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Incorporating emerging knowledge into Emergency Medical Service (EMS) competency assessments is critical to reflect current evidence-based out-of-hospital care. However, a standardized approach is needed to incorporate new evidence into EMS competency assessments because of the rapid pace of knowledge generation.
Objective:
The objective was to develop a framework to evaluate and integrate new source material into EMS competency assessments.
Methods:
The National Registry of Emergency Medical Technicians (National Registry) and the Prehospital Guidelines Consortium (PGC) convened a panel of experts. A Delphi method, consisting of virtual meetings and electronic surveys, was used to develop a Table of Evidence matrix that defines sources of EMS evidence. In Round One, participants listed all potential sources of evidence available to inform EMS education. In Round Two, participants categorized these sources into: (a) levels of evidence quality; and (b) type of source material. In Round Three, the panel revised a proposed Table of Evidence. Finally, in Round Four, participants provided recommendations on how each source should be incorporated into competency assessments depending on type and quality. Descriptive statistics were calculated with qualitative analyses conducted by two independent reviewers and a third arbitrator.
Results:
In Round One, 24 sources of evidence were identified. In Round Two, these were classified into high- (n = 4), medium- (n = 15), and low-quality (n = 5) of evidence, followed by categorization by purpose into providing recommendations (n = 10), primary research (n = 7), and educational content (n = 7). In Round Three, the Table of Evidence was revised based on participant feedback. In Round Four, the panel developed a tiered system of evidence integration from immediate incorporation of high-quality sources to more stringent requirements for lower-quality sources.
Conclusion:
The Table of Evidence provides a framework for the rapid and standardized incorporation of new source material into EMS competency assessments. Future goals are to evaluate the application of the Table of Evidence framework in initial and continued competency assessments.
In response to the global upward trend of humanitarian emergencies, the humanitarian health workforce has grown substantially in the last decades. Still, humanitarian education and training programs are limited in availability, geographical locations, and teaching methods, and are too expensive for local respondents. To address these gaps, an e-learning tool for humanitarian public health has been developed and evaluated.
Method:
Action research was used to develop the e-Learning tool. 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 from within and outside CRIMEDIM. Qualitative data were analyzed using thematic analysis. Quantitative data were appropriately summarized. Pre/post-test change in knowledge score was tested with paired t-test.
Results:
Although different levels of training are needed, targeting health professionals at the entry-level in the humanitarian field is identified as a priority. Scenario-based e-Simulation covers health needs assessment, essential health services, communicable diseases standards, and the health system was developed and evaluated. Trainees were highly satisfied by the clear objectives, the realism of the simulated scenarios, quizzes, and interactivity. In the 1-7 numerical scale, the median for overall experience satisfaction was 6.3 (IQR=5.3-7, N=35). The mean of the post-test score was 7.71, which was significantly higher than the mean of the pre-test score of 5.88. The large effect size of 1.179 indicates the training effectiveness. Poor internet was identified as a potential barrier to delivering the training.
Conclusion:
This participatory study resulted in the development of effective Scenario-based e-Simulation. Offline mode of training will be adapted for trainees with poor internet connection settings. Successful factors in instructional design will be used to inform the development of advanced training in the field.
During the COVID-19 outbreak in May 2021, Taipei City has transformed many vacant hotels to augmented quarantine hotels, recruiting retired medical staff to provide medical care, in order to preserve hospitals’ medical capabilities. In an augmented quarantine hotel at Caesar Park Hotel Taipei, the complexity of COVID quarantine, quarantine status of the residents, and hotel staff working with medical staff has made the original emergency response plan inappropriate. Henceforth, a series of modifications were made to ensure the emergency response readiness of Caesar Park Hotel Taipei.
Method:
The enhancements of emergency response capability of the augmented quarantine hotel at the Caesar Park Hotel Taipei, were made in accordance with the following list: 1. Revise evacuation plan, 2. Setup emergency equipment cart, 3. Modify emergency response procedure, 4. Update staff training and resident notice, 5. Routine stock count of medical supplies and emergency equipment.
Results:
The enhanced emergency response plan has ensured the safety of all personnel, plans were made in accordance with the COVID-19 quarantine status, and the staff has a clear perception of their duty with a picture of the overall emergency response plan.
Conclusion:
The enhanced emergency response plan was completed and under implementation in June 2021, and at the end of that month there was a fire that took four lives with 22 injured at a quarantine hotel in Changhua County. A review of the enhanced emergency response plan was made by the staff and corresponding hospital; many problems that happened at the Chunghua County quarantine hotel fire had already been considered or prevented in the enhanced emergency response plan. Such a method for building an enhanced emergency response plan has the potential to be implemented in more locations, and possibly in different scenarios.
Comprehensive emergency management (CEM) and hazard vulnerability analysis (HVA) are two vital concepts in hospital emergency management (EM). Teaching these two concepts by lectures may be less effective and interesting. Therefore, a tabletop game was used to teach CEM and HVA. This study aimed to evaluate the effect of teaching and possible reasons.
Method:
A tabletop game was created based on the concepts of CEM and HVA. Players of the game needed to manage hospitals against six kinds of emergencies. The impact of each emergency is different. Each hospital in the game has its vulnerability. The game players needed to use different strategies of prevention, mitigation, preparedness, response, and recovery to win the game.
The player’s knowledge was tested by 15 yes-no questions (10 points for each question). The interest in further learning and willingness of hospital EM participation were evaluated by questionnaire. The test and questionnaire were conducted before and after the game. Possible reasons for learning by the game were surveyed after the game.
Results:
Fifteen emergency department (ED) nurses were taught by the game and completed both pre- and post-game tests and questionnaires. The post-game test average score (103) was significantly higher than the pre-game average score (84) (p=0.008). The participants’ interest and willingness also increased significantly after the game. The most frequently mentioned reasons for learning by the game were “the game is more interesting than lectures”, “the chance to discuss with other participants in the game”, “the chance to see many CEM methods in the game”, and “ability to compare with other players”.
Conclusion:
A well-designed tabletop game can be an effective tool to teach CEM and HVA. The game can increase knowledge, interest in learning, and willingness of CEM participation, and it should be promoted in the future.
Emergency service workers are confronted with serious risks for their health, well-being and functioning. In order to prevent consequences to them and their families, emergency organizations should provide optimal support after an intensive period of employment. In many countries, the military pays special attention to the transition of their personnel from deployment to home via post-deployment adaptation programs (PDAPs). The objective of this presentation is to provide a structured analysis of the military approach to post-deployment adaptation and to identify potential lessons for emergency services.
Method:
A systematic literature search was performed to find original peer-reviewed studies on PDAP in six databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, PTSDPubs, and OpenGrey). The overall risk of bias of the articles was assessed using GRADE guidelines. The literature was analyzed guided by a program evaluation framework entailing different domains.
Results:
The search resulted in 1535 unique records that were screened for eligibility; 16 articles were included, of which only three showed low risk of bias. Most articles describe some form of third location decompression (N = 10) and also some agreement exists on how to adapt skills and cognitions after deployment (Battlemind; N = 4). The results suggest positive mental health effects and satisfaction of these elements.
Conclusion:
Empirical, high-quality evidence for PDAP is scarce. In addition, the existing literature reveals a lack of systematic method in describing the goals of PDAP and the ways of achieving these. Nevertheless, this study reveals promising elements that are in line with international guidelines, such as minimizing the level of exposure, intervention delivery and adjustment issues. We discuss how future research should incorporate these elements using a systematic approach.
The Emergency Department (ED) is the hospital’s main gateway, as well as the initial site for diagnosis and emergency medical care. In recent years, ED overcrowding is worsening in Israel and world-wide. Overcrowding has been shown to adversely affect patient service and care, fostering patient and caregiver dissatisfaction, as well as lowering quality of care and even increasing mortality. A main driver of ED overcrowding is ED patient boarding due to limited inpatient bed availability in conjunction with hospital policy. Measuring median length of ED stay (LOS) for admitted vs. discharged patients can serve as a simple indicator for the severity of the access block over time and between facilities.
Method:
ED operational data from the computerized system of four hospitals in Israel were collected over a year and analyzed. In parallel data was collected regarding hospital capacity and ED volumes. Data were analyzed using SPSS.
Results:
The Mean ED LOS was significantly higher for ED patients needing admission in all hospitals. Mean ED LOS for admitted vs. discharged patients was 227 min vs.431 in hospital A, 215 min vs. 222 in hospital B, 198 min vs. 440 in hospital C and 167 min vs. 190 in hospital D. The discrepancy in LOS for admitted patients was not related to the total hospital bed capacity or the hospital ED patient volume.
Conclusion:
ED boarding is a major challenge for ED's and hospitals worldwide and a significant contributor to ED overcrowding. A tool to assess boarding is proposed. The tool calculates the ratio of median ED LOS between patients admitted to the hospital and those discharged. Slightly higher LOS among those admitted is to be expected, considering the fact that they usually present with more complex medical problems. In this study the LOS ratios were 1.03, 1.12, 1.90 and 2.22.
Managing pandemics is dependent on the adherence of civil societies to directives and recommendations issued by governmental and public health authorities. In the context of the COVID-19 pandemic, hurdles were encountered by authorities regarding public compliance to orders and recommendations of protective health behavior. The objective is to investigate the factors that most powerfully enhance or impede compliance to varied measures–both regulations (i.e. lockdown, mask wearing, social distancing) and recommendations (i.e. vaccination etc.) in Israel.
Method:
A longitudinal study, based on structured questionnaires was conducted to investigate factors that enhance or impede the uptake of protective health behavior throughout two years of COVID-19.
Results:
Various factors throughout different phases of the pandemic have been identified as playing a significant role in compliance. During the initial phases of the pandemic, the most salient factors for enhanced compliance to non-pharmaceutical interventions (lockdown) were concern for family or self-health, while deterrence played little role. During the fourth wave, findings indicated that pandemic fatigue had begun to have cascading effects on vaccination efforts. Particularly at this stage, trust in authorities and even threat perception components were incapable of predicting uptake, while perceived importance of the vaccine and its effectiveness positively and significantly predicted uptake. Throughout the pandemic, a negative correlation between levels of resilience and distress symptoms and a positive correlation between resilience and enhanced compliance were identified.
Conclusion:
Utilizing tools for empowering the population rather than instilling fear or other deterrence measures are more effective approaches to increase compliance with governmental directives. Furthermore, the results highlight the importance of adapting and adjusting risk communication efforts to accommodate specific concerns and hesitations demonstrated by distinct groups during an evolving pandemic. Public health officials and authorities need to engage the public in resilience building activities to promote compliance.
Incarcerated individuals represent a particularly vulnerable sector of society, with a disproportionate burden of drug use, mental health problems, and chronic illness. The purpose of this study was to perform a descriptive analysis of EMS response to detention facilities.
Method:
Retrospective review of EMS calls to detention facilities between 1/1/2002 and 12/31/2021 within our EMS system. Data were analyzed using descriptive statistics and Student’s t-test. This study was deemed exempt by the Institutional Review Board.
Results:
3,126 requests for service occurred during the study period. Average patient age was 40.2 ± 13.3 years, compared with 54.0 ± 25.9 years for non-detention center calls (p < 0.001). The majority (80.8%) of patients were male. Mean scene time was 14:13 ± 7:49 minutes, compared with 12:04 ± 12:27 minutes (p < 0.01) for non-detention center calls. The most common complaints were chest pain (15.6%), trauma (13.6%), seizure (11.7%), behavioral (9.2%), and overdose (4.7%); OB requests accounted for 5.8% of calls for female patients. Most calls (86.0%) to detention centers involved incarcerated individuals. Four percent of patients refused treatment; 27.8% of these patients were still transported. One hundred and eight patients were identified by EMS as not needing transport. Consent for treatment/transport by the patient was documented in 5.2% of charts.
Conclusion:
Within our 911 service area, calls to detention facilities are not uncommon, predominantly involve incarcerated individuals, and are primarily due to chest pain, trauma, or seizures. Consent for treatment/transport was not documented in most EMS encounters. Further study is needed to better understand the health care needs of these patients, including ability to consent and access to chronic medications.
A collaborative project between Sweden and Kosovo with the aim to develop treatment guidelines for the ambulance services was undertaken. Firstly, relevant guidelines were identified, then translated, and processed to fit with the Kosovan ambulance service system. The next step was to train instructors in becoming proficient in training colleagues to use the guidelines. A train the trainer approach was chosen as it can be seen as grounded in Kolb's experiential learning theory and Crossan et al. organizational learning theory. Those theories describe how individuals learn and how organizations develop.
Method:
This implementation project supported training of local instructors to become proficient in training colleagues in 13 selected treatment guidelines for the ambulance services using scenario training. Initially, Kosovar instructors received directions from Swedish instructors then they observed the Swedish instructors. After this, they took more responsibility for the training. Seven Swedish instructors instructed eight Kosovar instructors for a week where about 100 Kosovan doctors and nurses were trained in patient assessment and treatment guidelines. The trainees were divided into four parallel groups of 4-5 participants with one Kosovar instructor supported by a Swedish instructor.
Results:
After the training week, eight instructors from two different ambulance service centers achieved proficiency in training colleagues in using treatment guidelines. Each Kosovar instructor was involved in 30 training occasions.
Conclusion:
The training resulted in the involved Kosovar ambulance service centers being able to train new colleagues in providing standardized patient assessment and treatment using treatment guidelines. In addition, the trained Kosovar instructors will be able to contribute to the development of new guidelines and revision of established guidelines.
Applying a train the trainer approach, theoretically grounded in learning theories, provides a sound basis to achieve systematic change for improving patient safety. Here, the knowledge distribution among practitioners is improved in an inexpensive manner.
The coronavirus disease (COVID-19) poses an urgent threat to global public health and is characterized by rapid disease progression even in mild cases. In this study, we investigated whether machine learning can be used to predict which patients will have a deteriorated condition and require oxygenation in asymptomatic or mild cases of COVID-19.
Method:
This single-center, retrospective, observational study included COVID-19 patients admitted to the hospital from February 1, 2020, to May 31, 2020, and who were either asymptomatic or presented with mild symptoms and did not require oxygen support on admission. Data on patient characteristics and vital signs were collected upon admission. We used seven machine learning algorithms, assessed their capability to predict exacerbation, and analyzed important influencing features using the best algorithm.
Results:
In total, 210 patients were included in the study. Among them, 43 (19%) required oxygen therapy. Of all the models, the logistic regression model had the highest accuracy and precision. Logistic regression analysis showed that the model had an accuracy of 0.900, precision of 0.893, and recall of 0.605. The most important parameter for predictive capability was SpO2, followed by age, respiratory rate, and systolic blood pressure.
Conclusion:
In this study, we developed a machine learning model that can be used as a triage tool by clinicians to detect high-risk patients and disease progression earlier. Prospective validation studies are needed to verify the application of the tool in clinical practice.
The World Health Organization (WHO) has developed and supported numerous initiatives to build capacity and awareness about health emergency and disaster risk management (Health EDRM). These include establishing the Health EDRM Research Network (Health EDRM RN) in 2018 and the publication of the Health EDRM Framework in 2019. These initiatives recognize that research is vital to generating the evidence to inform decision making and research that is integral to disaster preparedness, response and recovery will be vital to delivering the aspirations associated with caring, coping and overcoming in an increasingly challenging world.
Method:
To strengthen the capacity for conduct and use of research, resources were developed by the WHO Guidance on Research Methods for Health EDRM.
Results:
This first WHO textbook on Health EDRM research methods was published in 2021 and updated in 2022 with a chapter on Health EDRM research in the context of COVID-19. The 44 chapters offer practical advice about how to plan, conduct and report on a variety of quantitative and qualitative studies that can inform questions about policies and programs for health-related emergencies and disasters across different settings and level of resources. Case studies of direct relevance to Health EDRM provide real-life examples of research methods and how they have modified policies.
More than 160 authors in 30 countries contributed to the guidance, which is relevant to researchers, would-be researchers, policy makers and practitioners. It should help improve the quality of Health EDRM research; the quality of policy, practice and guidance supported by the evidence generated; and research capacity, collaboration and engagement among researchers, the research community, policy-makers, practitioners and other stakeholders.
Conclusion:
The Guidance is being supplemented by additional resources, including audio podcasts, slideshows, video presentations and webinars, and the content as a whole will be discussed in this presentation.
With an aging population and patients on end-of-life care (EOL) pathways, emergency departments (ED) are seeing an increase in patients requiring EOL care. There is paucity of data of attitudes and knowledge of physicians providing EOL care in the ED both internationally and in Ireland. The aim of this project was to assess the attitudes and knowledge of ED physicians towards EOL care.
Method:
This was a cross-sectional electronic survey of ED physicians working in Irish Eds, facilitated through the Irish Trainee Emergency Research Network (ITERN) over six weeks from September 27, 2021, to November 8, 2021. The questionnaire covered the following domains: Demographic data, Awareness of EOL Care, Views, and attitudes towards EOL care.
Results:
A total of 311 completed questionnaires across 23 participant sites were analyzed, with a response rate of 45%. The majority of the respondents were under the age of 35 (62%), were male (58%) and at SHO level (36%). In terms of awareness 32% (98) of respondents were not aware of palliative care services in their hospitals while only 29% (91) were aware of national EOL guidance. Fifty-five percent (172) reported commencing EOL care in the ED, however 75.5% (234) respondents reported their knowledge of EOL care to be limited or non-existent. Few (30.2%) respondents felt comfortable commencing EOL care in the ED without speciality team input. There appears to be a lack of clarity on the roles and responsibilities of ED nurses and doctors in the care of the dying patients in ED with only 31.2% (95) being clear on this role. Significant differences were observed with regards to clinical experience and physician grade.
Conclusion:
This study has highlighted a lack of awareness and knowledge of EOL care, particularly among less experienced ED physicians. However, there was a willingness to commence EOL care in the ED.
Various COVID-19 countermeasures were taken at Japan border control policy, especially, the return mission of Japanese nationals from Wuhan and the response to the Diamond Princess are considered to be cases that have stood out worldwide attention.
On the other hand, in response to the variants after December 2020, strict measures were taken, such as testing all those who entered Japan, quarantining those who tested positive, and requiring those who entered from certain regions to wait at some hotels even if they tested negative.
Method:
Report the response of quarantine in Japan.
Results:
In particular, for the Omicron variant in December 2021, the government took measures such as limiting the total number of people entering Japan, securing a maximum of over 20,000 rooms in a very short period of time, and providing domestic air transportation when necessary. The results of measures will be reported in this study.
Conclusion:
Various countermeasures taken as border control against COVID-19 in Japan were reported.
Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged in HIV Testing Services (HTS). In Kenya, these persons are often treated in emergency departments (EDs) for injuries, a healthcare interaction where HTS including HIV self-testing (HIVST) could be leveraged. There is, however, limited data from stakeholders on ED-HTS which impedes programmatic advancement.
Method:
A qualitative study was completed to understand facilitators and challenges for ED-HTS and HIVST delivery in Kenya (12/2021-03/2022). Data were collected via 28 in-depth patient interviews (14 males and 14 females) who had been treated in the Kenyatta National Hospital (KNH) ED and through seven focus-group discussions conducted with 49 ED healthcare personnel (nurses, doctors, HIV testing counselors, and administrators). Transcripts were double-coded and thematically analyzed with Dedoose™ software using a parallel inductive and deductive approach to capture both a priori and emergent themes.
Results:
Patients and providers viewed ED-HTS as a beneficial provision that was facilitated by engaged staff, education, perceived high HIV risk, and confidentiality. However, ED-HTS was limited by burdens on staff time and material resources, lacking systems integration, and patient illness severity. Facilitators of ED-HIVST delivery were perceived to have greater autonomy and confidentiality as well as lower health resource utilization. Challenges for ED-HIVST identified included patients’ concerns about HIVST accuracy and psychological stress, as well as providers’ concerns for loss to follow up and inability to complete confirmatory testing.
Conclusion:
ED stakeholders are receptive to HTS and HIVST provisions. This data provides insight into the patient, provider, and systems aspects that can be leveraged in ED-based HTS to enhance program impacts via intervention functions in the forms of education, care integration, resource scaling, and solidified post-self-testing follow-up mechanisms.
Over the last 20 years disasters have increasingly involved children, and pediatric disaster medicine research is growing. However, this research is largely reactive, has not been categorized in terms of the disaster cycle, and the quality of the research is variable. To understand the gaps in current literature and highlight areas for future research, we conducted a scoping review of pediatric disaster medicine literature. This work will help create recommendations for future pediatric disaster medicine research.
Method:
Using a published framework for scoping reviews, we worked with a medical librarian and a multi-institutional team to define the research question, develop eligibility criteria, and to identify a search strategy. We conducted a comprehensive Medline search from 2001-2022, which was distributed to nine reviewers. Each article was independently screened for inclusion by two reviewers. Discrepancies were resolved by a third reviewer.
Inclusion criteria included articles published in English, related to all stages of the disaster cycle, and disaster education, focused on or included pediatric populations; published in academic, peer-reviewed journals, and policies from professional societies.
Results:
967 pediatric disaster medicine articles were imported for screening and 35 duplicates were removed. 932 articles were screened for relevance and 109 were excluded. In 2000, three articles met inclusion criteria and 66 in 2021. We noticed reactive spikes in the number of articles after major disasters. Most articles focused on preparedness and response, with only a few articles on recovery, mitigation, and prevention. Methodology used for most studies was either qualitative or retrospective. Most were single site studies and there were < 10 meta-analyses over the 20 years.
Conclusion:
This scoping review describes the trends in and quality of existing pediatric disaster medicine literature. By identifying the gaps in this body of literature, we can better prioritize future research.
Natural disasters and catastrophes are challenges faced by emergency services. These are dangerous environments in which there are life-threatening victims as in other CBRN incidents, which can add great risks for nearby populations and the environment. The main objective of this project is the development and testing of new technologies that increase the safety and efficiency of the work of first responders in disasters.
Method:
The SnR consortium, with 28 partners, has designed, implemented, and tested new technologies, with an advanced communication and monitoring system for professionals, victims, and other first responders, with innovative positioning and assistance ICT that facilitate the exploration and evaluation of disaster areas.
These technological advances are validated and evaluated with performance, efficiency, and usability indicators, in laboratories and in real working conditions, through a total of seven case studies, in seven different countries, covering a wide range of representative disaster scenarios.
Results:
The development of a new communication and monitoring system for professionals and victims, coordinated on the Concorde platform, together with chemical alert sensors, synchronized with smartwatches, smart uniforms, and pediatric immobilizers, are some of the tools tested. The pilots carried out to confirm the usefulness of the 26 technological tools designed and tested in the field, which have helped to reduce the damage and casualties that can occur in S&R operations.
Conclusion:
In conclusion, the H2020 European Search and Rescue project (S&R), through the development of new technologies, offers a holistic approach to the effective response to emergencies and provides increased capabilities and resources to first responders in the field, increasing their effectiveness and safety. This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement (No. 882897).
The Comprehensive Framework for Disaster Evaluation Typologies (CFDET) was originally developed in 2017 with minor updates in 2018 (CFDET2.0). CFDET was created to unify and provide agreement on the identification, structure and relationships between multiple evaluation typologies found in the disaster setting. Since the publication of this framework, the world has witnessed unprecedented disaster-related events including two (2) Public Health Emergencies of International Concern (PHEIC): COVID-19 and Monkey Pox as well as the emergence and continuation of armed conflict in various countries around the world. This work presents CFDET3.0 which incorporates updates on international disaster frameworks, disaster health updates and evaluation guidelines.
Method:
A scoping literature review on international disaster frameworks, disaster health updates and evaluation guidelines has been undertaken and included reviewing peer-reviewed and grey literature.
Results:
The scoping literature review revealed updates on the following important publications:
World Health Organization (WHO) Health Emergency Disaster Risk Management (H-EDRM) (2019);
International Health Regulations;
Universal Health Coverage (UHC);
Climate Change Conference (COP27);
Fragile and Conflict-affected Contexts (FCAC);
Public Health Emergencies of International Concern, and
Updated evaluation standards, guidelines, evidence-based reviews and knowledge management.
Conclusion:
Incorporation of these international updates into CFDET2.0, strengthens global health and international disaster health responses with a focus on disaster health evaluation. The updated framework will be referred to as CFDET3.0. Future research is scheduled to develop a series of toolkits that will support an improved disaster evaluation process.
Arrival to the emergency room (ER) can increase stress levels in patients and family members. Thus, there is a need for a short and effective form of PFA provided by ER staff members, to reduce acute stress responses (ASR). Past studies have shown that psychological interventions based on emotional expression do not help to regulate extreme emotional expressions nor does it prevent post-traumatic stress disorder (PTSD). Alternatively, the Six C's model adopts a neuropsychological approach that focuses on cognitive communication, challenging for efficient activation, organizing the event's chronological order and reduction in loneliness by committing to stay with them. This experimental design study examined the effectiveness of the Six C's model on reducing signs of ASR.
Method:
Sixty-three participants (mean age 41.8 years) voluntarily took part. They were randomly assigned to the Six C's intervention (experimental condition) or to supportive emotional expression (control condition). They listened to a three minute audio recording of a real emergency 911 phone call. Interventions (SIX C's or emotional) were provided before and after listening to the recording. Before, immediately after, and five minutes after the recording, participants' anxiety, heart-rate variability (HRV) and mental resilience levels were measured.
Results:
For all three outcomes, the Time x Group interactions were statistically significant. Following "simple effects", analysis revealed that The Six Cs participants showed lower anxiety and less reductions in HRV and resilience than controls immediately after the stressor. Furthermore, the Six C's participants recovered faster on all three outcomes compared to controls, five minutes after the stressor.
Conclusion:
This study showed the Six C's model moderates people's ASR. Furthermore, the Six C's method helps people to "bounce back" faster psychologically and neuro-physiologically. These findings support using the Six C's model to reduce ASR and increase resilience, which is highly relevant to ER staff.
The purpose of this study is to develop a disaster nursing learning support system and a list of learning contents developed by our team to effectively and efficiently acquire the necessary disaster nursing competencies in the acute phase of disasters.
Method:
As the first step, based on the ICN Framework of Disaster Nursing Competencies, we examined the teaching materials using nine competencies extracted through prior literature, interviews with disaster nursing practitioners and reviews of disaster nursing experts. Next, we extracted learning contents that are considered difficult to learn in daily work from textbooks used in disaster relief nurse training. We gained new information on disasters using interviews with experts and internet search review literature.
Results:
Educational materials, including links to five open access sites, a summary of basic knowledge and original videos (case reports on dispatching disaster relief nurses, lectures on evacuation center management by experts, triage using the START-method and the PAT-method, psychological first aid, handling medical records and J-SPEED+ apps), were implemented. A test as an entry point for learning, a rubric to check current learning achievement, learning confirmation tests for each competency, a forum as a place for exchanging opinions among the learning community and an automatic certificate issuance system were set up.
Conclusion:
Disaster nursing is an extension of daily nursing, and many matters can be learned in daily work. There are few things that general clinical nurses should learn in addition as this study showed. However, it is inferred that it is not easy to select and update the knowledge and information that nurses need from the abundance of data available in the information society.
It is meaningful to have a learning support system that allows nurses at medical institutions that are expected to collaborate in the event of an emergency to learn together during the silent phase.