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The coronavirus disease 2019 (COVID-19) pandemic had detrimental impacts across multiple sectors of the Mexican health care system. The prehospital care system, however, remains largely under-studied. The first objective of this study was to calculate the monthly per capita rates of injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) during the early pandemic period (January 1 through June 30, 2020), while the second objective was to conduct these calculations at the borough-level for the same outcomes and time period. The third objective was to compare monthly per capita rates of injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) during the pre-pandemic (January 1 through June 30, 2019), early pandemic (January 1 through June 30, 2020), and later pandemic periods (January 1 through June 30, 2021).
Methods:
A retrospective analysis was conducted to examine injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) and borough-levels. Monthly per capita rates were calculated using four datasets, including Mexico City’s Public Release 9-1-1 Emergency Calls, National Institute of Statistics and Geography’s (INEGI) Traffic Accidents Micro-Dataset, Mexico City’s Attorney General’s Office Crime Dataset, and Projections of the Population of the Municipalities of Mexico, 2015 to 2030. All statistical analyses were conducted using STATA 17.0.
Results:
During the early pandemic period, injury-related 9-1-1 emergency calls, traffic accidents, and crime experienced similar trends in monthly per capita rates at the state-level and borough-levels. While the monthly per capita rates remained constant from January to March 2020, starting in March, there was a precipitous decrease across all three outcomes, although decline rates varied across boroughs. The monthly per capita rates across the three outcomes were higher during the pre-pandemic period compared to the early pandemic period. As the COVID-19 pandemic progressed, the monthly per capita rates during the later pandemic period increased across the three outcomes compared to the early pandemic period, although they did not reach pre-pandemic levels during the study period.
Conclusion:
The precipitous decline in injury-related 9-1-1 calls, traffic accidents, and crime in Mexico City occurred at the same time as the issuance of the first wave of public health orders in March 2020. The largest decrease across the three outcomes occurred one to two months post-issuance of the orders.
Despite the increasing risks and complexity of disasters, education for Malaysian health care providers in this domain is limited. This study aims to assess scholarly publications by Malaysian scholars on Disaster Medicine (DM)-related topics.
Methodology:
An electronic search of five selected journals from 1991 through 2021 utilizing multiple keywords relevant to DM was conducted for review and analysis.
Results:
A total of 154 articles were included for analysis. The mean number of publications per year from 1991 through 2021 was 5.1 publications. Short reports were the most common research type (53.2%), followed by original research (32.4%) and case reports (12.3%). Mean citations among the included articles were 12.4 citations. Most author collaborations were within the same agency or institution, and there was no correlation between the type of collaboration and the number of citations (P = .942). While a few clusters of scholars could build a strong network across institutions, most research currently conducted in DM was within small, isolated clusters.
Conclusion:
Disaster Medicine in Malaysia is a growing medical subspecialty with a significant recent surge in research activity, likely due to the SARS-CoV-2/coronavirus disease 2019 (COVID-19) global pandemic. Since most publications in DM have been on infectious diseases, the need to expand DM-related research on other topics is essential.
In Australia, aeromedical retrieval provides a vital link for rural communities with limited health services to definitive care in urban centers. Yet, there are few studies of aeromedical patient experiences and outcomes, or clear measures of the service quality provided to these patients.
Study Objective:
This study explores whether a previously developed quality framework could usefully be applied to existing air ambulance patient journeys (ie, the sequences of care that span multiple settings; prehospital and hospital-based pre-flight, flight transport, after-flight hospital in-patient, and disposition). The study aimed to use linked data from aeromedical, emergency department (ED), and hospital sources, and from death registries, to document and analyze patient journeys.
Methods:
A previously developed air ambulance quality framework was used to place patient, prehospital, and in-hospital service outcomes in relevant quality domains identified from the Institutes of Medicine (IOM) and Dr. Donabedian models. To understand the aeromedical patients’ journeys, data from all relevant data sources were linked by unique patient identifiers and the outcomes of the resulting analyses were applied to the air ambulance quality framework.
Results:
Overall, air ambulance referral pathways could be classified into three categories: Intraregional (those retrievals which stayed within the region), Out of Region, and Into Region. Patient journeys and service outcomes varied markedly between referral pathways. Prehospital and in-hospital service variables and patient outcomes showed that the framework could be used to explore air ambulance service quality.
Conclusion:
The air ambulance quality framework can usefully be applied to air ambulance patient experiences and outcomes using linked data analysis. The framework can help guide prehospital and in-hospital performance reporting. With variations between regional referral pathways, this knowledge will aid with planning within the local service. The study successfully linked data from aeromedical, ED, in-hospital, and death sources and explored the aeromedical patients’ journeys.
There is no all-encompassing or universally accepted definition of the difficult airway, and it has traditionally been approached as a problem chiefly rooted in anesthesiology. However, with airway obstruction reported as the second leading cause of mortality on the battlefield and first-pass success (FPS) rates for out-of-hospital endotracheal intubation (ETI) as low as 46.4%, the need to better understand the difficult airway in the context of the prehospital setting is clear. In this review, we seek to redefine the concept of the “difficult airway” so that future research can target solutions better tailored for prehospital, and more specifically, combat casualty care. Contrasting the most common definitions, which narrow the scope of practice to physicians and a handful of interventions, we propose that the difficult airway is simply one that cannot be quickly obtained. This implies that it is a situation arrived at through a multitude of factors, namely the Patient, Operator, Setting, and Technology (POST), but also more importantly, the interplay between these elements. Using this amended definition and approach to the difficult to manage airway, we outline a target-specific approach to new research questions rooted in this system-based approach to better address the difficult airway in the prehospital and combat casualty care settings.
Emergency Medical Services (EMS) is a critical part of Disaster Medicine and has the ability to limit morbidity and mortality in a disaster event with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training in the country. As a result, EMS physicians are trained in a variety of specialties.
Armenia is also a country prone to disasters, and recently, the Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War broke out in the midst of the SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic.
Study Objective:
This study aims to assess the current state of disaster preparedness of the Armenian EMS system and the effects of the simultaneous pandemic and war on EMS providers.
Methods:
This was a cross-sectional study conducted by anonymous survey distributed to physicians still working in the Yerevan EMS system who provided care to war casualties and COVID-19 patients.
Results:
Survey response rate was 70.6%. Most participants had been a physician (52.1%) or EMS physician (66.7%) for three or less years. The majority were still in residency (64.6%). Experience in battlefield medicine was limited prior to the war, with the majority reporting no experience in treating mass casualties (52.1%), wounds from explosives (52.1%), or performing surgical procedures (52.1%), and many reporting minimal to no experience in treating gunshot wounds (62.5%), severe burns (64.6%), and severe orthopedic injuries (64.6%). Participants had moderate experience in humanitarian medicine prior to war. Greater experience in battlefield medicine was found in participants with more than three years of experience as a physician (z-score −3.26; P value <.01) or as an EMS physician (z-score −2.76; P value <.01) as well as being at least 30 years old (z-score −2.11; P value = .03). Most participants felt they were personally in danger during the war at least sometimes (89.6%).
Conclusion:
Prior to the COVID-19 pandemic and simultaneous 2020 Nagorno-Karabakh War, EMS physicians in Armenia had limited training and experience in Disaster Medicine. This system, and the frontline physicians on whom it relies, was strained by the dual disaster, highlighting the need for Disaster Medicine training in all prehospital medical providers.
During a disaster, comprehensive, accurate, timely, and standardized health data collection is needed to improve patient care and support effective responses. In 2017, the World Health Organization (WHO) developed the Emergency Medical Team (EMT) Minimum Data Set (MDS) as an international standard for data collection in the context of disasters and public health emergencies. The EMT MDS was formally activated for the first time in 2019 during the response to Cyclone Idai in Mozambique.
Study Objective:
The aim of this study was to analyze data collected through the EMT MDS during Cyclone Idai of 2019 and to identify the benefits of and opportunities for its future use.
Methods:
The EMT MDS was used for data collection. All 13 international EMTs deployed from March 27 through July 12 reported data in accordance with the EMT MDS form. The collected data were analyzed descriptively.
Results:
A total of 18,468 consultations, including delivery of 94 live births, were recorded. For children under-five and those five-years and older, the top five reasons for consultation were minor injuries (4.5% and 10.8%, respectively), acute respiratory infections ([ARI] 12.6% and 4.8%, respectively), acute watery diarrhea (18.7% and 7.7%, respectively), malaria (9.2% and 6.1%, respectively), and skin diseases (5.1% and 3.1%, respectively). Non-disaster-related health events accounted for 84.7% of the total health problems recorded. Obstetric care was among the core services provided by EMTs during the response.
Conclusion:
Despite of challenges, the EMT MDS reporting system was found to support the responses and coordination of EMTs. The role of the Mozambican Ministry of Health (MOH), its cooperation with EMTs, and the dedicated technical support of international organizations enabled its successful implementation.
The objective of the present work was to characterize the coping strategies used by first responders to emergencies in the face of exposure to traumatic events.
Methods:
A systematic search was performed in the databases MEDLINE (Ovid), EMBASE, LILACS (Latin American and Caribbean Literature in Health Sciences), and the Cochrane Central Registry of Controlled Clinical Trials (CENTRAL) from their inception through February 2022. First responders to emergencies with training in the prehospital area and who used validated measurement instruments for coping strategies were included.
Results:
First responders to emergencies frequently used nonadaptive coping strategies, with avoidance or disconnection being one of the main strategies, as a tool to avoid confronting difficult situations and to downplay the perceived stressful event. The nonadaptive coping strategies used by these personnel showed a strong relationship with posttraumatic stress disorder (PTSD) symptoms, burnout syndrome, psychiatric morbidity, and chronic stress. As part of the adaptive strategies, active coping was found, which includes acceptance, positive reinterpretation, focusing on the problem, self-efficacy, and emotional support, either social or instrumental, as protective strategies for these personnel.
Conclusions:
Developing adaptive coping strategies, whether focused on problems or seeking emotional support, can benefit emergency personnel in coping with stressful situations. These coping strategies should be strengthened to help prevent people from experiencing long-term negative effects that could arise from the traumatic events to which they are exposed. Active coping strategies instead of avoidance strategies should be promoted.
Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM).
Study Objective:
The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC).
Methods:
A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking.
Results:
In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were “Human Resources” (n = 15), “Planning and Coordination” (n = 7), and “Community Capacities for Health EDRM” (n = 6) in the LMIC group. “Policies, Strategies, and Legislation” (n = 7) and “Human Resources” (n = 7) were the components with the most recommendations for the HIC group.
Conclusion:
The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.
To some planners, allocating resources for emergency response may look unnecessary if not wasteful. Low-probability events can be perceived as unlikely, and for that reason, not worth considering within the regular planning structure. This is almost a dictum when planners must operate in a low-resource setting, where competition for available resources favors an approach that focuses in addressing pressing, not eventual needs.
Objectives:
Understanding this context, it is also important for planners to consider the importance of systemic resiliency, implicit in the early utilization of Emergency Medical Teams for disasters mitigation, and for that reason, as necessary instruments to reduce impact - in terms of lives lost - and cost - financial and social - of medical emergencies that result from natural and man-made disasters.
Method/Description:
Conducting an adverted DALYs cost analysis of a recent disaster is an instrument that could help policy, decision makers, and planners in general gain greater visualization of the potential social and financial costs reduction associated to the implementation of EMTs and, as a corollary, acknowledge the importance of preparation for necessary systemic resilience and its impact in equity and societal well-being.
Results/Outcomes:
Initial analysis shows that preparation for early responses by EMTs to mitigate disasters can result in lower costs while reducing overall mortality and morbidity and potentially favoring faster systemic recovery.
Conclusion:
The approach utilized requires improvement and expanded discussion with experts and beneficiaries will most likely result in its refinement and advancement.
There is an increasing global recognition that medical education systems world-wide have a major gap in training students for medical response to disasters. The IFMSA developed the International Training on Disaster Medicine (ITDM) project to address this gap.
Objectives:
To provide medical students with essential competencies in Disaster Medicine through a peer-to-peer approach.
Method/Description:
Selected number of students go through a Training of Trainers course organized annually over four months, jointly with the Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health in Novara, Italy. Graduates then lead ITDM workshops world-wide. The workshop is based on peer-to-peer education and incorporates interactive exercises, simulating real-life scenarios. In the workshop, medical students are introduced to core concepts and skills in Disaster Medicine, public health in disaster settings, and disaster management frameworks.
Results/Outcomes:
The ToT course was organized first in 2015 in Italy. It has been held seven times, graduating 120 trainers from 55 countries. While the ITDM workshop was first organized in Malta in 2016, it has been conducted a total of 22 times in 19 different countries, building the capacity of more than 250 medical students world-wide. Furthermore, more than 500 medical students have been influenced by sporadic educational activities organized by ToT graduates.
Conclusion:
The ITDM project aims to fill the gap in Disaster Medicine education in medical curricula. It has offered a much-needed space for the education and training of medical students, equipping them with basic competencies in responding to disasters to prepare them to act when needed.
Evaluation of the Emergency Unit resilience during COVID-19 outbreak is important. In this study, we discuss steps to develop a valid and reliable national Iranian toolkit to assess the EU resilience.
Objectives:
To develop a toolkit to evaluate the EU resilience during COVID-19 pandemic.
Method/Description:
Comprehensive literature reviews, experts panel discussion, focus group discussion, semi-structured interviews, and two-round Delphi surveys were used to develop a questionnaire. Then the items reviewed for their readability, feasibility, clarity of wording, layout, and style. A web-based form was designed to evaluate their face and content validity by a separate panel of experts. The final draft was tested on 30 voluntary EU managers two times (14 days apart). The gathered data were analyzed by SPSS software.
Results/Outcomes:
Descriptive statistics used to examine the floor and ceiling effects. The short answer comments were analyzed using meaning condensation developed by Svend Brinkmann & Steinar Kvale. Spearman correlation coefficients was used to examine test-retest reliability for agreement with the level of significance set at P<.05.
Cronbach alpha was used to evaluate the internal consistency reliability and Cohen’s kappa scores was used to measure reliability.
Finally, a 47-item questionnaire was developed and sent to the MOH to be used for evaluating EUs resilience.
Conclusion:
A valid and reliable national toolkit is essential to evaluate EU resilience to deliver a high-quality emergency care and all the emergency managers should be familiar with the process of developing a valid and reliable toolkit.
Simulation is an “educational method that can be applied to the training of processes, technical, and non-technical skills.” Literature underlines how simulating with the maximum realism possible improves the quality of training.
Objectives:
To describe the methodology used by CRIMEDIM to create a high-quality database of clinical cases to improve the realism of the EU MODEX exercises.
Method/Description:
In 2021, CRIMEDIM created a new database of clinical cases with disaster and non-disaster-related injuries and diseases to be used for the EU MODEX exercises. Each clinical case has four temporal stages: prehospital, T0, T1, and T2, and each of them has two possible variations: Type A (improvement) and Type B (deterioration). Timing and treatments received (or not received) determine the evolution between one step and the following one. Each clinical case consists of past medical history, disaster-related history, drugs, and allergies. There are also various exams (eg, blood tests [blood count, ABG, biochemical test, coagulation], imaging [ultrasound, XR, CT], and EKG) and other clinical information. The database allows printing casualty cards, each containing instructions for role players and make-up artists.
Results/Outcomes:
At this moment, the database consists of 1,174 clinical cases, with the possibility to create new cases according to different disaster scenarios, training needs, and learning objectives.
Conclusion:
According to participants’ feedback, the introduction of such an innovative and comprehensive database seemed to have improved the quality and the realism of the Medical EU MODEX.
COVID-19 tremendously affected Papua New Guinea in late 2021, which accompanied by a low vaccination rate (<4%), lead to an International EMT Request for Assistance.
Objectives:
Study’s aim is to share how UK-Med, a part of the UK EMT, developed best practices related to risk communication and community engagement integration within a COVID-19 emergency response.
Method/Description:
A participatory health promotion program was piloted in Western Highland Province among 71 health care workers. Training of trainers approach was adopted to build the capacity of health workers in advocating for vaccines uptake. Perception survey was used at the baseline and at the end of the program to assess the knowledge, skills, and attitude of the participants towards COVID-19 vaccine acceptance. A descriptive analysis and paired t-test were used.
Results/Outcomes:
Health care professionals are not well-equipped with accurate, scientific, and up-to-date information related to COVID-19 vaccines; which leads to increase in concern and fear among them. Health care workers affect community members’ decision to take the COVID-19 vaccine, being viewed as referents within their communities. The paired t-test showed a significant increase in the knowledge, skills, and attitude (P value <.001) of the participants toward COVID-19 vaccines. Participants described being ready to engage community influencers and cascade training to further reach out to community groups.
Conclusion:
Integrating RCCE within EMT deployments plays a crucial role in leveraging health care capabilities to influence community members and advocate for COVID-19 vaccines uptake; which will ultimately decrease morbidity and mortality. Further research is required to strengthen the role of health promotion in emergencies.
The World Health Organization (WHO) Emergency Medical Teams (EMT) Initiative is an important mechanism for strengthening surge capacities for clinical care during public health emergencies (PHE) in West Africa. To enhance preparedness, response capacity, and resilience, the West African Health Organization (WAHO) helps countries to establish, manage, and strengthen essential EMT capacities with other partners.
Objectives:
We describe the EMT capacity-building experience in West Africa and highlight gaps and lessons learnt.
Method/Description:
We conducted a descriptive, cross-sectional assessment using data from regional and national EMT awareness workshops and other activities reports. We also administrated a questionnaire to a convenient sample of EMT stakeholders for identifying challenges and gaps in strengthening EMTs.
Results/Outcomes:
A total of 14 EMT awareness workshops have been performed in West Africa resulting in on-going implementation national actions plans. Member States were at different levels of implementation of their EMT’s action plan. Only one National EMT is fully operational. The main challenges in EMT implementation included lack of political will, lack of skilled workforce, lack of guidelines for developing SOPs, and inadequate funding for EMT operations. A total of 606 health workers have been trained including 492 males (80.92%). The trainees were public health specialists (44.90%), clinicians (15.80%), support staff (13.65%), and non-health actors (25,66%).
Conclusion:
Our study highlighted critical challenges to guide the EMT implementation in West Africa. Despite the knowledge gained from the trainings, there is a need to take some urgent actions in West Africa for improving national EMT functionality and performance in West Africa.
Civil-military collaboration in response to an epidemic or health crisis could strengthen countries’ capacities to provide adequate medical care and limit casualties. Many countries have received the support of military medical services during an emergency,1 guided by their multi-disciplinary human resources, with a strong background in rapid deployment, logistics and trauma management, and the civilian teams with a good capacity in epidemic management.1,2
Objectives:
This study analyzes the determinants of a good civil-military partnership for rapid management of health emergencies on the African continent.
Method/Description:
We conducted a systematic review of literature from published (PUBMED, Hinari, and Google Scholar) and grey databases guided by the PRISMA guideline.
Results/Outcomes:
A good collaboration requires a formal agreement with a defined institutional anchor structure between the two institutions.1,3 The coordination should remain flexible with the co-leadership of each institution.1,3,4 The roles of all participating teams should be defined at the onset,1-5 and plans instituted based on the type of emergency to enhance cooperation. Both civilian and military teams need to know and understand the approved management protocols. Military health services are better experienced in trauma management, while civilians are more equipped to manage epidemics.1,4 Besides, there is a need for periodic evaluation of patient outcomes, resource management, challenges, and lessons learned after the response.
Conclusion:
Civil-military teams jointly responding to emergencies can be challenging but should be built around four defined pillars: collaboration, coordination, capacity building, and evaluation to capitalize on the teams’ strengths.
In the aftermath of disasters, Emergency Medical Teams (EMTs) are dispatched to help local rescue efforts. Although EMTs are recognized to be a critical component of the global health workforce, concerns have emerged over their functioning and effectiveness.1 For example, lack of cooperation and coordination between different EMTs has been a longstanding issue, resulting in fragmented disaster management.2 To enhance the provision of EMT’s field teamwork, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established,3 and later further updated with novel scenarios and exercises (ie, adapting EMT operations to a sudden disaster; becoming a modular team; reflecting on ethical dilemmas) in the complementary “TEAMS 3.0” project where a more comprehensive training package was developed.
Objectives:
The aim of this study was to assess the effectiveness and quality of the TEAMS 3.0 training package in four training programs in Portugal, Germany, Norway, and Turkey.
Method/Description:
Participants completed a set of questionnaires designed to assess self-efficacy, teamwork, and quality of training.
Results/Outcomes:
The results from the Portugal and German training suggest an improvement for both teams’ self-efficacy and teamwork. The quality of training is regarded as high and deemed as an appropriate tool package for addressing the objectives of the project and the perceived needs of EMT disaster deployment.
Conclusion:
Thus far, the TEAMS 3.0 project has demonstrated to be effective in promoting EMT teamwork capacities. The Norwegian and Turkish training results are expected to be available by the time of the WHO EMT Global Meeting 2022.
Tables and Figures (optional)
Table 1.
Comparison of Means Before and After the TEAMS 3.0 Training, per Country, for the Team Self-Efficacy Scale, Teamwork Scale, and Quality of Training Scale
In November 2021, a tanker exploded in Freetown, injuring and killing people. The WHO facilitated a seven-week first deployment of the Senegalese military to support the Ministry of Health (MOH) in providing care to the wounded in three referral hospitals.
Objectives:
Review the deployed team’s processes and outputs of medical care provided to burns patients.
Method/Description:
This is a cross-sectional After-Action Review (AAR) debrief of the deployment, including the WHO and MOH staff (n =14) in a virtual workshop. Six thematic areas: mobilization, deployment, coordination, case management activities, national capacity, and community acceptance were analyzed.
Results/Outcomes:
The WHO facilitated the team’s deployment and mobilized medical supplies and equipment whilst the MOH provided accommodation and logistics through collaboration. The team dispensed their functions with professionalism, adapted to the environment and available resources, and augmented the care provided by the available health workers. They offered additional care: reconstructive surgery, pain management, palliative and wound care, rehabilitation, physiotherapy, and psychosocial counselling, which were initially inadequate. 87 out of 155 patients were discharged home at the end, the national clinicians acquired additional skills, and the community appreciated the team. Despite being perceived as a weakness, the language barrier did not hinder the patient-doctor/nurse relationship or the provision of clinical care.
Conclusion:
This sub-regional response had significant benefits, including speed, political acceptability, and health context experience to support rapid and safe deployment. Mechanisms to facilitate rapid and quality-assured deployment of EMTs at regional and sub-regional levels in collaboration with WHO should be strengthened in region to support future responses.