History of emergency medicine in Bhutan.

Emergency medicine in Bhutan has made significant progress in the past few decades and continues to evolve. In this article, we provide valuable insights into the history of emergency medicine at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) and in Bhutan and highlight some of the future challenges we face as we move forward to meet the demands of increased patient volume and complexity.

Norway's Battery Electric Vehicles and Public Health- Findings From the Literature.

The transportation sector is among the highest contributors to the increase in greenhouse gas emissions in European nations, with private cars emerging as the primary source. Although reducing emissions presents a formidable challenge, the emergence of battery electric vehicles (BEVs) offers a promising and sustainable avenue toward achieving zero greenhouse gases within the transportation infrastructure. Since the 1990s, the Norwegian parliament has fervently supported this transition, leveraging public awareness campaigns and a range of financial incentives for its users nationwide. The widespread utilization of BEVs promises substantial health benefits, including ensuring cleaner air for all citizens regardless of their socioeconomic status and fostering improvements in public health outcomes. This transition potentially curtails hundreds of thousands of annual deaths attributed to climate change, enhances the quality of life, bolsters civilian productivity, and fuels economic and population growth. The adoption of BEVs offers a myriad of advantages, including reduced health risks and premature mortality, as well as a quieter environment with diminished noise pollution. Nonetheless, the integration of BEVs necessitates robust road infrastructure with considerable maintenance costs, alongside limitations on driving range for users. Concerns arise regarding potential particle emissions from BEV tire wear due to the increased weight of batteries compared to conventional vehicles. Rapid acceleration capabilities may accelerate tire degradation, contributing to higher particle emissions, of which only 10% to 20% remain suspended in the air, whereas the majority settles on road surfaces, posing a threat to nearby aquatic ecosystems when washed into water bodies and soils. While BEVs hold promise for valuable benefits, successful policy creation and implementation require a detailed awareness of their limitations and challenges to ensure a comprehensive approach to sustainable mobility and public health improvement. Therefore, more research on the limitations of BEVs can help inform improved tactics for maximizing their benefits while limiting potential disadvantages.

A swift transition to electric vehicles is a good public health intervention that benefits the quality of the air and climate systems. It is expedient to know that this new technology will not solve all problems caused by transportation systems, as there will always be some unwanted and unexpected side effects as usual with new technologies. We suggest more advanced research on EVs shortcomings for better understanding and usage.

Lessons and Best Practices on Risk Communication and Infodemic Management during the COVID-19 Pandemic in Bhutan.

During the recent COVID-19 pandemic, risk communication and community engagement (RCCE) were instrumental in inducing behavior change in tandem with the evolving evidence and phases of the pandemic. Infodemic management also became one of the areas where much emphasis was laid in Bhutan's response to the COVID-19 pandemic along with other critical response strategies such as surveillance, contact tracing, quarantine, isolation, and testing. Over the past 3 years of the pandemic, much has been learnt about the significance and impact of RCCE. In this article, the authors will highlight some of the methods and practices that were implemented to manage public information and also share experiences with regard to RCCE over the course of Bhutan's response to the pandemic. Furthermore, it will also outline some of the media and risk communication mechanisms that were in place before Bhutan's response to the COVID-19 pandemic.

Hand Hygiene, Face Mask Use, and Associated Factors during the COVID-19 Pandemic among the Students of Mongar Higher Secondary School, Bhutan: A Cross-Sectional Study.

Non-pharmacological measures, such as hand hygiene and face mask use, continue to play an important role in the fight against the COVID-19 pandemic. However, there is a paucity of studies on the adherence to these measures among students in Bhutan. Therefore, we aimed to investigate hand hygiene and face mask-wearing behaviours, as well as their associated factors, among the students of Mongar Higher Secondary School, Bhutan. We conducted a cross-sectional study amongst the students of Mongar Higher Secondary School in Bhutan. The students self-answered the questionnaire on web-based Google Forms. Multivariable logistic regression for good hand washing and face mask use was conducted in order to identify statistically significant socio-demographic covariates. The correlation between hand hygiene and mask use was investigated using Pearson's correlation coefficient. A total of 533 students completed the survey questionnaire, 52.9% (282) of whom were female students. Facebook (44.3%, 236) and TV (35.5%, 189) were the two most popular sources of information on COVID-19 prevention and control. Good (scores of ≥80% of total scores) hand hygiene and face mask use were reported in 33.6% (179) and 22.1% (118) of students. In multivariable logistic regression, male students presented 79% (adjusted odds ratio [AOR] = 1.79, 95% confidence interval [CI] = 1.23−2.613) odds of engaging in good hand hygiene, compared to female students. Compared to grade 9, those in grade 10 were 60% (AOR = 0.4, 95% CI 0.158−0.998) less likely to engage in good hand hygiene. Boarding students presented 68% (AOR = 1.68, 95% CI 1.001, 2.813) higher odds of wearing a face mask compared to day students. There was a significant positive correlation between good hand hygiene and face mask use (r = 0.3671, p-value < 0.001). Good hand hygiene and face mask use were reported in less than one-third of the study participants. It is recommended to continue educating students on good hand hygiene and face mask use through popular information sources.

Challenges in the management of high-altitude illnesses and emergencies in Bhutan and Nepal.

Many popular tourist attractions and trekking routes in Bhutan and Nepal are situated between 3000 and 6000 m in elevation. High-altitude emergencies are becoming more common and medical providers must be aware of the practical and medical issues in managing these disorders. We reflect on the challenges in providing high-altitude emergency medical services in Bhutan and Nepal.

Characteristics and outcomes of patients triaged as critically ill in the emergency department of a tertiary care hospital in Bhutan.

BACKGROUND: In Bhutan, where the Emergency Medical System is forming and evolving, the number of acutely ill patients requiring critical care, both in the emergency departments and intensive care units, is steadily increasing. Given the lack of baseline data and the ever-increasing number of critical care patients, this study was aimed at describing the characteristics and outcomes of patients triaged as critically ill in the emergency department. METHODS: An observational study was conducted over a yearlong period in the emergency department where all patients triaged as critically ill were approached for inclusion in the study. A case record form was used for the purpose of data collection. Epidata analysis was used for descriptive analysis and SPSS was used for binary logistic regression. RESULTS: A total of 657 critically ill patients of all age groups visited the emergency department over the 1-year study period, with adults constituting the majority (81%). The majority (67%) of these patients had a favorable outcome of surviving to discharge. The most common diagnosis among critically ill neonates was neonatal sepsis. Among the critically ill pediatrics and adults, sepsis, respiratory illnesses, and trauma were the most common diagnoses. Intubation followed by mechanical ventilation and blood product transfusion were the most common lifesaving interventions performed on critically ill patients. CONCLUSION: The findings from this study constitute the first ever local database, at the national referral hospital in Bhutan, of critically ill patients treated in the emergency department. It highlights the central role the emergency department plays in their management and provides information for strengthening critical care services. It also highlights the areas of improvement and identifies high yield areas of training for the emergency department.

Performance of an Emergency Road Ambulance Service in Bhutan: Response Time, Utilization, and Outcomes.

Background: An efficient ambulance service is a vital component of emergency medical services. We determined the emergency ambulance response and transport times and ambulance exit outcomes in Bhutan. Methods: A cross-sectional study involving real-time monitoring of emergency ambulance deployments managed by a central toll-free (112) hotline (20 October 2021 to 20 January 2022) was carried out. Results: Of 5092 ambulance deployments, 4291 (84%) were inter-facility transfers, and 801 (16%) were for emergencies. Of the latter, 703 (88%) were for non-pregnancy-related emergencies (i.e., medical, surgical, and accidents), while 98 (12%) were for pregnancy-related emergencies. The median ambulance response and patient transport times were 42 (IQR 3-271) and 41 (IQR 2-272) minutes, respectively. The median round-trip distance travelled by ambulances was 18 km (range 1-186 km). For ambulance exit outcomes that were pregnancy-related (n = 98), 89 (91%) reached the health facility successfully, 8 delivered prior to ambulance arrival at the scene or in the ambulance during transport, and 1 had no outcome record. For the remaining 703 non-pregnancy deployments, 29 (4.1%) deployments were deemed not required or refusals, and 656 (93.3%) reached the health facility successfully; 16 (2.3%) died before the ambulance's arrival at the scene, and 2 (0.3%) were not recorded. Conclusions: This first countrywide real-time operational research showed acceptable ambulance exit outcomes. Improving ambulance response and transport times might reduce morbidities and mortalities further.

Knowledge, Attitude, and Practice of Infection Control and Waste Management among Traditional Medicine Practitioners in Bhutan, 2019: A Nationwide Cross-Sectional Survey.

BACKGROUND: In Bhutan, Traditional Medicine (TM) is a part of the government-sponsored free healthcare system and Traditional Medicine Units (TMUs) are colocated with allopathic hospitals. Prevention of healthcare-associated infections and patient safety must apply to all institutionalized healthcare settings including TMUs. This study assessed the knowledge, attitude, and practice of TM practitioners in Bhutan in the field of infection control and waste management practices. METHODS: This was a descriptive study among TM practitioners selected through simple random sampling. Data were collected using a structured pro forma and entered in EpiData 3.1 and analyzed in STATA 13.1. RESULTS: There were 132 respondents (response rate 98%). The majority (64%) knew the seven steps of handwashing but their knowledge of WHO's Five Moments for Handwashing was poor, especially handwashing after aseptic procedures (17%) and handwashing after touching patient surroundings (5%). Handwashing before palpation of the pulse (37%) and using gloves while dispensing medicines (9%) were poor; but the proportions of handwashing before performing moxibustion (96%), correct disposal of sharps (84%), and disinfection of cupping sets (78%) were high. The majority of participants hold a positive attitude towards the adoption of infection control and waste management practices for the benefit of patients. Only 23% had received preservice and 44% had received in-service training on infection control. CONCLUSIONS: The knowledge and practices of infection control and waste management are optimal only in select domains of practice. The practitioners hold a positive attitude towards the adoption of infection control and waste management standards.