Last updated 10th July 2024: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website https://www.cambridge.org/news-and-insights/technical-incident
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
This journal utilises an Online Peer Review Service (OPRS) for submissions. By clicking "Continue" you will be taken to our partner site
https://mc.manuscriptcentral.com/pdm.
Please be aware that your Cambridge account is not valid for this OPRS and registration is required. We strongly advise you to read all "Author instructions" in the "Journal information" area prior to submitting.
To save this undefined to your undefined account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your undefined account.
Find out more about saving content to .
To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The risks of NBC (Nuclear, Biological and Chemical) or CBRNE (R: radiological, E: explosive) hazards are rapidly increasing even in civilian areas, as well as those of natural disasters (earthquakes, hurricanes, etc.). Therefore, one of the most important and emergent issues for medical staff, especially for general surgeons is the necessity of skills to deal with various mega- or major disasters to help people as well as, protecting themselves. This has been a point of emphasis since 2005, when the Disaster Medicine Compendium was published and continues to be updated today.
Method:
The research focuses on NBC/CBRNE hazards: Pandemics such as COVID-19, Monkeypox, influenza, the Tokyo Subway Sarin Incident, and the 2011 Tōhoku Earthquake, followed by Fukushima Plant Incident, Chernobyl, earthquakes with tsunami, such as the 2004 Indian Ocean earthquake, and the September 11 terrorist attacks in the US.
Results:
The skills that should be accustomed to are protection, prevention, diminution of toxicity, decontamination, as well as routine medical/surgical treatments. The relevant education is varied and not easily performed. For example, it was found that Japan DMAT or disaster medical assistant teams struggled with a lack of techniques to deal with the nuclear plant hazard during the above-mentioned Fukushima plant accident.
Conclusion:
In the event of hazards including NBC/CBRNE, surgical skills are necessary. However, medical teams require training in advance. Surgical methods and other skills, intensive care, and examinations performed wearing PPE or personal protection equipment is important, as well as the safety and security of the medical teams, in addition, to supporting the vulnerable/weak victims, ensured using an Incident Command System.
Women in coastal Bangladesh face greater challenges while staying at evacuation centers during cyclone emergencies. This study explores the lived experience of women and their well-being as evacuees.
Method:
The research undertook a phenomenological approach to conduct in-depth interviews of nineteen women from three extremely vulnerable districts of coastal Bangladesh.
Results:
The interviews revealed that women experienced obstacles to maintaining hygiene, using the toilets and accessing privacy, and suffered distress as pregnant women, lactating mothers, and through menstruation, which affected them physically and hampered their mental health. Coming from a male-dominated socio-cultural background, female evacuees unaccompanied by male guardians experienced fear and uncertainty. Some participants recollected facing social pressure and overwhelming emotions as carers of children and elderlies, whereas some reconciled traumatizing incidents such as witnessing death. Such experiences led to anxiety, stress, and depression with either temporary or permanent trauma. Participants frequently mentioned panic attacks and stress-related physical issues such as heart palpitations, dizziness and light-headedness. However, spiritual beliefs and social bonds within the community enabled peace and optimism among the women. Findings highlight that certain factors determined women evacuees' experience of wellbeing. Social context of the women imposed burdens of responsibility and caused inaccessibility of resources to restore physical-mental wellbeing. The settings, infrastructures and environment of the evacuation centers were not women-friendly, which resulted in many negative experiences among the evacuees, greatly affecting their sense of wellness. However, participants could channel positive mindsets through prayers and spiritual faith. Women were able to access some resources and use these for their well-being through social bonding and connecting with the women within the shelters.
Conclusion:
Unconditional trust in a deity and sisterhood within communities have been two quintessential features of women, which played major roles in women’s experiences and molded their understandings of well-being in the cyclone shelters.
Over the past years, the Outaouais region (Quebec, Canada) and their residents have had to endure no less than five natural disasters (floods, tornadoes). These disasters are likely to have a variety of consequences on the physical and mental health of adolescents, as well as on their personal, family, school and social lives. The experiences of teenagers are also likely to vary depending on whether they live in rural or urban areas.
Method:
Data were collected via a self-administered questionnaire in February 2022. A total of 1307 teenagers from two high schools participated in the study by completing an online survey. The questionnaire measured various aspects of the youth's mental health using validated tests, such as manifestations of post-traumatic stress, anxiety and depression, as well as the presence of suicidal thoughts and self-harm. Other aspects of the youth's experience were measured, including their level of social support, school engagement, alcohol and drug use, and coping strategies.
Results:
One third of young students (n=1307) were experiencing depressive symptoms and suicidal thoughts, as well as significant daily stress. More than 25% of the students had moderate or severe anxiety and thoughts of self-harm. These problems were significantly more prevalent among youths with prior exposure to a natural disaster. The study data also revealed that youths living in rural areas had a more worrying profile than those living in urban areas.
Conclusion:
Similar to other studies (Ran et al., 2015; Stratta et al., 2014), our research data revealed that youths living in rural areas presented a more concerning profile than those residing in urban areas. It therefore seems important, in future studies and services, to focus more specifically on these teenagers to better understand their needs and to develop adapted services more likely to meet them.
It is widely recognized that there is an increasing demand for healthcare in emergency departments (ED) around the world as well as a global shortage of healthcare workers (HCWs). This has led to ED overcrowding, which increases risks of avoidable complications and suboptimal care provision. Since ED overcrowding impacts patients, staff and quality of care, new strategies are needed for optimizing patient throughput and reducing waiting times. One such strategy is to reconsider the specific roles and professional duties of different cadres of HCWs. Empowering nurses to take on some of the tasks historically performed by physicians is a promising solution for improving ED healthcare provision. However, nurses’ professional responsibilities and competencies differ significantly from country to country. There are few studies about best practices and how to effectively implement such task-shifting strategies. The aim of this study is to map the evidence published in the scholarly literature on nurses’ advanced roles in ED as a strategy for reducing overcrowding, facilitating ED throughput, and, ultimately, improving quality of care.
Method:
A mapping review was performed by searching the following databases: PubMed, Embase, Scopus and Web of Science.
Results:
A total of 168 studies were analyzed and the data were grouped according to the countries where advanced tasks were implemented. The type of tasks that were carried out were: autonomous management of patients with minor injuries, triage-based ordering of exams and administration of therapy and management of patient flow.
Conclusion:
In some high-income countries having nurses take on advanced roles is well-established, and it contributes to reducing overcrowding in ED. Further evidence is needed to assess the barriers and facilitating factors to implementing this strategy in other contexts.
Traditionally, helicopters or special types of airplanes have been used to transport emergency patients when an aeromedical transport is necessary. However, despite its excellent utility, the cost of each flight is relatively expensive and has many limitations. So as an alternative to traditional aircrafts, there has been a movement to overcome the limitations of traditional air transport through the development and application of emergency medical drones. In this study, practical applications of emergency medical drones were investigated.
Method:
As a first step, through literature and internet searches, the current state of development, field of use, results, and problems of emergency medical drones were investigated. Based on this first investigation, a second Delphi survey of experts was conducted to investigate the appropriate fields for the use of emergency medical drones and the expected future applications.
Results:
Currently, emergency patient support drones are being used to transport first aid equipment including an automatic external defibrillator, manage emergency patient status and on-site remote evaluation, and transport human organs during organ transplantation. Emergency medical drones for emergency patients are being developed, including systems that manage the patient's condition by applying additional advanced technologies.
Conclusion:
Emergency medical drones were classified into drones for transporting emergency patients and drones for emergency medical support according to whether emergency patients were on board. Drones for emergency patient support were being used to transport first aid equipment, manage emergency patient status and on-site remote evaluation, and transport organs during organ transplantation. The trend of air transport in the future is expected to change to a futuristic means of transportation in the form of emergency medical drones.
Validation of the new MCI Triage protocol of Regione Piemonte by comparing it with the already published and internationally used START/Jump START protocol. Compare its accuracy, execution time, over and under triage indices and the influence of any rescuer characteristics in reference to adult and pediatric victims when in use in a simulated multi-casualties event setting.
Method:
We conducted a randomized controlled experimental study in a simulation setting. A group of 35 people involved in an incident (volunteer participants) was assessed by a population of trained and untrained healthcare professionals (nursing students and nurses). The participants were randomly divided into two homogenous groups to which the two protocols were explained separately and carried out the simulation in single-blind. Evaluation data were collected and statistically processed. The resulting items were used to compare the accuracy, over- and under-triage rates and any items related to rescuer characteristics for each triage system.
Results:
74 subjects were included in the study. Of these, 56.7% were healthcare professionals in training and 43.4% were trained nurses. Compared to standard criterion definitions, the MCI triage protocol showed a higher accuracy rate than START (88.4% vs 80.4%, p<0.01). MCI triage had a significant lower rate of underestimation compared to START (8.9 vs 13.6%, p< 0.01) as well as overestimation (3.2% vs. 6.8%, p< 0.01). Time is only correlated with the performance of MCI triage, influencing its accuracy. There were no significant differences in the accuracy of diagnosis in pediatric patients.
Conclusion:
We found that MCI method triaged adult patients more often correctly than START method. Underestimation and overestimation were lower than in the control method, although there tended to be a significant overestimation of white codes which were not present in the START system. In the assessment of pediatric patients, the protocols are equivalent.
This study evaluates the perceptions of preparedness and willingness to work during disasters and public health emergencies among 213 healthcare workers from 10 ministries of health hospitals in the southern region of Saudi Arabia, which is exposed to the risk of disasters such as flash floods in wadis, fires, sandstorms, armed conflicts at the border and ongoing waves of COVID-19 pandemic.
Method:
This study employed a quantitative research design by using a survey (Fight or Flight).
Results:
The results showed that participants' willingness to work unconditionally during disasters and emergencies varied based on the type of condition: natural disasters (61.97%), seasonal influenza pandemic (52.58%), smallpox pandemic (47.89%), SARS/COVID-19 pandemic (43.56%), special flu pandemic (36.15%), mass shooting (37.56%), chemical incident and bombing threats (31.92%), biological events (28.17%), Ebola outbreaks (27.7%), and nuclear incident (24.88%).
Conclusion:
Among several factors that determine healthcare workers’ willingness to work during disasters and public health emergencies, appropriate knowledge and skills to confidently manage an incident and the assurance of their families’ safety are two decisive factors. Although we could only find a significant correlation between education and willingness to work during emergencies, previous reports have confirmed a significant correlation between education, age, and years of experience and the perception of hazards and fear and consequently willingness to work under threatening circumstances. While unsuccessful management of disasters and emergencies may be the result of organizational shortcomings and resource scarcity, healthcare workers’ lack of knowledge, skills, and confidence and emotional distractions due to uncertainty about their own safety and that of their families may also play a significant role. Besides educational initiatives, which increase staff members’ confidence through knowledge acquisition and skill improvement, other measures, which guarantee their families’ safety and well-being during an emergency, should be established and implemented.
Studies on the impact of disasters on communities often occur months to years after the event. Pre- and peri-event details collected from participants may be imprecise or even unobtainable as memory is affected by time. More so, delays in data collection can introduce recall bias when participants with adverse outcomes provide differential responses about exposure. In 2019, the US Centers for Disease Control (CDC) and RTI International designed a study to mitigate these issues by surveying within weeks of a natural disaster to examine associations of preparedness to peri-event exposures, emergency services, and health.
Method:
Given the unpredictability of natural disasters, a significant challenge for the team was to plan a rigorous study design applicable to several types of severe weather events. This presentation will review our forethought, planning, and resulting strategy, including important considerations related to IRB and OMB applications with unspecified disaster/location details. We will share decision-making on sampling, instrumentation, communication materials, and multi-mode data collection procedures. The impact of delays due to COVID-19 and waiting to select a disaster that met a prior disaster inclusion/exclusion criteria will also be presented.
Results:
Results are forthcoming. We will present details on RTI’s 2022 survey implementation in the Fort Myers area of Florida within weeks of Hurricane Ian landfall including information on our final sampling strategy, field period, and outcome rates among key community groups and exposures.
Conclusion:
Conclusions will be presented. Pragmatic lessons learned related to timeline, labor, and other resources will be used to compare our strategy to rapid needs assessment methodology as well as more typical self-report surveys with later post-disaster data collection periods. Researchers working in emergency preparedness/response and disaster epidemiology will have gained a solid understanding of the advantages and disadvantages to planning studies for the immediate aftermath of undefined disasters.
This presentation describes an initiative to provide psychosocial support to children in Ukraine during the ongoing war using a children’s storybook, coloring book, and activity book. The resources promote emotion identification, self-expression, coping skills, and social support–variables with empirical support in promoting children’s mental health in response to trauma.
Method:
The book: “An Unusual Situation” is a bibliotherapy intervention for children struggling with difficult situations. By identifying with the characters, children learn about their own struggles, they learn that other children share similar concerns, and learn important coping skills.
The book was translated into Ukrainian and Russian; supplementary materials including a coloring book, activity book and a guidebook were developed. Following a three-hour training, Ukrainian mental health professionals worked with children on the materials in their respective wartime settings.
Results:
Results of the following research questions will be presented:
1) How do mental health professionals working with children in Ukraine utilize the associated book resources measured by a survey and completed by the professionals engaged in the project.
2) What do children who use these resources report about their experiences coping with the ongoing war, measured by:
a) Collecting children’s responses in the activity book.
b) Surveying the mental health professionals about their observations of the children during the intervention process.
3) Does the intervention reduce children’s distress, interpersonal functioning, or problematic behaviors, measured by pre-post scores on the Youth Outcome Questionnaire 2.0.
Conclusion:
This pilot study will provide information to guide the implementation of a broad psychosocial support intervention for children living in the setting of the ongoing war in Ukraine. Conclusions to be presented include:
1) Tailoring the intervention to the current needs of Ukrainian children
2) Designing a wide-scale implementation plan tailored to Ukrainian mental health professionals’ recommendations
The occurrence of disasters and mass casualty incidents (MCIs) is on the rise, thus training and rehearsal for disaster response remain paramount. Virtual reality (VR) platforms have previously been shown to be well-received, engaging, and immersive for disaster training. The primary objective of this study was to ascertain if a human actor-based VR MCI scenario could elicit a sympathetic response, as measured by heart rate variability (HRV), in medical doctors and trainees compared to a baseline state.
Method:
A simulation was filmed with students, residents, and surgeons on a GoPro 360 camera. Subjects (n=35) were recruited to sufficiently power (1-b=0.8) a Wilcoxon matched-pairs test and Welch’s t-test. Subjects watched the simulation on an Oculus Quest headset while having HRV recorded. Multivariate logistic regression was performed to identify factors associated with increased odds of significant sympathetic activation. Statistical significance was established at p<0.05.
Results:
Thirty-five subjects were enrolled and included three trauma surgeons, three emergency medicine (EM) attendings, eight EM residents, six surgery residents, and 15 medical students. A significant decrease in HRV was observed across all groups in the MCI (median 20 ms IQR 16.2, 31.4 ms) compared to baseline (33.2 ms IQR 27.2, 44.1 ms; p<0.0001). Sympathetic activation was most pronounced in students, then attendings, then residents. There was no significant difference in the fold-difference of sympathetic activation of EM physicians (-48.5% +/- 32.1%) versus surgeons (-49.5% +/- 25.2%; p=0.57). In all groups, SNS activation occurred independently of heart rate, age, sex, number of years in practice, first responder experience, or prior MCI response.
Conclusion:
Live-actor VR MCI simulation elicited a strong sympathetic response from students, residents, and attending physicians. By recruiting and disinhibiting essential neural pathways via controlled SNS activation, VR MCI training has the potential to enhance the encoding and consolidation of disaster training in a low-cost and reproducible manner.
Disaster research is primarily posthoc analysis, locally focused or within response organizations, overlooking the wellness and safety of first and second responders or the broad multi- and interdisciplinary activities necessary to foster and sustain recovery. A broad framework to span locality, institutional, and professional boundaries supports the development of a true learning community–a health EDRM sector that supports society in recognizing lessons, refining findings, and free and fluid global sharing.
Method:
Several organizations joined to create a robust disaster health learning community: CREDO, GloHSA, ICDM, and ECDM, a multi-national, multi-disciplinary collaborative network of patients, universities, societies, regulators, publishing, healthcare, and technology partners designed to foster expert level education and training with shared educational design concepts, milestones, and core curricula that embrace the strength of a standardized base upon which to link unique pillars of excellence of separate functions, institutions, nations, and regions.
Results:
The Emergency Disaster Global Health Sciences (EDGHS) model developed by University of Texas Southwestern Medical Center is interactive, open, and responsive. EDGHS addresses critical gaps in applied research by convening leaders across the healthcare and public health continuum to map the way forward, designing and implementing high-quality, evidence-based practical and policy research.
This defines essential public health functions for national contexts, including a focus on emergency preparedness and response, strengthening competency-based education on essential public health functions, and mapping and measurement of occupations delivering EDRM functions, offering an exportable model of global relevance.
Conclusion:
Putting disaster prevention into recovery processes is a strategic opportunity to improve the well-being of future generations. The survivability and well-being needs of present and future generations are contingent on knowledge-based, lived experiences of recoverable disaster loss and damage, and the capacity to thrive sustainably. This presentation serves as an invitation to join the growing momentum of creating a learning health EDRM community.
During disasters households may experience lost communication and roads may become impassable; thus a common recommendation is to prepare an emergency supply kit that can be used to shelter-in-place during evacuation. The decision to prepare for disasters becomes more challenging during pandemics because individuals may be hesitant to evacuate to shelters or may be unsure of items to include in emergency supply kits. Because of this, many preparedness estimates before 2020 may no longer reflect current levels of preparedness. The aim of this research was to provide information on what actions people take to prepare for disasters, determine whether households have supply kits, and help guide next steps to better prepare for and respond to disasters during a pandemic.
Method:
We conducted descriptive statistics, chi-square analyses, and backward-step regressions on 10 questions collected through Porter Novelli’s ConsumerStyles surveys in Fall 2020 (n=3,625), Spring 2021 (n=6,455), and Fall 2021 (n=3,553) to examine factors that contribute to overall household preparedness levels and supply kit ownership.
Results:
Being married, having children in the home, and having a household income of $150,000 or more are all associated with increased preparedness levels. Persons living in mobile homes, recreational vehicles (RVs), boats, or vans are half as likely to have preparedness plans compared to those living in single family homes. While there was a significant association between level of preparedness and supply kit ownership, overall kit ownership is also lacking. While most respondents believed a kit would help their chance of survival, only a third had one. Age, sex, education level, and region of the country were significant predictors of kit ownership.
Conclusion:
This study helped close existing knowledge gaps surrounding preparedness and emergency supply kits to guide public health research and prevention strategies, including messaging, to help reduce adverse health impacts during multiple emergencies.
Children are frequently victims of disasters. However, gaps remain in pediatric disaster preparedness. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty events that involve large numbers of children. The NYC PDC conducted a functional exercise testing surge, communications, and secondary transport. Participants included 28 NYC hospitals, the NYC Fire Department-Emergency Medical Services (FDNY-EMS), NYC Emergency Management (NYCEM), NYC DOHMH and the NYC Medical Reserve Corps (MRC).
Method:
The hospitals and agencies participated in group and individual planning meetings. Scenario-driven, operations-based activities challenged participants to employ their facility's existing pediatric surge and secondary transport plans during an event. The exercise assessed: Communications, Emergency Operation Plans, Surge, Patient Tracking, Patient Transfer, Supplies, and Staffing. Internal and external evaluators assessed the exercise performance.
Results:
An After-Action Report was written based on information from evaluation data, site-specific and group hot-washes, and an after-action conference. Strengths included meaningful improvement of plans before/after the exercise and doubling pediatric critical care capacity through the implementation of the exercise objectives. Challenges included: gaps in communication/patient tracking, lack of sufficient sub-specialty support, the need for "babysitters” and inadequate supplies of blood products and ventilators.
Conclusion:
Conducting a multi-hospital and agency pediatric specific exercise demonstrated current planning and produced lessons learned to address planning and training gaps that can improve citywide planning and capabilities during future full-scale exercise and real-time events.
Disaster Medicine (DM) is currently underrepresented in medical schools’ curricula worldwide, and existing DM courses for medical students are extremely heterogeneous due to the lack of pragmatic and standardized guidelines. Moreover, there is a gap in knowledge regarding the curriculum development methodology used for DM courses. This study aims to identify DM courses for medical students worldwide and to map their curriculum development methodologies by reviewing available literature.
Method:
The search was conducted on three databases using the terms “Disaster medicine” AND “Education”. Following the PRISMA approach, twenty-five articles that described the content and implementation of DM curricula were included in the analysis.
Results:
Nine studies thoroughly described the curriculum development process. Expert opinion and literature review were the methodologies mostly used to develop DM curricula. Only four studies followed a multi-method process made up of four different methodologies, including expert opinion, literature review, survey, and Delphi methodology. Most of the courses adopted a face-to-face approach combining different training modalities, including the use of virtual reality simulations and drills.
Conclusion:
This systematic review provides a compendious analysis of the curricula and curriculum development processes in DM training for medical students. The scarce usage of reproductible, comprehensive curriculum development methodologies and consequently a great heterogenicity of the covered topics and course design were brought forward. Therefore, there is a need for standardization in DM education. Overall, this systematic review highlights the need for evidence-based educational curricula in DM and provides recommendations for developing DM courses following a scientific approach.
Saudi Arabia has experienced special challenges calling for effective teamwork in the management of disasters and emergencies, such as wars, earthquakes, and major accidents linked to the Hajj pilgrimage over the years. In 2015, 769 pilgrims died in a crowd stampede during Hajj. The outcome of the incident could have been different if the rescuers had the necessary multiagency and collaborative disaster education. This study aims to determine the development of Saudi HCWs’ teamwork during collaboration exercises.
Method:
This study employed two methods to gather data: (observational) during three-level-collaboration (3LC) tabletop-exercises and semi-structured interviews, by employing two theoretical models (team development models). The number of participants was (100) HCWs.
Results:
The results of these exercises had a positive impact on the functionality of HCWs and helped them prepare for disaster management and mitigation inside and outside of a medical facility. Based on the theoretical framework of the integration of team members, the participants reported that the trans-professional team developed because they understood the scenarios. In addition, the participants underscored they developed their skills and knowledge of disaster management because of the attempts made in scenario one. Furthermore, on the theoretical framework of team maturity, several participants indicated that immaturity in scenario one is because of the team members not having the same knowledge and skills. While in scenario two, they are mature because of training and challenges resulting in individual development.
Conclusion:
This study focused on determining the development of healthcare teamwork during collaborative exercises. HCWs were exposed to two scenarios. The tabletop training enabled HCWs to gain the maturity in team building and disaster management. Immature and overripe HCWs cannot easily embrace teamwork. In addition, the public should be made aware of disasters that may come their way. Continuous training of HCWs and creating public awareness are essential parts of disaster management.
An exhausted, isolated, increasingly desperate Russia, still in possession of over 4,400 nuclear warheads, puts the world at risk. Since the outbreak of war in Ukraine, Russian rhetoric and military doctrine have evinced an increasing nonchalance toward the employment of tactical nuclear weapons as stockpiles of conventional weapons are depleted. Poor targeting control (or outright perfidy), demonstrated by recent events in Poland possibly violating NATO’s collective defense clause, have only incensed an imminently combustible situation. Given this threat, it behooves medical professionals to gain thorough acquaintance with Acute Radiation Sickness (ARS), including an assessment of sources of exposure, presentation, prognostic indicators, immediate treatments, long-term concerns, and sources of consultant support.
Method:
Through thorough review of military and civilian sources, training courses, historical cases, injury mechanisms, first-responder concerns, hospitalization parameters, and laboratory indicators, the ARS spectrum will be explored. Surgical, anesthetic, and intensive care implications will be discussed, as will infection and nutritional concerns. Emerging practices, specialized therapy, and long-term medical sequelae will be covered.
Results:
A thorough discussion of potential sources (civil and military), clinical recognition, and presentation of ARS will focus on best clinical guidance, providing the most up-to-date treatment strategies, and will give clear guidance regarding how best to prepare, treat, and obtain specialist consultation.
Conclusion:
It is the earnest hope of the presenter (a senior naval physician with nuclear power experience, anesthesiology consultant/board examiner, and intensivist, who studied radiation safety and injury for much of his career and wrote a Diploma in the Medical Care of Catastrophes dissertation on radiologic injury management) that the audience will never face the horror of a single radiologic casualty. However, the likelihood of such wishful thinking seems as remote as ever. Attendees will not only learn guidance for treatment and prognostication, but will know how to obtain support and expert consultation.
The Thai government has established public health policies to cope with COVID-19 and reduce the spread of disease by promulgating the Emergency Decree since March 26th 2019 in concept “stay at home, stop the spread of the virus for the sake of nation.” Those measures had been affected to people in all social levels whether it be urban or rural. The objective of this qualitative study was aimed to study the mechanisms and experiences of village health volunteers who work to control COVID-19 at the community level.
Method:
Forty village health volunteers in the 8th health region were included in the study. Data collection by using focus group discussion combined with audio recordings and the data were analyzed by content analysis.
Results:
The community’s context in the upper northeastern region of Thailand live in kinship. This is a factor supporting the operation of village health volunteers (VHVs) in the surveillance, prevention, and control of disease in the community. The mechanisms for disease prevention and control in the community are a virtual "Spider web" that connects people in the community, VHVs, Community Leaders, Public Health Officers, and Sub-district Administrative Organization (SAO) officers that operate together. While people in the community, especially "women", act in surveillance in the form of "watchdogs" that report abnormalities of community member movements to the VHV for coordination in surveillance, prevention, and control of disease in their community. The VHV and partners use management guidelines as prescribed by the Ministry of Public Health and adapted to the social and cultural context.
Conclusion:
The community's COVID-19 surveillance mechanism that mediates kinship begins with fear and panic from a lack of knowledge in the early stages of the outbreak. The kinship of people in the community is one of the strengths and factors of success in preventing and controlling the disease.
The use of ECMO devices began about 50 years ago. The purpose of the ECMO device is to enable gas exchange (oxygen and carbon dioxide) and/or hemodynamic support in situations of pulmonary or heart failure to recover or to serve as a bridge in a waiting period for heart pulmonary, heart, or artificial heart transplantation. The COVID-19 outbreak increased the need for the use of ECMO as a life-saving treatment. As a result, there was an increasing demand for qualified personnel in overloaded hospitals' ICUs to care for COVID-19 patients in general, specifically for those who required ECMO treatment. These required rapid team training and new methodology development collaboration between the Ministry of Health (MOH), multi-disciplinary teams, and a national professional committee that set the treatment protocols based on universal standards.
Method:
A professional national committee was appointed by the MoH. The committee included Physicians, Nurses, Cardiopulmonary Bypass Machine Operators/Perfusionists as well as MoH representatives. The role of the committee was to establish guidelines and standards for operating ECMO services. These guidelines were adopted by the MoH and are the basic recommendations for operating ECMO units in Israeli hospitals.
Results:
The whole process had a dual challenge. One challenge was establishing new ECMO units according to the guidelines and the universal standards created by the committee. The other challenge was to motivate the old and experienced ECMO units to adopt and work according to the official standards set by the committee.
Conclusion:
These days the committee started the evaluation of the old ECMO Units to bring all ECMO units in Israel to work by the same guidelines and standards.
The 2014-2016 Ebola Virus Disease (EVD) outbreak in West Africa resulted in 28,000 infected and over 10,000 deaths. Sierra Leone was one of the hardest hit countries. The purpose of this study is to examine the coping strategies employed by those most affected by EVD and its related stressors in Sierra Leone.
Method:
228 EVD-infected individuals, EVD-affected individuals, and community leaders were recruited using purposive maximum variation sampling. Key-informant interviews (n=42) and focus group discussions (n=27) were conducted across five districts in Sierra Leone. Data were analyzed and coded inductively by a team of researchers, using Thematic Content Analysis using NVivo (k=0.80 or above for interrater reliability).
Results:
Participants described stressors, coping and support on four levels: individual, family, community, and society. On the individual level, theft and spoiled belongings were leading sources of stress while faith and spirituality were main sources of coping and support. On the familial level, lack of financial resources and inability to work emerged as primary stressors, while engaging with family was a main source of support. On the community level, social exclusion emerged as a prominent stressor and community reintegration as a source of support. On the societal level, participants' lack of governmental support and termination of support from NGOs emerged as stressors, and provision of formal material assistance as a source of support.
Conclusion:
In a widespread public health crisis, understanding people’s perceptions of the most salient stressors and sources of support can inform future responses. In this study, participants experienced stressors and support across multiple levels of the social ecology, such as grief and faith, household financial pressure and kinship care, and formal material resources for survivors. Results also showed the importance of community-led initiatives that addressed material needs, as well as social acceptance and social support.
Veterinarians have been identified as a professional group at elevated risk for behavioral health issues associated with an emergency response. Prior studies demonstrate the significant and long-lasting mental health effects experienced by veterinary responders. To examine the scale and scope of behavioral health issues exhibited by veterinary responders, an online anonymous survey was conducted.
Method:
A Qualtrics® survey was conducted to identify the scope and scale of behavioral health issues of veterinarians responding to disasters. Informed consent language and the survey included stress warnings for participants to stop the survey and seek support if needed. A link to the survey was sent to veterinarians from contact lists and the survey link was coded for reuse so it could be forwarded to others. Sending emails announcing the survey were sent and the survey was open for one month following the second notice. The results were tabulated and analyzed by the authors.
Results:
Fifty-one percent of respondents reported experiencing at least one behavioral health symptom during the disaster response and 34% reported at least one behavioral health symptom six months after the event. Milder symptoms such as loss of sleep and anxiety decreased significantly after six months, however more severe symptoms such as mood swings (24/22), depression (21/21), nightmares (18/20), and suicidal thoughts (5/5) did not significantly decrease. Sixteen percent reported support during the event and 13% reported support after.
Conclusion:
Survey analysis indicated that the scale and scope of veterinary responders’ behavioral health issues are significant, and the findings indicate that further study and action to improve health outcomes is warranted. Recommendations include developing standards and guidelines, incorporating behavioral health training into response activities, developing assessment and reporting protocols, collaborating with other professions to determine best practices, and providing funding for further research on behavioral health.