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The differential impact and needs of women during disasters are highlighted in contemporary research, there is limited understanding of the distinctive contribution they make and the ways they cope. Women are the key drivers of livelihood, therefore, the economic losses resulting from natural hazards may have massive impacts on their mental health. This study examines how the self-help women's groups in rural Nepalese communities provide economic, social, socio-political, and public-health support to build safer, sustainable, and resilient communities.
Method:
In-depth open-ended interviews were conducted between January 2021–April 2021 with grassroots women leaders(n=8) representing their (women’s/mother’s) group inquiring about their activities related to risk reduction and perspectives on how they cope during natural hazards. The findings were analyzed and discussed using two analytical frameworks namely, the Sustainable Livelihood Approach (SLA) and Bronfenbrenner’s Socio-Ecological Model (SEM) as scaffolds. Data analysis followed the thematic analysis technique.
Results:
Two major themes emerged from the in-depth interviews: 1) Women are doing their part and 2) Help-seeking behavior as a barrier and facilitator. The traditional female household roles such as cooking, feeding, and caring during pre-disaster states are extended to rescuing, protecting, laborious cleaning, and providing physical and emotional support during disasters. The pre-and post-disaster care responsibility and help-seeking behavior have implications for health, safety, well-being and sustainability. The findings also suggest the inevitability of self-care for women during and post-disasters.
Conclusion:
The care roles of women involve both livelihood and health benefits for the family and the entire community. To mitigate the physical and mental health burden for women amplified during natural hazards, self-care should be a critical component of advocacy in disaster awareness campaigns and help-seeking behavior should be promoted as a strength rather than insufficiency.
The Japanese Red Cross Society has been supporting MCI response support for Palestine hospitals in Lebanon since 2018.
Method:
It was started from a hospital as a single topic in a one-year ER trauma course, which was combined with an ER triage course. In the next hospital it was revised into not only a theological lecture course but also a field triage training course with pre-hospital volunteers. As a result, when the Beirut explosion happened in 2020, the first hospital could accept more than 50 green patients at once, and the second one sent a pre-hospital team to do triage at the scene showing that training courses were useful in a real MCI case .
Results:
At this time, support is being provided in a new hospital by making use of these experiences. A current report will be available when this association is held.
Conclusion:
MCI response support for refugee camps is improving through trial and error, which would have much in common with other MCI responses in many countries and areas.
A resilient health care system is expected to withstand disruptive events and consistently deliver high quality care by continually adapting, learning, and improving. To achieve these expectations, medical command and control teams are responsible for making relevant strategic decisions, reallocating resources, and initiating cooperation. Early during Covid-19, medical command and control teams were faced with an unforeseen increase in number of patients, as well as unknown disease mechanisms and treatment regimes. Timely and adequate decision-making to become a resilient healthcare system and maintain high quality care was necessary. The aim of the present study was to describe the challenges and strategies in a medical command and control team during the early phase of the Covid-19 pandemic.
Method:
A semi-structured retrospective in-depth interview study with phenomenological approach and inductive design was used. Thirteen experienced decision makers serving in a regional medical command and control team were interviewed using the Critical Decision Method. The interviews were analyzed using manifest conventional content analyses.
Results:
The respondents described twelve separate episodes during the Covid-19 management. The analysis resulted in five themes: organization, adaptation, common operational picture, assumptions, and analysis. Organization described how organizational challenges affected the decision-making process. Adaptation described the strategies to overcome the obstructive organizational factors. Common operational picture described how challenges in lack of available information affected decision-making and strategies used in creating situational awareness. Assumptions offered descriptions of strategies used to make decisions. Analysis emphasized descriptions and strategies affecting the decision-making process.
Conclusion:
This study enables a better understanding of how medical command and control teams can be organized and structured, while also highlighting challenges in maintaining high-quality care during unexpected events. The findings obtained in the present study provide further knowledge about disaster resilience and can be utilized in educational and training settings for medical command and control.
Health service capacity has been an issue in Ireland since the 1980s swinging cuts. Government reports from 2003 have consistently identified a requirement for 3,000-5,000 extra beds on top of the current approximately 10,500 capacity. Acute hospital bed capacity issues have escalated, the formal system of recording “over capacity” patients or “patients on trolleys” has developed. A “Trolleygar” reports issues from the Health Service Executive (HSE) three times daily. This count is an underestimate as patients temporarily housed in day care units, surgical, or medical assessment units, discharge lounges and other clinical areas which have a bed space are not counted in this overcapacity measure. This study's aim is to calculate the annual number of days on which no patients were lodged on trolleys in Wexford General Hospital.
Method:
Descriptive study using anonymized freely available data from the national HSE Trolley GAR reports on trolley patients in Wexford General Hospital from January 2019 until September 2022. A Golden Zero trolley day was stated as a day on which there were no reported trolley-patients at the three time points, Silver Zero trolley day when two of the time periods recorded no trolleys and a Bronze Zero Trolley day when one period recorded a zero trolley count.
Results:
Data was collected on 1,369 days, with 90 days excluded due to missing data sets. There were 162 Golden days recorded (12.67% of total days). The year 2020 recorded the highest number of Golden days at 28.69% (105 days), followed by 2021 with 11.23% (41 days). During 2019 there were 3.84% (14 days) Golden days and 2022 had the lowest number (January-September) with 0.73% (2 days).
Conclusion:
Despite a zero-tolerance policy, Golden days are disappearing rapidly, capacity is urgently required with post-pandemic ED attendance surges worldwide. True recording of overcapacity patients is required for appropriate capacity modeling.
The current Incident Command System (ICS) was developed to manage wildland fires, then was adopted by general firefighting. It has since been adapted to multiple other sectors and widely used. The Hospital Emergency Incident Command (HICS) was introduced in 1991. An ICS currently is required to be used for hospital incident management in the US.
The overarching structure of traditional HICS consists of Command Staff (Incident Commander, Public Information Officer, Safety Officer, Liaison Officer and Medical/Technical Specialist) and General Staff. The General Staff has Sections consisting of Operations, Planning, Logistics and Finance/Administration. Multiple and flexible subgroups carry out the processes in these areas.
This HICS structure does not adapt easily to hospital daily functions and alternatives have been proposed. This includes structuring around essential functions and mixed models. Over time hospital systems have become larger, and incidents more complex and sustained. New more expansive and flexible ICS structures are needed for complex responses.
Method:
We reviewed both the published and grey literature for examples of different incident management structures and evidence of their effectiveness.
Results:
There is very little scientific literature on this topic. Several different descriptive reports exist. Multiple examples of hospital incident command organization structures from the hospital level progressing to hospital (and healthcare) system level and then multistate regional models will be reviewed. This includes the standard HICS model, emergency support function models and modifications following advanced ICS principles such as area command.
Conclusion:
Different ICS models exist that may offer individual healthcare systems improved ways to manage disasters.
Japan is an island nation surrounded by the ocean. Seventy percent of the country is mountainous, and there is no abundance of habitable flat land. Japan is a disaster-prone country, with an average of 25 typhoons per year occurring near Japan and 20% of the world's earthquakes of magnitude six or greater occurring in Japan. The Great East Japan Earthquake (2011) destroyed many medical facilities in coastal areas. The government is seeking ways to continue medical services using ships in preparation for future Nankai Trough Earthquakes. This study introduces the current status of studies for installing hospital ships in Japan.
Method:
Based on materials on hospital ships published by the Cabinet Office and reports on training exercises conducted by various organizations, this report summarizes the current status of studies on introducing hospital ships in Japan.
Results:
In 1991, a committee was established to gather domestic experts to study a multi-purpose ship, and various studies have been conducted intermittently. The current policy focuses on utilizing existing resources such as Self-Defense Force cargo ships, civilian car ferries, etc. The demonstration training for a hospital ship with the Self-Defense Force's field surgery system and the Red Cross Emergency Response Unit has been conducted. Other studies are underway to provide medical support to remote islands by ocean tugboats. Future issues for utilizing existing ships include 1) maintaining medical personnel and medical equipment and materials in times of disaster, 2) utilizing and maintaining ships during peacetime, and 3) establishing access to ships that are unable to dock at a port.
Conclusion:
Hospital ships in Japan are considered to utilize existing vessels rather than building new ones. However, there are unresolved issues, such as how to operate the ships during disasters, the cost of maintenance, and transporting patients from land.
Australian Standard 4080-2010 Planning for Emergencies in Health Care Facilities outlines the requirements for all health care facilities to have procedures in place to respond to internal and external emergencies. These procedures must include mechanisms to activate emergency response systems, and staff should be trained and familiar with these procedures.
Method:
To guide staff, Emergency Procedures Flip Charts have been developed and strategically placed throughout facilities. These Flip Charts address immediate actions for staff to follow, including notification and escalation via an internal emergency number.
Specific training has been developed for identified key staff, such as Fire Wardens, but for the general staff the training in Emergency Codes is generic and does not provide scope for staff to contextualize response actions in relation to their department and its nuances.
A survey of staff across all disciplines was conducted which identified knowledge gaps in the immediate response requirements for the different Emergency Codes. To address this knowledge gap, and to ensure staff have an increased understanding of the response expectations relevant to their department, the Six Minute Intensive Training (SMIT) Tools have been developed. These tools can be delivered by any staff member in any forum, such as safety huddles, handover, in-services and toolbox talks.
Results:
A survey was conducted three months after their implementation which identified an increased understanding of response requirements. This result, combined with After Action Reviews from actual responses, highlighted an increased knowledge of the Emergency Codes and response actions. It also identified areas to improve delivery using localized examples.
Conclusion:
The introduction of the SMITs is a successful first step for increasing staff knowledge and responses to Emergency Codes. The opportunity for staff to deliver these SMITs within their own departments provided an avenue to contextualize responses to local practices and nuances.
The complexity of disaster management is rising because of rapidly advancing technological changes and the challenges associated with coordinating responses among multi-organizational contexts. One of the common problems with multi-organizational disaster management is the need for an interoperability language. Therefore, by maintaining effective communication, risk can be reduced, and lives can be saved in times of crisis. The United States SCIPs represent one of the solutions used to achieve a culture of better interoperability. In 2019, The National Council of Statewide Interoperability Coordinators (NCSWIC) and CISA collaborated to create a tool that identified 25 Interoperability Markers. This tool is integrated with SCIPs to increase interoperability and serves as a national framework to describe interoperability maturity at the state levels.
Method:
This is a descriptive study documenting each state's 25 interoperability markers and analyzing common gaps and successes. Two methods were used for collecting data. First, an online search for each state's SCIP. Then, an email was sent to all state's Statewide Interoperability Coordinators (SWIC) to request the most recent update of that state’s SCIP. Data were collected from October 1-31, 2022 and exported into an Excel spreadsheet (Microsoft Corp; Redmond, Washington, USA) for descriptive statistics and analysis.
Results:
The level of interoperability maturity across the United States is 66%. The governance level in the interoperability continuum scored the highest across states with 76.4%. While the other levels of the interoperability continuum like technology, training and exercise, and interstate emergency communication scored 63.5%, 64%, and 60% respectively.
Conclusion:
This study identifies a high level of interoperability maturity across the United States at the governance level. It is essential to continue to improve interstate interoperability through compatible technological solutions and multi-agency training. Finally, further research on interoperability markers is needed to enhance multi-agency emergency response.
Improving access to emergency health services can reduce morbidity and mortality for patients with acute emergent conditions. The WHO and ICRC developed the Basic Emergency Care course to train frontline providers in a systematic approach to common and treatable life-threatening conditions. This study aims to evaluate the knowledge retention of Rwandan emergency care providers after implementation of this course.
Method:
A prospective, quasi-experimental, nonrandomized study was conducted at the University Teaching Hospital of Kigali (CHUK) in Rwanda. A formal survey was conducted to understand the current composition and training of Rwandan emergency care providers. Baseline and post-course assessments of knowledge were collected via an existing 25 multiple choice question survey tool which is an already established part of the BEC curriculum. Forty providers who care for patients with acute emergent illness were included. Data collected included age, gender, preferred language, as well as information about professional background, knowledge and skills. Providers with both baseline and post-test results were included in the analysis (n=40).
Results:
Of the 40 Rwandan providers, 47.5% (n=19) male and 52.5% (n=21) female, 26 were nurses, six were doctors, six were prehospital providers, one was both a prehospital provider and nurse, and one was a midwife. The mean age was 36.3. Out of 25, the mean baseline score was 17.8 (SD=3.2) and this significantly increased to a mean posttest score of 21.9 (SD=2.4). 85% (n=34) of providers’ knowledge improved, 2.5% (n=1) of provider’s knowledge stayed the same, and 12.5% (n=5) of providers' knowledge decreased. The difference between the pre and post-test scores was found to be statistically significant, 4.1 (SD=3.4), (P<0.0001).
Conclusion:
This study demonstrated that implementing the BEC course has significantly improved the emergency provider knowledge base. Further studies are needed to demonstrate the impact of BEC training on patient care and morbidity/mortality outcomes.
The world's second largest Ebola virus disease outbreak in DRC (August 2018-June 2020) caused 3,481 cases in 29 health zones, 2,299 deaths and about 250,000 contacts traced. It occurred in densely populated vast areas, with insecurity, ongoing humanitarian crisis and community reluctancy. Four hubs, sixteen sub-coordinations were set up with hundreds of experts to support local inexperienced health workers. Five health coordinators were deployed to lead more than 600 people at national and field level coordinations. This work aimed at reviewing coordinators’ leadership styles using leadership theories. Recommendations were made for future complex health operations.
Method:
The leadership styles of the five coordinators were reviewed retrospectively using different leadership theories. Three groups of theories: (1) Leader’s traits, characteristics, and skills; (2) Leader’s behaviors: behavioral, transformational, and situational; (3) Authentic and servant leadership.
Results:
Analysis with the three groups of leadership theory highlighted that leaders had mixed leadership approaches.
1) Self-confident, calm, determined, extravert (one a bit shy), conscientious, motivators; Sociable and empathic while dealing with staffs affected by incidents; Few strong characters affecting interpersonal relations; Strong negotiation skills while dealing with local stakeholders; Experienced and knowledgeable in analyzing, making judgment and decisions.
2) A participative approach when supporting nationals and partners; Using transformational leadership when coaching national counterparts and mobilizing partners, Directive when teams were to comply with rules or act quickly.
3) Compassion; building trust, confidence and capacity; empowering and coaching.
Conclusion:
The complex disease outbreak imposed a mixed leadership style. Leaders had specific traits and technical skills. Servant leadership style was often used to trigger participation and build capacity in support of national and international experts. Directive approaches were used to trigger urgent actions. Findings could help in selecting and training leaders for public health emergencies. It may require further empirical and operational research in emergency contexts.
Knowledge management on Disaster Health Management (DHM) is one of the priority areas in the Plan of Action to implement the ASEAN Leaders’ Declaration on DHM (POA/ ALD DHM) (2019-2025). The Japan International Cooperation Agency (JICA) has been implementing the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) since 2016 to assist the ASEAN region in strengthening coordination capacity on DHM. A regional training course on DHM for ASEAN member states (AMS) in Japan was proposed to be implemented in 2022 as a JICA’s Knowledge Co-creation Program (KCCP).
Method:
The training curriculum of the KCCP included emergency and disaster medicine in Japan, international trends on DHM, and underwent reviews by AMS representatives of the ARCH Project. Prior to the training, participants were required to prepare country reports (CRs) outlining information on legislation, system and structure related to emergency and disaster medicine, as well as systems to receive international emergency medical teams (I-EMTs).
Results:
The four-week KCCP course contained a trial implementation of a four-day training program for receiving I-EMTs and coordination among stakeholders in ASEAN disaster response, based on the regional standard curriculum developed by the ARCH Project, and invited experts in DHM not only from Japan but also from AMS as instructors. Participants analyzed and identified challenges on DHM in their countries, and developed draft action plans (APs) to improve the situation through the knowledge obtained from the program.
Conclusion:
The draft APs, the training deliverables, will be shared with the ARCH Project, and used to build a support mechanism to achieve national level targets of the POA/ ALD DHM, and the progress will be reflected in the CR in the subsequent year. The KCCP on DHM is expected to facilitate knowledge sharing in AMS and Japan, and contribute to fostering the culture of mutual learning.
The Diamond Princess cruise ship (DP) arrived in Yokohama, Japan, on February 3, 2019, with a confirmation of the Polymerase Chain Reaction test (PCR) positive for the Coronavirus disease 2019 (COVID-19) in a passenger who disembarked at Hong Kong. Japan National Emergency Medical Team (N-EMT), and Japan Disaster Medical Assistance Team (DMAT), were dispatched and measures to prevent the spread of viruses were taken for 3,711 (2,666 passengers and 1,045 crew members) on board.
Method:
Japan DMAT was dispatched and managed the medical operation for DP passengers and crew members. The records of communication logs for the DMAT were evaluated. In this study, evaluation of DMAT medical operations in the DP was conducted to find any positive effects
Results:
472 (157 doctors, 123 nurses, 161 medical logisticians, 31 pharmacists) members responded. Among them, 283 (97 doctors, 66 nurses, 91 medical logisticians, 29 pharmacists) worked inside the DP, and 189 (60 doctors, 57 nurses, 70 medical logisticians, two pharmacists) operated outside mainly for patient transport. DMAT conducted a strategic operation and developed categorization for medical care and patient transport. Eventually, DMAT constructed flow to provide rapid medical care and prescription distributions for passengers and crew members.
Conclusion:
DMAT has been required to respond to unforeseen disasters in the framework since the Fukushima Nuclear Plant accident in 2011. All the past several types of disaster response were contributed to managing medical operations at the DP. These operations are thought to reduce preventable deaths from COVID-19.
Around two billion people globally were affected by natural disasters between 2008 and 2018. Countries are required to effectively prepare their healthcare workers for disaster response. A greater level of preparedness is associated with a more effective response to disasters. The World Health Organization requires countries and governments to have disaster plans and emergency health workers ready and prepared at all times. This integrative review aims to understand emergency healthcare workers’ perceived preparedness for disaster management.
Method:
An integrative literature review using the PRISMA checklist guidelines was conducted to explore physicians, nurses, emergency medical services, and allied medical professionals’ preparedness for disasters. Literature was searched from 2005, published in the English language and from MEDLINE (PubMed), Google Scholar, EMBASE, PsycINFO, SCOPUS, ProQuest and CINAHL databases. Reviews, case reports, clinical audits, editorials and short communications were excluded. Studies were critically appraised using the Mixed Methods Appraisal Tool.
Results:
The initial search yielded 9,589 articles. Twenty-seven articles were included following the application of the eligibility criteria. Included studies were geographically diverse including North America, the Middle East, and the Asia Pacific. Most studies (n=24) assessed the knowledge of healthcare workers in general disasters. Studies using the Disaster Preparedness Evaluation Tool reported moderate disaster preparedness and knowledge, while studies using other instruments largely reported inadequate disaster preparedness and knowledge. Regional variations were recorded, with high-income countries’ reporting a higher perceived preparedness for disasters than low-income countries.
Conclusion:
The majority of emergency healthcare workers appear to have inadequate disaster preparedness. Previous disaster experience and training improved disaster preparedness. Future research should focus on interventions to improve emergency healthcare workers' preparedness for disasters.
COVID-19 resulted in 1.8 million reported deaths in 2020 and an excess mortality of at least 3,000,000 to date. Following the announcement of emergency measures mandating various public health interventions, international studies demonstrated a decline in ED attendances, potentiating a delay in seeking health services.
The objective was to examine ED attendance trends by age group and to categorize the attendances following the implementation of regulations related to COVID-19.
Method:
A single-center retrospective observational study of ED attendances from 2014 to 2022 at Wexford General Hospital, a 225-bed acute general hospital. Monthly attendance trends were analyzed covering all phases of the national response. Information was extracted from the electronic health record system iPMS.
Results:
Overall attendances decreased by 11.5% {42,637 (2019) to 37,751 (2020)}, well below expected annual growth projections from 2019 to 2020. A significant reduction in pediatric attendance (≤16 years) occurred, with 31.68% negative growth (10,351 to 7,071) in 2020 and sustained decrease of 15.3% (8,767 attendances) in 2021. In contrast, geriatric (≥65 years) attendances were unchanged in 2020 (17,751), with a surge of 8.9% to 19,333 attendances in 2021, the largest year-on-year growth since 2018. Comparisons of month-to-month trends in relation to public health measures correlated to a marked decline in attendances at the extremes of age during “lockdown” periods.
Conclusion:
The reduction in attendances is likely multifactorial, such as a reduction in school-related stress and patients deciding to stay home for fear of attending during the pandemic with non-emergent conditions. The increase in geriatric presentations in 2021 may reflect continuing restricted access to primary care and GP services, or neglect of prior conditions. Examining changing demographic attendances may offer opportunities to develop alternative ways of supporting frail populations and families in community care avoiding ED presentations.
In comparison to many nations in the developed world, the United States has more cases of civilian ballistic injuries. Both low and high velocity firearm injuries are frequently encountered in American urban trauma centers, and physicians become familiar with these traumatic injury patterns. Physicians from other nations may rarely encounter such injuries. With an increase in international conflict, there is an increased need for clinicians to participate in international medical aid which may include patients with ballistic injuries. Clinicians with limited familiarity of such injuries may result in under-triage and delayed recognition of injury severity, resulting in increased morbidity and mortality of patients. This study aims to show that a course on ballistic injuries will improve clinician recognition of injury patterns and comfort levels managing these patients.
Method:
Clinicians participated in a course which was designed to introduce ballistic injury patterns. The course was reviewed and supported by emergency medicine physicians who work in a large level I trauma center in the Southeastern United States and serve in clinical roles with EMS and community law enforcement. Course content included demonstrations of firearm injuries by discharging weapons into gels and models designed to replicate human body tissue. Participants were surveyed prior to and after completing the course regarding their comfort with firearms and firearm related injuries.
Results:
Participants reported increased comfort level with the management of ballistic injuries. The course requires a full day of expert physician time, approximately US$600 in supplies if performing live demonstrations, and the cost of designated space for safe firearm discharge and use.
Conclusion:
This course or a similar course with pre-fired demonstration rounds proved to be feasible and beneficial for those who will likely encounter firearm injuries in their clinical environment. There are both quantifiable and perceived benefits for physicians.
The current hybrid war in Ukraine clearly shows the impacts of modern warfare on civilians. Infrastructure, including healthcare facilities, energy sources, and every entity supporting the lifeline of the people are under attack, leaving no options but to leave the country for those who can. Since the outbreak of the conflict, over three million Ukrainian women and children have migrated to the neighboring countries. Although women and children might be the healthiest groups among refugees, they create other challenges within healthcare.
Method:
Qualitative and quantitative methods which describes all possible impacts of the war on the refugees’ situation in three periods of time.
Migration: During this period, besides the risk of trauma, there are other types of diseases such as infectious diseases that influence the outcome of the migration.
Settlement: This period consists of emergency physical and psychological conditions that bring the refugees to the hospitals. Hygenic issues and exposure to new diseases such as Covid-19 can be part of this period. Additionally, there might be social adjustment issues that need to be discussed.
The post-conflict: Consists of PTSD and other psychological impacts of the war, which may change the course of the life of many survivors. The final impact of the failure in social adjustment may also result in long-term socio-cultural issues.
Results:
We expect that the results of the submitted projects demonstrate the unforeseen physical and psychological wounds in refugees, irrespective of their age and background. One major outcome would be the failure of the social adjustment and if possible, a comparison with previous wars’ refugees.
Conclusion:
The research will conclude by presenting a summary of all results and categorization of the conditions that influence the well-being of refugees as well as the host country. New recommendations will be available based on the experience gained and the results presented.
Pharmacists’ pivotal role during the COVID-19 pandemic has been widely recognized, as they adapted to continue to provide an even higher level of care to their patients. We sought to gain deeper understanding of frontline pharmacists’ lived experiences of the COVID-19 pandemic and its impact on their roles and professional identity (what they do and what it means to them).
Method:
Photovoice was used, a visual research method that uses participant-generated photographs to articulate their experiences, and semi-structured interviews. This approach allowed us to explore the subjectivity of professional identity from the pharmacists’ lived experiences. Participants were asked to provide 3-5 photos that reflected on how they see themselves as a pharmacist and/or represents what they do as a pharmacist. The semi-structured interview guide asked open-ended questions about their photos, included a photo-elicitation exercise, and additional questions based on a recent scoping review. We recruited frontline community pharmacists who provided direct patient care during the COVID-19 pandemic in Alberta, Canada through social media and relevant pharmacy organizations. Data analysis incorporated content, thematic and visual analysis and was facilitated using NVivo software. Ethics approval was obtained from the University of Alberta ethics board.
Results:
Five primary themes emerged from the photographs and interviews: (1) autonomy, (2) clinical courage, (3) leadership, (4) safety, and (5) value and support. The photographs identified symbols participants associated with their lived experiences (e.g., worn shoes illustrate the relentless pace of pharmacists, a messy bed representing work-life balance out of control).
Conclusion:
This study identified that pharmacists’ felt the pandemic made them visible to the public and made them feel valued as a trusted resource and a safe-haven for ongoing healthcare. Additionally, it was highlighted how participants demonstrated clinical courage and led their communities by adapting their roles and using their autonomy to fulfil community needs.
The challenges that the health systems face in the last years increased exponentially. No matter if we are talking about the impact of the COVID-19 pandemic or the Russian military action in Ukraine, the European health ecosystem is facing new problems. In the light of these uncertainties, we assessed which could be the next trends that can impact the healthcare systems, in order to better prepare and adapt to the new contexts.
Method:
Using two foresights exercises (FSE), one in 2018 and the second one in 2022, we identified the most important trends in the political, economic, social, technological, security, environmental and medical sectors that could have an impact on health.
Results:
53 people participated in the first FSE and 40 in the second one. The respondents identified cyber security, an increased reliance on digital technologies for communications, CBRNE management of the patients, centrally coordinated attacks, demographic aging, reduced economic resources, violence against emergency medical staff and the increased need and demand for psychosocial support as the most important trends. Moreover, they considered that wars, hybrid threats, the fake news, pandemics and the influence of artificial intelligence could impact the healthcare systems.
Conclusion:
Many of the trends identified in 2018 as having a possible impact on the health system proved to be relevant four years later. Therefore, we consider the FSE a relevant tool in foreseeing the main areas that could have an impact on health and its results could guide the preparedness for the future.
People around the world are affected by traumatic experiences, ranging from collective events like natural disasters, mass violence, war, terrorism and to personal, even "everyday life" traumas such as road traffic accidents and the sudden football attack. The mTBI caused by traumatic events is a significant public health international matter. There is a greater demand for mTBI research from all cultures and societies. This paper attempts to explore the research status, focus and challenges by using a bibliometric analysis on mild traumatic brain injury (mTBI).
Method:
Publications on mTBI were retrieved from the Web of Science Core Collection by the title advanced search strategy from January 1, 2000, to October 31, 2022. Articles and reviews were included, and no language restrictions were applied. Microsoft Excel, RStudio, VOSviewer, and CiteSpace were used to extract, integrate and visualize the bibliometric information.
Results:
A total of 3,464 documents were retrieved from 2000-2022, with a general upward trend despite slight fluctuations in annual publications. The USA had an overwhelmingly dominant position in terms of both the number of publications (n = 2 028) and citations (n = 63 287). The Department of Veterans Affairs (n = 380) and Veterans Health Administration (n = 370) were the most productive institutions. Collaborations in cross-national, cross-institutional and different authors were weak. Iverson GL was the leading scholar and the Journal of Neurotrauma and Brain Injury were the most influential journals. Based on keyword co-occurrence analysis, the research focus could be divided into four clusters: epidemiology and prevention, characterization of mTBI, outcome assessment and prognosis.
Conclusion:
The mTBI research has drawn increasing attention over the years. However, the research on mTBI is still relatively limited and challenging, and collaborations that cross national, institutional, disciplinary, and sector boundaries are important to the advancement of improving mTBI worldwide.
Since February 24, 2022, at the time of writing this plan, approximately 400,000+ refugees had entered Moldova and 282,842 had exited Moldova. EMTCC will need to coordinate international medical teams assisting with the increasing refugee numbers crossing into Moldova from southern Ukraine for the MOH and international EMT’s in support of trauma management in Palanca and related borders and referral to health care facilities within Moldova.
Method:
This EMTCC operational plan sets objectives and explores trigger points that require actions in the context of International EMT’s, two service levels were trauma triage/stabilization and primary health care.
Results:
Odesa was a city located approximately 60 kilometers from the Moldova border crossing of Palanca. Trauma patients reaching the Palanca border would need to be identified in vehicular columns by roving triage teams (EMT 1 M) and expedited through the border. Survivability of severe trauma patients proceeding through the border crossing and expected to transit through to tertiary level care would be low without the intervention of trauma stabilization teams (damage control). The initial positioning of at least 2 trauma stabilization points would require the support, skills, logistics and self sustainability of classified EMT’s or similar. These would also need the additional support of specialized trauma/surgical cells at both Stefan Voda and Causeni Hospitals.
Conclusion:
Odessa escalation should have been the worst scenario, but we were able to work with MOH in Moldova to develop a plan to save more lives for trauma patients reaching the Palanca border.