Early in the Russian-Ukrainian conflict, the Ukrainian Ministry of Health (MoH) implemented policy reform to allow for pre-hospital whole blood transfusion (pWBT). Team Rubicon (TR) worked with a multinational group of experts to disseminate training that accelerated the implementation of pWBT across the country.

TR utilized an assess, align, and act (A3) approach to drive the pWBT implementation. TR established relationships with Ukrainian providers to understand current needs, restrictions, and protocols for pWBT. TR aligned pWBT advocacy efforts, working with the disaster medicine program at Ivano-Frankivsk Medical National University to create a local lead advocate. Existing and novel coordination mechanisms were used to unite and inform MoH, World Health Organization, Non-Governmental Organizations, and local health systems. Finally, TR coordinated a multispecialty, multi-national team of healthcare providers who developed and delivered a training package in alignment with national guidelines utilizing a combination of didactics, videos, and demonstrations. From August to October of 2022, TR conducted pWBT trainings across Ukraine. Pre- and post-surveys were utilized to determine comfort with pWBT and usefulness of the training.

TR emerged as the point of reference for pWBT in Ukraine. 109 individuals from over 14 organizations were trained. Participants included 69 physicians, 23 paramedics, 7 nurses, and 10 other professionals. 95% of those surveyed had not received prior pWBT training. Participants reported increased comfort levels, with average pre- and post-course comfort scores of 1.7 and 3.2 (4=very comfortable), respectively. The majority of participants found the training useful (average score of 3.8, 4=very useful). Feedback demonstrated high satisfaction ratings and an increased awareness of the regulatory changes.

TR utilized the A3 model to drive a coalition that supported policy reform and trauma system improvements in Ukraine. TR’s ability to leverage international medical expertise, work collaboratively with MoH, and provide material resources supported local implementation of pWBT.

As of October 2022, the civilian casualty count of the invasion of Ukraine is reported to be 16,295, with actual figures believed to be considerably higher. As explosive trauma continues to terrorize populations, frontline medical personnel are faced with escalating resource constraints including transport, imaging modalities, and electricity. Point of care ultrasound (POCUS) is considered the gold standard in acute trauma evaluation, but very few hospitals or pre-hospital medics have access to or training in POCUS.

In collaboration with the Ukrainian Ministry of Health, the World Health Organization, and the Global Health Program at Butterfly Network, Team Rubicon developed and conducted 64 practical trauma trainings and donated 50 Butterfly iQ+ portable ultrasound devices in Ukraine between August and October, 2022. Of these trainings, 19 specifically focused on the use of POCUS for trauma. Pre- and post-surveys were deployed to determine demographics, comfort level with POCUS for trauma care, and usefulness of the course.

In total, 149 individuals were trained in POCUS for trauma. Of these, 130 were physicians, 15 were paramedics, three were RNs, and one was a pharmacist. Only 14.8% of these clinicians self-reported any previous POCUS training. All participants reported an increase in comfort level, with an average pre- and post-course comfort scores of 1.9 and 3.3 (4=very comfortable), respectively. General satisfaction with the training was high (average score of 9.8/10). Qualitative feedback commended the quality and novelty of this training, requested further examples of pathology, and endorsed more POCUS trainings, generally. The most critical lesson learned was the need to re-orient training around the foundations of POCUS given low levels of experience and training.

Access and training in POCUS for trauma is critical for resource-constrained medical personnel operating in conflict-affected communities. A one-day POCUS practicum-oriented course is feasible to support awareness and proficiency.

In March 2022, Team Rubicon deployed an EMT Type 1 mobile team to provide medical care for internally displaced people in Ukraine. Regional medical facilities and universities identified a need for training programs to prepare for the expected increase in wartime casualties.

Deployed medical teams researched and compiled initial course content. Presentations were prepared and conducted with the assistance of Ukrainian translators. The curriculum was expanded to include whole blood transfusion and point of care ultrasound. After the prioritization of needs by the MOH, Team Rubicon deployed a seven-member team to conduct training in 16 cities over two months. They provided instruction in whole blood transfusion, hemorrhage control, blast injuries, prehospital triage, shock management, point of care ultrasound, and treatment of chemical exposures. Surveys were conducted pre- and post-training to assess the usefulness of the training provided.

In two months, a total of 1549 unique individuals were trained. The participants included 769 physicians, 244 nurses, 299 paramedics, 83 hospital administrators, and 154 additional professionals. They included 614 males and 935 females. The number of participants in each course included: 477 for hemorrhage control, 564 for treatment of chemical exposures, 483 for blast injury and field trauma, 412 for pre-hospital and triage training, 135 for point-of-care ultrasound, and 154 for whole blood transfusion.

With the assistance of the Ukrainian Ministry of Health, an NGO was able to conduct 64 sessions training 1549 individuals. This experience demonstrates the ability to create a robust educational platform to fulfill the medical needs of a community affected by warfare.

The purpose of this study is to identify gaps in support for parents of children with Hypoplastic Left Heart Syndrome.

Using a mixed-methods approach, the researchers first studied the parental and care team experience through interviews of Hypoplastic Left Heart Syndrome mothers and members of the inter-professional care team and then conducted an international survey of 690 Hypoplastic Left Heart Syndrome primary caregivers to validate the qualitative findings.

Parental and care team interviews revealed three main gaps in parental support, including lack of open communication, unrealistic parental expectations, and unclear inter-professional team roles. Survey results found that parents whose children were diagnosed with Hypoplastic Left Heart Syndrome after birth indicated significant dissatisfaction with the care team’s open communication and welcoming of feedback (p = 0.008). As parents progress through the stages of surgical intervention, they also indicate significant dissatisfaction with the care team’s anticipation of parental emotional needs and provision of coping resources (p = 0.003).

Parental support interventions should focus on providing resources to help parents cope, helping the care team model open communication, and welcoming feedback on the parental experience.

Interventions should be piloted with parents who are in the later stages of the surgical intervention timeline or whose children were diagnosed after birth as they are the populations who perceived the least support within this study.

The Rohingya refugee crisis in Bangladesh continues to overburden humanitarian resources and undermine the health and security of over 900,000 people. Spatial, sector-specific information is required to better understand the needs of vulnerable populations, such as women and girls, and to target interventions with improved efficiency and effectiveness.

The aim of this study was to create a gender-based vulnerability index and explore the geospatial and thematic variations in the gender-based vulnerability of Rohingya refugees residing in Bangladesh by utilizing pre-existing, open-source data.

Data sources included remotely-sensed REACH data on humanitarian infrastructure, UN Population Fund resource availability data, and the Needs and Population Monitoring Survey conducted by the International Organization for Migration in October 2017. Gaps in data were addressed through probabilistic interpolation. A vulnerability index was designed through a process of literature review, variable selection and thematic grouping, normalization, and scorecard creation. Pareto ranking was employed to rank sites based on vulnerability scoring. Spatial autocorrelation of vulnerability was analyzed with the Global and Anselin Local Moran’s I applied to both combined vulnerability index rank and disaggregated thematic ranking.

Twenty-four percent of settlements were ranked as most vulnerable, with 30 highly vulnerable clusters identified predominantly in the Upazila of Sadar. Five settlements in Dhokkin, Somitipara, and Pahartoli were categorized as less vulnerable outliers amongst highly vulnerable neighboring sites. Security- and health-related variables appear to be the largest drivers of gender-specific vulnerability in Cox’s Bazar. Clusters of low security and education vulnerability measures are shown near the refugee ingress point near Gundum.

The humanitarian space produces tremendous amounts of data that can be analyzed with spatial statistics to better target research and programmatic intervention. The critical utilization of these data and validation of vulnerability indexes is required to improve the international response to the global refugee crisis.