Pediatric disaster preparedness curriculum across emergency medicine residencies.

OBJECTIVE: To assess pediatric disaster medicine (PDM) instruction in emergency medicine (EM) residency programs and to identify barriers to integrating these skills into EM training. METHODS: National survey study of United States EM Residency Program Directors (PDs) and Assistant PDs during the 2021-2022 academic year. RESULTS: Of the 186 EM residency programs identified, a total of 24 responses were recorded with a response rate of 12.9 percent. Importance of training was rated 5.79 (standard deviation 2.51) using the Likert scale ranging from 1 to 10. Out of 24 programs, 17 (70.8 percent) do not have any PDM training as part of residency training. Live drill, simulation, and tabletop were identified as most effective methods to deliver PDM training with the Likert scale score of 4.78, 4.6, and 4.47, respectively. Senior trainees' level of -knowledge/skills with family reunification (Likert 2.09/5; chemical-biological-radiological-nuclear explosive 2.95/5) and mass casualty preparation of the emergency department (3.3/5) as assessed by the respondents. The main barrier to education included logistics, eg, space and costs (Likert 3.7/5), lack of didactic time (3.7/5), and limited faculty knowledge, skill, or experience (3.3/5). CONCLUSION: PDM training is lacking and requires standardization. This study highlights the opportunity for the creation of a model for EM resident education in PDM.

Footprint of Emergency Medicine Physicians in Disaster Medicine Publications: A Bibliometric Analysis.

INTRODUCTION: Investigating the developments in the ever-growing field of disaster medicine and revealing the scientific trends will make an important contribution to researchers in related fields. This study aims to identify the contributions of emergency medicine physicians (EMPs) and trends in disaster medicine publications. METHODS: The expressions "disaster medicine" or "disaster*" and "medicine*" were searched in the Web of Science (WoS) database. Research and review papers produced by EMPs from 2001 through 2021 were included in the study. Basic descriptive information was assessed such as the number of publications, authors, citations, most active authors, institutions, countries, and journals. In addition, conceptual, intellectual, and social structures were analyzed. RESULTS: The study included a total of 346 papers written by 1,500 authors. The mean citation rate per publication was 13.2. Prehospital and Disaster Medicine, Disaster Medicine and Public Health Preparedness, and Academic Emergency Medicine were the journals with the highest number of publications and the highest number of citations. The most common keywords used by the authors were "disaster medicine," "emergency medicine," and "disaster/disasters." According to the distribution of the corresponding authors by country, the United States (n = 175), Japan (n = 23), Italy (n = 20), Australia (n = 17), and Canada (n = 17) had the highest number of publications. The institutions that produced the most publications were John Hopkins University (n = 37), Brigham and Women's Hospital (n = 27), George Washington University (n = 25), University Piemonte Orientale (n = 24), and Brown University (n = 22). CONCLUSION: Increasingly, EMPs have contributed to disaster medicine publications over the years. This study can be used as a guide for EMPs and other researchers who want to contribute to the disaster medicine literature.

A disaster medicine course for Canadian medical students: first implementation of a large-scale mass-casualty simulation.

Mass-casualty incidents have a significant global impact. Despite calls for improved disaster-preparedness training, most medical curriculums do not include formal disaster-medicine education. In 2021, the Medical Council of Canada introduced new disaster-medicine learning objectives. This article presents a mass-casualty-incident course for 3rd-year Canadian medical students. The course includes lectures, and a large-scale simulation of an explosion scene, field triage zone, and simulated emergency department (ED). The simulation incorporated "Dark-team-member" facilitators and 17 live actor and 8 mannequin patients with moulage. Pre-/post-event evaluation data was collected. One-hundred and twenty medical students participated in the course. Confidence in managing a real mass-casualty incident, on a scale from 1 to 10 (no-confidence to completely confident) significantly improved based on a Mann-Whitney U test, p < 0.05. Few formal medical student mass-casualty-incident courses exist. Combining "Dark-team-members" with live actors, imbedding clinician facilitators with medical students, and having a simulation with a continuous disaster scene to the ED are unique to this course. The methodology is presented for future replication.

RéSUMé: Les incidents faisant de nombreuses victimes ont un impact mondial significatif. Malgré les appels à l'amélioration de la formation à la préparation aux catastrophes, la plupart des cursus médicaux n'incluent pas de formation formelle à la médecine des catastrophes. En 2021, le Conseil médical du Canada a introduit de nouveaux objectifs d'apprentissage en médecine de catastrophe. Cet article présente un cours sur les accidents de masse destiné aux étudiants en médecine canadiens de troisième année. Le cours comprend des cours magistraux et une simulation à grande échelle d'une scène d'explosion, d'une zone de triage sur le terrain et d'un service d'urgence (SU) simulé. La simulation comprenait des facilitateurs "Dark-team-member" et 17 acteurs réels et 8 patients mannequins avec moulage. Des données d'évaluation avant/après l'événement ont été collectées. Cent vingt étudiants en médecine ont participé au cours. La confiance dans la gestion d'un véritable incident de masse, sur une échelle de 1 à 10 (aucune confiance à une confiance totale), s'est améliorée de manière significative d'après un test U de Mann-Whitney p<0,05. Il existe peu de cours formels sur les accidents de masse à l'intention des étudiants en médecine. La combinaison de " Dark-team-member " avec des acteurs en chair et en os, l'intégration d'animateurs cliniciens avec des étudiants en médecine et la simulation d'une scène de catastrophe continue au service des urgences sont des éléments uniques de ce cours. La méthodologie est présentée pour être reproduite à l'avenir.

Editorial Comments: The 2023 Model Core Content of Disaster Medicine.

The recently published Model Core Content of Disaster Medicine introduces proposed curriculum elements for specialized education and training in Disaster Medicine. This editorial comments on the publishing decision for the manuscript.

The 2023 Model Core Content of Disaster Medicine.

INTRODUCTION: Disaster Medicine (DM) is the clinical specialty whose expertise includes the care and management of patients and populations outside conventional care protocols. While traditional standards of care assume the availability of adequate resources, DM practitioners operate in situations where resources are not adequate, necessitating a modification in practice. While prior academic efforts have succeeded in developing a list of core disaster competencies for emergency medicine residency programs, international fellowships, and affiliated health care providers, no official standardized curriculum or consensus has yet been published to date for DM fellowship programs based in the United States. STUDY OBJECTIVE: The objective of this work is to define the core curriculum for DM physician fellowships in the United States, drawing consensus among existing DM fellowship directors. METHODS: A panel of DM experts was created from the members of the Council of Disaster Medicine Fellowship Directors. This council is an independent group of DM fellowship directors in the United States that have met annually at the American College of Emergency Physicians (ACEP)'s Scientific Assembly for the last eight years with meeting support from the Disaster Preparedness and Response Committee. Using a modified Delphi technique, the panel members revised and expanded on the existing Society of Academic Emergency Medicine (SAEM) DM fellowship curriculum, with the final draft being ratified by an anonymous vote. Multiple publications were reviewed during the process to ensure all potential topics were identified. RESULTS: The results of this effort produced the foundational curriculum, the 2023 Model Core Content of Disaster Medicine. CONCLUSION: Members from the Council of Disaster Medicine Fellowship Directors have developed the 2023 Model Core Content for Disaster Medicine in the United States. This living document defines the foundational curriculum for DM fellowships, providing the basis of a standardized experience, contributing to the development of a board-certified subspecialty, and informing fellowship directors and DM practitioners of content and topics that may appear on future certification examinations.

Medical Care Management Based on Disaster Medicine for the Triathlon Events at the XXXII Olympiad and Tokyo 2020 Paralympic Games.

Planning the medical services for the triathlon competition at the 2020 Tokyo Olympic and Paralympic Games was predicted to be challenging because of possible last-minute changes related to the COVID-19 pandemic and abnormally high temperatures. Therefore, event planners organized and executed a disaster medical care plan, a plan for providing care during emergencies. Based on the basic medical plan for all venues provided by the Tokyo 2020 Organizing Committee, planners for the triathlon venue prepared a medical care plan according to the CSCATTT principles: Command and control, Safety, Communication, Assessment, Treatment, Triage, and Transport. After the event, planners evaluated the number of COVID-19, heatstroke, and injury cases at the venue. The events were conducted without spectators in July and August 2022 because at the last minute, planners held the event without spectators. The triathlon competition involved 638 individuals, including athletes and staff. In total, 7 cases of injuries, 3 cases of mild heatstroke, and 13 other cases were reported, with only 2 requiring emergency transportation. No cases of COVID-19 were reported from the triathlon venue, including during the observation period after the event. This medical plan was effective in preventing heatstroke and COVID-19 cases during the big event. Efficiently and effectively responding to various situations is possible in a shorter period by planning large-scale medical services for such special circumstances according to CSCATTT, a principle of disaster medical care.

Combating the Opioid Crisis and Its National Security Threat Through CReDO: A Multidisciplinary Solution With Disaster Medicine Implications.

For the first time in history, the United States surpassed 100 000 overdose-related deaths in a 12-month period, driven by synthetic opioids such as fentanyl. Also, for the first time, potential chemical weapons are readily available on the streets and the dark web. Opioids represent a rare trifecta, used for licit pain management, as an illicit drug of abuse, and with potential use as a weapon of terror. Community-based Response to Drug Overdose (CReDO) is an initiative to unite agencies, disciplines, government, and private partners in 1 coordinated opioid emergencies response plan under nationwide standards, and can be integrated into the disaster medicine discipline due to the risk of mass casualty incidents involving fentanyl or its derivatives. Attention to the opioid crisis through CReDO will save lives by promoting information sharing between disciplines, shortened response time to overdose clusters, community collaboration to identify criminal distribution networks, and holistic approaches to addiction.

[Content Analysis of Chinese National Laws and Regulations on Emergencies from the Perspective of Disaster Nursing on the Basis of Crisis Life Cycle Theory].

Objective: To analyze Chinese national laws and regulations on emergencies from the perspective of nursing and on the basis of the crisis life cycle theory, to discuss the weaknesses in laws and regulations concerning emergencies, and to provide evidence for the definition of the scope of disaster nursing practice in China. Methods: We selected emergency laws and regulations promulgated by the National People's Congress and its Standing Committee and the State Council as the subject matter of the study, constructing the analysis framework on the basis of the core competence of disaster nursing and crisis life cycle theory. Then, the 16 laws and regulations included in the study were analyzed with NVivo 12 software by the content analysis method. Results: A total of 6 laws and regulations concerning earthquakes, 3 concerning infectious diseases, 2 concerning fire, 2 concerning food poisoning, 2 concerning emergencies, and 1 concerning flood were selected. A total of 24 food poisoning-related codes, 23 infectious disease codes, 22 emergency event codes, 22 earthquake codes, 21 fire codes, and 16 flood codes were obtained. In the key links of emergency preparedness, early prevention had the highest number of reference points, whereas collaborative response had the lowest number of reference points. In the key processes of emergency preparedness, aftermath management had the highest number of reference points, whereas social services and continuous operation had the lowest numbers of reference points. Conclusion: Laws and regulations concerning emergencies are generally formulated on the basis of certain historical experience, with collaborative response, social services, and continuous operation being the weak links and processes. In the process of disaster nursing practice, we should effectively make up for the weaknesses in laws and regulations concerning emergencies by utilizing the positive aspects and the essence of the discipline.

Assessing Knowledge, Attitudes, and Perceptions of Medical Students Toward Emergency Preparedness and Disaster Medicine in Singapore.

OBJECTIVE: Despite rising incidences of global disasters, basic principles of disaster medicine training are barely taught in Singapore's 3 medical schools. The aim of this study was to evaluate the current levels of emergency preparedness, attitudes, and perceptions of disaster medicine education among medical students in Singapore. METHODS: The Emergency Preparedness Information Questionnaire (EPIQ) was provided to enrolled medical students in Singapore by means of an online form, from March 6, 2020, to February 20, 2021. A total of 635 (25.7%) responses were collated and analyzed. RESULTS: Mean score for overall familiarity was low, at 1.50 ± 0.74, on a Likert scale of 1 for not familiar to 5 for very familiar. A total of 90.6% of students think that disaster medicine is an important facet of the curriculum, and 93.1% agree that training should be provided for medical students. Although 77.3% of respondents believe that they are unable to contribute to a disaster scenario currently, 92.8% believe that they will be able to contribute with formal training. CONCLUSIONS: Despite low levels of emergency preparedness knowledge, the majority of medical students in Singapore are keen for adaptation of disaster medicine into the current curriculum to be able to contribute more effectively. This can arm future health-care professionals with the confidence to respond to any potential emergency.

Comparison of Disaster Medicine Education in Emergency Medicine Residency and Emergency Medical Services Fellowship in the United States.

INTRODUCTION: Disaster Medicine (DM) is defined by Koenig and Shultz as the "disciplines and organizations involved with governmental public health, public and private medical delivery including Emergency Medical Services (EMS), and governmental emergency management." The Accreditation Council for Graduate Medical Education (ACGME) sets curriculum requirements and standards for Emergency Medicine (EM) residencies and EMS fellowships, which include a limited portion of the DM curriculum topics recommended by the Society of Academic Emergency Medicine (SAEM). The ACGME does not currently approve DM fellowships, as DM is not recognized as a subspecialty by the American Board of Medical Specialties (ABMS). This lack of nationally standardized guidelines for DM training leads to variability in disaster-related knowledge and skills, even among physicians trained by ACGME-accredited programs. STUDY OBJECTIVE: The objective of this study is to analyze the DM components covered in EM residency and EMS fellowship in the United States and compare those to SAEM DM fellowship curriculum guidelines. METHODS: The DM curriculum components of EM residencies and EMS fellowships were evaluated, using the SAEM DM curriculum as a control. Overlapping topics, as well as gaps between the programs, were analyzed using descriptive statistics. RESULTS: Of the DM curriculum components developed by SAEM, EMS fellowship covered 15 of 19 (79%) major curriculum components and 38 of 99 (38%) subtopics, while EM residency covered seven of 19 major curriculum components (37%) and 16 of 99 (16%) subtopics. Together, EM residency and EMS fellowship cover 16 of 19 (84%) major curriculum components and 40 of 99 (40%) subtopics. CONCLUSION: While EMS fellowship covers a large portion of the DM major curriculum components recommended by SAEM, there are several important DM subtopics that are not covered either in EM residency or EMS fellowship. Furthermore, there is no standardization for the depth and manner that DM topics are addressed in either curriculum. Time constraints in EM residency and EMS fellowship may also prevent extensive review of important DM topics. Disaster Medicine covers a distinct body of knowledge, represented in the curriculum subtopics, that are not covered in either EM residency or EMS fellowship. The development of an ACGME-accredited DM fellowship and recognition of DM as a distinct subspecialty could allow for more effective DM graduate medical education.

Disaster Medicine Education for Israeli Medical Response Teams to the Ukrainian Refugee Crisis.

INTRODUCTION: Disaster Medicine (DM) requires skills, knowledge, and prior experience that are rarely put to test by health care providers. Pediatric DM presents unique challenges in terms of both knowledge and practice. METHODS: An anonymous survey consisting of demographic and five-point Likert scale questions was administered to physicians, nurses, and other medical personnel from Israel's major medical emergency teams who were deployed to respond to the refugee crisis in Ukraine. This included teams from the Hadassah and Tel Aviv Sourasky Medical Centers and the Israel Ministry of Health. RESULTS: Of the 171 members of the medical teams deployed on the Ukraine border, a total of 105 responses were obtained (61.4%) from 61 physicians, 50 nurses, and 12 other health care providers. The teams were composed of pediatricians (31.6%), internal medicine physicians (21.6%), Emergency Medicine and intensive care physicians (18.0%), and 31.0% other specialties.For 60% of the participants, this was their first deployment, and 78% had received no training in DM. Members rated the need for DM training at 4/5 (IQR 3-5). Forty-nine (49) members (46.6%) were not briefed on situational awareness and 97 members (89.5%) were not trained in the recognition of acute stress reactions. The responders also rated their concerns about providing medical aid to children at 2/5 (IQR 1-3). A medical clown was part of the teams 42.8% of the time; the presence of clowns was rated at a median of 4/5 (IQR 4-5). The team members underscored the need for more targeted training in DM at 5/5 (IQR 3-5). CONCLUSION: The findings highlight the need for the formulation of a disaster education model that includes pediatric DM.

The development of new remote technologies in disaster medicine education: A scoping review.

Background: Remote teaching and online learning have significantly changed the responsiveness and accessibility after the COVID-19 pandemic. Disaster medicine (DM) has recently gained prominence as a critical issue due to the high frequency of worldwide disasters, especially in 2021. The new artificial intelligence (AI)-enhanced technologies and concepts have recently progressed in DM education. Objectives: The aim of this article is to familiarize the reader with the remote technologies that have been developed and used in DM education over the past 20 years. Literature scoping reviews: Mobile edge computing (MEC), unmanned aerial vehicles (UAVs)/drones, deep learning (DL), and visual reality stimulation, e.g., head-mounted display (HMD), are selected as promising and inspiring designs in DM education. Methods: We performed a comprehensive review of the literature on the remote technologies applied in DM pedagogy for medical, nursing, and social work, as well as other health discipline students, e.g., paramedics. Databases including PubMed (MEDLINE), ISI Web of Science (WOS), EBSCO (EBSCO Essentials), Embase (EMB), and Scopus were used. The sourced results were recorded in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart and followed in accordance with the PRISMA extension Scoping Review checklist. We included peer-reviewed articles, Epubs (electronic publications such as databases), and proceedings written in English. VOSviewer for related keywords extracted from review articles presented as a tabular summary to demonstrate their occurrence and connections among these DM education articles from 2000 to 2022. Results: A total of 1,080 research articles on remote technologies in DM were initially reviewed. After exclusion, 64 articles were included in our review. Emergency remote teaching/learning education, remote learning, online learning/teaching, and blended learning are the most frequently used keywords. As new remote technologies used in emergencies become more advanced, DM pedagogy is facing more complex problems. Discussions: Artificial intelligence-enhanced remote technologies promote learning incentives for medical undergraduate students or graduate professionals, but the efficacy of learning quality remains uncertain. More blended AI-modulating pedagogies in DM education could be increasingly important in the future. More sophisticated evaluation and assessment are needed to implement carefully considered designs for effective DM education.

Teaching extent and military service improve undergraduate self-assessed knowledge in disaster medicine: An online survey study among Swedish medical and nursing students.

Background: The purpose of this study was to identify the possible needs for undergraduate disaster medicine education in Sweden and to make informed recommendations for the implementation of disaster medicine content in medical and nursing schools in Sweden. Methods: An online survey was distributed to undergraduate medical and nursing students through the directors of all medical and nursing programs at Swedish universities. The survey contained demographic questions, as well as questions about the amount of disaster medical education and previous experience with rescue, police, or military services. The final survey page contained self-assessments of disaster medical knowledge. Comparative statistics were applied between nursing and medical students, those with previous military service, and those without, as well as between universities. Results: A total of 500 medical and 408 nursing students participated in this study. A median of 2 h of disaster medicine education was provided to senior medical students and 4 h was provided to senior nursing students. Senior medical students scored their disaster medical knowledge lower than nursing students (t-test, p < 0.001). A proportion of 1% had served in rescue services or police, and 7% of the participants had a history of military service, of which 67% served in a medical role. Those who had served in rescue services, police, or the armed forces had a higher self-assessed disaster medical knowledge base than those who had not (p < 0.007 and p < 0.001, respectively). Conclusion: Most medical and nursing students in this study rated their disaster medical knowledge as insufficient. The correlation between the amount of disaster medical education and self-assessed disaster medical knowledge should influence and help direct Swedish educational policies.

Examining the disaster medicine curriculum in Canadian Emergency Medicine enhanced skills programs.

OBJECTIVES: Disaster medicine teaching is an important, and understudied, component of EM residency training programs. Little is known about disaster medicine training in Canadian EM programs, particularly within the 1-year EM enhanced skills programs. The purpose of this study is to (1) understand which disaster medicine topics are currently taught in EM enhanced skills programs and (2) establish a list of the highest priority disaster medicine teaching topics for those programs. METHODS: We distributed an eight-question survey to all 31 EM enhanced skills site directors across Canada by email. Questions on the survey asked which of 39 disaster medicine subtopics were (1) currently taught and (2) should be taught to EM enhanced skills residents. RESULTS: Of 31 invited participants, 16 completed the study (52% response rate). The most taught topic was introduction to disaster medicine/nomenclature (13/16 programs), while 11/16 programs currently teach decontamination indications and issues, personal protective equipment, prehospital disaster management, and trauma mass casualty incidents. Topics reported high or essential priority for teaching included introduction to disaster medicine/nomenclature (12/16 programs), decontamination indications and issues, personal protective equipment, and prehospital disaster management (11/16 programs). CONCLUSIONS: This study identified disaster medicine topics currently taught at Canadian EM enhanced skills programs, along with recommending a list of priority teaching topics. These findings can inform future disaster medicine content in EM training program curricula.

RéSUMé: OBJECTIFS: L'enseignement de la médecine de catastrophe est une composante importante et peu étudiée des programmes de résidence en MU. On sait peu de choses sur la formation à la médecine de catastrophe dans les programmes canadiens de MU, en particulier dans les programmes d'un an visant à améliorer les compétences en MU. L'objectif de cette étude est de 1) comprendre quels sujets relatifs à la médecine de catastrophe sont actuellement enseignés dans les programmes d'amélioration des compétences en MU et 2) d'établir une liste des sujets d'enseignement de la médecine de catastrophe les plus prioritaires pour ces programmes. MéTHODES: Nous avons distribué par courriel un questionnaire de huit questions aux 31 directeurs de sites d'amélioration des compétences en MU au Canada. Les questions de l'enquête portaient sur les 39 sous-thèmes de la médecine de catastrophe qui 1) sont actuellement enseignés et 2) devraient être enseignés aux résidents ayant des compétences renforcées en MU. RéSULTATS: Sur les 31 participants invités, 16 ont terminé l'étude (taux de réponse de 52 %). Le sujet le plus enseigné était l'introduction à la médecine de catastrophe/la nomenclature (13/16 programmes), tandis que 11/16 programmes enseignent actuellement les indications et les problèmes de décontamination, l'équipement de protection individuelle, la gestion préhospitalière des catastrophes et les traumatismes liés aux incidents de masse. Les sujets considérés comme prioritaires ou essentiels pour l'enseignement comprenaient l'introduction à la médecine de catastrophe/la nomenclature (12/16 programmes), les indications et les problèmes de décontamination, l'équipement de protection individuelle et la gestion préhospitalière des catastrophes (11/16 programmes). CONCLUSIONS: Cette étude a permis d'identifier les sujets relatifs à la médecine de catastrophe actuellement enseignés dans les programmes canadiens d'amélioration des compétences en MU, et de recommander une liste de sujets d'enseignement prioritaires. Ces résultats peuvent éclairer le contenu futur de la médecine de catastrophe dans les programmes de formation en médecine d'urgence.

A scoping review of metaverse in emergency medicine.

BACKGROUND: Interest in the metaverse has been growing worldwide as the virtual environment provides opportunities for highly immersive and interactive experiences. Metaverse has gradually gained acceptance in the medical field with the advancement of technologies such as big data, the Internet of Things, and 5 G mobile networks. The demand for and development of metaverse are different in diverse subspecialties owing to patients with varying degrees of clinical disease. Hence, we aim to explore the application of metaverse in acute medicine by reviewing published studies and the clinical management of patients. METHOD: Our review examined the published articles about the concept of metaverse roadmap, and four additional domains were extracted: education, prehospital and disaster medicine, diagnosis and treatment application, and administrative affairs. RESULTS: Augmented reality (AR) and virtual reality (VR) integration have broad applications in education and clinical training. VR-related studies surpassed AR-related studies in the emergency medicine field. The metaverse roadmap revealed that lifelogging and mirror world are still developing fields of the metaverse. CONCLUSION: Our findings provide insight into the features, application, development, and potential of a metaverse in emergency medicine. This study will enable emergency care systems to be better equipped to face future challenges.