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Ebola Virus Disease (EVD) is the international health emergency paradigm due to its epidemiological presentation pattern, impact on public health, resources necessary for its control, and need for a national and international response.
The objective of this work is to study the evolution and progression of the epidemiological presentation profile of Ebola disease outbreaks since its discovery in 1976 to the present, and to explore the possible reasons for this evolution from different perspectives.
Retrospective observational study of 38 outbreaks of Ebola disease occurred from 1976 through 2019, excluding laboratory accidents. United Nations agencies and programs; Ministries of Health; the US Centers for Disease Control and Prevention (CDC); ReliefWeb; emergency nongovernmental organizations; and publications indexed in PubMed, EmBase, and Clinical Key have been used as sources of data. Information on the year of the outbreak, date of beginning and end, duration of the outbreak in days, number of cases, number of deaths, population at risk, geographic extension affected in Km2, and time of notification of the first cases to the World Health Organization (WHO) have been searched and analyzed.
Populations at risk have increased (P = .024) and the geographical extent of Ebola outbreaks has grown (P = .004). Reporting time of the first cases of Ebola to WHO has been reduced (P = .017) and case fatality (P = .028) has gone from 88% to 62% in the period studied. There have been differences (P = .04) between the outbreaks produced by the Sudan and Zaire strains of the virus, both in terms of duration and case fatality ratio (Sudan strain 74.5 days on average and 62.7% of case fatality ratio versus Zaire strain with 150 days on average and 55.4% case fatality ratio).
There has been a change in the epidemiological profile of the Ebola outbreaks from 1976 through 2019 with an increase in the geographical extent of the outbreaks and the population at risk, as well as a significant decrease in the outbreaks case fatality rate. There have been advances in the detection and management capacity of outbreaks, and the notification time to the WHO has been reduced. However, there are social, economic, cultural, and political obstacles that continue to greatly hinder a more efficient epidemiological approach to Ebola disease, mainly in Central Africa.
Within out-of-hospital emergencies, Primary Health Care (PHC) pediatricians will likely be the first to provide health care at the scene of a life-threatening emergency (LTE) in children. Pediatricians should be trained to initially intervene, safely and effectively the LTEs, including the activation of Emergency Medical Systems (EMS), an adequate stabilization of patients and transport to the hospital.
The aims of this study are to know the training received for out-of-hospital LTEs by PHC pediatricians of the Principality of Asturias (Spain) and the perception they have about their own theoretical knowledge and practical skills in a series of emergency procedures used in LTEs; also, to analyze the differences according to the geographical context of their work.
This was a cross-sectional, descriptive, and observational study of a sample of 27 PHC pediatricians from PHC Service of Asturias, Spain, from among the total of 88 pediatricians who make up the staff of pediatricians, conducted from April through May 2019. The survey was designed ad hoc using the Curriculum in Primary Care Pediatrics (CPCP) proposed by the European Confederation of Primary Care Pediatricians (ECPCP; Europe), which indicates the theoretical and practical procedures that must be acquired by the PHC pediatricians. It is composed of 30 procedures or techniques employed in LTEs using a 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to 10 (“Maximum”).
There are significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
Asturian pediatricians are generally well-prepared to solve LTEs with a few exceptions. The degree of self-perception and acquisition of general theoretical knowledge and general practical skills in LTEs is heterogeneous, with differences according to the scope of work.
The Richter Scale measures the magnitude of the seismic activity for an earthquake; however, it does not quantify the humanitarian need at the point of impact. This poses a challenge for humanitarian stakeholders in decision and policy making, especially in risk reduction, response, recovery, and reconstruction. The new disaster metrics tool titled “The YEW Disaster Severity Index” (DSI) was developed and presented at the 2017 World Congress of Disaster and Emergency Medicine, May 2017, Toronto, Canada. It uses a median score of three for vulnerability and exposure indicators, a median score percentage of 100%, and medium YEW DSI scoring of four to five as baseline, indicating the ability to cope within local capacity. Therefore, scoring more than baseline coping capacity indicates that external assistance is needed. This special real-time report was presented at the 2nd National Pre-Hospital Care Conference and Championship, October 2018, Malaysia.
The aim of this analysis is to present the real-time humanitarian impact and response to the 2018 earthquake and tsunami at Donggala and Palu, Sulawesi in Indonesia using the new disaster metrics YEW DSI. Based on the earthquake (measuring 7.7 on the Richter Scale) and tsunami at Donggala, the humanitarian impact calculated on September 29, 2018 scored 7.4 High in the YEW DSI with 11 of the total 17 indicators scoring more than the baseline coping capacity. The same YEW DSI score of 7.4 was scored on the earthquake and tsunami at Palu, with 13 of the total 17 indicators scoring more than baseline ability to cope within local capacity. Impact analysis reports were sent to relevant authorities on September 30, 2018.
Discussion & Conclusion:
A State of Emergency was declared for a national response, which indicated an inability to cope within the local capacity, shown by the YEW DSI. The strong correlation between the earthquake magnitude, intensities, and the humanitarian impact at Donggala and Palu reported could be added into the science of knowledge in prehospital care and disaster medicine research and practice. As a conclusion, the real-time disaster response was found to be almost an exact fit with the YEW DSI indicators, demonstrating the inability to cope within the local capacity.
Within out-of-hospital emergencies, primary health care (PHC) nurses must face life-threatening emergencies (LTEs), which are defined as “a situation associated with an imminent life risk that entails the start-up of resources and special means to resolve the situation.”
The objectives of this study were to know the training received for out-of-hospital LTEs by PHC nurses of Asturias, Spain and the perception they have about their theoretical knowledge and practical skills in a series of emergency procedures or techniques used in LTE emergencies; as well as to analyze the differences according to the geographical area of their work.
Cross-sectional, descriptive, and observational study was conducted in 2018 of a sample of PHC service nurses of Asturias, Spain.
A total of 236 nurses from PHC service centers of Asturias, Spain, from among the total of 730 nurses who make up the staff of nurses of the PHC service of Asturias, between April and May 2018, were surveyed. The survey was designed ad hoc using the Doctrinal Body of Emergency Nursing (DBEN) proposed by the Spanish Society of Emergency Medicine (SEMES; Madrid, Spain), which indicates the theoretical and practical procedures that must be acquired by the PHC nurses. It is composed of 37 procedures or techniques employed in LTEs using an 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to ten (“Maximum”).
There were significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
All PHC nurses must be perfectly trained to provide initial quality assistance to the LTE, with both theoretical and practical knowledge of the different techniques, so that it can continue to be attended by the corresponding Emergency Service.
The Richter Scale measures the magnitude of a seismic occurrence, but it does not feasibly quantify the magnitude of the “disaster” at the point of impact in real humanitarian needs, based on United Nations International Strategy for Disaster Reduction (UNISDR; Geneva, Switzerland) 2009 Disaster Terminology. A Disaster Severity Index (DSI) similar to the Richter Scale and the Mercalli Scale has been formulated; this will quantify needs, holistically and objectively, in the hands of any stakeholders and even across timelines.
An agreed terminology in quantifying “disaster” matters; inconsistency in measuring it by stakeholders posed a challenge globally in formulating legislation and policies responding to it.
A quantitative, mathematical calculation which uses the median score percentage of 100% as a baseline, indicating the ability to cope within the local capacity, was used. Seventeen indicators were selected based on the UNISDR 2009 disaster definition of vulnerability and exposure and holistic approach as a pre-condition. The severity of the disaster is defined as the level of unmet needs. Thirty natural disasters were tested, retrospectively, and non-parametric tests were used to test the correlation of the DSI score against the indicators.
The findings showed that 20 out of 30 natural disasters tested fulfilled the inability to cope, within local capacity in disaster terminology. Non-parametric tests showed that there was a correlation between the 30 DSI scored and the indicators.
By computing a median fit percentage score of 100% as the ability to cope, and the correlation of the 17 indicators, in this DSI Scale, 20 natural disasters fitted into the disaster definition. This DSI will enable humanitarian stakeholders to measure and compare the severity of the disaster objectively, as well as enable future response to be based on needs.
YewYY, Castro DelgadoR, HeslopDJ, Arcos GonzálezP. The Yew Disaster Severity Index: A New Tool in Disaster Metrics. Prehosp Disaster Med. 2019;34(1):8–19.
The goal of this study was to find out the training received in Urgent and Emergency Medicine (UEM) by the Primary Health Care (PHC) physicians of Asturias (Spain), as well as their perception of their own theoretical knowledge and practical skills in a series of procedures employed in life-threatening emergencies (LTEs), and also to analyze the differences according to the geographical area of their work.
This was a cross-sectional survey of PHC physicians using an ad hoc survey of a sample of 213 physicians in Asturias regarding their self-perception of theoretical knowledge and practical skills in techniques used in LTEs by areas of work (rural, suburban, and urban). The interview was conducted by mail from April through May 2017. The data processing has used absolute and relative frequencies, as well as central tendency parameters and dispersion parameters. The estimates for the entire population have been made using confidence intervals for the mean of 95%. In the comparison of parameters, the differences between parameters with a probability of error less than five percent (P<.05) have been considered significant. For the comparison of means between the different techniques in the different areas of work, ANOVA was used.
With respect to the training of physicians, in general, for managing emergencies, both at the regional level and by areas of work (rural, suburban, and urban), none of the sets analyzed attained five points. By areas of work, it was the suburban region where there was a greater average general level of knowledge. There were significant differences in the average theoretical knowledge and the average practical skills in the procedures studied according to the different areas of work. The greater number of significant differences was between the urban and suburban regions and within the urban area.
It’s necessary to ensure an adequate homogeneity of the levels of theoretical knowledge and practical skills of PHC physicians in order to guarantee the equity of provision of health care in emergencies in different geographical areas.
Cernuda MartínezJA, Castro DelgadoR, Ferrero FernándezE, Arcos GonzálezP. Self-Perception of Theoretical Knowledge and Practical Skills by Primary Health Care Physicians in Life-Threatening Emergencies. Prehosp Disaster Med. 2018;33(5):508–518.