Health, Human Factors, Medical Logistics and Equality Diversity & Inclusion. The network hosted 14 CPD events from March 2021 to November 2022. In terms of research capacity building, the work of IPERN has been presented at six international conferences and the IPERN Team has successfully secured four grants since the foundation of the network.
Conclusion:
Due to the complex and multidisciplinary nature of out-of-hospital care a strategic and collaborative approach to research capacity-building is essential. Underpinning evidence-based practice is a strong research culture and it is imperative that all clinicians involved in out-of-hospital care have the opportunity to develop knowledge and expertise. IPERN takes a participatory approach to research and our events provide an open and friendly platform for members to engage in research, building a vibrant research community both in Ireland and internationally.
Existing studies have identified the national rate of PVT for severely injured patients to be 9-16%, our ED has displayed a PVT incidence of 35.4%, suggesting a substantial difference in ED arrival. This study aims to explore descriptive demographics and injury characteristics of patients who arrived by PVT to our ED.
Method:
A prospective, single-center observational study conducted in Detroit, Michigan. Included patients aged 15 ≥ years who arrived at the ED by PVT for blunt or penetrating trauma. The sample population consisted of 128 patients from August 2019-April 2021. Each subject completed a survey regarding their injury and prehospital care. A retrospective chart review was conducted to acquire information on their injuries.
Results:
The mean age was 44.3 ± 20.3 years old, range 15-93. 51/128 female, 77/128 male. Patients comprised 93/128 African American, 19/128 Caucasian, 4/128 Asian, 4/128 Hispanic/Latino, and 8/128 other. The most common insurance was Medicaid, comprising 63/128 patients, 25/128 of patients had Medicare and 38/128 had private coverage. Utilizing ESI indices to evaluate severity levels, 73/128 arrived at the ED with an ESI level of 3, 47/128 level of 2, 5/128 level of 4, and 3/128 level of 1, the most severe. Majority of patients 36/128, presented with trauma-related injuries due to a fall. 25/128 presented with a laceration, and 22/128 presented after a motor vehicle crash. The upper extremities were the most common location of trauma 38/128 followed by the lower extremities 23/128. The mean ED length of stay was 11.18 hours.
Conclusion:
Overall, the findings from this study allowed us to characterize our population of PVT trauma patients through their demographics and injury characteristics. We were able to establish some descriptive characteristics that delineate the population of patients at our ED in Detroit, which is the first step in identifying why trauma patients choose varying modes of transportation.
Children younger than 18 years constitute approximately 25% of the US population. During disasters, they are the most vulnerable population and have age-specific vulnerabilities that heighten their risks and magnify their unique needs. These include physiological vulnerability to pathogens, toxins, radioactive isotopes, and harsh conditions. Increased skin permeability, faster metabolism, more active cell division, higher respiratory rate, and higher surface area–to–mass ratio all contribute to greater susceptibility to physical threats. Behavioral/Developmental differences such as more hand-to-mouth contact, under-developed sense of self-preservation, more time spent outdoors, difficulty communicating symptoms and increased vulnerabilities. Children in disasters may develop mental health problems, including acute and post-traumatic stress disorder, and depression. Some children with disabilities are dependent on medical technology.
Method:
A US national conference in 2015 determined that significant gaps in pediatric disaster preparedness include transport, space, staffing, equipment, supplies, and training capabilities. To address these gaps the National Pediatric Disaster Coalition (NPDC) was established to advocate for enhanced pediatric disaster preparedness, and advance community healthcare preparedness, mitigation, response, and recovery for infants, children, and families in disasters.
Results:
The NPDC consists of subject matter experts, national advisory committees, commissions, agencies, and organizations. It utilizes pediatric SME knowledge to help plan for the allocation of appropriate and essential resources to address pediatric specific needs in disasters. It serves as an information clearinghouse on pediatric disaster preparedness informed by real events, research and evolving best practice. The NPDC disseminates information through organizing and participating in conferences, and web-based training.
Conclusion:
Based on the special needs of children in disasters, the NPDC assessed current gaps and has established an effective advocacy and information sharing platform to match resources to pediatric needs during disasters. The NPDC can serve as a model for addressing gaps in the special needs of children and their families during disasters.
Effectively responding to an incident across jurisdictions and coordinating with regional and jurisdictional partners is extremely challenging. The COVID-19 pandemic exemplified the need to develop an operational structure which would serve as a regional medical operations hub. Although there has been guidance for using a Medical Operations Coordination Cell (MOCC), the concept can be difficult to apply and develop for the specific needs of varying regions and jurisdictional entities.
Method:
The Mountain Plains Regional Disaster Health Response System (MPRDHRS) has developed a Medical Emergency Operations Center (MEOC) to address gaps in response coordination efforts across the six state Region VIII within the United States. This MEOC has been developed to synchronize and integrate existing systems and processes to manage the medical components of a response. This center is similar to other MOCC concepts. However, in a novel approach, the MPRDHRS organized a response framework that focuses on functional roles based on the specific needs of our region with response coordination and personnel availability. This organization is similar to the use of emergency support functions in a jurisdictional EOC.
Results:
While developing the MEOC, a local Lean team collaborated with the MPRDHRS on continuous improvement initiatives. Drills, workshops, and exercises were used to test the MEOC and offer just in time training to MPRDHRS members to staff different positions within the MEOC. The MEOC was activated for an incident response within the MPRDHRS region with many lessons learned.
Conclusion:
The MEOC is a new, developing system augmented to meet the needs of regional partners. The system was developed using feedback and ideas from partners, process improvement experts, and internal team members. Additionally, lessons learned from incidents and applications of drills, workshops, and exercises will be shared to leverage within any organization.
Humanitarian aid is an important part of an emergency response to Disasters and crises situations. When a community or a country is hit by disasters, urgent responses are needed to save lives and provide for the basic needs of the people affected. Humanitarian actors like the Nigerian Red Cross Society, play a vital role in these urgent actions and the aid they provide is fundamental to crisis responses. Responses to humanitarian emergencies involve the mobilization of resources.
The Nigerian Red Cross Society, Lagos State Branch carried out some humanitarian actions for Lagos State populace during the peak of the Covid 19 pandemic in the year 2020 and also in 2021 with the support of well meaning Nigerians, IHS, and the British Red Cross who donated, supported and sponsored the activities.
The offshoot of the COVID-19 operation which subjected us to an extremely helpless corner, was the high magnitude of the most vulnerable people crying out for food in different suburbs and slums of Lagos following the State’s lockdown.
Method:
Humanitarian assistance was delivered based on assessed needs, and according to the humanitarian principles of humanity, neutrality, impartiality and independence, which is the fundamental principles of the Red Cross movement. The methodology of the Humanitarian Aid used includes the following:
1. Rapid Assessment
a. Criteria to be used
b. Questionnaire Guide
c. Checklist
d. Rapid Assessment Form
2. Compilation of Information obtained from the Rapid Assessment carried:
3. Validation of Data
4. Data Analysis
5. Delivery
Results:
The outcome was to limit the impact of Covid 19 and help people return to normal. The anticipated effect of the intervention on the members of the communities was achieved.
Conclusion:
Nigerian Red Cross Society Lagos State Branch’s humanitarian investments have been able to save lives, reduced suffering and restored human dignity.
Over the past decade, the world has wrestled with two major pandemics: Ebola and COVID-19. While Ebola revealed that we needed a strategy, Covid-19 showed we still didn't have one. Apart from ensuring that we isolate and contain the virus, one of the major concerns in responding to a pandemic is limiting transmission to healthcare personnel.
Method:
This presentation describes a clinician's experience with employing the same infection control strategies used for Ebola in a makeshift Ebola Treatment Unit in a school in Sierra Leone and at a COVID-19 alternate care facility built in a convention center in the US.
Results:
Transmission control strategies used for healthcare workers during Ebola were also successful for COVID-19. Both facilities, despite grossly different access to financial resources, ensured all clinicians didn’t break protocol of safety, due to rigorous donning and doffing entrances and exits, internalized individual risk, separated spaces with tape, and zoned areas.
Conclusion:
Two facilities with access to vastly different resources to treat two distinct infectious diseases used the same infection control measures for staff with success. Highlighting the priority of internalization of risk by healthcare workers alongside critical infection control measures proves to be the most valuable resource over multi-million dollar facilities erected during COVID.
Ambulatory care sensitive conditions (ACSCs) are health conditions for which appropriate primary care intervention could prevent hospital admission. ACSC hospitalization rates are a well established parameter for assessing the performance of primary health care (PHC). Although this indicator has been extensively used to monitor the performance of PHC systems in peacetime, its consideration during disasters has been neglected. The World Health Organization (WHO) has acknowledged the importance of PHC in guaranteeing continuity of care during and after a disaster for avoiding negative health outcomes.
Method:
A systematic review was conducted to evaluate the extent and nature of research activity on the use of ACSCs during disasters, with an eye toward finding innovative ways to assess the level of PHC function at times of crisis. Online databases were searched to identify papers.
Results:
A final list of nine publications was retrieved. The analysis of the reviewed articles confirmed that ACSCs can serve as a useful indicator of PHC performance during disasters, with several caveats that must be considered.
Conclusion:
The reviewed articles cover several disaster scenarios and a wide variety of methodologies showing the connection between ACSCs and health system performance. The strengths and weaknesses of using different methodologies are explored and recommendations are given for using ACSCs to assess PHC performance during disasters.
As the population in the Republic of Ireland increases, the number of Emergency Department (ED) attendances and admission rates increase, placing significant pressure on the health care system, the limited staff and hospital resources.
The aim of this study is to assess the admission rates in an Irish Public Hospital Emergency Department between 2014 and 2022.
Method:
This retrospective study was done using information provided by the Health Service Executive Integrated Patient Management System. Data for the period between February 2014 to September 2022 were collected. From the data, the admission rate can be calculated and trends observed.
Results:
Emergency department attendance rates have increased from 29,236 to 42,637 between 2014 and 2019, with a decline noticed in 2020 to 37,751 and a drastic increase in 2021 at 43,182. Currently up until September 2022 there has been 35,503 attendances and 8,570 admissions, with an admission rate of 24.14%. The number of admissions has ranged from 9,056 in 2014 to the highest being 12,175 in 2019. This means the admission rate is averaging between 24% to 31% per annum, with the highest being 31,04% in 2015, and the lowest in 2017 at 24,99%.
Conclusion:
This study showed a steady increase in attendances per annum, which correlates to an increase in the total admissions from 2014 to 2022, with approximately one third of all ED attendances resulting in admission. The increase in attendances and admission rate could be related to the population growth from 4.6 to 5.1 million from 2014 to 2022. The decrease in attendances during 2020 could be attributed to the Covid-19 pandemic restrictions being implemented, and lifted in 2021 which showed a drastic increase in ED numbers. Ultimately, the increase in admissions will place a burden on the Public Hospitals in Ireland.
Severe bleeding from external wounds is a major reason for death. Immediate control of hemorrhage is of highest priority. We present the novel Acute Wound Occluder (AWO) which was developed for rapid and targeted wound occlusion. Here, we present the design, in-vitro testing, and in-vivo performance compared to QuikClot® using a clinically-relevant pig model.
Method:
AWO is made of an applicator with pushing function into which a self-expanding, Silicone coated Nitinol meshgraft is mounted to enable plugging into the wound-channel. In-vitro tests included biocompatibility, cytotoxicity, skin sensitization, and aging validation. Next, 12 pigs underwent standardized sized femoral-artery puncture to mimic life-threatening bleeding and were either treated with the AWO (n=6) or QuikClot® (control). Animals were followed-up for 4hrs, before device-removal macroscopic assessment.
Results:
The AWO successfully passed all in-vitro tests. The AWO could be delivered within 40±15 seconds to the wound to achieve instant bleeding control, and no additional manual compression needed. Quick Clot application was less convenient, with approximately four minutes (application 56±8ss, plus three minutes of manual compression) to achieve bleeding control. In all AWO treated pigs, exsanguination could be prevented immediately, no major blood-pressure drops occurred, with four pigs where bleeding could be completely stopped, and two pigs with irrelevant oozing which stopped within 75-150 seconds leading to minimal blood-loss of 12ml and 2ml. Tissue-analysis showed only small hematomas in five out of six animals. In contrast, QuickClot treated pigs showed significant bleeding and a blood-loss of 19ml. All six pigs showed substantial hematomas, two out of six showed very large hematomas. AWO application appeared to be safe with no peri-procedural adverse-events (AEs) or collateral damage to surrounding tissues.
Conclusion:
The AWO enables rapid and targeted control of life-threatening bleeding without any AEs. The AWO may represent a promising hemostatic device for bullet or knife-stab wounds.
There are known higher rates of drug and alcohol consumption in music festival attendees. Patterns of MDMA use had been changing over a number of years however the festival season (Sept 2018 - May 2019) in NSW saw a dramatic rise in drug related mortality and morbidity which had not been seen in other states in Australia although similar instances had been noted overseas.
With over 70 music festivals in NSW in this period, five deaths in four months and 29 severely unwell patrons transported to NSW hospitals, the impact was significant.To support both the festival site and NSW hospitals a Health Response Team (HRT) deployment model was implemented
Method:
The planning and intervention strategies included provision of onsite specialist critical care teams to complement existing event management and paid healthcare providers. Disaster management principles, although documented, had not previously been used in the music festival setting. To deploy such a team, guidance on equipment, pharmaceutical and physical requirements were scarce. Our team developed processes and protocols for all aspects of this unique deployment.
Operational procedures included specific equipment, medications, documentation processes, and clinical protocols were developed and reviewed and refined after each festival.
Results:
The effectiveness of the teams was evidenced through the early recognition and management of severe drug toxicity seen at the five festivals to which WSLHD deployed HRTs. This management resulted in good outcomes with minimal morbidity and no deaths of the 29 festival patrons treated by the HRT noting 25 required intensive care admission.
Conclusion:
Innovative processes and collaborative arrangements enabled effective deployment to NSW music festivals. Expert HRTs were key in preventing drug related morbidity and mortality through early recognition and management of complications. Team members gained unique and invaluable experience as a result of their deployments and patients transported to hospital were managed more effectively.
The use of simulation games in education has been rising in recent years. Triage is not only a major content among the EMS (emergency medical services) but also a necessary skill for students to improve their first-aid ability. This study aims to investigate a game for education called MASS (movement, assessment, sort, and sending), which attempts to enhance students’ capability of disaster response.
Method:
A randomized controlled trial was conducted among students who took the course: “Understanding Disaster and Surviving Risk” during the term and volunteered to participate in teaching research from different faculties in Sichuan University. Participants were trained by using the simulation game or the online course before class. The simulation game is MASS, which uses virtual reality techniques to create a realistic 3D tanker explosion scene, and the online course is a Massive Open Online Course created by the teaching team. In the class, questionnaires with subjective and objective multiple choices were carried out after a discussion. With SPSS version 27.0, statistical significance among groups was determined by Mann-Whitney U-test for rank variables, Fisher’s exact test for binary variables.
Results:
73 students were included in this study, including 45 in the online course group and 28 in the simulation game group. The qualitative experience survey showed the two groups were significantly different in experience of disaster scene challenges, application scenes, and method of triage (P=0.031, 0.007, 0.031, respectively). Students in the simulation game group showed significantly better performance in knowledge acquisition including application scene of triage, key of the expectant’s assessment, and rescue condition for thoracentesis than in the Online game group (P=0.048, 0.020, 0.010, respectively).
Conclusion:
Simulation games can improve students’ experience and performance in triage training. Due to the unrepeatability of disaster, the study suggests that games can be used to conduct simulation education for disaster medicine.
The local, national, and global disasters have increased the demand for Emergency Management professionals. Institutions of higher education can play a key role to support and respond to this demand. One institution of higher education responding to this demand is Anna Maria College (AMC). AMC is a four-year, independent, Catholic institution accredited by the New England Commission of Higher Education, which was formerly known as the New England Association of Schools and Colleges. Established in 1946 by the Sisters of Saint Anne, the College was founded to increase access to quality education, educational innovation, and respect for service to others through development of the total human being. AMC offers exceptional professional programs at all degree levels, especially in community-oriented professions, propelling students to lives of civic, spiritual, and personal consequence. Based on the number of public safety majors and their networks, an area of interest has become how the college could contribute and respond to the demand for emergency managers.
Method:
These search resources were used: Chronicle, HigherEd jobs, Indeed, GoogleScholar Emergency Management majors curriculum, with searches from 2012 onward. Keywords used included emergency management jobs, higher education emergency management curriculum, public safety and community networking, disaster, and emergency preparedness, and filling the emergency management pipeline.
Results:
Data collection and analysis planned for completion by February 2023.
Conclusion:
Higher education can support the pipeline to narrow the gap and respond to the demands for trained and educated community members in disaster and emergency preparedness. Higher education responses include strategies such as, creative emergency management curriculum and community networking.
The COVID-19 pandemic has not only put a strain on the health care system throughout the world but has had an extreme impact on health care workers caring for these patients on a daily basis. These workers have been isolated from their families and experienced significant stress and loss at work and home. Some health care workers experienced rationing of care, inadequate personal protective equipment, and found themselves without the resources needed to care for patients. This paper reports on a systematic review of wellness and stress interventions targeting healthcare workers during the COVID-19 pandemic.
Method:
A systematic review of Pubmed and SCOPUS articles published between January 1, 2020 and November 1, 2022 was conducted using the terms “healthcare worker”, “nurse”, “doctor”, “paramedic”, ”emergency medical technician”, “mental health”, “resilience”, “wellness”, “stress”, “sleep” , “intervention”, “Covid-19”, “coronavirus”, and “pandemic.” These results were imported into Covidence. Inclusion criteria were studies on interventions of healthcare workers. Exclusion criteria were papers not describing health care workers, papers not describing interventions, health care workers not caring for COVID19 patients, and papers not written in English.
Results:
A total of 26 papers were included in the analysis after the final screen. These papers were examined and sorted into groups based on the types of interventions on health care workers. The groups of interventions included 1. Psychological interventions, 2. Wellness or well-being interventions, 3. Work-related interventions, and 4. Pharmacologic interventions. Two studies were longitudinal in nature. The most common intervention was psychological (10), followed by work-related interventions (6).
Conclusion:
Psychological interventions were the most commonly deployed and included hotline establishment or speaking with a therapist. This was followed by wellness interventions such as exercise, sleep regulation, breathing exercises, and healthy eating. Fewer interventions were included in the work-related or pharmacologic categories. Data regarding effectiveness and feasibility of interventions was heterogenous.
Early recognition and treatment of critical clinical conditions have decreased morbidity and mortality in critically wounded and sick patients. Worldwide, Emergency Rooms (ER) are overcrowded, and the complexity and number of patients keep increasing. This phenomenon challenges health professionals when applying time-sensitive interventions generating unfavorable outcomes. Considering that the ER is the first point of contact for patients of Hospital Escuela, a 1306-bed, academic, tertiary care hospital in Honduras, we describe the creation of a Resuscitation Room (RR) to improve patient care in the ER.
Method:
Data from patients, including dates, source of admission, diagnosis, and outcomes, were recorded daily in a database from June 1, 2022, until October 31, 2022. Then the analysis and interpretation were made using Microsoft Excel.
Results:
In the five-month period, 1,118 patients were admitted to the RR, with 58% males, a 52-year-old mean, and October as the busiest month (33%). Most patients consulted between 0600 and 1800 hours (70%). The primary admission cause was a medical condition (71%), and shock (41%) was the most common type of emergency followed by trauma (25%). After stabilization, 86% of patients remained in observation areas of the ER, only 5% went to the operating theater, and 1% to the intensive care unit. The mortality rate was 5%, 48% trauma related.
Conclusion:
A RR meeting the minimal standards for space, trained staff, medical equipment, and consumable resources has been shown to be beneficial in improving interdisciplinary work in the ER. This RR has enabled life-threatening conditions to be recognized and treated rapidly while also promoting information gathering on critically wounded and sick patients and their outcomes. The need to standardize the clinical care to such patients has also been identified. Further efforts to protocolize the response are needed to improve patient care.
Disasters have the potential to cause a surge of patients, some of which may require admission to an intensive care unit (ICU). Due to the high resource requirements of ICUs, normal standards of care may need to be altered to treat more people with limited resources, a care model referred to as crisis standards of care (CSC). The pragmatic implementation of CSC in ICUs due to patient surges from disasters has not been well explored in the literature.
Method:
This scoping review guided by the Joanna Briggs institute methodology for scoping reviews searched medical databases including CINHAL, PubMed, ProQuest and SCOPUS. Articles were included if they reflected on the actual implementation of CSC delivered in ICU as a result of a patient surge from a disaster. Quantitative data was extracted into tables and qualitative content was thematically analyzed.
Results:
A total of 17 papers were included in the review. The disaster event that dominated the results was COVID-19. Most papers relayed subjective accounts of how care models were impacted by patient surges. Common themes included the repurposing of other clinical areas to accommodate ICU patients, resource shortages (particularly ventilators) and staff shortages. Moral strain was felt when processes such as palliation and treatment modality were altered due to resource restrictions.
Conclusion:
This review highlights the dearth of high-quality research in implementing CSC in ICUs. Understanding the pragmatic experiences of CSC shows not only the logistical insufficiencies that have been experienced, but the moral and clinical repercussions that these insufficiencies have caused. Inadequate preparation for future disasters, particularly short notice disasters, may lead to further implementation of CSC resulting in poorer outcomes for patients and detrimental impacts on healthcare workers. More research into the practical application of CSC in ICU may help mitigate the impact of patient surges from disasters.
Following the outbreak of hostilities in Ukraine and the resultant humanitarian crisis, the State of Israel deployed a field hospital inside Ukraine. Challenges included a large refugee population, disruption of routine medical services to the local population, first-time deployment of a civilian field hospital, and deployment to a country at war.
Method:
The activity of the field hospital during a deployment in Ukraine is described along with lessons learned for future deployments.
Results:
A Rapid Assessment Team (RAT) performed needs assessment and coordination with local authorities. The main necessity encountered was delivery of primary care to both the refugee and local population. During the 6 weeks of deployment, 6,161 patients were treated in the hospital. 65 patients were hospitalized and 59 underwent surgery. The hospital was completely digitalized. 103 remote consultations were performed using telemedicine techniques. Capacity building of local teams was given high priority and 796 Ukrainian health professionals underwent training.
Conclusion:
Deployment of a national civilian field hospital in a country of war is possible through coordination with local authorities while undertaking the necessary security measures.
The change in caseload from expected war trauma to predominantly primary care necessitated agility in planning and operation with subsequent adaptation of hospital and staff structure.
The use of telemedicine enhanced capabilities, allowing access to consultation with the most experienced specialists in Israel.
Capacity building of local teams should be given a high priority. This was implemented by combining clinical training and the inclusion of a medical simulation unit in the hospital.
Dispatching a team delivering medical care and extending a helping hand in time of need, especially when done by a national entity, contributes greatly to building the people's faith, hope, and resilience during the crisis, and has a critical role in the recovery effort.
The Concept of One Health is a cross-sectoral approach that aims at the protection of humans, animals, and the environment acknowledging their interconnection at a global, regional and local level.
The "One Health" approach is officially recognized by the Italian Ministry of Health, and in the Lombardy Region, which has included it as a pillar of the new reform law of the regional health system (LR n.22 of 2021). All international organizations, as a relevant strategy in all sectors, benefit from the collaboration between different disciplines (doctors, veterinarians, environmentalists, economists, sociologists, etc.).
Method:
Disseminating basic knowledge of the "One Health" public health approach among the hospital staff of the hospital’s Complex of Valtellina and Alto Lario (with three hospitals), in consideration of the geographic location, far from urban Hospital centers and in the Alpine Mountain area.
Promoting the culture of “One Health” through a hospital information and training campaign in recognizing the health of people, animals and ecosystems are interconnected, involving the population in cultural change. To create the basis for networks of collaboration in a multidisciplinary approach, especially at the level of human-animal interface, such as the surveillance of the emerging zoonoses in the light of the climate changes, using models from research to complex networks.
Results:
Promoting the application of an approach collaborative, multidisciplinary, inter-sectorial, and coordinated to address potential or existing risks, which originate from the interface between animal-human ecosystems. To disseminate a new public health culture based on “One Health" concepts and on future planning prospects and vision to the population as well.
Conclusion:
One Health represents a new paradigm of the vision of public health on a global level, which implies an awareness and a challenge of cultural change for the development of a more sustainable future.