Disaster Medicine and Public Health Preparedness最新文献

Cyclone Alfred disrupted dialysis services across South-East Queensland. Digital tools, including real-time surveys and AI-assisted analysis, were used to evaluate impact and guide immediate improvements. This low-cost, tech-enabled response demonstrated how agile methods can support disaster resilience and inform planning for vulnerable patient groups during extreme weather events.

Objective: The study aims to explain the challenges experienced by Emergency Medical Services workers in a massive disaster due to resource scarcity.

Methods: In this qualitative study, in-depth interviews were conducted with 14 Emergency Medical Services workers in the region within the first 72 hours of the Kahramanmaraş Earthquakes. Participants were determined by snowball sampling method, and data were collected using a semi-structured interview form. Collected data were evaluated using descriptive and content analysis methods.

Results: When the data were analyzed, the difficulties experienced by the participants were covered in two main themes and eight sub-themes. The main themes were physical and managerial challenges, and the sub-themes were nutrition, shelter and adverse weather conditions, hygiene, safety, sleep shortage and exhaustion, operational, logistics and transportation, communication and coordination.

Conclusion: The findings suggest that challenges in meeting the basic physical needs of Emergency Medical Services workers during massive disasters may reduce the overall effectiveness of response efforts. Ensuring their physical safety, particularly in large-scale earthquakes that cause severe structural damage, emerges as a persistent concern. Disaster preparedness efforts should more carefully consider the fragility and vulnerability of high-risk zones when developing national response plans.

Well-established within the field of Emergency Management is the Disaster Cycle: Mitigation, Preparedness, Response, and Recovery. Less standard, however, is the inclusion of pediatric considerations in efforts within each of these phases, despite the significant population share that children hold and their unique vulnerabilities to disasters. Building upon a tool designed to spur pediatric inclusion in the "Mitigation" phase of the cycle, the Regional Pediatric Hazard Vulnerability Analysis, this paper introduces a novel Pediatric After-Action Report template. This is an all-hazards template that provides emergency managers and other partners within a region a vital resource to ensure that children are effectively considered in post-event review efforts within the "Recovery" phase, whether those reviews are customary or not. The Pediatric After-Action Report presents critical questions related to pediatric needs in previously established categories, promotes the identification of areas for improvement, and facilitates the creation of actionable plans for future preparedness.

Introduction: Mass casualty incidents (MCIs) in high-risk environments pose major challenges for coordinated emergency response. Training is often infrequent, resource-intensive, and lacks interagency consistency. This study explores the use of Virtual Reality (VR) simulation to train responders in the RAMP triage model across emergency services.

Methods: An observational qualitative design was used. Sixteen participants from various emergency services engaged in a VR-based MCI scenario involving 26 patients and hazardous conditions. The scenario required rapid RAMP triage based on essential cues (radial pulse and the ability to follow commands). Structured interviews followed, and data were analyzed thematically.

Results: Three themes emerged: (1) Deficiencies in current training, including inconsistent MCI protocols, lack of guideline familiarity, and limited interagency practice; (2) VR as an effective, low-resource training method enabling repeatable and safe practice-RAMP triage was found intuitive and efficient, even for non-medical personnel; and (3) prerequisites for VR implementation, such as realistic design, technical infrastructure, and stakeholder involvement to support shared understanding.

Conclusion: VR-based MCI training is a feasible and effective supplement to traditional drills. It enables scalable and flexible skill-building, though it should complement and not replace live exercises.

Objective: To explore the experiences of military medical first responders managing mass casualty incidents (MCIs) during the ongoing conflict in Ukraine to identify key challenges and insights.

Methods: This qualitative study employed in-depth, semi-structured interviews with medical first responders who managed MCIs in Ukraine. Thematic analysis was leveraged by our research team to identify recurring themes and patterns within the interview data.

Results: Our results revealed crucial takeaways related to the (1) need for preparedness and training, (2) variability of triage, (3) importance of communication and teamwork, and (4) the resulting psychological strain.

Conclusions: These firsthand accounts offer valuable lessons for identifying challenges of first responders, developing areas of future research for MCI response strategies, and enhancing the readiness and well-being of medical first responders in current and future conflicts.

Objective: To compare and analyze COVID-19 control outcomes, including case severity, vaccination, and excess mortality, across 6 nations (USA, UK, China, Russia, Japan, and South Africa) from January 2020 to December 2022.

Methods: This study utilized data from the "Our World in Data" dataset to characterize the epidemiological features of COVID-19 across 6 countries. Generalized linear models (GLMs) were employed to examine the associations between Stringency Index (SI), vaccination coverage, and epidemiological outcomes.

Results: The USA had the highest median cases per million and the UK the highest deaths per million, while China reported the lowest for both. Hospitalization and ICU rates were highest in the UK and the USA, respectively, and lowest in Japan. Vaccination coverage was highest in China and lowest in South Africa. Excess mortality was highest in Russia and lowest in Japan. Generalized linear models indicated a negative association between the SI and cases in China (β = -40, P = 0.015), which became stronger after adjusting for vaccination (β = -311, P < 0.001), but positive associations were observed in the USA, UK, and South Africa. SI was negatively associated with excess mortality in most countries.

Conclusions: Effective pandemic control is highly context-dependent. The relationships among vaccination, variant prevalence, and health care burden were complex, shaped by implementation context, public compliance, and health care capacity.

Objectives: Examine the association between dementia and all-cause 5-year mortality among skilled nursing facility (SNF) residents exposed to Hurricane Sandy flooding.

Methods: This study analyzed Medicare fee-for-service (FFS) beneficiaries aged ≥65 receiving care in SNFs located in flooded ZIP codes in New York, New Jersey, and Connecticut (October 2012). A 20% Medicare FFS sample was linked to Minimum Data Set assessments, LTCFocus, Care Compare, and American Community Survey data. Flooding exposure was defined using 2012 U.S. Geological Survey flood shapefiles. Follow-up extended 5 years. Analysis included Kaplan-Meier curves, multivariable Cox models, and propensity-score matching.

Results: Of 1,627 SNF residents, 767 (47%) had dementia. Compared with those without dementia, they were older (≥85y: 52% vs 38%; P < 0.001), less often non-Hispanic White (67% vs 75%; P < 0.001), and more frequently dually eligible for Medicare/Medicaid (63% vs 40%; P < 0.001); Charlson comorbidity burden was similar (mean 4.9; P = 0.95.). Dementia was associated with higher 5-year mortality after full adjustment (HR 1.20, 95% CI 1.05-1.37), and propensity-score matching (HR 1.24, 95% CI 1.08-1.44). Median survival was 1.68 years vs 2.61 years.

Conclusions: SNF residents with dementia in flooded areas had higher 5-year mortality, underscoring the need for dementia-specific disaster plans.

Objective: This study examined public attitudes and experiences in using the Internet for first aid guidance in real-life medical emergencies.

Methods: The study involved: (1) an analysis of YouTube comments (n = 6,786) on first aid videos using latent Dirichlet allocation topic modeling; (2) a survey of completers of an online Basic Life Support course (n = 731).

Results: Topic modeling of social media comments revealed users' frustration with unskippable advertisements, reflecting a collective perception of online videos as a source of immediate advice on first aid in real-life emergencies. According to the survey data, 14.6% of respondents sought online first-aid instructions during a real-life emergency. An additional 8.9% reported similar experiences among friends or relatives. Of those who searched for advice, 90.7% found and implemented instructions. Most respondents showed readiness to attempt this in future as they believe it could be lifesaving.

Conclusions: The existing public demand for, and continued use of, the Internet as a source of advice on first aid, the risks arising from laypeople's reliance on information of questionable quality, and the potential usefulness of authoritative digital guidance for instances where other means of assistance are unavailable constitute an intricate public health issue that requires attention and comprehensive solutions.

Objective: The risk of Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) incidents is increasing due to terrorism, technological advancements, conflicts, and emerging diseases. Hospitals, as critical response centers, face unique challenges during such events. Comprehensive training is crucial to ensure effective response and protect both patients and staff. This scoping review assesses the effectiveness of CBRNE training in enhancing knowledge, competencies, and preparedness among hospital-based health care providers.

Methods: Comprehensive searches were conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and CINAHL using targeted keywords. Papers were screened using Covidence. Data were analyzed to evaluate the effectiveness of various training methods used in hospital settings.

Results: A total of 23 papers were included in this review. Training effectiveness was reported in 91% of the reviewed articles. Nurses were the predominant group participating in hospital-based training programs. Tabletop exercises were the most commonly used training method, and biological hazards were the most frequent scenario type. No study identified a single superior method for improving training effectiveness.

Conclusions: CBRNE training incorporating diverse modalities improves health care providers' knowledge and competencies. Enhanced preparedness supports better responses to disasters, potentially leading to improved patient outcomes and public safety.

Objective: This study explored the prevalence and attributes of triage errors made by emergency responders during virtual reality simulations of mass casualty incidents.

Methods: The study analyzed errors made by 99 emergency responders during their triage and treatment of a mass casualty incident in virtual reality. Responders received training on the Sort, Assess, Life-saving Intervention, Treatment, Transport (SALT) protocol, then responded to a virtual bombed subway station. Responder accuracy, efficiency, and application of treatments were tracked. Error analysis was performed through the lens of human factors. Accordingly, errors were categorized by their nature: either perception, proficiency, or procedure.

Results: Responders correctly triaged 70% of virtual patients, and 78% demonstrated relative efficiency. Interaction times between responders and patients averaged 20 seconds. The time to assess and treat all patients for life-threatening bleeding injuries across the entire scene averaged six minutes. Most errors were related to proficiency (e.g., competence or experience). However, procedural errors (shortcomings of SALT) and perceptual errors (degraded sensory input from programmed environmental chaos, i.e., virtual smoke/debris and louder sound) were also observed. Most errors were related to patients with either respiratory issues or multiple injuries.

Conclusion: Virtual reality (VR) offered a controlled environment for studying errors made by emergency responders in a mass casualty incident, which will lead to improved training and protocols to better prepare them for these events.