Personal protective equipment preservation strategies in the covid-19 era: A narrative review.

BACKGROUND: The COVID-19 pandemic has led to personal protective equipment (PPE) supply concerns on a global scale. While efforts to increase production are underway in many jurisdictions, demand may yet outstrip supply leading to PPE shortages, particularly in low resource settings. PPE is critically important for the safety of healthcare workers (HCW) and patients and to reduce viral transmission within healthcare facilities. A structured narrative review was completed to identify methods for extending the use of available PPE as well as decontamination and reuse. METHODS: Database searches were conducted in MEDLINE and EMBASE for any available original research or review articles detailing guidelines for the safe extended use of PPE, and/or PPE decontamination and reuse protocols prior to September 28, 2020. Grey literature in addition to key websites from the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), Infection Prevention Association of Canada (IPAC), and the National Health Service (NHS) was also reviewed. RESULTS: Extended use guidelines support co-locating patients with confirmed COVID-19 within specific areas of healthcare facilities to enable the use of PPE between multiple patients, and reduce PPE requirements outside these areas. Decontamination strategies for N95 respirators and face shields range from individual HCWs using conventional ovens and microwave steam bags at home, to large-scale centralized decontamination using autoclave machines, ultraviolet germicidal irradiation, hydrogen peroxide vapors, or peracetic acid dry fogging systems. Specific protocols for such strategies have been recommended by the US CDC and WHO and are being implemented by multiple institutions across North America. Further studies are underway testing decontamination strategies that have been reported to be effective at inactivating coronavirus and influenza, and on SARs-CoV-2 specifically. CONCLUSIONS: This narrative review summarizes current extended use guidelines and decontamination protocols specific to COVID-19. Preserving PPE through the implementation of such strategies could help to mitigate shortages in PPE supply, and enable healthcare facilities in low resource settings to continue to operate safely for the remainder of the COVID-19 pandemic.

Early lessons from COVID-19 that may reduce future emergency department crowding.

The COVID-19 pandemic has produced significant changes in emergency medicine patient volumes, clinical practice, and has accelerated a number of systems-level developments. Many of these changes produced efficiencies in emergency care systems and contributed to a reduction in crowding and access block. In this paper, we explore these changes, analyse their risks and benefits and examine their sustainability for the future to the extent that they may combat crowding. We also examine the necessity of a system-wide approach in addressing ED crowding and access block.

Just the Facts: Protecting frontline clinicians during the COVID-19 pandemic.

There is no patient emergency more important than protecting health care workers during a pandemic.

The Role of Fear-Related Behaviors in the 2013-2016 West Africa Ebola Virus Disease Outbreak.

The 2013-2016 West Africa Ebola virus disease pandemic was the largest, longest, deadliest, and most geographically expansive outbreak in the 40-year interval since Ebola was first identified. Fear-related behaviors played an important role in shaping the outbreak. Fear-related behaviors are defined as "individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. FRBs modify the future risk of harm." This review examines how fear-related behaviors were implicated in (1) accelerating the spread of Ebola, (2) impeding the utilization of life-saving Ebola treatment, (3) curtailing the availability of medical services for treatable conditions, (4) increasing the risks for new-onset psychological distress and psychiatric disorders, and (5) amplifying the downstream cascades of social problems. Fear-related behaviors are identified for each of these outcomes. Particularly notable are behaviors such as treating Ebola patients in home or private clinic settings, the "laying of hands" on Ebola-infected individuals to perform faith-based healing, observing hands-on funeral and burial customs, foregoing available life-saving treatment, and stigmatizing Ebola survivors and health professionals. Future directions include modeling the onset, operation, and perpetuation of fear-related behaviors and devising strategies to redirect behavioral responses to mass threats in a manner that reduces risks and promotes resilience.

Fear factor: The unseen perils of the Ebola outbreak.

As illustrated powerfully by the 2013-2016 Ebola outbreak in western Africa, infectious diseases create fear and psychological reactions. Frequently, fear transforms into action - or inaction - and manifests as "fear-related behaviors" capable of amplifying the spread of disease, impeding lifesaving medical care for Ebola-infected persons and patients with other serious medical conditions, increasing psychological distress and disorder, and exacerbating social problems. And as the case of the US micro-outbreak shows, fear of an infectious-disease threat can spread explosively even when an epidemic has little chance of materializing. Authorities must take these realities into account if they hope to reduce the deadly effects of fear during future outbreaks.

Fear-related behaviors in situations of mass threat.

This Disaster Health Briefing focuses on the work of an expanding team of researchers that is exploring the dynamics of fear-related behaviors in situations of mass threat. Fear-related behaviors are individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. Importantly, fear-related behaviors modulate the future risk of harm. Disaster case scenarios are presented to illustrate how fear-related behaviors operate when a potentially traumatic event threatens or endangers the physical and/or psychological health, wellbeing, and integrity of a population. Fear-related behaviors may exacerbate harm, leading to severe and sometimes deadly consequences as exemplified by the Ebola pandemic in West Africa. Alternatively, fear-related behaviors may be channeled in a constructive and life-saving manner to motivate protective behaviors that mitigate or prevent harm, depending upon the nature of the threat scenario that is confronting the population. The interaction between fear-related behaviors and a mass threat is related to the type, magnitude, and consequences of the population encounter with the threat or hazard. The expression of FRBs, ranging from risk exacerbation to risk reduction, is also influenced by such properties of the threat as predictability, familiarity, controllability, preventability, and intentionality.

Speak fast, use jargon, and don't repeat yourself: a randomized trial assessing the effectiveness of online videos to supplement emergency department discharge instructions.

BACKGROUND: Emergency department discharge instructions are variably understood by patients, and in the setting of emergency department crowding, innovations are needed to counteract shortened interaction times with the physician. We evaluated the effect of viewing an online video of diagnosis-specific discharge instructions on patient comprehension and recall of instructions. METHODS: In this prospective, single-center, randomized controlled trial conducted between November 2011 and January 2012, we randomized emergency department patients who were discharged with one of 38 diagnoses to either view (after they left the emergency department) a vetted online video of diagnosis-specific discharge instructions, or to usual care. Patients were subsequently contacted by telephone and asked three standardized questions about their discharge instructions; one point was awarded for each correct answer. Using an intention-to-treat analysis, differences between groups were assessed using univariate testing, and with logistic regression that accounted for clustering on managing physician. A secondary outcome measure was patient satisfaction with the videos, on a 10-point scale. RESULTS: Among 133 patients enrolled, mean age was 46.1 (s.d.D. 21.5) and 55% were female. Patients in the video group had 19% higher mean scores (2.5, s.d. 0.7) than patients in the control group (2.1, s.d. 0.8) (p=0.002). After adjustment for patient age, sex, first language, triage acuity score, and clustering, the odds of achieving a fully correct score (3 out of 3) were 3.5 (95% CI, 1.7 to 7.2) times higher in the video group, compared to the control group. Among those who viewed the videos, median rating of the videos was 10 (IQR 8 to 10). CONCLUSIONS: In this single-center trial, patients who viewed an online video of their discharge instructions scored higher on their understanding of key concepts around their diagnosis and subsequent care. Those who viewed the videos found them to be a helpful addition to standard care. TRIAL REGISTRATION: ClinicalTrials.gov NCT01361932 http://clinicaltrials.gov/ct2/show/NCT01361932?term=nct01361932&rank=1.

Medical preparedness for chemical, biological, radiological, nuclear, and explosives (CBRNE) events: gaps and recommendations.

The Workshop on Medical Preparedness for Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) events: national scan was held on 20 and 21 May 2010 at the Diefenbunker Museum in Ottawa, Canada. The purpose of the workshop was to provide the CBRNE Research and Technology Initiative with a Canadian national profile of existing capabilities and anticipated gaps in casualty management consistent with the community emergency response requirements. The workshop was organised to enable extensive round-table discussions and provide a summary of key gaps and recommendations for emergency response planners.

A multiphase disaster training exercise for emergency medicine residents: opportunity knocks.

BACKGROUND: Disaster planning is a core curriculum requirement for emergency medicine (EM) residency programs. Few comprehensive training opportunities in disaster planning incorporating the appropriate competencies have been reported. OBJECTIVES: To design, pilot, and evaluate a combination interactive Web-based disaster planning curriculum and real-time multidisciplinary full-scale disaster exercise. METHODS: Residents were assigned to groups led by a faculty mentor. Each group used an Internet-based platform to review the literature pertaining to their component of a disaster plan. The groups then used the platform to redesign an existing institutional disaster plan. Finally, they implemented their disaster plan for 80 simulated casualties resulting from a police, fire department, and emergency medical services multiple-casualty rescue exercise. All health professions then participated in a joint debriefing session. All aspects of the program were supervised by specialty EM faculty, and the exercise was evaluated using a five-point Likert scale with specific anchored descriptors. RESULTS: Sixteen residents and 17 faculty members participated in the exercise. Trained volunteers and high-fidelity simulations represented casualties varying in age from 6 months to 65 years, and in severity from ambulatory to moribund. Residents found the exercise enjoyable (4.9/5), relevant (4.6/5), and educational (4.8/5). CONCLUSIONS: Emergency medicine residency programs can benefit from participating in high-quality medical disaster exercises coordinated with local disaster response agencies. Residents report high satisfaction and learning from realistic simulations of disasters, and from collaboration with other community services.