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Multiple triage algorithms have been proposed to optimize the allocation of medical resources in mass casualty incidents. Despite attempts at standardization, first responders often assign patients to triage categories that deviate from those prescribed by these algorithms. This study seeks to understand what patient level factors cause these deviations, and identify clinical factors which cause variance toward over or under triage. Rather than evaluate these decisions against a gold standard, we instead seek to identify patients that cause controversy among first responders with respect to their choices.
Method:
This will be an online survey distributed to EMT and Paramedic students in the US. They will be provided with fifty patient cards containing a clinical vignette including description of injuries and vital signs. For each vignette, they will select a triage category (Red, Yellow, Green, or Black.) We will analyze responses to identify areas of controversy, where triage classification showed a significant split between respondents. We can then evaluate these patients for clinical trends.
Results:
Data collection and analysis are planned for completion by March 30, 2023.
Conclusion:
Identifying patient-level characteristics that contribute to triage variance can allow emergency managers to anticipate under-triage and over-triage following an MCI. This can aid emergency providers as they plan to receive an influx of patients. It also addresses the sub-cognitive biases that impact first responders decision-making, which may aid EMS educators who train first responders in triage.
A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain first responder competencies with the challenge of the FSEx. The translational science (TS) T0 question: How can students achieve similar MCI competencies through the use of simulation MCI exercises as with a FSEx?
Method:
Initial TS phase T1: Scoping Review
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review was conducted to develop statements for the TS second phase T2 modified Delphi study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.
Second TS stage T2: modified Delphi study
The database was analyzed and initial draft statements were created. Selected modified Delphi experts were presented with 27 statements with instructions to rank each statement on a seven-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤1.0.
Results:
After three modified Delphi rounds 19 statements attained consensus and eight did not attain a consensus.
Conclusion:
The modified Delphi experts agreed that the simultaneous integration of individual duty and incident management skills should be incorporated into simulation MCI exercise design to achieve competencies depending on high physical fidelity to develop the individual’s manual abilities, as well as high conceptual fidelity, to develop the individual’s clinical reasoning and problem-solving skills. MCI simulation exercises can be developed to achieve similar competencies as FSExs incorporating the 19 statements that attained consensus through the TS phases of a scoping review (T1) and modified Delphi study (T2). The TS process should continue with development of these exercises in the T3 implementation stage and then evaluated in the T4 stage.
New Zealand is widely known across the globe as an adventure tourism destination. On December 9, 2019, the natural wonders of the country became a major disaster that impacted the lives of many and stretched the resources of the New Zealand healthcare system.
Whakaari/White Island is an uninhabited, privately owned island 50 km off the North Island of New Zealand. It contains two strato-volcanoes, which were and remain a popular tourist destination. While an international tourist group were enjoying their guided tour of the crater, one of the volcanoes erupted, sending superheated debris and gas into the air. Of the 47 individuals on the island at the time, 39 were rescued. Overall, 25 people survived. The mortality of this event was significantly lower than historic volcanic eruptions involving ballistic and pyroclastic injuries. We are fortunate to present information specifically on the chemical and physiological changes noted from exposure to volcanic ash.
Located in New Zealand’s largest city is Middlemore Hospital, home of the National Burns Center. This center is supported by three regional burn centers throughout the country. Prior to Whakaari, mass-casualty plans were in place, however, system-wide adaptations were required on many levels to ensure delivery of healthcare. This included changes in pre-hospital triage, support for regional burns centers and repatriation to home countries.
This poster presentation takes you on the journey of adaptation experienced within the National Burns Service, focusing on operating theater, intensive care and acute burns management.
As of October 2022, the civilian casualty count of the invasion of Ukraine is reported to be 16,295, with actual figures believed to be considerably higher. As explosive trauma continues to terrorize populations, frontline medical personnel are faced with escalating resource constraints including transport, imaging modalities, and electricity. Point of care ultrasound (POCUS) is considered the gold standard in acute trauma evaluation, but very few hospitals or pre-hospital medics have access to or training in POCUS.
Method:
In collaboration with the Ukrainian Ministry of Health, the World Health Organization, and the Global Health Program at Butterfly Network, Team Rubicon developed and conducted 64 practical trauma trainings and donated 50 Butterfly iQ+ portable ultrasound devices in Ukraine between August and October, 2022. Of these trainings, 19 specifically focused on the use of POCUS for trauma. Pre- and post-surveys were deployed to determine demographics, comfort level with POCUS for trauma care, and usefulness of the course.
Results:
In total, 149 individuals were trained in POCUS for trauma. Of these, 130 were physicians, 15 were paramedics, three were RNs, and one was a pharmacist. Only 14.8% of these clinicians self-reported any previous POCUS training. All participants reported an increase in comfort level, with an average pre- and post-course comfort scores of 1.9 and 3.3 (4=very comfortable), respectively. General satisfaction with the training was high (average score of 9.8/10). Qualitative feedback commended the quality and novelty of this training, requested further examples of pathology, and endorsed more POCUS trainings, generally. The most critical lesson learned was the need to re-orient training around the foundations of POCUS given low levels of experience and training.
Conclusion:
Access and training in POCUS for trauma is critical for resource-constrained medical personnel operating in conflict-affected communities. A one-day POCUS practicum-oriented course is feasible to support awareness and proficiency.
The use of ketamine in the prehospital setting has increased with EMS providers. Adverse effects of prehospital ketamine administration have not been well-established in the trauma population. The objective of this study was to evaluate the effects of pre-hospital ketamine on trauma patients presenting to a Level 1 trauma center. This study hypothesized that respiratory depression or oversedation from ketamine would increase the number of ED (Emergency Department) intubations.
Method:
A retrospective chart review of adult trauma patients receiving prehospital ketamine from 2016-2021 was performed. Patients with severe traumatic brain injuries were excluded. A 1:1 propensity match was performed of patients with similar demographics, injury severity, and mechanism of injury who did not receive prehospital ketamine. Univariate analyses were used to compare the groups. The primary outcome was the incidence of intubation in the Emergency Department.
Results:
Seventy-four trauma patients who received prehospital ketamine were identified. The average ketamine dose was 39 mg IV and 226.4 mg IM. 35.1% of patients received ketamine for pain while 29.7% received it for agitation. The ED intubation rate was higher in the prehospital ketamine group with 17.6% (n=13/74) requiring intubation as compared with 4.8% (n=3/63) who did not receive ketamine (p=0.03). Patients who required intubation in the ED had higher average doses of both IV/IO (37.7 +/- 4.8 mg vs. 55.0 +/- 24.2 mg) and IM ketamine (196.4 +/- 41.7 mg vs 290.0 +/- 41.3 mg).
Conclusion:
ED intubation rate was higher in the ketamine group. Patients that were intubated had received higher ketamine doses on average. Further studies are needed to understand and refine prehospital dosing and indication protocols to allow for more efficacious utilization of pre-hospital ketamine in trauma patients. A multicenter trial is ongoing.
In Japan, natural disasters such as earthquakes and typhoons are extremely frequent. It is predicted that Tokyo Inland earthquakes will occur within the next 30 years. Disuse syndrome and Disaster-related deaths have increased in disasters. It has been reported that Disuse syndrome and Disaster-related deaths are particularly prevalent among those who require special care. Therefore, it is necessary to consider support for them in the future disaster. Telemedicine has become increasingly popular in recent years. Previous researches using telemedicine have reported that it is useful for rehabilitation and management of chronic diseases. This study aimed telemedicine would be useful to prevent Disuse syndrome and Disaster-related deaths.
Method:
The subjects were physicians, nurses, physical therapists, occupational therapists, and speech therapists. Semi-structured interviews were conducted with the subjects on how telemedicine could be used to assist them. The data were analyzed using Krippendorff's content analysis.
Results:
The research interviewed medical staff including physical therapists and occupational therapists with knowledge about disaster medicine. Thirteen categories of problems with telemedicine were identified, including problems with infrastructure and operation by the elderly. Eight categories of support that could be provided were generated that were common to all rehabilitation professionals, two categories for physical therapists, two categories for occupational therapists, and five categories for speech therapists.
Conclusion:
This study examined what kind of support can be provided using telemedicine to prevent Disuse syndrome and Disaster-related deaths. Common support by rehabilitation professionals included instruction in exercises and prevention of economy class syndrome. It was suggested that speech therapists could provide oral swallowing exercises and support for those with dysphagia. However, the handling of communication devices by the elderly, and the interaction of medical personnel were cited as problems. In response to these issues, there was a possibility to support the victims by collaborating with remote and local medical professionals.
On August 4, 2020 a massive explosion struck the Beirut Harbor in Lebanon. Approximately 220 people were killed and over 7000 were injured, of which 12% were hospitalized. Despite being weakened by an economic crisis and increasing numbers of COVID-19 cases, the national healthcare system responded promptly. Within a day, International Emergency Medical Teams (I-EMTs) started arriving. Previous studies have found that I-EMTs have arrived late and have not been adapted to the context and dominating healthcare needs. The aim of this study was to document the organization, type, activity, and timing of I-EMTs deployed to Beirut and to discuss their relevance in relation to medical needs.
Method:
Data on all deployed I-EMTs were retrieved from all available sources, including internet searches, I-EMT contacts, and from the World Health Organization (WHO) EMT coordination cell (EMT CC) in Lebanon. The WHO EMT classification was used to categorize deployed teams. Information on characteristics, timing, and activities was retrieved and systematically assessed.
Results:
Nine I-EMTs were deployed to Beirut following the explosion. Five were equivalent to EMT Type 2 (field hospitals), of which three were military. The first I-EMT arrived within 24 hours, while the last I-EMT was set up one month after the explosion. Four civilian I-EMTs provided non-clinical support as EMT Specialized Care Teams. A majority of the I-EMTs were focused on trauma care. Three I-EMT Specialized Care Teams were rapidly re-tasked to support COVID-19 care in public hospitals.
Conclusion:
A majority of the deployed I-EMT Type 2 were military and focused on trauma care rather than the normal burden of disease, including COVID-19. Re-tasking of EMTs requires flexible EMTs. To be better adapted, the I-EMT response should be guided by a systematic assessment of both healthcare capacities in the affected country as well as the varying health effects of hazards before deployment.
The Covid-19 pandemic strained health care organizations to their limits, and sometimes beyond. Different countries took different approaches to minimize the effects of the pandemic, both to protect public health and to safeguard the capability of the health care system.
A collaborative project between Sweden and Bosnia-Hercegovina with the aim to share and learn from experiences of managing the COVID-19 pandemic from a medical command and control perspective, initiated in 2021.
The project departed from three theoretical stances: sociotechnical systems perspective, experiential learning theory, and organizational learning theory. Framing the problem using a holistic systems approach, compared to focusing on individual experts, allows for understanding interactions on a system level. Hence, could these theories contribute to supporting individuals' learning and organizational change?
Method:
A two-day workshop involving participants from both Swedish and Bosnian (N=21) medical command and control allowed for the exchange of experiences and another's perspective on similar challenges. During the workshop, two themes were addressed: common operational picture and evaluation. First, an introductory presentation was held, then the theme was discussed and reflected upon in small groups. After this, the groups presented their conclusions, and a full group discussion was moderated.
Results:
The discussions resulted in participants sharing perspectives on the selected themes, providing personal insights and experience, allowing for deepened and increased understanding of the theme. In spite of major differences between the Swedish and the Bosnian health care systems and Covid-19 approaches, several shared conclusions were identified. For example, reflections on decision processes and strategies, as well as interest in improving the crisis organization.
Conclusion:
Exposing participants to different views on well-known processes and challenges allows for reflecting, verbalizing, and reaching a deeper understanding. By displaying a culturally differently organized way of approaching the challenges the contrast is even more evident.
Pediatric patients represent a small (but important) subset of the patient population routinely visiting emergency departments (ED) each year. With the aim of better understanding the disaster preparedness level for pediatric-specific mass casualty and surge incidents, a survey was conducted involving all hospitals that routinely manage pediatric patients in their emergency departments, to better understand the preparedness levels for these facilities.
Method:
This is a retrospective analysis of data collected in 2014 and repeated in 2021. Our focus included one predominantly rural state in the United States of America (USA). We examined results from surveys conducted where facilities self-reported objective criteria that resulted in a readiness score (as it relates to pediatric readiness). Reporting stratification reflected the annual pediatric ED volume with groups of; Low (<1800/year), Medium (1800-4999 /year), Medium to High (5000-9999/year), and High (>10,000/year).
Results:
Low-volume hospitals scored (Mean=59/Median=56), Medium volume hospitals scored (Mean=62/Median=60), Medium to High volume hospitals (Mean=67/Median=65), and hospitals with High volumes (Mean=82/Median=83). All hospital volume ranges had outlier hospitals that scored between 82-97. The general tendency, lower volume hospitals had a lower level of readiness, and higher volume hospitals had a higher (to much higher) level of readiness.
Conclusion:
Pediatric disaster readiness needs to be improved at the community level. It is encouraging that pediatric disaster readiness has been addressed in the larger medical centers. Yet, it should be noted that even very low-volume hospitals (had outliers with) scores as high as 94 indicating that with ample support, and resources, pediatric disaster preparedness is achievable in every hospital regardless of size or volume. The results point to a need to develop, improve, and distribute resources and support local hospitals with pediatric disaster readiness.
Sengkang General Hospital (SKH) is a part of the national network of hospitals to respond to civil emergencies including hazardous material (Hazmat) incidents in Singapore. The HDS course aims to train our staff on basic knowledge of the effects of hazardous material exposure and the operations of the HDS.
Method:
HDS course was planned in three phases:
Phase one aimed to train all DEM personnel so as to have a critical mass of personnel equipped to operate the HDS upon immediate notice. Phase two involves hospital staff from non-emergency departments. Material and simulations for phase two was simplified to focus on the skills and prompt decontamination. Phase three aims to test out capabilities of HDS and review processes through department simulations and hospital.
Results:
155 staff have completed HDS training since 2019, amongst them, 23 as instructors. 67.7% found the demonstrations, skills and practices exceeded expectations. 69% were able to apply skills taught during simulation and overall, 71.2% were able to understand topics covered in the modules.
SKH was at the forefront of battling Covid-19 and resources were tight. We have resumed trainings to complete Phase two. We aim to train more than 35% of manpower in non-emergency departments to achieve higher recall.
Conclusion:
Training for national emergencies is challenging. HDS is located right outside the emergency department and has advantages of allowing smooth traffic to decontaminate patients and prompt treatment. However, training can get disrupted with incoming ambulances, patient influx and lack of resources.
SKH aims to be well prepared in handling pandemics and still maintain its capabilities in assisting in national emergencies. There are plans for hospital simulation exercises for all relevant stakeholders and internal and external reviews are required to improve decontamination systems and processes. It is important to continue training hospital personnel to support HDS during crises.
The COVID-19 pandemic poses challenges in maintaining global medical education partnerships, with travel restrictions and infection control concerns forcing program adaptation. The Pediatric Emergency Medicine Specialty Training and Accelerated Review (PEM-STAR) program is one such international collaboration which addresses education and training gaps in emergency care for children within Thailand. As an assessment of PEM-STAR’s ability to deliver consistent outcomes despite COVID-19 constraints, we compared program results for Cohort #1 (2018-2019, pre-pandemic) and Cohort #2 (2019-2021, spanning pandemic).
Method:
Oregon Health & Science University and Bangkok Dusit Medical Services implemented the PEM-STAR tandem physician-nurse curriculum in 2018. The cornerstone of the year-long course is a set of 22 PEM-specific topic modules, incorporating remote-accessible voiceover slide lectures, quizzes, and scholarly references to teach pediatric emergency medicine essentials. Content is reviewed via monthly teleconferences. Baseline and final assessments include written knowledge tests and high-fidelity simulation cases led by physician-nurse teams. Cohort #1 simulations were performed with evaluators in-situ using critical action checklists and validated teamwork assessment tools. Due to COVID-19 restrictions, Cohort #2 final assessments were hybrid; students completed Thailand-based simulations while Oregon leaders assessed and debriefed teams via videoconference.
Results:
Written exam scores for pre-pandemic Cohort#1 improved from 48.6% (95%CI 40.30-56.9) to 92.0% (95%CI 88.1-95.9) (p< 0.001). Cohort #2, during the pandemic, had scores improve similarly from 48.5% (95%CI 40.1-56.9) to 96.4% (95%CI 94.8-98.0) (p< 0.001). One-hundred percent of physician-nurse teams from both Cohort #1 and Cohort #2 achieved the program’s established passing score on final simulation testing: performing >85% of critical action items and scoring > 85% on the teamwork tool.
Conclusion:
The PEM-STAR design, with its emphasis on videoconferencing, web-based content, and asynchronous learning, required minimal modifications to maintain satisfactory knowledge and skill acquisition during the pandemic. Educational partnerships emphasizing these features have distinct sustainability advantages in times of global disorder.
In the USA, traumatic injuries are the leading cause of death before age 45 and have significantly lower mortality if treated in a verified trauma center. Burn injuries are included in trauma statistics and represent 1.1 million injured people annually seeking medical assistance. Routing of burn injuries to ABA-recognized burn centers has yet to be assessed as it has in trauma injury. Our goal was to examine the impact of prehospital routing of burn injuries on hospital length of stay, mortality, and potential costs-of-care through a statewide care coordination center.
Method:
Our study is a retrospective statewide analysis of burn injuries from 01/01/2017 thru 12/31/2019 using the Louisiana Hospital Inpatient Discharge Database. Routing of burn patients was implemented in 2018 using the ABA burn referral criteria. Data included: total admissions with primary burn diagnosis, region, discharge status, length of stay, and raw mortality by region and state. Descriptive and comparative statistics were performed to assess the impact of routing burn-injured patients. Cost analysis was performed using Louisiana Medicaid per diem rates from 2021 at $1,907.92/day.
Results:
1,288 patients were treated in Louisiana during the study period, with 855 post-routing and 433 pre-routing. The mean length of stay was reduced from 11.84 days in 2017 to 8.82 days in 2018 (p value=0.0988), with a potential savings of 761 inpatient care days or $2.17 million. Overall mortality across the state was unchanged except in the highest volume region, where it dropped from 7.9% in 2017 to 3.6% in 2019 (54%).
Conclusion:
Burn injuries are a time-sensitive trauma. This study marks the first analysis pre and post-implementation of routing for burn injuries by a statewide care coordination center. Our study demonstrates improvement in length of stay and mortality but a continued need to examine other contributing factors, such as injury severity and concomitant trauma.
The pandemic caused by the SARS-CoV-2 virus, which has been rapidly developing globally since the beginning of 2020, has forced individual states to take many restrictive decisions aimed at stopping the pandemic and controlling the crisis situation. In Poland, the strategy of fighting the pandemic in the initial phase covered the entire country and was based primarily on preventive mechanisms to identify and quell the pandemic.
Method:
A retrospective analysis was conducted incorporating media and a literature review. This retrospective analysis was performed using legal acts and press resources and other media reports to investigate every province of Poland.
Results:
This research describes one element of the state security system tasks, that of securing an appropriate number of hospital beds for COVID-19 patients. The process focused first on establishing both the purpose and tasks of dedicated hospitals followed by discussions of the potential problems related to the functioning of these specialized facilities for patients infected with SARS-COV-2 virus. Primary attention was given to ensuring both the security of the crisis situation and the diligent monitoring of the current epidemic
Conclusion:
In order to effectively use human and infrastructural resources, it was crucial to implement objective, unified methods of organization and management, as well as ongoing evaluation of the results of the conducted activity.
A large urban jurisdiction identified a lack of experience and knowledge in use of the established regional patient tracking system among frontline emergency department employees. Lack of nursing retention, shifted departmental priorities throughout the pandemic response, and decreased opportunities for exercising were notable causes of this identified knowledge gap. Effective patient tracking has a significant impact during response to any event with the capacity to strain the hospital and healthcare system. Mass casualty incidents pose a global threat to all jurisdictions. Recognition of this threat magnifies the importance of establishing a patient tracking system and empowering frontline staff, through education and training, to immediately implement the exercised patient tracking platform.
Method:
Bolstering hospital readiness through site visits and first-receiver clinician engagement during special event planning improved effective use of a citywide patient tracking system during planned events. “Just-in-time” training tools were developed and distributed during site visits. Notably, identification of key clinical staff at each institution was an important step in meaningful clinician engagement. Utilization of these systems during special events is an opportunity to exercise a high stakes procedure during a low stakes incident.
Results:
Site visits and training material distribution effectively enhanced first-receiver participation in patient tracking during a special event in comparison to previous special events. Users required less prompting throughout the response, and the post-intervention survey indicated an increase in user confidence levels. Increased utilization of the system improved visibility into the hospital's lived experience while engaged in the response.
Conclusion:
Targeted site visits and educational material tailored to first-receiver clinicians during special events improved patient tracking efforts throughout a large urban healthcare system. During real and planned events, person and patient tracking allows for patient load balancing across the healthcare system, assists with patient and family reunification, and directs future planning, funding, and first responder and receiver education.
Hospital preparedness for a massive influx of victims relies, to a certain extent, on actions, programs, and systems that are created and executed ahead of time, but also on the knowledge, skills, and professional competences of the hospital's staff. This study aims to understand the factors influencing the preparedness of Tunisian University Hospital staff in facing a massive influx of victims.
Method:
This is a multi-method qualitative descriptive study, conducted in nine general University Hospitals (UH) in Tunisia; the first component was a phenomenological design via open-ended interviews; the second component was a qualitative observational non-participatory design via field observations.
Results:
17 participants were recruited, in an intentional non-probabilistic way. Participants to this study discussed issues related to the material and financial resources of their hospitals; the psychological impact of managing an influx of victims; their training, their involvement in the process, and the norm versus the circumstances in the field. Which led to the conclusion that: "For multiple reasons, the Tunisian University Hospitals are not ready to properly manage a massive influx of victims"
Conclusion:
This multi-method qualitative study discussed the factors that affected the preparedness of staff and readiness of UHs included. Factors were mainly resources (material and financial), psychological burden, lack of training, lack of involvement in the process and issues related to evidence-based practice. Data collected supports the idea that more research and more practical interventions need to be performed to increase the preparedness level of Tunisian UHs and their staff.
As there have been no reports concerning the relationship between incontinence and disease severity in patients in the prehospital setting, a retrospective investigation examined this relationship using data from Shimoda Fire Department.
Method:
Patients who were transported by Shimoda Fire Department from January 2019 to December 2021 were investigated. The following details of the subjects were collected: age, sex, contents of incontinence, season of transportation, weather, wind speed, temperature, place of collapse, scene time, classification of disease, disease severity (as judged by a physician at a receiving hospital) and mortality rate at the initial treatment. The subjects were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [-]). We compared the variables mentioned above between these groups.
Results:
There were 499 cases with incontinence and 8,241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the Incontinence (+) group were significantly greater in comparison to the Incontinence (-) group, while the average temperature in the Incontinence (+) group was significantly lower than that in the Incontinence (-) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions.
Conclusion:
This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.
Standardization of data collection and reporting within EMT’s is challenging. In past deployments, the Red Cross Red Crescent Type one and two facilities (Emergency Response Units- ERU’s) have collected data by hand using paper-based form and Excel spreadsheets. This process can be laborious, time consuming and often inaccurate.
Method:
RCHIS is both an electronic medical record (EMR) and health information system (HIS). RCHIS has been designed to produce pre-made reports including the MDS in seconds extracting data from the patient records. Through significant testing and pilot deployments in a domestic type one fixed clinic, the rapid production of reports such as the MDS has increased compliance and accuracy with reporting.
Results:
The utilization of an EMR and integrated HIS system for increasing compliance and accuracy with the MDS has been hugely successful. An in-depth analysis of the export data was done to confirm the 100% accuracy within the MDS report.
Furthermore, feedback from users and managers within the ERU’s expressed the excitement for the ease of reporting not only to the EMTCC, but also to IFRC and back-donors. Moving forwards, this data collection will also be used to collect essential data to audit and improve the quality of care provided within the RCRC ERU’s.
Conclusion:
In conclusion, the utilization of RCHIS within a domestic ERU (equivalent to an EMT type one or two) has been hugely successful. The next steps will involve the deployment of RCHIS within an international deployment.
Hurricane Ian impacted Southwest Florida in September 2022 leaving massive destruction. Notably, the barrier islands were isolated by destroyed bridges and docks. Delivery of Search and Rescue, Medical Care, and other aid required a joint Civilian-Military Air Operation to provide essential services.
Method:
This presentation will detail the just-in-time development and operation of a massive joint civilian-military air operation in order to provide essential disaster response services.
Results:
Components of the joint air operation included:
the establishment of a regional air asset request center
creation of a command structure for air mission tasking
the use of an airborne military air traffic control asset for forward control
setting up a helibase at an international airport
creation of multiple helispots in remote damaged areas with forward control assets
the coordination with numerous private, NGO, municipal, county, state, federal, and military agencies
heavy, medium, and light lift helicopter operations
both civilian and military dedicated medevac
hoist and water rescue operations
accommodating a US presidential visit during operations
Together these operations supported the transportation needs of Search and Rescue, Medical, Command, Planning, and Logistics Operations for XXX days until the establishment of reliable ground transportation.
Conclusion:
This presentation will not only provide insight into the planning and operation of the joint air operation but will also share the impacts on the medical care from the physicians who were directly involved in the medical care delivered on the barrier islands of Florida.
As the largest body of health professionals, nurses are looked upon during a disaster for leadership, clinical assistance, and support during these events. Nurses are at the forefront of managing disasters in their communities, yet their complex role as advanced nurse practitioners, clinicians, managers, and leaders is not always fully understood and/or recognized. The aim of this paper is to explore the level of Advanced Nursing Practice (ANP) in Australia that takes place in a disaster
Method:
This scoping review was guided by Arksey and O’Malley’s framework. The review searched five relevant databases. A scoping review design was chosen as the authors expected that evidence in the field would be produced using a wide variety of methodologies.
Results:
Nurses work long hours during a disaster with hospitals and nurses becoming the center of events and the "go to" place during a disaster. During disasters nurses often have little sleep, have limited time to meet their individual/personal needs, and frequently put others needs before themselves. Nurses mentioned in these studies were reported to have worked while they were worried for themselves and their families. These nurses reported feeling capable and reported that all their experience and skills came to the fore during these challenging situations.
Conclusion:
During disasters, most nurses are found to be flexible and adaptable, with many taking on a variety of roles. Nurses are quick to find solutions with problem-solving keys and their ability to respond to disasters "just what you do." The nurses in these studies demonstrated fundamental expertise and had the agility to pivot when the occasion demanded. As a result of this study, it is evident, and not surprising, that these Australian nurses work beyond conventional limits during a disaster.
The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions, like stroke and transient ischaemic attack (TIA). Thus, the aim of this study was to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA.
Method:
Following a published study protocol, a systematic search of databases was conducted up to May 31, 2022. Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic were considered for inclusion. The methodological quality of the included studies was assessed using the appropriate Joanna Briggs Institute tool. Overall pooled estimates of ambulance times (activation, response, patient care time) were calculated. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Stroke/TIA emergency call volume was reported using a narrative synthesis. Clinical stakeholders and Patient and Public Involvement Contributors were involved from research question development to dissemination of results.
Results:
Of 4083 studies identified, 56 unique articles met the inclusion criteria. Early data from 8/12 studies reporting ambulance times, suggests that patient care time increased. Furthermore, emergency call volume for stroke/TIA decreased during the COVID-19 pandemic, according to 43/56 studies that reported this outcome. Terminology for ambulance time intervals differed between studies. The majority of studies reported time from call to hospital arrival, whereas the minority of studies reported activation time.
Conclusion:
Preliminary results from our systematic review and meta-analysis show that conflicting evidence exists on the impact of the COVID-19 pandemic on ambulance times and emergency call volume for stroke/TIA. Thus, this review synthesized available evidence on the varied effects across different countries, healthcare systems and ambulance time terminology. Review findings may inform our understanding of healthcare system resilience in response to crises on a broader level.