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The effectiveness of Emergency Medical Teams (EMTs) is strongly related to their time of arrival, and usually only few teams arrive within 24-48 h postdisaster. The decision to deploy and the scale of deployment rely heavily on context and nature of the event and consequently a rapid assessment of needs/gaps is critical to an appropriate and customized response.
In this study, we describe a desk-based study that provides: (1) knowledge about the medical needs that can be anticipated according to the phases of the disaster that is not rich in literature; and (2) a decision support framework for the deployment of EMTs to earthquakes that combines the results of a literature research and a Delphi study involving the opinion of 12 experts in the field.
The resulting framework is a tool that will help better mapping the configuration to the needs on the ground at the time the team becomes operational in the field and will assist those responsible for deploying and/or accepting EMTs in making informed decisions on deployment after an earthquake.
With additional research the framework approach may be adapted to other types of international relief such as to deploy a Search And Rescue (SAR) team.
Complex challenges may arise when patients present to emergency services with an advance decision to refuse life-saving treatment following suicidal behaviour.
To investigate the use of advance decisions to refuse treatment in the context of suicidal behaviour from the perspective of clinicians and people with lived experience of self-harm and/or psychiatric services.
Forty-one participants aged 18 or over from hospital services (emergency departments, liaison psychiatry and ambulance services) and groups of individuals with experience of psychiatric services and/or self-harm were recruited to six focus groups in a multisite study in England. Data were collected in 2016 using a structured topic guide and included a fictional vignette. They were analysed using thematic framework analysis.
Advance decisions to refuse treatment for suicidal behaviour were contentious across groups. Three main themes emerged from the data: (a) they may enhance patient autonomy and aid clarity in acute emergencies, but also create legal and ethical uncertainty over treatment following self-harm; (b) they are anxiety provoking for clinicians; and (c) in practice, there are challenges in validation (for example, validating the patient’s mental capacity at the time of writing), time constraints and significant legal/ethical complexities.
The potential for patients to refuse life-saving treatment following suicidal behaviour in a legal document was challenging and anxiety provoking for participants. Clinicians should act with caution given the potential for recovery and fluctuations in suicidal ideation. Currently, advance decisions to refuse treatment have questionable use in the context of suicidal behaviour given the challenges in validation. Discussion and further patient research are needed in this area.
Declaration of interest
D.G., K.H. and N.K. are members of the Department of Health's (England) National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group (which developed the quality standards for self-harm services). He is currently chair of the updated NICE guideline for Depression. K.H. and D.G. are NIHR Senior Investigators. K.H. is also supported by the Oxford Health NHS Foundation Trust and N.K. by the Greater Manchester Mental Health NHS Foundation Trust.
To collate the opinions of experts and to reach consensus about the research priorities in the management of major incidents.
A three-round e-Delphi study was conducted using an international panel of experts drawn from active researchers and active educators in major incident management. General areas for consideration were derived from the literature analysis undertaken as part of the overall project.
Experts generated 221 statements in 11 topic areas in the first round. Fifty-one of these statements reached consensus in Round 2. A further 23 statements reached consensus in Round 3, leaving 147 statements that did not reach consensus.
An international expert panel reached consensus on 74 topics of research priority in major incidents management. The strongest themes within these topics were education and training, planning, and communication.
Mackway-Jones K, Carley S. An international expert Delphi study to determine research needs in major incident management. Prehosp Disaster Med. 2012;27(4):1-8.
In the last few decades there have been a number of high-profile disasters, memories of which can be evoked by the mention of a place name. There have been criticisms regarding the unplanned and uncoordinated nature of psychosocial input following several disasters, leading to calls for the creation of multiagency planning groups that include mental health professionals to plan appropriate responses before disasters occur. Post-traumatic stress disorder (PTSD) is the most discussed psychiatric disorder following disaster but it is important to remember that it is not the only psychiatric disorder or emotional response experienced following a disaster. In over 50% of cases of PTSD, another comorbid psychiatric diagnosis will be present. There are eight completed randomized controlled trials of multiple-session early psychosocial interventions including a total of 625 individuals. The availability of psychosocial support should be communicated to those involved and co-ordinated by the psychosocial response team.