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Disaster planning and preparedness for a burn mass casualty incident (BMCI) must consider the needs of those who will be directly involved and support the response to such an event. An aspect of developing a more comprehensive statewide burn disaster program included meeting (regionally) with healthcare coalitions (HCC) to identify gaps in care and deficiencies.
Method:
Regularly scheduled (quarterly) HCC meetings are held around the state linking stakeholders representing local hospitals, health departments, emergency medical services (EMS) agencies, and other interested parties. We were able to use the HCCs regional meetings to serve as a platform for conducting focus group research to identify gaps specific to a BMCI and to inform strategy development for a statewide approach. Additionally, we held engagement meetings with state emergency response network (a state agency that coordinates the movement of ambulances to appropriate destinations) and the Burn Medical Directors findings were vetted from the focus groups.
Results:
One of the deficiencies identified, included a lack of burn-specific wound care dressings that could support the initial response. Relying on this same process, a consensus was attained for equipment types and quantities, including a kit for storage. Furthermore, a maintenance, supply replacement, and delivery to the scene processes were developed for these kits of supplies that could augment a BMCI response.
Conclusion:
Focus group feedback reminded us that outside of the world of burn care, many report an infrequent opportunity to provide care for patients with burn injuries. Several types of burn-specific dressings can be expensive, and with the occurrence being infrequent. EMS agencies and rural hospitals alike reported that it was unlikely their agency/hospital would have more than a minimal stock of burn injury supplies. Developing supply caches that can be quickly mobilized and deployed to the impacted area was one of the deficiencies we addressed.
Educational initiatives such as Stop the Bleed continue to educate medical laypeople in first aid for massive bleedings. The effect of including realistic blood early in Stop the Bleed-type training remains unknown. The aim of this study was to investigate the effects of including realistic blood early in a Stop the Bleed-type training on medical laypeople's intent to provide future aid and self-perceived ability to provide aid.
Method:
In total, 46 medical laypeople participated in this study. Two bleeding control tasks, wound packing and tourniquet application, were performed in a simulated scenario on a manikin with a wound. Participants received brief Stop the Bleed-type training and were divided into two groups: with (Blood) or without (Control) blood present during the tasks. After the experiment, two surveys were administered, one on confidence in their ability to perform each task, and a previously established survey on their intent to aid a bleeding victim in real-life situations.
Results:
The post-trial survey showed that the participants in the Blood group had lower confidence than the Control group in their wound packing ability (MBlood = 2.09, SDBlood = 0.85; MControl = 3.04, SDControl = 0.86), t(43) = 3.725, p < .001, but not regarding their tourniquet application ability, t(43) = 0.019, p = 0.985. Further, there was no difference between the groups in their intent to aid in future real accidents (MBlood = 91.00, SDBlood = 6.10: MControl = 90.39, SDControl = 8.30), t(43) = 0.282, p = .782.
Conclusion:
This study shows that introducing realistic blood early in Stop the bleed-type training of laypeople results in decreased confidence in their wound packing ability. However, it does not decrease their intent to aid in future emergencies. Future studies should investigate when and how complicating factors such as blood should be introduced in laypeople hemorrhage control training.
Emergency patients have to stay in the Emergency Department (ED) for hours to days to get ward admission for definite care in Nepal. Access block is a major issue in the ED of University Level Teaching Hospitals (ULTH) in Nepal. This study aimed to analyze the impact of access blocks in the EDs of Nepal.
Method:
Meta-analysis of different publications on ‘duration of ED Boarding’ and ‘mortality outcome of ED’ of ULTHs of Nepal till November 15, 2022
Results:
9.7% of ED patients were admitted to the ward. The time period from ED arrival to respective ward team consultation is 5.7 hours, consultation to ward admission is 5.6 hours, and admission to ward transfer is 8 hours. The average ED boarding time is 18.1 hours. 38% of patients arrived in ED via Ambulances. The time period from ED arrival to ward team consultation for those who need transfer to another center are 6.9 hours, consultation to admission is 5.7 hours, and admission to transfer is 8.7 hours (ED Boarding time 21.3 hours). Meta-analysis of three major ULTH’s showed mortality with respect to ED boarding time to be 17% in < 1 hour, 40.4% in 1 - 6 hours, 27.4% in 6-12 hours, 9.1% in 12-24 hours, 4% in 24-28 hours and 2.1% in >48 hours. Among them, higher age, greater mortality rate. The immediate causes of mortality comparing 2018 vs 2010 are Sepsis & Septic shock 32.2% vs 18%, Cardiac Causes 21.8% vs 14.8%, Aspiration Pneumonia 19.5% vs 14.8%, Severe Lung Diseases 12.7% vs 16.4%, Hypovolumic & Haemorrhagic Shock 9.2% vs 34.4% and Poisoning 4.6% vs 1.6%.
Conclusion:
Prolonged ED boarding due to Access Block is triggering increased mortality in the ED.
Rapid developments in healthcare technology can significantly improve the quality, availability, and immediacy of care in health emergency events; however, without a cohesive framework to conceptualize the interplay between emerging technologies, we risk creating silos, ignoring applications, and reducing interoperability between innovations.
Method:
This framework was developed after reviewing the current literature regarding new technologies in healthcare assessment and delivery, discussing relevant innovations with experts, and analyzing global market trends in emerging health technology capabilities.
Results:
Innovative health technologies deployed in disaster settings can be grouped by their relevance to (1) Disease and Injury Surveillance and Detection, (2) Population Protection, (3) Responder Protection, and (4) Disease and Injury Management. The first category encompasses technologies that help characterize the severity and scope of an event at its onset, utilizing a network of wearable devices, sensors, remote infectious disease sampling, and other tools. Once an incident occurs, technologies aimed at Population Protection are necessary to preserve the well-being of unaffected citizens. Scaled-up on-demand manufacturing for prophylactic medical countermeasures and needle-free delivery mechanisms for pre-treatments against CBRN threats will be paramount. Healthcare and emergency responders require additional support before and during incident response, especially just-in-time training through virtual and augmented reality, biometric monitoring, next-generation personal protective equipment, and enhanced communications capabilities. Finally, delivering care to patients in healthcare emergencies will require optimized allocation of scarce resources based upon acuity and survivability. Effective healthcare service delivery can be bolstered using Telehealth, autonomous patient transport, drone delivery, robotic and haptically guided care delivery, and decision support tools.
Conclusion:
To effectively manage the successful adoption and implementation of innovative tools applicable to health emergencies, areas of impact and utility should be comprehensively categorized. This framework guides emergency managers, policymakers, and innovators alike to understand how individual developments coalesce in the larger context of disaster prevention, response, and recovery.
Despite advancements in health behavior theories, understanding the human motivation to engage in disaster preparedness remains elusive. Most attempts at engaging the public in protective behavior rely on risk communication that assumes an information deficit among the people; ergo, risk communicators operate under the assumption that by increasing awareness of risks, sufficient motivation can be generated for preparedness behavior. Yet, this is far from being true.
A growing body of literature indicates the prevalence of fear-directed preparedness behavior, which is suboptimal in motivating behavioral change. This should come as no surprise, as using fear appeal tactics in risk communication designed to promote health behaviors have been proven to be primarily a failure.
Arguably, the phenomenon of failed risk communication campaigns could be linked to unconscious concerns about death, as proposed in the context of the Terror-Management Theory (TMT). According to TMT, since the experience of death-related thoughts triggers the potential for anxiety, the human psyche responds with motivated avoidance. In other words, the mind utilizes mechanisms that prevent death from becoming salient and remove death-related thoughts from focal attention when they arise. In turn, these defense mechanisms may yield procrastination in adopting protective behavior generated by denial as an adaptive coping mechanism.
Preliminary data suggest that procrastination in preparedness behavior until the threat becomes actual and imminent might be explained by TMT; however, explicit evidence for this association is yet to be provided. Should this understanding of the phenomenon be substantiated, it could significantly contribute to expanding our knowledge of the theoretical model behind public preparedness behavior.
The presentation will discuss the state-of-the-art research currently being done by the author to support the above claims. It will provide preliminary findings and will call the community to reconsider the current paradigm of disaster risk reduction and risk communication.
In order to deal with disastrous situations needing massive healthcare support, a new tool, financed by FEDER European funds (Interreg POCTEFA program) has been designed: the multipurpose mobile hospital Europe Occitanie (UMPEO). It is a projectable, foldable, versatile and autonomous truck with an interchangeable function from advanced medical post to operational command center, for acute events involving mass gathering or during multiple victims disasters. This study aims to show the usefulness of this structure during the COVID-19 health crisis.
Method:
The UMPEO is a shelter deployable in an emergency ward or intensive care unit, mobilizable in one hour, projectable by truck and autonomous for the first two hours. A descriptive, transversal, European study was carried out to describe its use in the cross-border countries of the Pyrenees (France, Spain and Andorra). When applicable, demographic data were gathered and/or a satisfaction questionnaire was given to the caregivers involved.
Results:
Between September 8, 2020 andFebruary 25, 2021, UMPEO was mobilized as a COVID-19 testing center, emergency department, vaccination center or as a command center at a political summit. Thus, 1322 screening tests were carried out over the screening three weeks deployment and 91% of the volunteers considered the screening operation useful. Used as a hospitalization ward, UMPEO was able to accommodate 266 patients over a period of four weeks. Eight hundred people were able to benefit from two doses of vaccines during the six weeks of the mobile vaccination campaign.
Conclusion:
This tool, initially designed to be used in the event of a catastrophic event of an accidental or terrorist type or as a help station during mass gathering, has been diverted without any modification of its structure to meet the challenges of the global health crisis and provide a solution adapted to the population of countries bordering the Pyrenees.
As Ireland's population increases and chronic disease becomes more prevalent, demand for limited general practice services will increase. Nursing roles within a general practice are now considered to be standard, yet alternative non-medical professional roles are under-explored within an Irish context. Non-medical personnel such as Advanced Paramedics (APs) may have the capability to provide support to general practice.
Method:
A sequential explanatory mixed methodology was adopted. A questionnaire was designed and distributed to a purposeful sample of GPs attending a rural conference followed by semi-structured interviews. Data was recorded and transcribed verbatim and thematically analyzed.
Results:
In total n=27 GPs responded to the survey and n=13 GPs were interviewed. The majority of GPs were familiar with APs and were receptive to the concept of closely collaborating with APs within a variety of settings including out-of-hours services, home visits, nursing homes, and even roles within the general practice surgery.
Conclusion:
GP and AP clinical practice dovetail within many facets of primary care and emergency care. GPs believe that current models for providing rural general practice care are unsustainable, and they realize the potential of integrating APs into the general practice team to help support services into the future. These interviews provide a detailed insight into the opinions of rural general practitioners in Ireland on healthcare provision and the clear necessity for support and change.
Postgraduate education is important in preparing and enhancing health professionals for the practice of disaster and terror medicine. The World Association for Disaster and Emergency Medicine (WADEM) has formulated a standardized international perspective for education and training in disaster medicine and health. Notwithstanding, there continues to be a reported gap in competency-based training in disaster and terror medicine internationally, particularly across Asia Pacific, which is a known vulnerable region. We report on a new Graduate Diploma in Disaster and Terror Medicine, to be expanded to Master level in 2024. The course is delivered mainly online to a multidisciplinary international audience. This paper summarizes the development of the course and outlines the key influences that have contributed to the design of the course.
Method:
A survey of the critical care workforce conducted by the Department of Critical Care at the University of Melbourne in early 2020 identified the need to develop education in disaster and terror medicine. A market and competitor analysis identified there was a gap in clinician focused courses offered in Australia and internationally. Based upon these results, a new course was developed to meet these needs.
Results:
Based on the results of the survey and feedback from expert stakeholders, the new postgraduate courses in disaster and terror medicine were developed. They offer both core and elective subjects, utilizing a modular approach with supervised simulation and practical training. The courses incorporate problem-based learning, the principles and practices of online education and advances in simulation-based learning, providing both a public health and clinical lens.
Conclusion:
The nested suite of postgraduate disaster and terror medicine courses at the University of Melbourne is at the forefront of learning within this field and meets the contemporary needs of health professionals who practice disaster and terror medicine
International reports suggest there have been prehospital delays for time-sensitive emergencies like stroke and TIA during the COVID-19 pandemic. The aim was to investigate the impact of the COVID-19 pandemic on ambulance times and emergency call volume for adults with suspected stroke and TIA in Ireland.
Method:
We conducted a retrospective cohort study of patients ≥ 18 years with suspected stroke/TIA, based on data from the National Ambulance Service. We included all cases assigned code 28 (suspected stroke/TIA) by the emergency call-taker, from 2018-2021. We compared ambulance times and emergency call volume by week, the four COVID-19 waves (defined by the Health Protection Surveillance Centre) and annually. The COVID-19 period was from March 1, 2020 - December 19, 2021 and the pre-COVID-19 period January 1, 2018 - February 29, 2020. Continuous variables were compared with t-tests and categorical variables with Pearson’s χ2 tests.
Results:
40,012 cases were included: 20,281 in the pre-COVID-19 period and 19,731 in the COVID-19 period. Mean patient age significantly decreased between the two periods, from 71 years (±16.5) to 69.8 years (±17.1); p<0.001. Mean ambulance response time increased between the two periods from 17 minutes 31 seconds to 18 minutes 59 seconds (p<0.001). The number of cases with symptom onset to emergency call time of >4 hours significantly increased from 5,581 to 6,060 during the COVID-19 period (p<0.001). Mean calls/day increased from 25.1/day to 30.1/day during the COVID-19 period.
Conclusion:
Early findings from the study suggest an increase in call volume for stroke/TIA between the COVID-19 and pre-COVID-19 periods. An increase in response times during the same periods was also found. We concluded that longer symptom-to-call times indicate a change in healthcare-seeking behavior. Sustaining high levels of compliance with stroke code protocols is crucial during healthcare crises. Future research will involve further analysis including controlling for confounders.
Road traffic accidents and natural disasters cause significant numbers of deaths and life-changing injuries in low & middle-income countries. Most of these countries have limited resources for pre-hospital care and training. In 2021, there were 155,622 deaths due to road accidents and >18,000 railway-related deaths. Natural and manmade disasters also contribute to high numbers of serious injuries and deaths in the region. India is the pilot for developing an international training course for prehospital trauma care.
Method:
A review of pre-hospital care training and ambulance services in Tamil Nadu and Kerala states of India was carried out in 2019. An international workshop on developing pre-hospital care in India was held in Chennai in October 2022. The workshop included experts from UK and India and 52 practitioners from various parts of India.
Results:
India has developed a country-wide ambulance service sub-contracted to private providers under a public-private partnership initiative and in addition, there are private and charitable providers. In-transit care and resuscitation are limited and the vehicles are primarily a transport mechanism with a scoop-and-run policy. Infrastructure, traffic congestion, rural and hard-to-reach areas, poorly equipped ambulance services and variations in training and scope of practice contribute to the challenges of providing high quality pre-hospital care.
Conclusion:
There is a need for high-quality pre-hospital care training, regulation and continuing professional development within the pre-hospital care sector. Delivery of pre-hospital care could be reinforced by wider involvement of doctors such as General Practitioners and other allied health care professionals. It was agreed by all delegates and speakers that an international course on pre-hospital care based upon an existing UK course from the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh, edited to take account of India’s current resources, should be piloted in Chennai in 2023.
A traffic accident injury is one type of unintentional injury that contributes to the third leading cause of death in Indonesia, according to the WHO 2013 Global Road Safety Report based on Indonesian Police, estimated 37,000-47,000 fatalities annually and 46,000 experiencing severe injuries. The injury surveillance pilot project by the Ministry of the Health Republic of Indonesia in the Fatmawati Hospital Emergency Department is trying to describe the magnitude of injury along with its components and risk factors.
Method:
This study aims to determine the risk factors of severe road traffic injury documented by injury surveillance forms in the Fatmawati Hospital Emergency Department from March to July 2016. The research design used was cross-sectional with a number of samples of 600 road traffic injury cases.
Results:
The results show risk factors that contributed as predictors for severe road traffic injury are being male, OR 2.03 (95% CI 1.37-3.02); age greater than 30 years old, OR 1.57 (95% CI 1.11 - 2.22); low education (not attending school until high school graduate) with OR 1.59 (95% CI 1.12-2.25); during working days with OR 1.53 (95% CI 1.08 – 2.17), and cyclists with OR 4.84 (95% CI 0.87-29.0).
Conclusion:
Based on this research, the Ministry of Health of the Republic of Indonesia needs to continue advocating the use of injury surveillance forms at hospital emergency departments to provide a complete picture of injury characteristics and risk factors and to educate and develop road traffic injury prevention and risk communication for the community.
Health emergencies such as the COVID-19 pandemic, strain health systems and emergency response mechanisms. Identifying critical points during the response cycle where the emergency workforce and operational capacity can be improved can help break the protracted nature of responses. Global health emergency workforce, or health emergency and alert response teams such as multidisciplinary Public Health Rapid Response Teams (RRTs) and Emergency Medical Teams (EMTs), play critical roles in response to public health emergencies.
The project aims to explore and understand how countries manage and operationalize their RRT and EMT programs. With anecdotal evidence of countries integrating the two historically disparate groups, we propose to examine how countries are jointly or separately addressing legal frameworks and policies; management practices, reporting processes and protocols, training, as well as program operations and standards.
Method:
Through existing global partnerships and networks, a convenience sample of national focal points responsible for the management of their RRT and EMT program are sent an online survey followed by participating in a one-on-one interview, and descriptive and thematic analyses.
Results:
Sixteen countries representing all six World Health Organization regions with both RRT and EMT programs have been selected for engagement.
Conclusion:
Factors contributing to/or against countries’ integration of RRT and EMT programs will be identified. Areas of divergence or synergy of plans and standard operating procedures will be mapped. Recommendations for strengthening global health emergency alert and response teams will be generated.
Located in a disaster-prone country, more than 3000 hospitals in Indonesia must have a Hospital Disaster Plan (HDP). Instead of pursuing only the hospital accreditation requirements, HDP should be beyond that. Since 2008, CHPM UGM has been providing various HDP training. However, during the COVID-19 pandemic, there was a change in offline assistance that shifts to online. This study reports the learning activities, output, and challenges.
Method:
There were three batches of HDP-paid online courses in 2021. Each batch consists of three series courses. The first series was a basic HDP seminar. The second series was for intensive HDP mentoring for two months. In the second series, the participants focused on analyzing risk and hospital safety index (HSI), detailing job action sheets, and detailing disaster standard operating procedures. Moreover, the third series in the fourth month was an online tabletop exercise (TTX).
Results:
25 hospitals and 112 people participated. However, only five hospitals that committed finalized the HDP document. The learning process challenges were the participant’s unstable network and their focus on who was on duty while attending the courses. Although the TTX online was a new trial, it worked to asses hospital preparedness for disaster management through well preparation, detailed scenario and proper evaluation instrument. However, it was still difficult to assist participants in completing the HDP documents online, because observation of the hospital environment cannot be carried out while the evidence provided by participants were limited, for example supporting evidence for the HSI indicators.
Conclusion:
The online series of HDP is feasible because it saves accommodation and transportation costs. However, the intensive online mentoring should be carried out longer to allow participants to do assignments and collect evidence of indicators that must be shown to the facilitators.
Early in the Russian-Ukrainian conflict, the Ukrainian Ministry of Health (MoH) implemented policy reform to allow for pre-hospital whole blood transfusion (pWBT). Team Rubicon (TR) worked with a multinational group of experts to disseminate training that accelerated the implementation of pWBT across the country.
Method:
TR utilized an assess, align, and act (A3) approach to drive the pWBT implementation. TR established relationships with Ukrainian providers to understand current needs, restrictions, and protocols for pWBT. TR aligned pWBT advocacy efforts, working with the disaster medicine program at Ivano-Frankivsk Medical National University to create a local lead advocate. Existing and novel coordination mechanisms were used to unite and inform MoH, World Health Organization, Non-Governmental Organizations, and local health systems. Finally, TR coordinated a multispecialty, multi-national team of healthcare providers who developed and delivered a training package in alignment with national guidelines utilizing a combination of didactics, videos, and demonstrations. From August to October of 2022, TR conducted pWBT trainings across Ukraine. Pre- and post-surveys were utilized to determine comfort with pWBT and usefulness of the training.
Results:
TR emerged as the point of reference for pWBT in Ukraine. 109 individuals from over 14 organizations were trained. Participants included 69 physicians, 23 paramedics, 7 nurses, and 10 other professionals. 95% of those surveyed had not received prior pWBT training. Participants reported increased comfort levels, with average pre- and post-course comfort scores of 1.7 and 3.2 (4=very comfortable), respectively. The majority of participants found the training useful (average score of 3.8, 4=very useful). Feedback demonstrated high satisfaction ratings and an increased awareness of the regulatory changes.
Conclusion:
TR utilized the A3 model to drive a coalition that supported policy reform and trauma system improvements in Ukraine. TR’s ability to leverage international medical expertise, work collaboratively with MoH, and provide material resources supported local implementation of pWBT.
The Sydney North Health Network (SNHN) covers an area of 350 square miles in Eastern Australia. It is one of 31 Primary Health Networks (PHNs) across Australia. The purpose of PHNs is to improve access to primary healthcare particularly those at risk of poor health outcomes. During disasters these vulnerable groups may be even more disadvantaged. As part of SNHN's role in enhancing the wellbeing, resilience, and preparedness of communities and primary healthcare providers during disasters, SNHN is focusing on recovery and resilience initiatives that build on local strengths, while addressing challenges.
Method:
The aim of this community engagement research was to determine the impact of recent extreme weather events on the community, and identify strategies to improve wellbeing, resilience and preparedness. The research was approached through a co-design process to explore assets, strengths and vulnerabilities within vulnerable community members during disasters, and to ascertain their perspective on their needs during disasters. SNHN funded a well-established local community organization to conduct surveys and focus groups with the SNHN community to inform future community-led programs to support individuals and communities in disasters.
Results:
Participants considered impacts on mental and physical health, children, the environment, and property as key challenges. Equally, they acknowledged they didn't start as a "blank slate", but came to the disaster with considerable individual and community strengths and assets, that enabled their resilience, including numerous resources to support social capital. Person-centered, community-inclusive planning, preparedness, and connectedness was seen as key solution.
Conclusion:
In order to promote and enhance the wellbeing, resilience, and preparedness of communities and primary healthcare providers, successful recovery and resilience initiatives should build on local strengths, while addressing challenges. Individuals and communities should be integral in designing programs to build their local resilience and wellbeing, as they know their attributes and strengths, and their needs.
In Japan, there is an 80% probability that the Nankai Trough Mega Earthquake will occur within 30 years, and a tsunami of more than 30 meters is expected to hit the Pacific coast, killing more than 320,000 people and devastating many towns. This study clarifies the necessity and feasibility of a high-performance medical container developed by Showa to fill the gap in medical care during a large-scale disaster, especially after the sub-acute stage.
Method:
1) Simulation of the damage to disaster center hospitals in the event of the Nankai Trough Mega Earthquake.
2) To clarify the feasibility of immediate response, a demonstration experiment was conducted by combining and installing ten units of medical containers.
Results:
1) Of the prefectures where the death toll from Nankai Trough Mega Earthquake is estimated to be 5,000 or more, 119 disaster center hospitals located in cities and towns with coastlines were examined to determine if they were in the tsunami inundation zone. The results showed that 44 hospitals, or about 37%, were inundated and their medical functions were likely to be paralyzed.
2) Ten containers of medical treatment rooms, ICUs, CTs, power supplies, and oxygen could be assembled in seven days. This is by far the shortest time compared to the more than two months it takes for a temporary hospital.
Conclusion:
It is clear that medical containers can fill the void of medical care in the event of Nankai Trough Mega Earthquake.
Deployment of EMT from one institution is a common thing to do in Indonesia. However, it is still rare to deploy a composite team that is combining two or more different institutions and area of origin. CHPM UGM had coordinated composite EMT deployment during West Sulawesi Earthquake in 2021. They sent a management team from Yogyakarta and a medical teams from Central Sulawesi. This paper aimed to report the experience of sending composite EMT to earthquake disasters amid the COVID-19 pandemic.
Method:
Documentation studies were carried out during the process of coordination, planning, and deployment of EMTs. Initial coordination was carried out with the Central Sulawesi Health Office which was the nearest neighboring province to affected West Sulawesi. The Central Sulawesi’s medical team arrived in Mamuju in less than 24 hours. Followed by the health cluster management team on the second day.
Results:
Three composite EMTs came from different institutions and diverse competencies (midwives from PHC, nurses and medical doctor from hospital, health promotion and management from university) were deployed during the emergency response. Coordination activities were carried out through WHATSAPP chat, Zoom, and telephone. The handover process was carried out via online streaming. In addition, prevention of infected COVID-19 was conducted by preparing PPE for personal and team, limiting service time only during the day, ensuring sufficient rest and nutrition, as well as screening and isolation before and after duty. However, there were two people who were infected with COVID-19 at the exit screening.
Conclusion:
Intense coordination is required during the preparation and deployment process, including an extra personal approach when the team first meets on the field. In addition, the Covid-19 pandemic situation has made the composite team's task even more challenging.
Hazardous materials (HazMat) training is not a requirement for accreditation of US Emergency Medicine (EM) residencies, nor for EM board certification by the American Board of Emergency Medicine (ABEM). However, the US Occupational Safety and Health Administration (OSHA) requires hospitals train all personnel expected to deal with contaminated patients. This QI project aimed to develop an EM physician-specific HazMat course and evaluate the physician comfort level with HazMat personal protective equipment (PPE) donning and doffing, triage, procedural skills, and decontamination.
Method:
A four-hour “HazMat for Docs” course was designed at a large urban academic trauma center and offered to second-year EM residents. Additionally, we performed a quantitative survey of a cohort of 72 current and recently graduated EM residents (classes 2019-2024), some of whom had taken the course in person. Our primary outcome was to measure improvement in comfort level with essential HazMat tasks after completing the course. Our secondary outcome was to evaluate the current or recently graduated EM physician's overall comfort levels with managing a HazMat incident, as well as HazMat skills and knowledge retention.
Results:
A total of 53 responses (73.6%) were obtained. 45.3% of the respondents were male and 54.7% female. 37.8% of the respondents were recent EM graduates, with 20.8% PGY-4, 13.2% PGY-3, 15.1% PGY-2, 13.2% PGY-1. 16/53 (30.2%) had prior EMS experience. EM Physicians were most comfortable with donning and doffing PPE (4.92 on a 7-point scale) and least comfortable with decontamination procedures (2.98/7). After completing the HazMat course, EM physicians increased their comfort level with HazMat decontamination procedures by 8.6% and with organizing a multi-disciplinary ED HazMat response by 10.5%.
Conclusion:
EM Physician comfort levels with HazMat procedures are low. Increased training aimed at improving physician knowledge, preparedness, and comfort level for such events is necessary and can be accomplished through a short course.
Front loading tests reduce Patient Experience Time (PET) in Emergency Departments (ED). “Blanket” or “scattergun” approach to test requests results in prolonged PET, increase in laboratory workload with wastage of resources. Coagulation studies are one of the most commonly ordered investigations. Previous to the 2020 audit, it was suggested that 70% of ED coagulation requests were unnecessary not changing management. By establishing local guidelines, we worked to reduce coagulation test requests.
Method:
The aim of this study was to assess reduction in coagulation tests following implementation of local guidelines in ED. The coagulation indicator checklist was introduced to ED areas storing coagulation bottles. Presentations, small group education, reminders about clinical indications for appropriate coagulation requests were given to nurses, doctors, and advising about audits of practice. From February 1-14, 2022, nurses and doctors were instructed to send coagulation samples after filling out audit forms for the laboratory indicating the purpose of the request.
Results:
Prospective data in February demonstrates a 20% decline in coagulation requests. Only 47% of requests had accompanying coagulation forms filled and the remaining 53%was not filled. In 57% of cases, coagulation samples were requested appropriately, and in 43% there were no indications.
Conclusion:
Through microsystem interventions and awareness campaigns, unnecessary coagulation requests can be reduced. By introducing local guidelines, regular training of new doctors and nurses at induction and intervals, clinical practice changes can be embedded. Consideration should be given to specific coagulation request forms stating the indication for the request. The cost of each sample is 2.87 euro. Obtaining 90% compliance with coagulation requests can save approximately 100,000 euros annually.
Triage in a disaster scenario centers around doing the greatest good for the greatest number of people. There are a variety of triage systems, and to this date there is no US national endorsement of one system because triage is a dynamic procedure and there is no fixed rule for it. The Simple Triage and Rapid Treatment (START); Sort, Assess, Life-saving interventions, Treatment/Transport (SALT); Sacco; CareFlight; JumpSTART; and Pediatric Triage Tape (PTT) triage systems are discussed with emphasis on how they perform.
Method:
There are approximately 20 adult and two pediatric triage systems that exist for primary disaster triage. The focus is on six primary triage systems. A literature search was performed using textbooks and original research.
Results:
A basic assignment to immediate, delayed, minimal, or expectant can sort a large group of casualties in a matter of minutes, but improper category assignment can lead to under-triage or over-triage.
When assessed by a trained paramedic arriving at a Level 1 pediatric trauma center, SALT was found to be the most accurate triage system at 59% compared to JumpSTART, CareFlight, and TriageSieve. All triage systems exhibited under-triage rates of at least 33% and SALT had the highest over-triage rate at 6%. In another study, the START triage system was found to be 85% sensitive and 86% specific in predicting critical injury in designated trauma patients.
Conclusion:
Mass casualty incidents are unfortunately becoming more common as the increasing numbers of violent attacks produce an overwhelming number of victims. One triage process may not work in all disasters, but first responders should be trained to evaluate for the most critical patients in a sea of evolving patient presentations. Furthermore, randomized, controlled trials in real-world conditions are nearly impossible to perform given the specific circumstances of disasters.