International Journal of Emergency Medicine最新文献

Introduction: Health systems play a pivotal role in managing chemical weapons of mass destruction (WMD) terrorist incidents, particularly in reducing casualties and facilitating crisis management. The growing recognition of the need for precise and effective preparedness in these sectors underscores the importance of this research. The present study aimed to identify the essential components of hospital preparedness and to develop and validate a comprehensive model for hospital readiness in response to chemical WMD terrorist incidents.

Methods: This study was conducted in 2025 using a three-phase exploratory sequential mixed-methods approach. First, a scoping review was conducted in accordance with Arksey and O'Malley's methodological framework and the PRISMA guideline to identify key components of hospital preparedness for chemical WMD terrorist incidents. Second, a qualitative study was conducted using semi-structured interviews, and the data were analyzed through a conventional content analysis approach to further identify preparedness components. Third, the components derived from the previous two phases were integrated and validated through two rounds of the Delphi technique. Ultimately, a comprehensive hospital preparedness model was developed.

Results: Following integration of the scoping review and qualitative findings by an expert panel, 88 preparedness components were identified. After two rounds of the Delphi technique, 82 preparedness components were finalized and classified into 16 subcategories and seven main categories: specialized training and empowerment; psychological support and ethical considerations; security measures; specialized clinical and therapeutic processes; optimal management of surge capacity; integrated information and communication management; and contingency strategic management and planning. Finally, based on the Delphi assessment, the proposed preparedness model was approved by the expert panel.

Conclusions: Hospitals facing chemical terrorism require a comprehensive preparedness strategy encompassing specialized training, psychological support, and robust clinical systems. Effective management, intersectoral coordination, and security measures are essential for an effective response. Implementing preparedness strategies aligned with the proposed model can significantly enhance health systems' readiness and resilience to chemical WMD threats.

Background: Recurrent syncope with seizure-like stiffening may mimic epilepsy or neurological disorders, and when routine tests are repeatedly normal, intermittent arrhythmia can be easily overlooked.

Case presentation: We report a case of a 65-year-old man with hypertension, hyperuricaemia, dyslipidaemia, and asthma who experienced recurrent syncopal episodes over one month. He presented several times to emergency departments and tertiary hospitals. Neurological and cardiovascular investigations-including brain MRI, echocardiography, coronary angiography, laboratory tests, and a previous Holter ECG-were consistently unremarkable. The initial diagnosis was hypertensive crisis based on marked post-event blood pressure surges, which was later recognized as a secondary phenomena rather than the primary cause of syncope. On the index admission, continuous emergency monitoring captured a sinus arrest of ~ 17 s with absent arterial pulse waveform, followed by bradyarrhythmia. Post-event blood pressure spiked to 220/110 mmHg. A repeat Holter ECG confirmed intermittent Mobitz II and complete AV block with asystole up to 18.6 s. EEG, performed during this admission to exclude epilepsy, was normal. A dual-chamber permanent pacemaker was implanted with complete resolution of symptoms (Shen et al, Circulation 136(5):e60-e122, 2017; Kusumoto et al, Circulation 140(8): e382-e482, 2019; Brignole et al, Eur Heart J 39(21):1883-1948, 2018).

Conclusion: This case demonstrates how intermittent AV block may masquerade as seizure or hypertensive crisis, underlining the critical role of emergency department monitoring and prolonged ECG recording in recurrent unexplained syncope.

Introduction: The Republic of Moldova, an upper-middle-income nation in Eastern Europe, has encountered overlapping public health and humanitarian challenges that have tested the resilience of its health system. Following the COVID-19 pandemic and 2022 influx of refugees from neighbouring Ukraine, the Ministry of Health (MoH) identified an urgent need to upskill healthcare providers in emergency care. The World Health Organization-International Committee of the Red Cross Basic Emergency Care (BEC) course was selected as a rapid solution to train a range of providers in managing acute patients. This study assessed BEC's effects on emergency care knowledge and confidence in Moldova.

Methods: From February 2023 to December 2024, 15 BEC courses were taught in Moldova. Participants completed pre- and post-course knowledge tests, confidence self-assessments, and feedback forms. Quantitative scores were assessed using descriptive statistics and nonparametric testing, and qualitative responses were analysed thematically.

Results: Of 371 enrolled participants, 312 (84%) completed all course requirements. Post-course knowledge scores were significantly higher than pre-course (mean score: +20.2%, p < 0.001). Self-reports also improved, with mean scores (ranging from 1 - least - to 4 - most) increasing from 1.85 (SD: 0.91) to 2.17 (SD: 0.67) for confidence (p < 0.001) and 1.58 (SD: 0.79) to 2.07 (SD: 0.61) for competence (p < 0.001). Most (89%) found the course highly relevant to their work and rated instructors as excellent (97%). Participants valued the symptom-based approach, hands-on simulations, short course duration, and interactive teaching, while suggesting more time for hands-on skills practice.

Conclusion: National BEC implementation in Moldova showed that a standardized short course can generate significant gains in emergency care knowledge and confidence across diverse provider cadres in a matter of days. Participants gained significant emergency care knowledge and confidence, even though the healthcare system was under immense strain at the time of implementation. The rollout's decentralized delivery and high acceptability underscore its potential for national scalability and integration into existing preparedness frameworks. Moldova's experience demonstrates how targeted education can strengthen surge capacity and sustainably contribute to resilient health systems, even amid crises.