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International psychosocial support guidelines reflect consensus on support principles and interventions. However, no consensus exists on what recipients consider important elements of service delivery. Within two contexts – after a potentially traumatic event (PTE) and people with Spinal Muscular Atrophy (SMA)–the aims were to contribute to (1) understanding which psychosocial support aspects are considered important by recipients and relevant stakeholders; (2) developing instruments to test and integrate those aspects in practice, in order to evaluate the quality of psychosocial support from the recipient’s perspective.
Method:
Concept mapping was used to achieve consensus on key themes of psychosocial support. These were operationalized in surveys and pilot-tested, conforming to the Consumer Quality Index. This determines the importance and needs for improvement.
Results:
Concept mapping resulted in eight key themes within the PTE context and six in the SMA context. PTE survey (N= 132) results showed key themes “an approach that starts from the needs and capacities of the affected one” and “monitoring individuals affected and initiating follow-up where needed” were most important. Key theme “providing information on common emotional reactions” received the highest score of perceived need for improvement. SMA survey (N= 57) results showed key themes “an approach that incorporates all aspects of a human being” and “a respectful approach and awareness of personal boundaries” as most important. The perceived need for improvement of the key theme “availability and accessibility of quality information” was ranked the highest.
Conclusion:
The similarities between both contexts support the notion that there are universal aspects of psychosocial support. Simultaneously, the context-specific idiosyncrasies found underscore the necessity to adapt to context. The surveys have the potential to contribute to a growing toolbox of quality evaluation instruments.
Utilization of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing avoidable attendance is an important area for intervention in the prevention of ED crowding. This study aims to develop a consensus among clinicians across care settings about the “appropriateness” of attendance at the ED in Ireland.
Method:
The Better Data, Better Planning study was a multi-center, cross-sectional study investigating factors influencing ED utilization in Ireland. Following ethical approval, data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels.
Results:
The National Panel determined that 11% (GP) to 38% (EMC) of n=306 lower acuity presentations could be treated by a GP within 24-48h (k=0.259; p<0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered “inappropriate” (k=0.341; p<0.001). For attendances deemed “appropriate” the admission rate was 47% compared to 0% for “inappropriate” attendees. There was no consensus on 45% of charts (n=136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0-59% and for inappropriate attendances ranged from 0-29%. For the Local Panel review (n=306) consensus on appropriateness ranged from 40-76% across sites.
Conclusion:
Multidisciplinary clinicians agree that “inappropriate” use of Irish EDs is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogeneous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.
Mass gatherings are becoming increasingly more common and require adequate preparedness in order to ensure the safety of participants. Standardized planning tools for optimal resource utilization during these events are lacking. We analyzed prehospital data from a high census US theme park to determine whether heat index and wet bulb index are predictive of patient presentation and transport rates.
Method:
This was a retrospective analysis of prehospital data from a high census US theme park. Daily EMS data including call and transport volume as well as corresponding local weather information were gathered between May 2021 to September 2022. The relationship between patient presentation rate and transport rate and weather information was analyzed using Analysis of Variance Testing. Patient presentation rates were calculated based on average daily attendance according to unofficial attendance tracking sources. Seasonal attendance variation was accounted for by comparing variations in patient presentation and transports to the average call and transportations rates for that respective month.
Results:
A total of 515 days of data were included. We found that higher wet bulb temperature readings correlated with both higher patient presentation rates per 10,000 attendees (>80F 4.09, 70-79F 3.39, <69F 2.84 patients; P<0.05) and increased hospital transport rates per 10,000 attendees (>80F 1.38, 70-79F 1.29, <69F 1.09 patients; P<0.05). Adjusted for seasonal variation of attendance, higher wet bulb temperatures were likewise correlated with increased presentation (>80F 102%, 70-79F 98%, <69F 93% of average patients per day; P<0.05) and transports (>80F 101%, 70-79F 100%, <69F 93% of average transports per day; P<0.05). Additional analysis noted similarly increased patient presentation and transport rates on days with higher maximum heat indices.
Conclusion:
In the setting of a high census US theme park, higher wet bulb and heat indices were strongly associated with increased patient presentation rates and patient transport rates.
Ultrasound is the standard imaging technique for diagnosing lower limb deep venous thrombosis (DVT). The National Institute for Health and Care Excellence (NICE) guidance 158 recommendation 1.1.3 states that all patients with sufficient pretest probability for DVT should be offered a proximal leg vein ultrasound within four hours. However, due to high patient volumes, formal radiology department ultrasound wait times often exceed one week. Point-of-care ultrasound (POCUS) is used to bridge diagnostic delay in our emergency department (ED) .
This study aimed to quantify numbers offered POCUS for suspected proximal lower DVT in our ED and accuracy of such studies.
Method:
A retrospective review of electronic records was conducted for patients who underwent formal lower-limb ultrasound for suspected DVT at our hospital over a three-month period (August 1, 2022-October 12, 2022). Patient charts for all ED presentations were assessed to determine whether POCUS was offered and whether DVT was diagnosed.
Statistical analysis was conducted using PRISM v9.
Results:
80 formal ultrasound scans were performed at our hospital for lower limb DVT. 58 were requested for patients presenting to ED, of which 42 had complete records available meeting selection criteria.
POCUS was offered to 24 patients in ED (57.1%). Sensitivity was 66% (95% CI 12%- 98%), and specificity was 94.1% (95% CI 75%-99%). Overall accuracy was 90%, with only one false negative study identified at formal follow-up ultrasound.
Conclusion:
Although sample size was small, our results suggest that POCUS is an accurate but underused tool to diagnose lower limb DVT. Developing a standardized protocol for performing and reporting POCUS DVT scans in ED should allow for earlier diagnosis and initiation of appropriate treatment where necessary.
This Australian-first project explored residents’ values about living in one of Australia’s extreme bushfire risk areas. The project team developed the Upper Beaconsfield Bushfire and Biodiversity Tool (UPB&BT) which delivers tailored local information for residents living in the area. Designed to empower residents to make informed decisions, this user-friendly, online tool visualizes a community’s devastating bushfire history, reveals residents’ values about living in this area, and provides evidence-based actions to protect biodiversity and manage bushfire fuels on private property.
Method:
Structured decision-making methodology informed the survey design to elicit residents’ values about biodiversity protection and bushfire risk reduction, by inviting approximately 3000 residents to complete the survey. This community-led project applied a participatory approach by inviting collaboration between government, agencies, universities, and community representatives.
Results:
Key results revealed 75% of respondents valued nature and lifestyle. 51% saw bushfire risk as an important factor for managing vegetation on private land, while 65% either mow or slash to manage vegetation. Synthesized data informed the content of the UPB&BT, which sourced evidence-based knowledge or specialists’ expertise to provide tailored content and actions that met residents’ diverse values. This included the consequences of chosen actions, which helps residents understand the impact of their decisions. However, results identified confusion in roles and responsibilities.
Conclusion:
This ground-breaking community-led, government-funded project joined with government, agencies, universities, and community representatives to develop a new bushfire and biodiversity tool to help residents understand biodiversity protection and bushfire management in their local community. Results aim to empower residents to make their own evidence-based and informed choices about managing their properties, thereby contributing to the community good. They decide what is important and identify available actions and their potential consequences. Other communities could replicate this process to localize their own disaster risk reduction strategies.
This research aims to review the impact of drug addiction, domestic violence and suicide in Australia through the lens of disaster risk reduction. This study explores whether drug addiction, domestic violence and suicide can be considered as disasters according to established thresholds and definitions; and whether contemporary health emergency and disaster risk management (HEDRM) practice can be adapted to support action to reduce the impact of these events and inform disaster risk reduction.
Method:
A literature review was conducted to explore drug addiction, domestic violence and suicide as societal disruptions causing disasters. Key Australian government reports describing deaths associated with suicide, domestic violence and drug addiction were identified, following which a constrained snowball sampling was applied to the bibliography of each document to gather further key articles and inform the evolution of the impact of these themes in Australia over the period 2000-2018. The search strategy included both peer reviewed and grey literature. We used the search terms ‘social disruption’, 'non-traditional', ‘drug addiction’, ‘domestic violence, ‘suicide’ and 'societal disruption' as key words and included articles if they demonstrated an analysis of the theme related to health impact related to disaster settings.
Results:
Utilizing the Australian Disaster Resilience Knowledge Hub and the international CRED criteria for a disaster, the impact on human health of drug addiction, domestic violence, and suicide upon the Australian population each meet the criteria of a disaster.
Conclusion:
Public health practice through the lens of the determinants of social disruption combined with activities that consider hazards, vulnerability, and exposure, can institute prevention, preparedness, response, and recovery programs to reduce the impact of drug addiction, domestic violence, and suicide.
Midway through the ‘Sendai Framework for Disaster Risk Reduction 2015-2030’, many nations are spending time, money and effort to enhance their level of preparedness when facing disasters, on the other hand communities, countries and even continents are being left behind. This study was conducted aiming at evaluating the level of disaster preparedness and response of Tunisian University Hospitals.
Method:
This is a cross-sectional nationwide study conducted in Tunisia, from November 2020 to April 2021. Including nine Tunisian University Hospitals and using the Hospital Safety Index. The data were analyzed using the 'Module and safety index calculator'.
Results:
This study showed that seven out of the nine University Hospitals were assigned the ‘B’ category of safety with overall safety indexes that ranged between 0.37 and 0.62. Also, four out of nine University Hospitals had safety scores less than 0.20 regarding their emergency and disaster management.
Conclusion:
This is the first study to evaluate disaster preparedness and response of university hospitals in Tunisia and in north Africa. It showed that the lack of knowledge, resources and willingness, are the most important issues that need to be addressed in order to enhance the preparedness of Tunisian hospitals.
St. Joseph's Mission Hospital, Nyabonda, Kenya is the site chosen for a new Trauma Response Center as part of a new national highway development scheme. This highway will significantly increase in traffic volume expected in the region. With increased traffic volume, there will be an expected increase in trauma presentations as well as medical presentations due to increased populations in the area. This center is expected to serve a population of four million people. To date, the majority of nurses, medical officers and doctors in the pre-existing facility received no formal post graduate training in medical and surgical emergencies.
Method:
Global Emergency Medical Skills (GECS) is a registered charity, with an aim to provide medical education for the management of both trauma and medical emergencies for both adults and children. GECS was invited to attend St. Joseph's Missionary Hospital to provide education to nurses, medical officers and doctors. A curriculum encompassing the management of medical and surgical emergencies through both didactic lectures, practical skills training and simulation based workshops was composed and delivered by a group of 11 faculty, crossing Emergency Medicine, Intensive Care, Anesthesia and General Medicine. This curriculum had 28 participants and was conducted over a five day period. A "train the trainer" model was employed to ensure the strongest candidates were chosen for further training on how to deliver course material and organized simulations for future colleagues in St. Josephs Trauma Center.
Results:
Questionnaires of both staff and students have highlighted the utility of GECS and its curriculum in preparing staff for the opening of this new trauma center.
Conclusion:
This program was the first of its kind undertaken in St. Joseph's Hospital and has provided valuable education to the staff of this new trauma center. This project has enabled the continuity of this knowledge through chosen trainers.
During the Covid-19 Pandemic, the Department of Emergency Medicine is the one of most busy in Nepal. Challenges and complexities of providing emergency medical service during the waves of the Covid-19 pandemic in Nepal were analyzed.
Method:
Three years (2020 – 2022) of data was analyzed from Covid patients registered in Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine for reference with National Data of Ministry of Health and Population, Government of Nepal.
Results:
On November 15, 2022, there were 5,969,338 Covid PCR tests and 1,452,639 Covid Antigen tests in Nepal with 1,000,826 (16.8%) PCR, 152,197 (10.5%) being positive. The cure rate was 98.7% (988,316 cases). There were 12,019 mortalities with 1.2% case fatality. In TUTH 2020 – 2022 records; 3,794 total severe Covid-19 patients were admitted; In the first year, only two patients (1M:1F); In the second year 2,056 patients 1.8M:1F and in the third year 1,736 with 1.1M:1F. The age groups with the first wave vs the second wave were 6.42% vs 5.47% of 0-20 years; 24.22% vs 26.84% of 21-40 years; 30.57% vs 30.87 of 41-60 years and 38.57% vs 36.87% of above 60 years. The hospital mortality rate was 751 (19.8%). Challenges were due to resource limitation, limited PPE, scarcity of oxygen, medication, and ventilators. In TUTH, all levels of emergency management and various definite care were provided 24/7 hours in the pandemic period. There are a lot of challenges in Pre-Hospital Emergency Care Service due to a limited number of designated Advance Ambulances during transportation of severe Covid patients. With these challenges and complexities, there were six deaths of their own hospital staff due to severe Covid-19.
Conclusion:
The challenges and complexities of providing emergency medical services during the Covid-19 pandemic in Nepal have been overcome with teamwork and activation of the emergency care system in Nepal.
During the 2022 Multinational Monkeypox Response, cases of Monkeypox illness reported in children and adolescents in the US were rare. Early in the response, little was known about MCM safety and efficacy for treating monkeypox in children and adolescents. As cases in children and adolescents increased, knowledge about safety and efficacy evolved.
Method:
Cases of monkeypox in children <18 years of age across the US were reported to CDC. MCM consultations from clinical and regulatory affairs subject matter experts supported clinician administration and management of antiviral and immunoglobulin treatment. Data from the first pediatric cases were collected to help answer some of these questions on the use of MCM in pediatric populations.
Results:
Across the US, 116 cases of monkeypox in children <18 years of age have been verified through October 2022. Of these cases, 41 occurred in patients twelve years of age or less, with 75 cases in adolescents 13-17 years of age. Ten percent of patients were hospitalized, none required ICU care and no deaths occurred. Children were most commonly hospitalized due to young age, rash near or including the eye, secondary bacterial infections, or pain management. At least eleven patients with confirmed orthopoxvirus were treated with tecovirimat and two with Vaccinia Immune Globulin. Those who received MCM recovered and tolerated treatments well with one patient stopping treatment secondary to development of a drug rash.
Conclusion:
Data on the safety and efficacy of MCM for monkeypox are limited in pediatric populations. As of November 3, 2022, most cases of monkeypox in the pediatric population in the 2022 monkeypox outbreak were mild and self-limited. Patients who received MCM recovered and tolerated treatments without serious adverse events. These findings can inform clinicians and public health providers about the clinical features of monkeypox in children and provide information about MCM treatment options.
Explosive hazards like landmines are known to contaminate over sixty countries and continue to threaten the health of affected communities across generations. The current study is the first to consider the impact of landmines and explosive remnants of war by drawing on global casualty data to determine mortality patterns.
Method:
This study is a retrospective analysis of secondary multi-source data on over 100,000 explosive hazard casualties from 17 low and middle income conflict-affected countries. This data was collected from mine action centers, international non-governmental organizations, and international bodies (e.g., United Nations), and include surveillance data, retrospective and prospective survey, and data collected through organizational operations.
Results:
The global case fatality rate was 38.8 deaths per 100 casualties. Males represented 87.4% (n = 34,642) of those killed, however females had higher odds of death when involved in an explosive incident (OR = 1.29, 95% CI: 1.24 – 1.34, p < 0.01). Adults experienced higher odds of death compared to children (OR = 1.60 95% CI: 1.55 – 1.64, p < 0.01). Case fatality ranged between countries with Lao PDR, Angola and Ukraine the countries with the highest proportion of deaths. Improvised explosive devices (IEDs) and ERW had higher odds of death compared to antipersonnel landmines (OR = 1.78, 95% CI: 1.67 – 1.91, p < 0.01; OR = 1.55, 95% CI: 1.50 – 1.60, p < 0.01).
Conclusion:
Mortality from landmines and other explosive hazards remains a public health issue in conflict impacted countries. This study addresses the lacunae of global data for explosive hazard casualties and provides an understanding of how fatal injury is endured. Adult males represent the most deaths globally, however case fatality ranges across conflicts. ERW and IED had the highest risk of death. These findings underscore the need for a global health response and strengthen advocacy measures for conflict affected communities as well as weapons prohibition campaigns.
As public health emergency management (PHEM) is a growing field, so is the development of its workforce. Ensuring workforce readiness from graduate-level education and courses can be challenging given the limitations of the traditional classroom environment. This presentation highlights a novel curriculum created and taught by first responders consisting of simulation and application of practical skills developed within a public health graduate certificate program.
Method:
The semester-long course reviews foundations of PHEM and students progress through a sequence of increasingly complex discussions and operation-based exercises for both domestic and international disaster preparedness and response. Students progress through case studies, tabletops, functional exercises, and full-scale exercises with practical skills interspersed. This includes creation of SMART objectives and incident action planning, crisis communication and public messaging drills, use of radios, personal protective donning and doffing, and Geiger counter use.
During the COVID-19 pandemic, the curriculum was adapted for asynchronous and live virtual sessions with further offerings including various online trainings that are required for most employments in the field and guest speakers with national recognition for their experiences in public health and healthcare emergency management and subject matter expertise in various fields related to preparedness and response.
Results:
Since commencing in 2016, approximately 100 students have completed the course and feedback has been overwhelmingly positive even with limitations of in-person activities during the COVID-19 Pandemic. Student feedback has noted that the majority of students feel that the knowledge and skills from the coursework is applicable to future employment and that their ability to think critically about the subject matter increased as a result of taking the course.
Conclusion:
Implementation of this innovative graduate level course can serve as a model to enrich students’ education through practical activities and hands-on simulations.
Large-scale mass-sporting events pose unique challenges for emergency health teams. Data is limited in athletes with sudden cardiac arrests (SCAs) and the emergency medical services (EMS) in major sporting events that took place after the coronavirus pandemic.
Method:
This retrospective observational study describes data from the Taipei Marathon event that took place on December 19, 2021, in Taiwan. The temperature was about 15.2–19.3°C. Four SCAs among 18,144 half-marathoners and the EMS were enrolled.
A medical command center was set up 100 meters from the finish line. Ten medical tents, one first-aid station, and nine event ambulances were distributed along the course, and one medical tent was placed near the baggage storage area. Each medical tent comprised: 1 doctor, 1–3 nurses, and 1–3 paramedics. The in-event EMS also comprised a mobile first-aid team. Thirty paramedics rode motorcycles and carried automated external defibrillators and emergency medical kits throughout the racecourse.
Results:
Among the 7,811 full- and 18,144 half-marathoners, the total number of SCAs was four male half-marathoners. Three runners (75%) stated that they decreased their weekly running volume during the pandemic restrictions’ period. Two runners (50%) experienced cardiac arrest in the final quarter of the race. The median interval of time between SCA occurrence and EMS arrival was 2.5 minutes (interquartile range, 0.5–4 minutes). Electric shocks were delivered to all the four runners (100%) experiencing ventricular fibrillation, and all of them were successfully resuscitated in the field. The median interval of cardiopulmonary resuscitation duration before return of spontaneous circulation was 8.5 minutes (interquartile range, 6–9.5 minutes).
Conclusion:
4/18144 is a significantly high number of SCA compared to data from the annual Taipei Half-Marathon between 2016 and 2020 and past half-marathons worldwide. The high prevalence rate of SCA (22 per 100,000) may be due to inadequate acclimation and training volumes.
The Institute for Emergency Medical Assistance of Canton Sarajevo covers 1,777 square kilometers. All teams are physician staffed and are organized in ten geographic points. Patients are transported to a tertiary care level facility–University Clinical Center Sarajevo. Our objective was to determine the association between total prehospital time and severe trauma patient outcomes in a physician staffed emergency medical system with the hypothesis that the length of prehospital time is insignificant to patient outcome if physician treatment begins on scene.
Method:
This was a descriptive, retrospective, analytical study conducted from June to December 2020. The data of 153 patients with an ISS score of ≥ 16 was selected from patient registries of both facilities. According to transport duration, patients were assigned to one of four groups: <15 minutes (group 1); 16 to 30 minutes (group 2); 31-45 minutes (group 3) and > 45 minutes (group 4). Both groups according to the TRISS score were equal in mortality with an expected survival rate margin taken at 70% due to this being the approximate intrahospital survival rate of our patients. The primary outcome was in-hospital mortality, and secondary outcomes included length of hospital stay, length of ICU stay and 30-day survival rate.
Results:
We found no statistically significant difference to in-hospital mortality in relation to the length of pre-hospital transport when physician treatment begins on scene (p = 0,186). We ruled out any significant difference in length of stay and ICU stay (p = 0,179 and p = 0,173, respectively) among the preselected groups in relation to the length of prehospital time. Also, the 30 day survival rate was unaffected by the length of transport in physician led teams (p = 0,156).
Conclusion:
With strategically placed physician staffed EMS teams and physician treatment beginning on scene, patient outcome is unaffected by the length of transport.
The mental health consequences of health emergencies and disasters have the potential to be sustained and severe. In recognition, the 2018 Kobe Expert Meeting on Health Emergency and Disaster Risk Management (Health EDRM), prioritized mental health as one of the key research areas of Health EDRM, to be addressed in a multi-country research project supported by WHO (Kayano et.al., 2019). As climate change, growing urbanization, population density and viral transmission generate increasingly severe hazards, attention to mental health will be critical.
Method:
The Asia Pacific Disaster Mental Health Network was established in 2020 to foster advancements in mental health research and policy in the region. Building connections between researchers, practitioners and policy makers, the Network includes broad representation from interdisciplinary scholars and organizations across eight Asian and Pacific nations. A research agenda was designed in early meetings, and collaborative research projects were established.
Results:
The Network has supported the development of innovative disaster mental health research investigating community engagement in recovery, psychosocial interventions, and evaluation frameworks. A recent multilingual systematic review of more than 200 longitudinal studies identified the long-term trajectories of post-traumatic stress symptoms, depression and anxiety following disasters and pandemics (Newnham et al., 2022). Synthesized evidence of risks related to age, gender and disaster type were determined to inform intervention targets.
Conclusion:
The Asia Pacific Disaster Mental Health Network established a platform for scholarly connection, intervention planning and knowledge dissemination. This presentation will provide an overview of the Network’s activities, and research highlights that have identified targeted points for policy and practice.
The recently approved COVID-19 vaccine in 2021 provided a glimmer of hope to all people who had isolated, or lost loved ones to the SARS-COVID-19 virus. Clinics were rapidly established in non-traditional settings in order to meet the need in the early phases of the vaccination program. Contractor support provided rapid personnel support to meet the needs of many locations in several states. Consideration of basic infrastructure requirements such as Incident Command, security, HVAC, electricity, water and sanitation were part of a state supported vaccine clinic in an economically challenged neighborhood in downtown Miami, Florida.
Method:
Topics to be discussed include staffing mixes, language/cultural concerns, handheld EMR applications, patient flow, immunization practices, testing practices, vaccine security, adverse event management, infection control procedures and the ever present supply chain challenges. The discussion will be framed from the perspective of the Chief Nursing Officer in an ever challenging vaccine environment.
Results:
Over 20,000 vaccines were successfully provided in a little over three months, and a community-based Student Internship program was also implemented.
Conclusion:
Vaccine administration is possible in a variety of settings. Foundational principles of vaccine security, management of the environment and provision of safety and security for patients and staff will help to ensure a successful public health campaign.
Japan Disaster Medical Assistance Team (JDMAT) consists of four personnel. They are selected in 47 local governments in Japan, and after the completion of a four day boot camp, they are registered in the list of JDMAT. Hyogo Emergency Medical Center (HEMC) has been playing an important role as one of the oldest boot camps with Disaster Medical Center in Tachikawa. The boot camp's significance is obvious, but the JDMAT system requires a trainer for the course. Many courses were discontinued and affected by the COVID-19 Pandemic.
Method:
Retrospective, single institute data, observed in the number of participants for instruction. The periods are from March 2019 to September 2022. Instructing members of this boot camp consist of three categories of Drs, Nurses, and logisticians.
Results:
In FY2019, from April to March during the pre-pandemic year, a boot camp was held nine times. During those days, the total number of instructors, including potential ones, was 659 persons, and fortunately 75 people participated for the very first time. However, during the Corona era, in FY2020, the boot camp was held only four times. The total number of instructors was 161 persons, and 14 people participated for the first time. In FY2021, the boot camp was held only three times. The total number of instructors was 141 persons, and 11 people participated for the first time. In FY2022, after two quarters passed, the boot camp was held five times according to the schedule. The total number of instructors was 256 persons, and 18 people participated for the very first time.
Conclusion:
Officers were not trained for future disaster response for two years because of the pandemic.
In Germany, emergency care is provided by ambulances and rescue helicopters. Emergency physicians are part of prehospital care. The rescue helicopter in Dresden covers the city with 540.000 inhabitants and surrounding areas. The goal of the study was to evaluate cases of traumatic cardiac arrest (TCA) and to describe factors that affect the primary success of prehospital cardiopulmonary resuscitation (CPR) in trauma.
Method:
Data of all emergencies from the German Air Rescue (DRF-Luftrettung®) Helicopter Base Dresden were recorded on a standardized protocol and transferred to a central database (MEDAT®, HEMSDER®). Data from all patients with severe injuries, classified as polytrauma between January 2006 and December 2015 were analyzed.
Results:
There were a total number of 14,126 emergency cases involving the rescue Helicopter. The Helicopter was on the scene within 10.9 minutes [4-34]. Polytraumatized patients were identified in 673 cases (4.76%), the mean age was 43.73 years [2-98], and 498 patients were male (73.99%). In 444 cases, traffic accidents were responsible, in 188 cases falls from high. In 46 cases a suicide was documented. Mean ISS was 34,04 [16-75]. The main injury regions were head, extremities and chest. In 115 patients (17.08%) a TCA was observed. 43 pat. were pronounced dead initially and no treatment was initiated. 72 pat. (62.6%) received CPR. 39 of these pat. (54,17%) were also pronounced dead after treatment. 14 pat. (19.44%) were transported to hospital with ongoing CPR. 19 pat. (27.38%) reached the return of spontaneous circulation (ROSC). Male pat. reached more often ROSC.
Conclusion:
According to present guidelines for TCA, it is important that reversible causes of cardiac arrest in trauma pat. are to be treated. If we ensure the treatment of hypoxia, hypovolemia, tension pneumothorax and cardiac tamponade consequently, there will be a survival chance. Regular training for manual skills and simulation can be a key factor.
Children are almost systematically involved in mass casualty events, especially in the context of terrorist attacks. Unfortunately, the emergency medical responder preparedness is quite often low when it comes to pediatrics, on both technical and emotional sides. Preliminary training is indispensable, and full-scale simulations are arguably the best solution to tackle the needs of the first responders. The purpose of the study was to describe a simulation-based pediatric training with pediatric psychological support set up for the drill.
Method:
A full-scale exercise involving children between five and fifteen years old was conducted in the Toulouse municipal stadium during the preparation of the 2016 UEFA (European Football Championship) in France. As children welfare was the primary concern, a psychological support team was present at each stage of the drill and assessed any mental harm that could have happened. Children were asked about their feelings at the end of the exercise with a 5-point Likert rating scale and their parents had to report any perceived changes in the following week.
Results:
Out of 16 children participating in the drill, four were in an immediate situation (P1), four were in an emergent situation (P2), and eight were in an urgent situation (P3). One hundred percent of them rated their experience as very good and expressed no stress to their parents in the week that followed, and no harm was detected by the psychological support team during the exercise.
Conclusion:
The results of the study show that involving children as victims in pediatric disaster drills is possible in these conditions without impacting the mental welfare of children.
The rise of the COVID-19 pandemic caused significant concerns due to the risk of transmission in such mass gatherings. Too many variables for such a critical challenge made it more of a complex situation, with an enormous negative impact on either decision. In this paper, we aimed to summarize the experience of Saudi Arabia in hosting and managing Hajj throughout the pandemic for three seasons, the public health strategies to control the COVID-19 transmission during Hajj, and the policies and regulations that were implemented for the safe return of Hajj.
Method:
This is a summary of our experience in managing Hajj seasons throughout the COVID-19 pandemic for the period 2020, 2021, and 2022. A description of the factors, models, and tools used to assess the situation for each year, and the bundles of measures followed to mitigate the events aiming to hold a "Safe Hajj".
Results:
2020 was a unique year, with the pandemic at its height with no vaccination available. So, the decision was to hold a symbolic strict Hajj of only 1,000 pilgrims residing within Saudi Arabia. In 2021, as the World was easing restrictions and distributing vaccines, around 60,000 internal pilgrims got to perform Hajj, and 2022 hosted one million international pilgrims. That is still 40% of 2019 Hajj with 2.5 million due to considerations to avoid usual overcrowding and mandating COVID-19 full vaccination status.
Conclusion:
Our experience with the COVID-19 pandemic over the past three years has informed us that huge MGs can be conducted safely during the pandemic if adequate measures were implemented. That would include an accurate and reliable risk assessment to inform policymakers about the most effective strategies.