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Disaster responders operate in situations that are cognitively, emotionally, and morally distressing. The prevalence of mental health sequelae amongst disaster responders is well-documented. The World Health Organization (WHO) has published minimum standards for Emergency Medical Teams (EMTs), which requires them to assess the mental health and psychosocial support needs of their patients and staff, provide first aid, and ensure referral pathways for follow-up care are available. Specific to EMT staff and volunteers, the standards require that support services are always accessible. However, there is no requirement for EMTs to have their own mental health specialists, nor is having a mental health specialist assigned to each team and mission necessarily practical.
Objectives:
This study will assess the existing mental health resources of WHO EMTs and their use of telemedicine in mental health care.
Method/Description:
A survey will be distributed to the leadership of all WHO EMTs that are currently credentialed to capture descriptive statistics.
Results/Outcomes:
Data expected to be collected and analyzed by October 1, 2022.
Conclusion:
The absence of a mental health specialist significantly limits the availability of support services for EMT personnel. Given that the use of telemedicine in both disaster response and mental health services has been well-documented, telemedicine could be a low-resource method to link WHO EMT staff and volunteers with mental health specialists throughout the deployment cycle.
During COVID-19 pandemic, the EMS of the city of Madrid decided to make available its human and material resources to the Government. Despite its vast experience in disaster care and management, this mission was challenging. EMT1 SAMUR-PC was deployed, fully trained and self-sufficient inside and outside the city.
Objectives:
To review EMT1 activities during coronavirus disease, checking its adaptation to unusual circumstances.
Method/Description:
Description of settings where our teams (physicians, nurses, emergency care assistants, and logisticians) were deployed.
Results/Outcomes:
As elderly people were highly affected, EMT1 offered assessment and advise at nursing homes in Madrid and other cities. Personalized visits were planned and performed addressing personnel and material needs and processed to authorities in daily meetings.
Logisticians advised about how to control clean and dirty zones, isolating positive cases. Meanwhile, doctors and nurses wearing PPE provided health care and referred severe patients. Quality of care in elderly was measured, improvement areas were notified directly to heads.
We were deployed to some hospitals in the country, reinforcing medical and nursing staff at wards, observation areas, and intensive care units. It was also necessary to transfer critical patients between hospitals.
Decontamination lines were set up by CBN experts. Rapid response teams were ready to provide care to colleagues.
Conclusion:
During COVID-19 pandemic, Spanish EMT1 was able to adapt its normal way of working at different settings, supporting and re-establishing essential health services. It required flexibility, taking advantage of existing structures, and focusing on vulnerable populations. Its role was important for saving lives, preserving health, and alleviating suffering.
Since its inception, the World Health Organization’s Emergency Medical Teams (EMT) Initiative has strived to save lives, preserve health, and alleviate suffering through inclusiveness, transparency, global cohesion, and regional adaptation of quality standards and methodology.1 The mission of the Global EMT Initiative is to enhance the surge capacity of countries through the promotion of rapid mobilization and efficient coordination of both national and international medical teams and health care workforce to reduce loss of life and prevent long-term disability because of disasters, outbreaks, and other emergencies.1
Over the past decade, four EMT Global Meetings have been held and serve as a platform to foster collaboration and support among the global EMT community, which consists of clinicians and non-clinical providers, Member States, and partners. The gatherings in Geneva, Panama, Hong Kong, and Bangkok created momentum for the development of a global network and proved vital in guiding the direction of the initiative.
Under the leadership of the EMT Strategic Advisory Group, the 2022 EMT Global Meeting in Yerevan convened over 500 participants from 110 countries and organizations. The event provided the network an opportunity to define a longer EMT strategy – EMT 2030 – which serves to strengthen national EMT and rapid response capacities as part of the global health emergency preparedness, response, and resilience (HEPR) architecture outlined by the 75th World Health Assembly in May 2022.2
One of the four core objectives of the EMT 2030 strategy is to Strengthen information systems, evidence, and research. To further this objective, for the first time in 2022, the EMT secretariat introduced a research program into the EMT Global Meeting.
The overall aim of research among EMTs is to support improvement of care provided to populations affected by emergencies, and therefore further the mission and vision of the EMT initiative. Even though the adoption of an experience-based strategy has had a positive impact in the past years, there is a need for an evidence-based generalizable guidance, aiming to increase predictability of response, strengthen advanced planning, and facilitate early actions. To this end, since late 2021, the EMT Secretariat has begun compiling a Global EMT Research Agenda, including documenting innovative solutions and products, deployments of national and international teams, and lessons learned from responses. The Secretariat also launched new platforms for advocacy and information exchange among the EMT Network.
The 2022 EMT Global Meeting abstracts highlight the vast number of accomplishments that the EMT Network can and has already accomplished. From documenting the process of developing teams to modeling impact of effective responses, to demonstrating regional and sub-regional enhancements in knowledge sharing and after-action reviews of responses, there has been a wealth of experience presented in Yerevan. It is our pleasure to present them here.
We look forward to strengthening the evidence base for EMT preparedness and response, with many of these abstracts developed further into manuscripts and more research to come.
The Tonga Emergency Medical Assistance Team (TEMAT) responded to the Hunga Tonga-Hunga Ha’apai (HTHH) volcano and tsunami in early 2022. The HTHH volcano erupted violently on January 15, 2022 triggering a tsunami that struck many of Tonga’s 169 islands.1 84% of the country’s population was affected.2 Tonga’s undersea internet cable was cut, stopping most communication. At the time of the eruption/tsunami, Tonga was COVID-19-free with its borders effectively closed, forcing reliance on national emergency resources, including TEMAT.
Objectives:
Describe TEMAT’s response to the 2022 HTHH volcano eruption and tsunami.
Method/Description:
TEMAT deployed four rotations of clinical and public health teams in response to the eruption/tsunami. Team members included clinicians from the Ministry of Health, with logistics support from His Majesty’s Armed Forces. TEMAT carried out emergency assessments, facilitated medical evacuations, aided in the evacuation of an entire island’s population, and provided essential health services.
Results/Outcomes:
From January 17 through March 4, 2022, TEMAT cared for 381 patients including patients with non-communicable diseases (>50), psychosocial complaints (39), communicable diseases (27), and traumatic injuries (13). The team supported five referrals to higher level care, conducted patients home visits, aided in health center repairs, and responded to a boat sinking during their deployment.
Conclusion:
TEMAT’s deployment demonstrates that deployment-ready and self-sufficient national EMTs are essential for response to sudden-onset disasters in vulnerable countries. A trained and well-prepared national EMT can respond independently, quickly, and effectively to emergencies, despite limited resources and high-impact events.
The humanitarian health field has grown rapidly in the last decades. However, education and training programs are still limited in number, especially where it is needed most. Additionally, the cost of the training is too expensive for local humanitarian health respondents. If developed appropriately, E-Learning can potentially address these gaps.
Objectives:
Develop an effective E-Learning tool for humanitarian public health training.
Method/Description:
The tool was developed using an institutional-based, action research method. Rapid prototyping - a modified analysis, design, development, implementation, and evaluation (ADDIE) model - was used to identify the content and instructional design. This iterative process involved consultations and feedback from public health and disaster medicine instructors and students at different levels and training programs. Different methods were used to collect and analyze data, such as literature and courses reviews, observation, interviews, and questionnaires.
Results/Outcomes:
Four scenario-based E-Simulations - targeting entry-level humanitarian health professionals - were developed and piloted based on identified needs. Formative evaluation clarified training objectives and structure. Trainees were satisfied by the simulated scenario, interactivity, questions, and timely feedback. Poor internet was identified as a potential barrier to delivering the training in the humanitarian context.
Conclusion:
Clear objectives and quality content are the prerequisites for training effectiveness. Yet, instructional design is a critical element that can enhance training effectiveness. The tool’s offline mode is being adapted to improve access in poor internet connection settings. A summative evaluation will be conducted to measure the training’s effectiveness. Furthermore, successful factors in instructional design will be used to inform the development of advanced training in the field.
Amidst the COVID-19 pandemic, the EU-MODEX exercise had to rethink its logistics in order to promote safer environments for its participants.1
Objectives:
To describe the Blended EU-MODEX exercise as a method to minimize the risk of COVID-19 contagion and the role of CRIMEDIM during such innovative approach.
Method/Description:
The first post-COVID-19 EU-MODEX exercise was performed in October 2021. To avoid travels, three EMTs from Austria, Romania, and Estonia virtually deployed in a fictious country hit by a typhoon, operated independently in their own country. The Excon worked remotely from Germany. The interoperability among the EMTs was simulated using an online tool. When a patient, simulated by a local role player, needed a transfer from the EMT1 in Romania or Austria, all clinical information were shared online and a new role player was prepared with that information to continue the simulation in Estonia. CRIMEDIM personnel located at each EMT were tasked to ensure the consistency and the quality of all the clinical cases, matching the clinical information of the incoming patient with the new role player, especially regarding the treatment received and the makeup instruction.
Results/Outcomes:
During the exercise, 425 clinical cases were played by the three EMTs. The exercise lasted for 60 hours and provided unique challenges due to its blended nature. No COVID-19 outbreaks were registered following the exercise.
Conclusion:
The experience of the Blended EU-MODEX exercise showed the potentiality of the virtual simulation environment as an effective alternative to avoid secondary contagion as well as reduce costs.
Fiji consists of 110 populated islands over an area of 2,600,000 square kilometers and is prone to disasters such as tropical cyclones.1 To increase national capacity to respond to disasters and outbreak, the Fijian government, under the commissioning of Ministry of Transport and with technical guidance from the Ministry of Health, designed a medical ship called the MV Veivueti. During Fiji’s COVID-19 surge, MV Veivueti was utilized to provide operative health services during the surge in COVID-19 patients at other health facilities.2
Objectives:
To describe FEMAT’s COVID-19 response utilizing the medical ship, MV Veivueti, in Fiji’s Pacific island setting.
Method/Description:
MV Veivueti has been used on multiple disaster responses, however the COVID-19 surge in mid-2021 was the first time the vessel was used during an outbreak to allow for the continuation of surgeries when other health facilities were overwhelmed with COVID-19 patients. The medical ship is staffed with a comprehensive team from Fiji’s EMT - FEMAT - including surgeons, pediatricians, obstetricians, a dentist, nurses, and other medical staff.
Results/Outcomes:
From May 5 through July 6, 2021, a 12-member medical team staffed the medical ship 24-hours a day, providing primarily operative management of cases that were referred from health facilities. COVID-19 screening and IPC measures were in place and a clear patient flow was designed for patient transferred to health care facilities.
Conclusion:
The use of the MV Veivueti helped ensure continuity of critical health services during the peak of the Delta VOC outbreak in the Fiji Islands.
The NCCTRC is the custodian of the Australian Medical Assistance Team (AUSMAT) capability. AUSMAT achieved World Health Organization (WHO) verification as a Type 2 Emergency Medical Team (EMT) in 2016.
The NCCTRC explored a quality framework to support quality improvement beyond WHO minimum standards. The Australian Council on Healthcare Standards (ACHS) accreditation standards were applied to a unique field capability setting.
Objectives:
Establish a quality improvement framework for AUSMAT deployable capability to ensure delivery of the highest standard of care to populations affected by disasters and health emergencies.
Method/Description:
ACHS surveyors conducted a scoping assessment in 2017. The ACHS EQuIP Framework provided flexibility to accommodate the complexity of a deployable health facility, the fixed and virtual workforce, and the application of disaster response/humanitarian principles.
Self-assessment identified gaps, which were remedied by the development of multiple tools, and an on-going program of improvement in formal documentation of process.
Results/Outcomes:
NCCTRC achieved ACHS EQuIP accreditation in June 2019. NCCTRC was awarded the ACHS Global Quality Improvement Award in November 2019. Survey in May 2021 demonstrated continued achievement.
Conclusion:
The application of a national accreditation framework to an EMT is unique. The NCCTRC applied a quality improvement framework to provide a standard of care that meets national health facility accreditation criteria, setting a new standard of clinical quality in the field.
The Minimum Data Set (MDS) has allowed governments of disaster-affected countries to collect, examine, and evaluate standardized medical data from Emergency Medical Teams in real-time. However, little study has been conducted on the use of MDS data to predict health care needs.
Objectives:
This research proposes an outlook on the use of machine learning and MDS data to predict the need for medical care in disaster-affected areas.
Method/Description:
The characteristics of the data collected by MDS and the optimal machine learning model were discussed.
Results/Outcomes:
The primary causes of disease after disasters are trauma (MDS Nos. 4–8), which frequently occurs immediately after a disaster, and infectious diseases (MDS Nos. 9–18), which can increase due to decreasing hygiene conditions. Furthermore, certain infectious diseases can spread quickly because of living in congested evacuation centers, and early detection is crucial.
Therefore, predicting the need for medical care in a disaster area is complicated and requires a combination of many machine-learning models. Data-driven methods are mostly linear approaches and cannot capture the dynamics of infectious disease transmission. Additionally, statistical models depend heavily on assumptions, making real-time infection prediction challenging. Thus, deep learning is employed to model without losing the temporal component.
Conclusion:
Real-time prediction of health care needs using machine learning and MDS can be useful to policymakers by enabling them to better deploy and allocate health care resources, which is useful to patients and front-line health care providers. More detailed predictions for regions and diseases are also anticipated.
Pacific Island Countries and Areas (PICs) represent some of the most remote and logistically challenging locations – with thousands of islands covering vast ocean territory. Since 2017, Pacific Ministries of Health have been developing EMTs, and all have worked to train team members to be deployment-ready.1
Objectives:
To describe an EMT training package specifically tailored to PIC contexts, including curated content, practical exercises, and “talanoa” discussions to improve EMT readiness, with a focus on logistics in remote and austere PIC contexts.
Method/Description:
WHO leveraged EMT training materials developed globally and regionally to continuously tailor an in-person EMT training package, emphasizing readiness for the deployment of light, mobile clinical teams for disaster-prone small island/large ocean countries. Emphasis was placed on practical learning exercises focusing on skills and competencies needed to manage complex Pacific deployments, and to care for populations on remote, difficult-to-reach islands with limited resources and referral options.
Results/Outcomes:
The Pacific EMT training program includes a mix of didactic and practical sessions coupled with a full-scale simulation exercise; it was designed with and for Pacific EMTs. The effectiveness of the training package has been evidenced through many successful national EMT deployments in several PICs, as well as through consistently positive participant feedback.
Conclusion:
Tailoring training materials to specific country contexts is essential. In the Pacific, core EMT training content with an emphasis on practical activities and simulations and “talanoa” discussions reflecting on previous deployments in remote islands has been viewed by participants as critical to preparing them for real-world deployments.
Palau is a small island/large ocean nation in the Pacific with a population of approximately 18,000 and a high level of vulnerability to natural or climate-related disasters. In June 2022, Palau became the smallest nation in the world by population to establish a national Emergency Medical Team (EMT). The team is named “Klemat,” after the rope that holds the sails of Palau’s traditional canoes.
Objectives:
To establish a national EMT capable of self-sufficient, high-quality clinical response to disasters and outbreaks that may occur locally or in neighboring jurisdictions.
Method/Description:
The development of Klemat required a multi-step process with support from technical and funding partners. Online orientation webinars and meetings were held in 2019 and 2020, and a national Technical Working Group (TWG) was formed in 2022. A national EMT coordinator was jointly hired by the WHO and the Ministry of Health and Human Services of Palau in 2022, and EMT Standard Operating Procedures were drafted.
Results/Outcomes:
Klemat is the nation’s deployable clinical response capacity, capable of fully self-sufficient tented out-patient and emergency care in the most austere disaster or outbreak circumstances. There are now 18 fully trained clinical and support team members. Klemat is working with relevant stakeholders to be codified in the national disaster risk management framework of Palau.
Conclusion:
Palau’s development of a national EMT demonstrates that even the smallest of countries can establish self-sufficient EMTs capable of national or regional response.
The Federated States of Micronesia (FSM) is a Pacific Island nation of just over 100,000 people, with 607 islands spread over an ocean territory of over 2.5 million square kilometers. The nation is regularly struck by disasters and outbreaks - most recently Typhoons Wutip and Maysak, which affected populations on hundreds of islands. To strengthen rapid response to future emergencies, the FSM Government, with support from WHO, Japan, and USAID, is now developing a national Emergency Medical Team.1
Objectives:
To describe the development of FSM’s national EMT.
Method/Description:
FSM’s EMT development began with a workshop facilitated by WHO in November 2019, with participants from the National Department of Health & Social Affairs (DHSA) and representatives from all four of FSM’s State Health Departments. A national EMT focal point was jointly hired by WHO and FSM’s DHSA, a Technical Working Group was established, and SOPs developed. WHO initiated procurement of a tailored Pacific EMT cache for FSM’s EMT, along with other Pacific EMTs. FSM’s EMT development has been slowed by COVID-19, but there are plans to train team members from the country’s four States to be ready for self-sufficient national deployments by early 2023.
Results/Outcomes:
With support from partners, FSM is developing a self-sufficient national EMT capable of rapid response across hundreds of islands spread over a vast ocean territory.
Conclusion:
FSM is strengthening readiness for future emergencies by developing a national EMT capable of rapid response to the most remote and austere post-disaster conditions, including throughout its remote outer islands.
EMT’s training is considered of high importance for disaster preparedness and response. The PT EMT, joined the TEAMS 3.0 Consortium, seeking to develop a universal training program for EMTs.
Objectives:
The purpose of this study is to evaluate the effectiveness of the PT EMT E-learning Course in preparing trainees for disaster during their EMT initial training.
Method/Description:
The analyzed data were collected through the application of a final questionnaire, which aimed to assess the effectiveness of the topics covered and the self-perception of disaster preparedness. A total of 31 trainees attended the E-learning Course, but only 25 answers were collected.
Results/Outcomes:
The results showed that 92% of the trainees considered as the most important themes three areas: (1) Disaster and Humanitarian Principles; (2) Safety & Self-Protection; and (3) Disaster Logistics. The overall mean score was 4.52 points (SD = 0.770) out of five for the importance of this training for the performance of their mission roles and 4.48 points (SD = 0.770) in the contribution of these contents to their individual development. After completing this E-learning module, 88% consider themselves better prepared to disaster response and to attend the practical module of the initial training program.
Conclusion:
The PT EMT E-learning Course, preceding the practical TEAMS 3.0 course, proved to be effective in the preparation of trainees for the practical training, but especially, it adds a huge variety of important knowledge, solidifying their preparedness for disaster response.
The development of common training bases for EMTs, with both modules, will improve the disaster preparedness and response.
The Standard Operating Procedure for Coordination of Emergency Medical Teams in ASEAN (EMT SOP) was developed to facilitate the swift deployment of I-EMTs by ASEAN Member States (AMS) to disaster-affected countries in the ASEAN region and to effectively provide appropriate medical services to the affected population. It is one of the various products and activities by the ARCH Project, which was implemented in collaboration between ASEAN and Japan from 2016 through 2021. The EMT SOP was developed in line with the WHO EMT Initiative, and various WHO forms have been incorporated as ASEAN official forms for the management and coordination of I-EMT.
Objectives:
On the other hand, disaster management in ASEAN is conducted by National Disaster Management Organization (NDMO) of each AMS under the coordination of the ASEAN Coordinating Centre for Humanitarian Assistance on disaster management (AHA Centre) in accordance with the Standard Operating Procedure for Regional Standby Arrangements and Coordination of Joint Disaster Relief and Emergency Response Operations (SASOP), the sole official document for ASEAN regional collaboration in disasters, and AMS I-EMTs are required to follow the SASOP for their deployment to the affected AMS.
Method/Description:
Discussions were held between the NDMOs and MOHs, and a table-top exercise to test the EMT SOP was conducted involving NDMOs and MOHs with the facilitation of the AHA Centre.
Results/Outcomes:
The EMT SOP has been incorporated as an additional chapter of the SASOP.
Conclusion:
The institutionalization of the EMT SOP is an important milestone in strengthening the ASEAN regional cooperation mechanism on disaster management.
As disasters disrupt health systems and create additional health needs, Mobile Health Units (MHU) are deployed to help cover primary health care (PHC) needs. However, MHUs have been critiqued for being logistically burdensome and poorly adapted to dominating health needs. Guidelines exist, including WHO Classification for Emergency Medical Teams (EMT) Type 1 mobile, but the usefulness of MHUs in disasters has been poorly studied.
Objectives:
To explore the use of MHUs for PHC in disasters and identify key characteristics as described in the literature.
Method/Description:
A scoping review was conducted following framework by Arksey and O’Malley using thematic content analysis. Twenty-six bibliographic databases and websites were screened for white and grey literature on the use of MHUs in disasters published from 2000-2021.
Results/Outcomes:
The search resulted in 24 reviews and operational reports, highlighting nine themes. While MHUs were reported to improve health service delivery, 16 documents highlighted challenges related to logistics, organization, and coordination. Seven publications described cooperation with local authorities and stakeholders to help improve relevancy of care by adapting service provision to health needs. Several studies highlighted the need for a functioning referral system and inclusion of local and culturally sensitive staff.
Conclusion:
Findings of this study highlight the added value and areas of improvement of MHUs for PHC in disasters. Recommendations of best practices were proposed based on the literature and may guide future deployments. However, there is a paucity of publications, and further data on EMT Type 1 mobile are needed to evaluate MHUs in disasters and improve guidelines.
During health emergencies, significant disruptions occur concurrently within critical components of acute care systems such as workforce, medical supplies, clinical workflows, patient care pathways, and hospital essential support services. The ability to map both existing and surge capacities across the acute care health system is a complex, nuanced, and often lengthy process which is heavily dependent upon localized knowledge applied in specific, individual contexts.
Objectives:
Outline an innovative, “All Hazards” tool developed through a standardized framework approach to rapidly and consistently identify, assess, and prioritize key system-wide health capacity indicators in acute care hospital settings during health emergencies.
Method/Description:
Initially designed as a health systems preparedness and planning tool for use in sudden-onset disasters in 2017, the “7S” framework has been successfully applied during recent AUSMAT outbreak emergency responses to assist local Ministries of Health to effectively identify, articulate, rationalize, and prioritize clinical and operational health response priorities.
Results/Outcomes:
Multiple operational health leaders found the “7S” framework valuable in efficiently managing both the assessment of and priority allocation of resources in health systems under duress. The tool was simple to understand and explain, time efficient, and comprehensive. Additionally, the tool provided an effective structure for communicating with local health and response leaders.
Conclusion:
The “7S” framework has demonstrated excellent utility as a highly effective and scalable, locally adapted “All Hazards” tool for use during health planning, preparedness, and acute care response phases in diverse health emergencies contexts.
The Commonwealth of the Northern Mariana Islands (CNMI), a chain of 14 Pacific islands with a population of around 50,000 and a United States territory, experienced two major typhoons exceeding 150 mph/240 kmph in three years. The resiliency of the people of the CNMI is evident, and has been supplemented through support from international Emergency Medical Teams (EMTs). As a US territory, support is available from the United States federal government and international partners, but an island territory far from the US mainland, the CNMI requires strong local emergency response capacity.
Objectives:
To describe:
How the CNMI health system conducted an environmental scan to identify and address gaps in out-patient support in disasters;
How the health system improved and expanded its capacity to respond to emergencies with a significant impact on the community’s health; and
How leveraging the integration of clinical and public health capacities contributed to the development of a multidisciplinary local Type 1 EMT in the CNMI.
Method/Description:
The CNMI brought together key local agencies involved in emergency response. Because of multiple recent disaster response efforts, agencies had deep knowledge and experience, and gaps were easily identified.
Results/Outcomes:
The territory’s experience with international EMTs guided the creation of a local EMT in the CNMI, engaging local agencies, physicians, nurses, and public health and preparedness staff from the territory’s health system to establish an EMT for local and potentially for regional response.
Conclusion:
Building local capacity using multi-sectoral agencies and multi-disciplinary individuals improves health system resiliency in health emergency response.
Standardization of data collection and reporting within EMTs is challenging. In past deployments, the Red Cross Red Crescent Type 1 and Type 2 facilities have collected data by hand using paper-based form and Excel spreadsheets. This process can be laborious, time-consuming, and often inaccurate.
Objectives:
To combat this issue with reporting, RCHIS (Red Cross Red Crescent Health Information System) has been designed to ensure that reporting is accurate and also very easy to complete, increasing compliance with the EMT-MDS reporting.
Method/Description:
RCHIS is both an electronic medical record (EMR) and health information system (HIS). RCHIS has been designed to produce pre-made reports including the MDS in seconds, extracting data from the patient records. Through significant testing and pilot deployments in a domestic Type 1 fixed clinic, the rapid production of reports such as the MDS has increased compliance and accuracy with reporting.
Results/Outcomes:
Overall, the utilization of an electronic medical system for increasing compliance and accuracy with the MDS has been hugely successful. An in-depth analysis of the export data was done to confirm the 100% accuracy within the MDS report.
Conclusion:
The utilization of RCHIS within a domestic ERU (equivalent to an EMT Type 1 or Type 2) has been hugely successful. The next steps will involve the deployment of RCHIS within an international deployment.
Emergency Medical Services (EMS) is a critical part of Disaster Medicine (DM) and can limit morbidity and mortality with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training available to EMS physicians. The Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War arose during the SARS-CoV-2 (COVID-19) pandemic.
Objectives:
This study assessed the state of disaster preparedness of the Armenian EMS system and effects of the simultaneous pandemic and war on EMS providers.
Method/Description:
This was a cross-sectional study by anonymous survey of Yerevan EMS physicians who provided care to war casualties and COVID-19 patients.
Results/Outcomes:
Most participants had been a physician for ≤three years (52.1%). Many were in residency (64.6%).
Battlefield medicine experience was limited prior to the war. The majority reported no experience treating mass casualties (52.1%), explosives wounds (52.1%), or performing surgical procedures (52.1%). Greater battlefield medicine experience was found with ≥three years of experience as a physician (z-score -3.26; P value <.01) or EMS physician (z-score -2.76; P value <.01), and being ≥30 years old (z-score -2.11; P value = .03). Most participants felt in danger during the war at least sometimes (89.6%).
Conclusion:
EMS physicians in Armenia had limited training and experience in DM prior to the 2020 Nagorno-Karabakh War, but practiced in a setting requiring extensive DM knowledge as evidenced by the simultaneous response to the COVID-19 pandemic and war. There is a strong need for DM training within the Armenian EMS system.