American journal of disaster medicine最新文献

The emergence of the COVID-19 pandemic has put health systems under enormous pressure, pushing for health systems' resilience. Malawi, mostly rural with hard-to-reach areas, had their first case in April 2020, amidst political turmoil. So far, much has been documented on how health systems contained the COVID-19 pandemic. This paper describes the role of community health system structures in ensuring health systems' resilience during the COVID-19 pandemic in rural Malawi. To highlight the role of community health structures in the Malawian health system, we developed and applied a framework on health systems' resilience through the community health system structures in a rural district in Malawi. Our data collection and analysis were informed by a desk review of government documents and other publications. We drew on authors' expertise and experience in Malawi community health, and joint reflections on the role played by community health structures in ensuring access to essential health services during the COVID-19 pandemic in Malawi. The desk review and experts' reflections have highlighted the strong Malawi community health strategy with a clear chain of command from national to community levels. The community health surveillance assistants and volunteers have shown to be the backbone of community health structures and positive service delivery, contributing to health systems resilience during the COVID-19 pandemic. Countries' existing health system structures are a key determinant of response to pandemics -regardless of the available resources. Even though Malawi's health system is under-resourced, the existing community-based health structures have shown to contribute to the health systems' resilience during the COVID-19 pandemic. The proposed framework in this paper is a great tool in allowing countries to reflect on having pre-existing health system structures to strengthen the health systems' resilience during such pandemics. Therefore, having independent disease prevention and control structures from national to community levels, as done in Malawi, can help countries to absorb the shocks of health system emergencies and maintain essential health services, the core business of the health system.

Objective: To compare the Emergency Severity Index (ESI) and Sort Assess Life Saving Interventions Treatment and Transport (SALT) triage categories for an existing emergency department (ED) patient population.

Design: A prospective, cross-sectional study.

Setting: An academic-affiliated community teaching ED at a Level 1 Trauma Center.

Participants: All patients presenting to the ED over 2 nonconsecutive 24-hour weekdays.

Main outcome measures: The correlation between triage system classifications was assessed using the Spearman's rank correlation coefficient.

Results: 100 percent of ESI 5, 83.3 percent of ESI 4, and 70.4 percent of ESI 3 were categorized as Minimal under SALT. 70.8 percent of ESI 2 was categorized as Delayed, and 71.4 percent of ESI 1 designations correlated with Immediate. Spearman's rank correlation coefficient was 0.509 (p < 0.001).

Conclusion: This study results suggest that ESI moderately correlates with SALT, particularly in lower acuity patients. This result may inform future protocol development for rapid triage of existing ED populations prior to the arrival of patients from a mass casualty event.

Objective: Evidence suggests that people of color, especially African Americans and non-White Hispanics, residing in low-income communities are the most vulnerable to natural disasters. This study assessed individual level of self-perceived disaster preparedness, disaster response actions, and sociodemographic predictors of disaster preparedness among older minority adults in Houston, Texas.

Method: Working with Houston-area community-based organizations and senior-living centers, a cross-sectional survey, available in English and Spanish, was disseminated between November 2020 and January 2021.

Participants: Five hundred and twenty-two older minority adults aged 55+ completed the electronic survey.

Main outcome measure(s): The main outcome measure was the level of self-perceived preparedness regarding emergencies and disastersie, prepared vs not prepared-among the study participants.

Results: Overall, about 58 percent of older minority adults did not perceive themselves to be prepared. Compared to individuals reporting annual incomes below $25,000, individuals reporting annual incomes between $25,000 and $74,999 were more likely to report being prepared [odds ratio (OR) = 2.28, 95 percent confidence interval (CI) = 1.29, 4.05]. Individuals who tested positive or had a close family member test positive for COVID-19 experienced 2.16 times higher odds of having self-perceived disaster preparedness than those who did not [OR = 2.16, 95 percent CI = 1.37, 3.42]. None of the other covariates were statistically significant.

Conclusions: While we observed no differences in self-perceived disaster preparedness between African American and Hispanic older adults, our findings suggest the importance of prior experience/exposure to previous disasters and the role of socioeconomic status in self-perceived disaster preparedness in minority older adults.

Objective: To assess the impact of repeated rocket attacks on a civilian population during successive military conflicts on the patterns of emergency medical services (EMS) utilization.

Design: This retrospective cohort study (2008-2021) analyzed EMS data from one region of Israel characterized by intensive rocket attacks on a civilian population during four successive military conflicts. EMS activity for the periods prior to, during, and after the conflicts was compared. Data included call volume, type of calls ("medical illness," "motor vehicle collision (MVC)," and "other-injuries"), and level of response (advanced life support (ALS) or basic life support (BLS)).

Results: Compared to the Pre-Conflict period, there were statistically significant decreased volumes of calls during the 2008 (-20 percent), 2012 (-13 percent), and 2021 (-11 percent) military conflicts for "medical illness" and during the 2008 (-23 percent), 2012 (-30 percent), and 2021 (-31 percent) for "MVC." Decreases in calls for "medical illness" were accompanied by decreased ALS dispatches (-28, -33, and -18 percent for 2008, 2012, and 2021, respectively). The number of calls returned to preconflict values during the Post-Conflict periods. No change was evidenced in numbers of calls during the 2014 military conflict.

Conclusion: Military conflicts involving a civilian population were usually found to be associated with lower numbers of calls for the categories of "medical illness" and "MVC." Less calls for "medical illness" were associated with fewer ALS dispatches. There was a rapid return of call volumes to preconflict levels shortly after a ceasefire was reached. The absence of change in calls during the 2014 conflict suggests involvement of habituation processes.

Since the events of 9/11, a concerted interagency effort has been undertaken to create comprehensive emergency planning and preparedness strategies for the management of a radiological or nuclear event in the US. These planning guides include protective action guidelines, medical countermeasure recommendations, and systems for diagnosing and triaging radiation injury. Yet, key areas such as perception of risk from radiation exposure by first responders have not been addressed. In this study, we identify the need to model and develop new strategies for medical management of large-scale population exposures to radiation and examine the phenomena of radiation dread and its role in emergency response using an agent-based modeling approach. Using the computational modeling platform NetLogo, we developed a series of models examining factors affecting first responders' willingness to work (WTW) in the context of entering areas where radioactive contamination is present or triaging individuals potentially contaminated with radioactive materials. In these models, the presence of radiation subject matter experts (SMEs) was found to increase WTW. Degree of communication was found to be a dynamic variable with either positive or negative effects on WTW dependent on the initial WTW demographics of the test population. Our findings illustrate that radiation dread is a significant confounder for emergency response to radiological or nuclear events and that increasing the presence of radiation SME in the field and communication among first responders when such radiation SMEs are present will help mitigate the effect of radiation dread and improve first responder WTW during future radiological or nuclear events.

Background: Telehealth emerged early as an important tool to provide clinical care during the COVID-19 pandemic, but statewide implementation strategies were lacking. Needs assessment: We performed a needs assessment at 15 pediatrics clinics in Washington regarding their ability to institute telehealth. Fourteen clinics (93 percent response rate) responded; none had ability to perform telehealth visits. Clinics needed the following specific support structures: (1) an easily implementable, low-cost system, and (2) parity billing for telehealth services. Disaster effort: Two weeks after the needs assessment was performed, we facilitated direct telehealth initiation support to 45 Washington clinics and created a coalition of statewide advocacy groups. These groups advocated for (1) a statewide solution for non-network or poorly resourced providers, which was delivered by the WA Health Care Authority, and (2) parity billing, which was delivered by emergency governor action.

Conclusion: Engagement with our regional pediatric disaster network was essential in providing guidance and expertise in this needs assessment, telehealth initiation process, and subsequent advocacy efforts. The power we have as pediatricians to coordinate with regional experts helped improve access to telehealth across Washington.

Objective: This simulation exercise was conducted to test the functionality of the hospital incident command system, triage, treatment areas, and external coordination and communication.

Design: This was an observational study. Coordination, logistic, technical design, staging, and evaluation of the exercise were planned for the exercise. The exercise was conducted in six hospitals. Observations were recorded, and a validated checklist was used to score.

Setting: This was a semisurprise exercise in the hospital setup.

Participants: Simulated patients and moulage were used for the exercise.

Intervention: Full-scale simulation exercise.

Main outcome: Gaps in knowledge and skills were identified in the running incident command center, skills of patient transferal from ambulance to triage area, and external coordination.

Result: Out of a total score of 220 in the evaluation sheet, the mean score was 161 ± 3.2 (73.2 percent) and the median score was 161.5.

Conclusion: Hospital incident command system, triaging, and patient transferal are the areas that can be improved in the future.

Objective: To review the literature on the effects seen after disaster on those with poor social determinants of health (SDOH) and individual social needs.

Design: The Disaster Preparedness and Response Committee of the American College of Emergency Physicians (ACEP) formed a work group to study healthcare disparities seen in disaster. This group was composed of six physicians on the committee, all of whom have extensive background in disaster medicine and the chair of the committee. A systematic literature review regarding past disasters and all the healthcare disparities seen was undertaken with the goal of organizing this information in one broad concise document looking at multiple disasters over history. The group reviewed multiple documents regarding SDOH and individual social needs for a complete understanding of these factors. Then, a topic list of healthcare disparities resulting from these factors was composed. This list was then filled out with subtopics falling under the header topics. Each member of the workgroup took one of these topics of healthcare disparity seen in disasters and completed a literature search. The databases reviewed include PubMed Central, Google Scholar, and Medline. The terms queried were disaster, healthcare disparities, disaster healthcare disparities, healthcare disparities associated with disasters, SDOH and disaster, special populations and disaster effects, and vulnerable populations and disaster effects. Each author chose articles they felt were most representative and demonstrative of the healthcare disparities seen in past disasters. These social determinant factors and individual social needs were then cross referenced in relation to past disasters for both their causes and the effect they had on various populations after disaster. This was presented to the ACEP board as a committee report.

Results: All the SDOH and individual social needs showed significant negative effects for the populations when combined with a disaster event. These SDOH cut across age, race, and gender affecting a wide swath of people. Previous disaster planning either did not plan or under planned for these marginalized populations during disaster events.

Conclusions: Disparities in healthcare are a pervasive problem that effects many different groups. Disasters magnify and more fully expose these healthcare disparities. We have explored the healthcare disparities with past disasters. These disparities, although common, can be mitigated. The recognition of these poor determinants of health can lead to better and more comprehensive disaster planning for future disasters. Subsequent research is needed to explore these healthcare disparities exacerbated by disasters and to find methods for their mitigation.

Objective: To identify the trauma sequelae after a major train disaster on the Great Belt Bridge in 2019 and to compare two different trauma measures.

Design: Five (T1) and 13 (T2) months after the disaster, a questionnaire included both the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the new The International Classifications of Diseases (ICD-11) criterion stand-ards for post-traumatic stress disorder (PTSD). Also, anxiety and depression were measured on both occasions.

Participants: All surviving passengers (N = 133) and the bereaved families (N = 8) were invited to participate through an electronic mailbox. At T1, 58 and 46 at T2 filled out all the questionnaires.

Main outcome measures: The primary study outcome measures were the Harvard Trauma Questionnaire (HTQ) and the International Trauma Questionnaire (ITQ).

Results: At T1, the HTQ screened 19 percent positive for PTSD, while the ITQ screened 15.5 percent. At T2, the numbers were 26 percent for the HTQ and 10.9 percent for the ITQ. At T1, 22.8 percent were screened positive for moderate or severe depression and 8.6 percent fulfilled the criteria for an anxiety diagnosis. The numbers at T2 were 19.5 percent for depression and 10.9 percent for anxiety.

Conclusions: There is a remarkable lack of train accident/disaster passenger studies. A large subgroup suffered from several psychological disorders both 5 and 13 months after the disaster. The two diagnostic systems used (DSM-IV and ICD-11) both -identified a considerable number of passengers in need of treatment; the latter identifying fewer than the former. Effective outreach procedures are recommended in the future.