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Since 1902, disasters in the Northern Triangle of Central America, which consists of the countries Guatemala, Honduras, and El Salvador, have caused over one-hundred-thousand deaths, affected millions of people, and caused tens of billions of dollars in damages. Understanding the nature and frequency of these events will allow stakeholders to decrease both the acute damages and the long-term deleterious consequences of disasters.
This study provides a descriptive analysis of all disasters recorded in the Emergency Events Database (EM-DAT) affecting Guatemala, Honduras, and El Salvador from 1902-2022.
Data were collected and analyzed from the EM-DAT, which categorizes disasters by frequency, severity, financial cost, distribution by country, burden of death, number of people affected, financial cost by country, and type of disasters most prevalent in each country. Results are presented as absolute numbers and as a percentage of the overall disaster burden. These trends are then graphed over the time period of the database.
The EM-DAT recorded 359 disasters in the Northern Triangle from 1902 through 2022. Meteorologic events (floods and storms) were the most common types of disaster (44%), followed by transport accidents (13%). Meteorologic events and earthquakes were the most severe, as measured by deaths (62%), people affected (60%), and financial cost (86%). Guatemala had the greatest number of disasters (45%), deaths (68%), and affected people (52%). The financial costs of the disasters were evenly distributed between the three countries.
Meteorologic disasters are the most common and most severe type of disaster in the Northern Triangle. Earthquakes and transport accidents are also common. As climate change causes more severe storms in the region, disasters are likely to increase in severity as well. Governments and aid organizations should develop disaster preparedness and mitigation strategies to lessen the catastrophic effects of future disasters. Missing data limit the conclusions of this study to general trends.
Industrial disasters can have a myriad of repercussions ranging from deaths, injuries, and long-term adverse health impacts on nearby populations, to political fallout and environmental damage. This is a descriptive epidemiological analysis of industrial disasters occurring between 1995 and 2021 which may provide useful insight for health-care systems and disaster medicine specialists to better prevent and mitigate the effects of future industrial disasters.
Data were collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all industrial disasters occurring between January 1, 1995, and December 31, 2021.
A total of 1054 industrial disasters were recorded from 1995 to 2021. Most of these disasters occurred in Asia (720; 68.3%), with 131 (12.4%) in Africa, 107 (10.2%) in Europe, 94 (8.9%) in the Americas, and 2 (0.2%) in Oceania. Half of these disasters were explosions (533; 50.6%), 147 (13.9%) were collapses, 143 (13.6%) were fires, 46 (4.4%) were chemical spills, 41 (3.9%) were gas leaks, and 34 (3.2%) were poisonings. There were 6 (0.6%) oil spills and 3 (0.3%) radiation events.
A total of 29,708 deaths and 57,605 injuries were recorded as a result of industrial disasters, and they remain a significant contributor to the health-care risks of both workers and regional communities. The need for specialized emergency response training, the potential devastation of an industrial accident, and the vulnerability of critical infrastructure as terror targets highlight the need to better understand the potential immediate and long-term consequences of such events and to improve health-care responses in the future.
This study aims to analyze and describe terrorism-related attacks in East Asia from 1970 through 2020.
East Asia consists of South Korea, North Korea, Singapore, Hong Kong, China, Japan, Taiwan, and Macao. According to the Global Terrorism Index (GTI) 2022, the impact of terrorism in East Asia is very low. However, the assassination of former Japanese Prime Minister Shinzo Abe on July 8, 2022 demonstrates that East Asia is not safe from terrorist attacks. This descriptive analysis of terrorist attacks in East Asia will help first responders, Emergency Medical Services (EMS), hospital-based medical providers, and policymakers establish a more refined hazard vulnerability assessment (HVA) framework and develop a Counter-Terrorism Medicine (CTM) mitigation, preparedness, response, and recovery plan.
This is a descriptive observational study drawing data from the Global Terrorism Database (GTD) from January 1, 1970 through December 31, 2020. Epidemiology outcomes included primary weapon type, primary target type, the country where the incident occurred, and the number of total deaths and injured collected. Data from 2021 were not yet available at the time of this study. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.
There were 779 terrorism-related events in East Asia from 1970 through 2020. In total, the attacks resulted in 1,123 deaths and 9,061 persons injured. The greatest number of attacks (371; 47.63%) occurred in Japan and the second most occurred in China (268; 34.4%). Explosives were the most used primary weapon type (308; 39.54%) in the region, followed by incendiary devices (260; 33.38%). Terrorist attacks drastically diminished from their peak of 92 in 1990, but there were additional peaks of 88 in 1996, 18 in 2000, 20 in 2008, and 36 attacks in 2014.
A total of 779 terrorist attacks occurred from 1970 through 2020 in East Asia, resulting in 1,123 deaths and 9,061 injuries. Of those, 82.03% attacks occurred in Japan and China. Terrorist attacks drastically diminished since their peak in 1996, but there is an overall uptrend in attacks since 1999.
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.
An electronic search of five selected journals from 1991 through 2021 utilizing multiple keywords relevant to DM was conducted for review and analysis.
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.
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.
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.
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.
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.
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%).
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.
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.
This study assessed the state of disaster preparedness of the Armenian EMS system and effects of the simultaneous pandemic and war on EMS providers.
This was a cross-sectional study by anonymous survey of Yerevan EMS physicians who provided care to war casualties and COVID-19 patients.
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%).
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.
Moral distress is a well-described phenomenon in medical providers. It has been linked to mental health deterioration, decreased job satisfaction, and early retirement. No study has been done on the level of moral distress associated with treating patients in simultaneous disasters.
1. To learn what is known about the experience of moral distress in frontline health care providers during the COVID-19 pandemic and the concurrent conflict in Armenia during 2020.
2. To determine how WHO EMTs can support their frontline staff experiencing moral distress.
A survey was designed to test the moral distress felt by Armenian EMS providers who had cared for both COVID-19 and war casualty patients. This was adapted from the Moral Distress Scale Revised (MDS-R).
Of the questions asked, respondents most often responded that they were disturbed by: “Continuing to participate in care for a hopelessly ill or injured person who is being sustained on a ventilator when no one will make a decision to withdraw support” (Mean 2.68/Median 3/Mode 4); and “Initiated extensive life-saving actions when I think they only prolong death” (2.47/3/3), which caused the next most distress to subjects.
It is expected that some health care workers in Armenia are likely facing on-going consequences of the moral distress they faced during this unprecedented period of global pandemic and war. Clinics and teams who are more likely to encounter potentially morally distressing events, such as disaster medicine workers, need to address their moral distress mitigation plan by identifying strategies across the continuum of disaster management.
One of the most severe outcomes of the Ukraine war has been the systematic destruction of communities resulting in mass migration of people to Poland. Millions of affected people have arrived in Poland as war refugees requiring medical attention from a fragile health care system overburdened by the COVID-19 pandemic. This study assesses ED utilization in Polish hospitals by Ukrainian refugees.
To assess the impact of Ukrainian refugees on ED utilization in Poland.
Demographic data, chief presenting complaints, diagnosis, and the level of care needed were registered. Bivariate and multivariate logistic regression analysis were performed to yield odds ratios (OR) with a 95% confidence interval.
At the time of investigation, there were 4,000 Ukrainian refugees admitted to Polish hospitals, of which more than half were children. Results are forthcoming.
Although COVID-19 pandemic highlighted the insufficiency of the Polish health care system, resulting in delayed treatment for many patients, the current mass migration from Ukraine emphasizes the lack of a proper organization for crisis management in Poland. Facing an unprecedented and historic challenge, the Polish health care system, operating at the limit of its capacity, is stretched beyond capacity resulting in excess mortality, which exceeded 200,000 deaths during the pandemic. The impact was directly due to the pandemic or the delay in treating other diseases such as cardiovascular diseases and cancer. Inconsistency in medical decision making, lack of proper recommendations from the authorities, and organizational insufficiency requires a renewed focus on adaptive capacity and long-term solutions that promote systems resiliency.
Global climate change (global warming) has been identified as the primary factor responsible for the observed increase in frequency and severity of wildfires (also known as bushfires in some countries) throughout the majority of the world’s vegetated environments. This trend is predicted to continue, causing significant adverse health effects to nearby residential populations and placing a potential strain on local emergency departments (EDs).
The aim of this literature review was to identify papers relating to wildfires and their impact on EDs, specifically patient presentation characteristics, resource utilization, and patient outcomes.
This integrative literature review was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines for data collection, and Whittemore and Knafl’s framework for data analysis. Data were collected from OvidSP, MEDLINE, DARE, CINAHL, PubMed, and Scopus databases. Various Medical Subject Headings (MeSH) and keywords identified papers relevant to wildfires/bushfires and EDs.
Literature regarding the relationship between ED presentations and wildfire events, however, is primarily limited to studies from the United States and Australia and indicates particulate matter (PM) is principally linked to adverse respiratory and cardiovascular outcomes. Observable trends in the literature principally included a significant increase in respiratory presentations, primarily with a lag of one to two days from the initial event. Respiratory and cardiovascular studies that stratified results by age indicated individuals under five, over 65, or those with pre-existing conditions formed the majority of ED presentations.
Key learnings from this review included the need for effective and targeted community advisory programs/procedures, prior to and during wildfire events, as well as pre-event planning, development, and robust resilience strategies for EDs.
Extreme heat and wildfires have health implications for everyone; however, minority and low-income populations are disproportionately negatively affected due to generations of social inequities and discriminatory practices. Indigenous people in Canada are at a higher risk of many chronic respiratory diseases, as well as other non-communicable diseases and hospitalization, compared to the general population. These wildfires occurring during the COVID-19 pandemic have demonstrated how disruptive compounding disasters can be, putting minority populations such as First Nations, Metis, and Inuit tribes at increased risk and decreased priority. Going forward, if the necessarily proactive mitigation and preparedness steps are not undertaken, the ability to attenuate health inequity in the indigenous community by building resiliency to wildfire disasters will be significantly hampered.
While the opioid epidemic engulfing the United States and the globe is well-documented, the potential use of powerful fentanyl derivatives as a weapon of terror is increasingly a concern. Carfentanyl, a powerful and deadly fentanyl derivative, is seeing a surge in popularity as an illegal street drug, and there is increasing congressional interest surrounding the classification of opioid derivatives under the Chemical Weapons Convention (CWC) given their potential to cause harm. The combination of the potency of opioid derivatives along with the ease of accessibility poses a potential risk of the use of these deadly agents as chemical weapons, particularly by terrorist organizations. Disaster Medicine specialists in recent years have established a sub-specialty in Counter-Terrorism Medicine (CTM) to address and research the unique terrorism-related issues relating to mitigation, preparedness, and response measures to asymmetric, multi-modality terrorist attacks.
Terrorism-related deaths have fallen year after year since peaking in 2014, and whilst the coronavirus disease 2019 (COVID-19) pandemic has disrupted terrorist organizations capacity to conduct attacks and limited their potential targets, counter-terrorism experts believe this is a short-term phenomenon with serious concerns of an escalation of violence and events in the near future. This study aims to provide an epidemiological analysis of all terrorism-related mass-fatality events (>100 fatalities) sustained between 1970-2019, including historical attack strategies, modalities used, and target selection, to better inform health care responders on the injury types they are likely to encounter.
The Global Terrorism Database (GTD) was searched for all attacks between the years 1970-2019. Attacks met inclusion criteria if they fulfilled the three terrorism-related criteria as set by the GTD codebook. Ambiguous events were excluded. State-sponsored terrorist events do not meet the codebook’s definition, and as such, are excluded from the study. Data analysis and subsequent discussions were focused on events causing 100+ fatal injuries (FI).
In total, 168,003 events were recorded between the years 1970-2019. Of these, 85,225 (50.73%) events recorded no FI; 67,356 (40.10%) events recorded 1-10 FI; 5,791 (3.45%) events recorded 11-50 FI; 405 (0.24%) events recorded 51-100 FI; 149 (0.09%) events recorded over 100 FI; and 9,077 (5.40%) events recorded unknown number of FI.
Also, 96,905 events recorded no non-fatal injuries (NFI); 47,425 events recorded 1-10 NFI; 8,313 events recorded 11-50 NFI; 867 events recorded 51-100 NFI; 360 events recorded over 100 NFI; and 14,130 events recorded unknown number of NFI. Private citizens and property were the primary targets in 67 of the 149 high-FI events (100+ FI). Of the 149 events recording 100+ FI, 46 (30.87%) were attributed to bombings/explosions as the primary attack modality, 43 (28.86%) were armed assaults, 23 (15.44%) hostage incidents, two (1.34%) were facility/infrastructure attacks (incendiary), one (0.67%) was an unarmed assault, seven (4.70%) had unknown modalities, and 27 (18.12%) were mixed modality attacks.
The most common attack modality causing 100+ FI was the use of bombs and explosions (30.87%), followed by armed assaults (28.86%). Private citizens and properties (44.97%) were most commonly targeted, followed by government (6.04%), businesses (5.37%), police (4.70%), and airports and aircrafts (4.70%). These data will be useful for the development of training programs in Counter-Terrorism Medicine (CTM), a rapidly emerging Disaster Medicine sub-specialty.
The coronavirus disease 2019 (COVID-19) pandemic has caused the greatest global loss of life and economic impact due to a respiratory virus since the 1918 influenza pandemic. While health care systems around the world faced the enormous challenges of managing COVID-19 patients, health care workers in the Republic of Armenia were further tasked with caring for the surge of casualties from a concurrent, large-scale war. These compounding events put a much greater strain on the health care system, creating a complex humanitarian crisis that resulted in significant psychosocial consequences for health care workers in Armenia.
The mass proliferation and increasing affordability of unmanned aerial vehicles (UAVs) in recent years has given rise to weaponized UAV use by terrorists, leading to mounting and credible concerns this attack methodology will be the next terrorism modus operandi. Counter-Terrorism Medicine (CTM) specialists need to consider how UAVs alter or create new mass-casualty scenarios that can further exploit existing medical preparedness vulnerabilities. With an opportunity to be proactive in disaster prevention, mitigation, and preparedness, it is imperative this gathering storm be acknowledged and stakeholders explore how best to prepare for, respond to, and mitigate the consequences of UAV incidents.
Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.
This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.
In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.
This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.
The goal of this study is to determine the impact of the Holy Month of Ramadan on emergency department (ED) and hospital resource utilization in comparison to the time of Hajj and the rest of the year, so as to better define future resource needs of hospitals responding to events of this large size and duration.
A retrospective chart review was conducted of electronic medical records, ED visits, and hospital admissions during Ramadan, Hajj, and all other months over a three-year period on the Hijra calendar (1438-1440) or Gregorian (2016-2019). Primary outcomes were the change in the number of ED visits, hospital admissions, and intensive care unit (ICU) admissions during Ramadan in comparison to during Hajj and other months. Secondary outcomes included mortality; number of surgeries by specialty; and admissions to cardiac, respiratory, orthopedic, and neurosurgery wards.
During the three years, ED visits increased during Ramadan by 83.0%, 74.8%, and 40.3%, respectively, when compared to non-Hajj, non-Ramadan months. Hospital admissions rose by 21.05%, 50.96% and 48.22%. Combined ED and in-hospital mortality rose by 15.21%, 21.47%, and 1.39%. While there was a large increase in ICU admissions during Ramadan of 1440 (May 2019), this was not a trend seen in other years. Despite there only being two years of data for comparison, there was a trend towards increased admissions to all specialty wards. There was an average 46.69% increase in admissions to the general surgery ward during Ramadan months compared to other months, a 31.06% increase in admissions to the orthopedic surgery ward, and a 44.05% increase in admissions to the cardiac care unit.
Ramadan is associated with a significant increase in the population of Makkah (Mecca), Saudi Arabia. Despite this study only focusing on a three-year period, and some variables with only two years of data available, it demonstrates a significant increase in ED visits, hospital admissions, and mortality during Ramadan compared to non-Hajj/non-Ramadan months. During mass gatherings of this size, it would benefit local and regional hospital systems to devote increased resources to patient care, especially to the ED, to prevent morbidity and mortality.
The objective of this study was to assess the current breaking point of crisis surge capacity of trauma services in Qatar and to develop a mitigation plan.
The study utilized real-time data from the National Trauma Registry. Data was explored cumulatively by weeks, months and a year’s interval and all trauma admissions within this time frame were considered as 1 ‘Disaster Incident.’
A total of 2479 trauma patients were included in the study over 1 year. The mean age of patients was 31.5 ± 15.9 and 84% were males. The number of patients who sustained severe trauma which necessitated Level 1 activation was 16%. The emergency medical services (EMS) surge attained crisis of operational capacity at 5 months of disaster incident for priority 1 cases. Bed capacity at the floor was the first to reach operational crisis followed by the ICU and operating room. The gap in the surge for surgical interventions was specific to the specialty and surgery type which reached operational crisis at 3 months.
The study highlights the surge capacity and capability of the healthcare system at a Level 1 trauma center. The identified gaps in surge capacity require several key components of healthcare resources to be addressed across the continuum of care.