Last updated 10th July 2024: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website https://www.cambridge.org/news-and-insights/technical-incident
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
This journal utilises an Online Peer Review Service (OPRS) for submissions. By clicking "Continue" you will be taken to our partner site
https://mc.manuscriptcentral.com/pdm.
Please be aware that your Cambridge account is not valid for this OPRS and registration is required. We strongly advise you to read all "Author instructions" in the "Journal information" area prior to submitting.
To save this undefined to your undefined account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your undefined account.
Find out more about saving content to .
To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Casualties need to be triaged, stabilized and treated before they can be evacuated to the hospital. However, when Field Medical Teams (FMTs) arrive at the First Aid Post (FAP), the staff has to perform outside of their usual settings. There are also differences in the conception of medical operations, organization of the FAP, availability of medical equipment and supply, as well as means of communication, command, and control which can affect their performance and eventually the optimal survival of casualties during a mass casualty incident.
Method:
Guided by Kern’s model for curriculum development, Disaster Medical Responder's Course (DMRC) was developed. The curriculum focused on disaster response operations and processes; roles and responsibilities; command, control and communication; as well as supplies and resources. The content was taught through interactive lectures and skill stations. Course evaluation was based on the Kirkpatrick Model. A feedback form evaluated the reaction of the participants as to whether the course was relevant, if they learnt new knowledge and skills, and if they could apply these to their roles as FMTs. A tabletop exercise evaluated learning with participants working collaboratively.
Results:
DMRC has been sustainable since 2013 with six to eight courses per year. There had been numerous revisions of the content and delivery to keep up-to-date with the latest concept of operations, best practices from the literature, as well as educational methodologies. The last update was in 2020 in response to the COVID-19 pandemic where course schedule and mode of delivery were adjusted to comply with the safe management measures.
Conclusion:
FMTs will require training so they can function to their maximum capacity and capability. In Singapore, DMRC is the course for this unique and important training of FMTs. DMRC plays a pivotal role in ensuring the preparedness and operational readiness of FMTs for mass casualty incidents.
On February 24, 2022, Russia invaded Ukraine, resulting in Europe’s largest refugee crisis since World War II. More than six million Ukrainians fled the country—half of these to Poland—and one-third of the population was internally displaced.
Border points became bottlenecks where fatalities were reported—people risked their lives in long queues and subzero temperatures.
Method:
This presentation focuses on experiential information obtained during a 17-week deployment of EMT Type 1 both at border points (fixed) and in northwestern Ukraine (mobile). Quantitative and qualitative data were obtained after deployment by online survey with 75 medical, logistical and interpreter volunteers.
Results:
Initial teams experienced extremely fluid demands and numerous challenges with security, team adherence to COVID-19 protocols, behavioral issues with less experienced volunteers, and collaboration with novel governmental and non-governmental partners to achieve objectives.
Conclusion:
1. Deployment to a conflict setting requires adherence to the Incident Command System, with daily security briefings and structured handover between teams at the beginning of each deployment.
2. Strict adherence to well-defined protocols for the prevention and management of emerging infectious risks such as COVID-19 is necessary, along with contingency plans to isolate infected team members.
3. There is a need for standardized pre-deployment vetting, training and orientation of all volunteers—particularly team leaders.
4. Identification of international partners should start pre-deployment and remain a continuous process during deployment.
Children differ from adults, developmentally, physiologically, and psychologically. Additionally, children lack legal agency, and thus rely on adults to gain access to the healthcare system and other resources. Though children are often the face of disaster relief, the desparate needs of children can fall through the cracks during disaster response. Many training programs for disaster responders do not give pediatric concerns and issues the appropriate attention they deserve. Pediatric disaster medicine is often minimally addressed in emergency medicine residencies and prehospital provider training. Furthermore, pediatric disaster supplies and protocols are often lacking and insufficient to meet the needs of children during and after disasters.
Method:
This is a modified Delphi study. An initial set of pediatric disaster medicine competencies from a systematic review of PubMed, EMBase and the gray literature will be presented to an initial group of Subject Matter Experts (SMEs) comment, additions, and edits. This modified set of competencies will then be distributed to a large group of providers with experience in the field. Through a series of surveys, each competency in the curriculum will be rated. Those competencies which achieve a high overall rating will be reported.
Results:
Data collection and analysis expected to be completed by April 2023.
Conclusion:
This modified Delphi study will establish and prioritize a set of core competencies for pediatric disaster response based on expert recommendations. The use of such gold standard core competencies to develop discipline-role-specific pediatric disaster training can increase pediatric disaster workforce capacity and competency critically needed to improve pediatric disaster response.
Disasters have adversely affected human life since the beginning of our existence. In response, societies have attempted to improve disaster response & reduce the consequences of disasters by developing standardized organizational arrangements, often known as Incident Command Systems (ICS). These ICS response systems have a military heritage in hierarchical organizational command & control (C2) that is authoritative by nature and fits well with bureaucratic organization. While emergency service agencies have embraced ICS, other agencies often involved in community-level disaster response, such as public health, non-government organizations and community groups, have not. Although ICS have become the backbone of disaster management (DM) policy in Australia and overseas, worldwide debate over the effectiveness of ICS continues. Therefore, this study investigated ICS systems used worldwide to aid in the development of an improved conceptual framework for managing the response to modern-day disasters, for all agencies, at all levels and across all hazard types.
Method:
Phase one involved a review and critical analysis of the literature. Phase two used inductive research methods to gain a better understanding of the barriers & facilitators of ICS to the multi-agency disaster response. Two studies were conducted in this phase: Study one used semi-structured interviews with key informants involved in the 2018 Central Queensland Bushfire & 2019 North & Far North Queensland Monsoon Trough Flood & Study two participants from any disaster. Phase three undertook a policy analysis of recent disaster reviews and inquiries. This was triangulated with previous findings and presented to an expert panel by way of a 2-round modified Delphi.
Results:
The most significant outcome of this research was the improved understanding of the strengths and weaknesses of ICS within the context of multi-agency engagement in disaster management.
Conclusion:
Development of conceptual framework based on modifications to the ICS principles and includes other phases of the DM continuum with psychological aspects taken into consideration.
On January 19, 2020, Washington State reported the first confirmed case of COVID-19. Two years later, the Centers for Disease Control and Prevention (CDC) reported over 90 million cases across every U.S. state and territory causing more than 1 million deaths, with numbers continuing to grow. As part of the overall pandemic response, CDC, in coordination with America’s Poison Centers, conducted enhanced surveillance of National Poison Data System (NPDS) data to detect potentially harmful, non-traditional behaviors taken to prevent, treat, or cure COVID-19 to provide situational awareness and ensure CDC continues to develop effective, evidence-based health communication messages and materials.
Method:
Data from the fifty-five U.S. poison centers (PCs) are uploaded in near real-time to NPDS. CDC monitored several categories including cleaners and disinfectants, medications/vitamins, and behaviors such as suicide and drug use. We characterized exposures by daily call volume, age group, management site, route of exposure, and medical outcome compared to previous years. We also conducted follow-up detailed review for certain anomalies, spikes, or extreme adverse events.
Results:
We reported PC data to several task forces within the CDC Emergency Operations Center. The daily number of exposures increased sharply beginning in March 2020 for exposures to cleaners and disinfectants. For example, bleach exposure calls saw a 62.1% increase compared to 2019. Several medications saw spikes in calls in coordination with media coverage of certain treatments (e.g., hydroxychloroquine) throughout the pandemic.
Conclusion:
This data helped ensure a coordinated public health response to COVID-19 and maximized the unique role of PCs in addressing public and medical provider concerns and questions. Results led to several actions including notifications to state health departments, targeted messaging, and tailored response efforts. PCs are a valuable resource for providing guidance and advice about exposures to hazardous substances and can help reduce the burden on the healthcare system.
The New South Wales (NSW) Biocontainment Centre (NBC) is the first high-level isolation unit in Australia. This state-wide referral facility, located at Westmead Hospital, Sydney, will provide care for patients with high-consequence infectious diseases (HCIDs), including viral hemorrhagic fevers (VHF). In preparation, a tabletop exercise with key stakeholders was held to introduce and socialize the NBC’s capacity to support NSW’s preparedness for the management of a patient with HCID.
Method:
Invitations were provided to key stakeholders within Westmead Hospital (facility executive, emergency and ICU services, security, switchboard); NSW Preparedness and Response Branch; retrieval services; peripheral hospitals; pediatric hospital network; and NSW Public health units (state and district).
The scenario presented was an unwell patient with suspected VHF arriving at a peripheral hospital emergency department.
Discussion during the four-hour long exercise was facilitated with directed questions and injects, and was recorded. Recommendations and key learnings from the exercise and debrief provided opportunities to enhance current response assumptions.
Results:
Forty-five people participated both face-to-face and virtually. Participant discussion showed increasing appreciation of patient presentations to any part of the NSW health system and available assistance. Recommendations included: enhanced access to NBC support with a direct “1-800 number”, coordination for communication, treatment, and transport, and if required, deployment of an NBC team to peripheral sites. Areas for future collaborative work were identified.
Conclusion:
This exercise successfully achieved collaboration of key stakeholders to develop an updated, comprehensive and robust plan for management of HCID patients within NSW, regardless of their presentation site. It has created an opportunity to brainstorm and optimize how the NBC can interact with other agencies to maximize the NSW HCID response.
Training in disaster medicine can be partly theoretical but it must include a large practical part. If part of it can be developed through exercises in virtual reality or on a computer, the realization of life-size disaster exercises bringing together all the disciplines is of great help in this learning. Exercises of such magnitude are difficult to carry out in civilian life for reasons of resources and cost. We therefore wanted to develop this disaster medicine course with the three French-speaking civil universities but also with the Royal Military School for the practical part.
Method:
Collaboration agreements were established between three civilian universities (ULB, UCLouvain, ULiège) and the Royal Military School. The army thus provides the infrastructures of the Belgian military units to organize the exercises, personnel, means of make-up, vehicles, and security, all free of cost. Coordination meetings before exercises are also organized during the year by the army.
Results:
The exercises are organized in complete safety conditions on military fields, isolated from the civilian environment without disturbing the daily functioning of civilians. Access is authorized and organized for the various disciplines (firefighters, police, red cross and other participants). Nearly 100 people (victims, firemen, policemen,...) and 50 vehicles per exercise make the scenario completely believable. Different scenarios are repeated six times to complete the training of 80 students.
Conclusion:
The collaboration between civilians and military has made it possible to set up quality training integrating a large part of life-size exercises at no cost and in complete safety. This ends the course by integrating in practice all the knowledge learned during the theoretical part and the virtual exercises.
Ambulance times are internationally recognized Key Performance Indicators (KPI) for prehospital care. International benchmarking by comparing ambulance times between countries is a valuable method to help to identify strengths and weaknesses across healthcare systems. However, ambulance times are not standardized across or sometimes even within countries. Thus, this benchmarking study aims to compare terminology and definitions of ambulance times from the ambulance services of a range of countries to facilitate international benchmarking.
Method:
A 23-point questionnaire was developed and pilot-tested on members of international emergency care organizations. The final questionnaire was administered to domestic and international Ambulance Services, who use the Advanced Medical Priority Dispatch System, asking for the terminology and definitions for times from “call received” to “arrival at hospital”. This included “clock start” and “clock stop” times. We asked for the ambulance terms and related variable names in the computer aided dispatch/reporting system. We engaged with clinical stakeholders and Patient and Public Involvement Contributors throughout the process.
Results:
We gathered information from 10 international ambulance services, representing nine countries, and three continents. Some services in the United Kingdom have standardized ambulance times terminology and definitions. However, in the majority of cases terminology differed greatly between countries, and at times within countries and between reports. Definitions of ambulance times varied between countries and regions, with some having different clock start and stop times and others not collecting data on the same time periods.
Conclusion:
The current level of variation in international ambulance times terminology and definitions poses a challenge for international benchmarking and research. International consensus or harmonization of language and definitions would result in more efficient and accurate global comparison. On a smaller scale, defining terms in publications and reports would begin facilitating this process.
According to the Internal Displacement Monitoring Centre (IDMC), more than 60% of the internal displacements recorded worldwide in 2021 were due to disasters. A conservative estimate by IDMC reports 65,000 new displacements between July 2019 and February 2020 as a result of the Black Summer bushfires and more than 42,000 displacements due to flooding in February and March 2022 in Australia. These are estimates as there are no consistent or consolidated data on those who are displaced in Australia affecting the measurement of the magnitude of displacement, and the knowledge of experience, impact and needs of displaced people to inform policy and practice. Thus, the aim of this study, as part of a larger project, is to review key international and Australian policies about data on internal displacement due to disasters.
Method:
We conducted a desk review of key international policies, such as the Sendai Framework for Disaster Risk Reduction and from the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), as well as Australian policies such as the Australian Disaster Preparedness Framework, Emergency Management Arrangements Handbook and even state level emergency legislation/acts and plans to understand the data collection and supports and services provided to those who become displaced due to disasters.
Results:
This review found that both international and Australian policies lacked specific focus on internal displacement, despite it being a key issue. While international policies and procedures in low income countries exist, in particular where the international humanitarian system is operational, this review found that Australia lacked specific focus on internal displacement.
Conclusion:
Data on displacement due to disasters, including the number of people displaced, and the patterns of their displacement is critical to inform better policies on prevention, emergency planning, evacuation response and finally to improve the support that people who are experiencing displacement receive.
In the Netherlands, a nationally coordinated research program has been initiated to monitor the immediate and long-term public health impact of the COVID-19 pandemic. This contribution describes the design and early results of a continuous dialectic process to involve national and local public health authorities and professionals in monitor-driven decision-making to anticipate the health impact of viral infections and mitigation measures.
Method:
An ongoing series of dialogue sessions was organized upon the release of quarterly and annual results of the monitoring program. Apart from supporting public health decision-making, the stepwise dialectic process aimed to ensure multi-sectoral learning and co-creation and nurture a sense of ownership among stakeholders from policy, practice and science. National and regional public health authorities served as hub coordinators and participated in determining and approaching relevant stakeholders. Whenever considered relevant, new stakeholders were invited to participate.
Results:
In the first year, three dialogue sessions were organized, with an emphasis on youth and young adults. Representatives from ministries, municipalities, health organizations, experiential experts and knowledge institutes attended the sessions. Based on the exchange, policy recommendations were formulated and shared among participants. The themes prioritized included mental health issues, overburdened healthcare services, involvement of vulnerable groups in policy development and understanding the complex myriad of risk factors. Moreover, several factors were identified that might facilitate or hinder the implementation and uptake of monitoring findings.
Conclusion:
The dissemination and discussion of monitoring data proved to be of added value in developing evidence-informed solutions and areas of attention for future monitoring, including the need to track progress of local and national implementation of recommendations. More broadly, the methodology piloted during the program requires further testing as a community engagement strategy and might be meaningful in other crises or problem contexts as well.
Trauma is one of the leading causes of death in patients under 40 years of age. The Advanced Trauma Life Support (ATLS) Guidelines are widely accepted as the standardized approach to trauma and classify hemorrhagic shock according to heart rate (HR), blood pressure (BP), urinary output, and mental status. Paradoxical bradycardia (defined as HR <60 bpm) in hemorrhagic shock is an uncommon presenting feature and presents a diagnostic challenge to the physician; its true incidence is unknown.
Method:
A case of paradoxical bradycardia was examined as a presenting feature in hemorrhagic shock.
Results:
A 17-year-old male patient presented to our Emergency Department (ED) with collapse and abdominal pain following a collision with another player during a sports match.
The patient was hypotensive (BP 92/42) and bradycardic at triage, with a heart rate of 50. He was pale and diaphoretic with a Glasgow Coma Scale of 13/15, thready pulses, and localized peritonitis in the left upper quadrant of his abdomen.
An increase in blood pressure was observed following initial fluid resuscitation; however, this was transient and preceded the onset of profound hypotension (BP 64/30). Bradycardia with a heart rate between 50-60bpm was persistent despite resuscitative efforts.
Abdominal ultrasound demonstrated intraperitoneal free-fluid, and Computerized Tomography confirmed the presence of a grade V splenic laceration. He was taken to the operating theater for emergency laparotomy and underwent splenectomy. A 2.3 liter hemoperitoneum was found intraoperatively. There were no further complications post-operatively, and he made a full recovery.
Conclusion:
Tachycardia is a potentially unreliable marker of blood loss, especially in young, healthy patients. A high index of suspicion is necessary to prevent this uncommon but life-threatening feature of hemorrhagic shock from being overlooked.
Cyberattacks against healthcare have been growing at an alarming rate globally targeting the theft of clinical research intellectual property, personally identifiable information, and personal health information. Recent studies have also shown a concerning correlation between cyberattacks and patient morbidity and mortality rates. Many top security experts consider cyberattacks a top national security concern.This paper is a descriptive analysis of healthcare-related breaches in the United States in the past decade and an analysis of cybersecurity threats that are currently facing the industry.
Method:
Breach reports of unsecured protected health information affecting 500 or more individuals in the US are publicly accessible through the U.S. Department of Health and Human Services Office for Civil Rights portal. The database was downloaded and searched for all reported breaches occurring between January 1, 2011 - December 31, 2021. Breaches were subdivided by states, dates, location, entity type, and individuals affected.
Results:
Of the 3,822 PHI breaches recorded, 1,593 (41.7%) were hacking/IT related, 1,055 (27.6%) were listed as unknown, 819 (21.4%) were theft related, 194 (5.1%) were loss related, 97 (2.5%) were related to improper disposal and 64 (1.7%) were listed as “others.”
Breaches occurred within the main categories as follows: network server (957 [25%]), email (877 [23%]), paper/films (665 [17%]), other (454 [12%]), laptop (341 [9%]), desktop (309 [8%]), and electronic medical records (220 [6%]).
Conclusion:
A total of 3,822 breaches affecting 283,335,803 people in the United States were recorded from January 1, 2011 to December 31, 2021.
The most reported breaches were from healthcare providers with 2,827 (75.1%) events, followed by health plans (500 [13.1%]), business associates (480 [12.6%]) and healthcare clearinghouses (10 [0.3%]). 4 (0.1%) breaches were from unknown sources.
This report may help healthcare providers understand the extent of the issue and mitigate some of the associated risks.
Triage at mass gathering events (MGEs) has no standard protocol that is widely accepted and applied uniformly across event types and locations. This investigation describes the current state of published literature as it applies specifically to the triage of patient presentations at MGEs, and identifies key roles and important limitations of triage methods in use at events.
Method:
A literature review search strategy was employed (previously published, Turris et al, 2021) to search for event case reports published for the period from 2010-2022. Included papers were reviewed and data were extracted for all references to triage; authors were contacted for any missing details. Data extraction looked specifically for the following (if available) : triage mention, triage scale used, triage categories with patient counts, triage training and any information on clinical dispositions subsequent to triage assignment.
Results:
A total of 60 papers were included (Data extraction in progress, numbers to be finalized for presentation). Of these papers, a minority even made mention of triage, very few specified the triage scale used, and almost none described any triage training. Only a handful of case reports contained counts of patient presentation by triage categories. A couple of papers mentioned triage scales that were event type specific (sports, etc).
Conclusion:
Published literature to date contains limited details and agreement on triage methods in use at MGEs. Methods are largely from the emergency and disaster domains. Triage utility appears generally to be limited to designating location and provider, and for a snapshot of acuity post event. The use of triage scale has not been solely predictive of the need for transfer to hospital.
The ISTARI unit is designed to be assembled in buildings or field hospitals to provide negative-pressure rooms in low-resource areas and decrease PPE use in the setting of highly-infectious diseases. Each unit is designed to perform ~20 air exchanges/hour with HEPA filters with multiple access points for providers to perform patient care without entering the unit while decreasing overall PPE usage. The goals of the design include patient safety, ease of use for, decreased infectious spread, and unit affordability.
Method:
A survey was obtained following a medical simulation within the ISTARI unit with Emergency Medicine resident physicians. The case involved an Ebola patient with Ventricular Tachycardia which progressed to cardiac arrest. Teams were given written and video instructions for the ISTARI unit and Ebola-level PPE. They were limited to one set of high-level PPE for the case. The survey scoring was a 0-5 scale, five being the highest.
Results:
Medical history-taking provider safety (PS)- 2.87, infection control (IC)-3.09, physical examination PS-3.52, IC-3.78, ultrasound usage PS-3.35, IC-3.43, intubation PS-2.35, IC-2.57, CPR PS-3.43, IC-3.65, cardioversion PS-3.35, IC-3.78, and overall average PS-3.145, IC-3.383.
Limitations were noted compared with traditional care, but 100% of teams met critical actions for patient management, including intubation, cardioversion, and CPR. GloGerm showed no contamination to those providing care outside the unit, but a small amount of contamination after doffing for those who entered the unit.
Conclusion:
The ISTARI unit is a cost-effective isolation unit maximizing provider safety in management of patients with highly-infectious diseases, particularly in low-resource settings. It allows for easy mobilization of units and decreased medical supplies waste. The preliminary study shows satisfactory data about provider safety and infection control when using ISTARI for a highly-infectious patient, especially in providers unfamiliar with typical high-level PPE. Providers were able to provide all necessary critical actions for highly-infectious, critically-ill patients.
Across the United States (US), there are approximately 2,000 burn beds in 133 burn centers, only 72 of which are verified by the American Burn Association (ABA). As such, many areas in the US are hundreds of miles from the closest burn center. Eight states do not have a burn center, and another 11 do not have an ABA-verified center. Further, the average center has 15 beds, and, on average, there are 90 available beds across the US. Therefore, in addition to patient care complexities, the broader infrastructure for burn patients is severely limited. These constraints suggest the burn healthcare system is particularly vulnerable to disasters, where the needs will exceed the resources available.
Method:
A literature review was conducted of available burn mass casualty incident (BMCI) plans from stakeholders in each level of a response. These response partners included prehospital agencies, hospitals (those with and without trauma center designations), emergency management agencies (local, state, and federal), healthcare coalitions, public health (district, state, and federal), regional coordinating burn centers, and the ABA.
Results:
The amalgamation of the BMCI plans yields a tripartite infrastructure not unfamiliar to emergency management professionals. The burn care agencies integrate into a response, similar to the way in which public health integrates into the emergency management infrastructure. The local to state to federal escalation of assets is reflected by an escalation from the local burn center to the regional coordinating burn center to the ABA. However, gaps remain in the communication between response partners. Few plans, particularly at the local level, reflect the integration of the burn system response.
Conclusion:
The burn healthcare infrastructure in the US is constrained and therefore is particularly vulnerable to a BMCI. Emergency responders should preemptively examine their plans and systems to specifically integrate the burn care and response infrastructure.
The aim of this cross-sectional, descriptive study was to determine the personality traits and motivation of nursing volunteers and their effects on pre-hospitalization emergency care.
Method:
Participants were 133 pre-hospital nursing volunteers from Taiwan. This study was performed using self-administered basic demographic information, Eysenck Personality Questionnaire-Revised Short (EPQ-RS), and Volunteer Motivation Scale with Chinese Volunteers (VMS-C). The statistical analysis was performed by SPSS 23.0. The data collections were analyzed by nonparametric statistics, correlation coefficient, covariance analysis, and one-way ANOVA analysis multiple regression analysis.
Results:
Our findings showed that having social desirability and extraversion personality had a positive impact on the attitudes of volunteers in terms of the provision of pre-hospital care. The first identified regulation was highlighted in the motivation scale; intrinsic motivation was secondarily emphasized. Pearson correlation coefficient revealed years of service in volunteering seniority, age, gender and nursing seniority were correlated. On the contrary, the job department and six municipalities were negatively correlated. Equivalence with the other relation, participants’ attending hours per month in volunteering and gender were positively related. Inverse correlations were found in age and nursing seniority. Extraversion personality and involvement in specific municipalities were positively correlated.
Conclusion:
Emergency Medical Services (EMS) has been developed in Taiwan for more than 20 years and must improve the quality of EMS. These results may be used to improve the quality of the pre-hospital care system and encourage nursing staff to join the system. Nursing volunteers in pre-hospital care are a particularly valuable resource, and satisfy a pivotal role early in the process of pre-hospital care. It is recommended that we provide a good interpersonal environment to maintain the good will of the dedicated, experienced, enthusiastic volunteers in Taiwan.
Emergency and disaster situations have a major impact on hospitals, some of which are already overloaded daily. The recent COVID-19 outbreak, attacks in Brussels, floods in Wallonia and influx of Ukrainian refugees show that the risk of facing a disaster and involvement of local hospitals (and stakeholders) is real. However, how hospitals implement their own hospital disaster plan (HDP), the position of the hospital disaster coordinator (HDC) and the real efficacy of these measures remain unclear. Therefore, an evaluation tool with an expert-consensus set of Key Performance Indicators (KPIs) and an evaluation of the HDC position is needed
Method:
A semi-quantitative survey, as part of evaluation research, was designed by a research group. This questionnaire was based on the document analysis of the main topics of the national template and accompanying legislation. To establish consensus on the importance of the KPIs concerning the HDP, a three-round email-based modified Delphi study (Policy Delphi) was undertaken.
Results:
For a task group, 15 qualified multidisciplinary professionals (in-hospital) agreed to participate, 11 completed all rounds. As a pilot group, a total of 25 ‘experts on the field’, were purposively selected from Belgian hospitals, nine of them completed the questionnaire. The modified Delphi reached the agreed consensus threshold (i.e.75%), resulting in five main themes: demographic characteristics/profile HDC, hospital incident management system (HIMS), pre-incident phase, incident phase, post-incident phase. Collectively including a core set of 289 KPIs (29 indicators to assess progress concerning the HDC position).
Conclusion:
This study employed a modified Delphi approach to establish consensus, resulting in the development of an evaluation tool to measure hospital disaster preparedness and to evaluate progress of the HDC position within Belgian hospitals. All indicators were considered relevant and immediately implementable. When the implementation of KPIs is completed, the statement is that a HIMS exists within the hospitals.
Understanding how to best prepare hospital staff for disasters or emergencies is critical, as there is increasing frequency and scope of these events. Considerations include: identifying key staff, their roles, strategies to support continuity of care, delivery mode of education, and resource allocation.
Method:
Participants experienced in disasters and major emergencies or preparation at three tertiary referral teaching hospitals were purposively selected during 2016 and 2019. An interpretive paradigm and case study design enabled the exploration of perspectives concerning effective and preferred methods for preparedness. Fifty-five allied health professionals, medical practitioners, and nurses participated in semi-structured interviews; and support staff participated in focus groups.
Results:
Key findings: 1. Recognition that allied health professionals and support staff are essential and must be included in disaster or major emergency preparation and plans. 2. Factors that increase the likelihood of staff deciding to be absent from work include: perception of danger, insufficient understanding of responsibilities, and hospital preparation is perceived inadequate. Staff understanding their role has a positive influence for attendance and coping during disasters. 3. Preferred and most effective method of disaster preparedness is practical learning, combined with other preparation methods. Online learning as the major mode was unpopular. 4. Challenges of inadequate resources limits managers’ ability to facilitate staff preparation and care delivery during disasters. Resources affect method, duration and multidisciplinary inclusion in disaster preparation.
Conclusion:
This research found disaster preparedness in hospitals is critical. Site and occupation specific differences need to be addressed. To mitigate impacts of disasters or major emergencies, preparation must include identification of required resources. Disaster preparedness and management must be inclusive of multidisciplinary staff, including allied health and support staff. Facilitation of role understanding to promote continuity of care during disasters or major emergencies is imperative to promote staff participation and effectiveness in response to disasters.
Germany is a highly developed country. Nevertheless, there are reports that people have supply problems or die lonely and alone in their homes. Despite a differentiated social system, there seem to be significant gaps for individuals or old people. The rescue service is often involved in situations with unclear emergency calls or calls from third parties regarding social and supply problems. In some emergency cases the rescue service is alerted to someone's home but there is no response. Depending on the available information, a timely decision must be made to have the opportunity for life-saving. The door opening procedure is executed by the fire department. Afterward, the medical emergency teams take over. The goal of the study is to analyze findings discovered after opening the door.
Method:
Data of all emergencies from the dispatch center of Dresden operated by the fire and rescue department between January 2021 and December 2021 were recorded and transferred to a central database. All cases with the need to force the door open were extracted and analyzed.
Results:
There was a total number of 157.522 cases of emergency. In 847 cases the door was opened by the fire department. After door opening there was no emergency reported in 265 cases. 100 patients were found dead, six patients had cardiac arrest and received cardiopulmonary resuscitation, and 310 patients were transported to a hospital. The causes for emergencies were social problems, downfall and injuries, hypoglycemia, convulsion, stroke, psychiatric emergencies, dementia and suicide attempt. The mean age was 71 [18-103], 54,15% of patients were female.
Conclusion:
There is a high number of emergencies with the need to open the door. The number of patients transported to a hospital is also high and justified the procedure. Since numerous patients were found dead, this underlines a gap in the German social system.
Since the beginning of the COVID 19 pandemic, the EU-funded project, NO FEAR collected lessons observed from the response. One of the issues raised in the retrospective “lessons observed” exercise, was the need to better integrate health care into “crisis management structures” (e.g. Civil Protection).
Method:
Lessons observed from the COVID-19 response were collected and analyzed by the NO FEAR project, through a questionnaire, discussion with consortium partners, and a large conference in Madrid, with a high-level briefing for policymakers.
Results:
During the Madrid conference, different speakers pointed out the lack of training for healthcare professionals in crisis management (processes and procedures)–except those with military training or EMS officers who are part of Fire and Rescue Services. In a same manner, crisis managers have very little (if any) training in health. This was identified as a gap in future preparedness.
Conclusion:
Looking into the future, healthcare professionals who will be called to take part in crisis management systems have to be trained in this task, as well as basic awareness of crisis managers to health issues in emergencies.