Decision Making in a Strategic Medical Command and Control Team During the Covid-19 Pandemic: A Case Study.

OBJECTIVE: To achieve resilience in the response of a major incident, it is essential to coordinate major processes and resources with the aim to manage expected and unexpected changes. The coordination is partly done through timely, adequate, and resilience-oriented decisions. Accordingly, the aim of the present paper is to describe factors that affected decision-making in a medical command and control team during the early COVID-19 pandemic. METHODS: This study used a qualitative method in which 13 individuals from a regional public healthcare system involved in COVID-19 related command and control were interviewed. Data was collected through semi-structured interviews and analyzed using qualitative content analysis. RESULTS: The factors affecting decision-making in medical command and control during early COVID-19 pandemic were grouped into 5 themes: organization, adaptation, making decisions, and analysis, as well as common operational picture. CONCLUSIONS: The present study indicated that decision-making in medical command and control faces many challenges in the response to pandemics. The results may provide knowledge about disaster resilience and can be utilized in educational and training settings for medical command and control.

Life-saving Field Amputation During the 2023 Türkiye Earthquake: Ethical, Social, and Legal Implications Beyond the Complex Medical and Rescue Procedures in the Rubble.

Amputation as a life-saving measure for earthquake-trapped patients is supported by WHO and INSARAG guidelines. However, implementing these guidelines in highly stressful contexts can complicate decision-making. This report presents a case of life-saving amputation during the 2023 Turkey earthquake, adhering to recommended guidelines. The 16-year-old patient was trapped for 55 hours in a narrow corridor. Extensive interdisciplinary discussions led to the decision for a field amputation after alternative rescue attempts failed. Consent was obtained from the family, given the patient's delirium. Meticulous planning and anesthesia using midazolam and ketamine ensured successful amputation with minimal blood loss. Challenges encountered during the disaster response were discussed. Delays in administering antibiotics, a lack of cervical protection, ethical dilemmas, psychological concerns, and legal implications were highlighted. Continued improvement and addressing ethical, legal, and psychological aspects are essential for optimal disaster response outcomes.

An Evidence Gap Map of Experience-based Evidence of Health Resource Allocation in Disaster and Humanitarian Settings.

OBJECTIVE: The aim of this review is to identify, evaluate, and graphically display gaps in the literature related to scarce health resource allocation in humanitarian aid settings. METHODS: A systematic search strategy was utilized in MEDLINE (via Ovid), Scopus, EMBASE, CINAHL Complete, and ProQuest Central. Articles were reviewed by 2 reviewers with a third reviewer remedying any screening conflicts. Articles meeting inclusion criteria underwent data extraction to facilitate evaluation of the scope, nature, and quality of experience-based evidence for health resource allocation in humanitarian settings. Finally, articles were mapped on a matrix to display evidence graphically. RESULTS: The search strategy identified 6093 individual sources, leaving 4000 for screening after removal of duplicates. Following full-text screening, 12 sources were included. Mapping extracted data according to surge capacity domains demonstrated that all 4 domains were reflected most of all the staff domain. Much of the identified data was presented without adhering to a clear structure or nomenclature. Finally, the mapping suggested potential incompleteness of surge capacity constructs in humanitarian response settings. CONCLUSIONS: Through this review, we identified a gap in evidence available to address challenges associated with scarce resource allocation in humanitarian settings. In addition to presenting the distribution of existing literature, the review demonstrated the relevance of surge capacity and resource allocation principles underpinning the developed framework.

A victim risk identification model for nature-induced urban disaster emergency response.

In recent years, nature-induced urban disasters in high-density modern cities in China have raised great concerns. The delayed and imprecise understanding of the real-time post-disaster situation made it difficult for the decision-makers to find a suitable emergency rescue plan. To this end, this study aims to facilitate the real-time performance and accuracy of on-site victim risk identification. In this article, we propose a victim identification model based on the You Only Look Once v7-W6 (YOLOv7-W6) algorithm. This model defines the "fall-down" pose as a key feature in identifying urgent victims from the perspective of disaster medicine rescue. The results demonstrate that this model performs superior accuracy (mAP@0.5, 0.960) and inference speed (5.1 ms) on the established disaster victim database compared to other state-of-the-art object detection algorithms. Finally, a case study is illustrated to show the practical utilization of this model in a real disaster rescue scenario. This study proposes an intelligent on-site victim risk identification approach, contributing significantly to government emergency decision-making and response.

Challenges and Clinical Impact of Medical Search and Rescue Efforts Following the Kahramanmaras Earthquake.

BACKGROUND: This study assesses the operational challenges and clinical outcomes encountered by a university-based Emergency Medical Team (EMT) during the medical search and rescue (mSAR) response to the February 2023 earthquakes in Kahramanmaras, Turkey. METHODS: In this observational study, data were retrospectively collected from 42 individuals who received mSAR services post-earthquake. The challenges were categorized as environmental, logistical, or medical, with detailed documentation of rescue times, patient demographics, injury types, and medical interventions. RESULTS: In this mSAR study, 42 patients from 30 operations were analyzed and divided into environmental (26.2%), logistical (52.4%), and medical (21.4%) challenge groups. Median rescue times were 29 (IQR 28-30), 36.5 (IQR 33.75-77.75), and 30.5 (IQR 29.5-35.5) hours for each group, respectively (P = .002). Age distribution did not significantly differ across groups (P = .067). Hypothermia affected 18.2%, 45.5%, and 66.7% in the respective groups. Extremity injuries were most common in the medical group (88.9%). Intravenous access was highest in the medical group (88.9%), while splinting was more frequent in the medical (55.6%) and logistical (18.2%) groups. Hypothermia was most prevalent in the medical group (66.7%), followed by the logistical group (45.5%). Ambulance transport post-rescue was utilized for a minority in all groups. CONCLUSION: The study concludes that logistical challenges, more than environmental or medical challenges, significantly prolong the duration of mSAR operations and exacerbate clinical outcomes like hypothermia, informing future enhancements in disaster response planning and execution.

Disaster Preparedness among Healthcare Professionals in Lebanon.

BACKGROUND: Disaster disrupts the normal functioning of a community, causing significant damages and losses. In recent years, Lebanon faced multiple disasters, including one of the largest explosions ever recorded, the Beirut Blast, in August 2020. Limited studies in the literature have examined disaster medicine preparedness among healthcare professionals (HCPs). OBJECTIVE: To examine the knowledge (K), attitude (A), readiness to practice (rP), and KArP associated with disaster medicine preparedness among HCPs in Lebanon. METHODS: A cross-sectional observational study was conducted in Lebanon using data from participants answering an online survey. Participants enrolled in this study were HCPs (residents and faculty), medical students, and postdoctoral research scholars. Levels of knowledge, attitude, and readiness to practice were assessed and used to examine their association with participants' socio-demographic characteristics. RESULTS: A total of 195 participants (average age 30.6 ± 11.4 years) were included in this study. Participants reported moderate scores of knowledge, attitude, and readiness to practice. Older participants reported better readiness to practice and a KArP score. A significant difference was observed in all categories according to gender, with men having higher scores than women. No significant difference was observed between the level of education and knowledge, attitude, and total KArP scores. CONCLUSIONS: Our study's findings showed that age and the level of education were positively correlated with readiness to practice. Men, compared to women, had significantly higher scores in all categories. Barriers to the KArP should be identified and targeted in future studies, as disaster preparedness at the institutional level may improve outcomes in future disaster encounters.

Field report: ambulance service in Ukraine during weaponized conflict.

Crises require changes to established structures, and this also applies to ambulance services. This case report addresses the Ukrainian ambulance service and the changes resulting from the armed conflict in Ukraine. The purpose of this article is to provide insight into the activities of the ambulance service of the Kharkiv region, the second-largest city in Ukraine. Kharkiv is still under heavy fire.

Telemedicine in civil protection: A controlled simulation study for the analysis of patient care.

Objectives: More and more disasters are occurring and there will be an increasing shortage of physicians in the future. Telemedicine could be a solution here to offer medical care despite the lack of physicians in the area of operation. This study analyzes whether telemedicine for lower-qualified paramedics is comparable to conventional disaster medicine. Methods: A simulation study was conducted in which one conventional and two telemedicine groups cared for thermal-traumatically injured in a stressful situation. The telemedicine was conducted on tablets with integrated vital sign monitoring or on smartphones. The physician engagement time, the number of physician contacts, the time for relevant measures and the usage behavior of telemedicine were examined between these groups. Results: One telemedicine group showed significantly fewer patient contacts. This can be attributed to the ongoing consultation in the intervention group with more contacts. There are no significant differences in the relevant measures. Conclusion: Telemedicine is comparable to conventional disaster medicine in civil protection. Due to potential technical failures, it should primarily be used to compensate for the lack of physicians, and training should focus on an exit-strategy in case of a failure of the telemedicine.

Saving lives and restoring hope: Enhancing outcomes through comprehensive understanding of maxillofacial surgery in disaster medicine.

This article delves into the profound impact of various types of disasters, examining some specific contexts. It provides insights into the unique challenges posed by different disasters, ultimately highlighting the invaluable role of maxillofacial surgery in addressing the critical healthcare needs of affected populations. A comprehensive review of the literature was conducted to analyze the role of maxillofacial surgery in disaster management. Relevant studies were examined to gather evidence supporting the criticality of maxillofacial surgeons in disaster response. Continuous training, coordination, and international collaboration among maxillofacial surgeons were reported as key factors in enhancing preparedness and improving post-disaster recovery. Sharing experiences, implementing best practices, and staying updated with advancements in the field seemed crucial for maximizing the impact of maxillofacial surgery in disaster medicine. By prioritizing the inclusion of maxillofacial surgeons in disaster response teams, lives can be saved, functional outcomes can be improved, and hope can be restored in affected communities. Understanding the intricacies and patterns associated with various types of disasters can be crucial details for successful rescue operations.

Evaluation of an On-Site Disaster Medical Management Course in Nepal.

The great 2015 Nepal earthquake of magnitude 7.6 killed about 9000 people. To better ensure a more coordinated disaster response, a Basic On-Site Disaster Medical Support (BOS-DMS) course was designed in 2017. This study evaluates the effectiveness of the BOS-DM course. The course was conducted twice and attended by 135 participants, of whom 113 (83.7%) answered pre-test and post-test based multiple-choice questions. Qualitative and quantitative feedback was provided by 94 participants (69.6%). Mean test scores for the participants increased from 4.24 ± 1.42 to 6.55 ± 2.16 (p-value < 0.0001; paired t-test). More than 92.0% of participants felt that the course prepared healthcare workers to manage acute medical situations at a disaster site. Subject knowledge scores increased from 34.8% to 90.2%. A three-day BOS_DMS course has the potential to improve on-site disaster management knowledge. Our study noted that precise scheduling, making attendance compulsory, translating course materials into the local language, inclusion of disaster exercises and training local master trainers can enhance course effectiveness.

Case Report: Difficulties faced by a home oxygen therapy patient who died after the Fukushima Daiichi nuclear power plant accident.

Following the Great East Japan Earthquake (GEJE) and the Fukushima Daiichi nuclear power plant accident in 2011, mandatory evacuation orders were issued to residents living near the nuclear power plant in Fukushima prefecture, including some patients receiving home oxygen therapy. Although the vulnerability of patients with home oxygen therapy (one of the population groups most vulnerable to disasters) has been noted, there is little information on the health effects of evacuation in the event of a radiation disaster. A 90-year-old man diagnosed with chronic obstructive pulmonary disease since the age of 70, and lived in a town located approximately 20 km south of the nuclear power plant, died 8 months after the disaster due to worsening health conditions. This case reveals the potential for both physical and psychological burdens experienced by vulnerable groups like patients undergoing home oxygen therapy during evacuations in times of disaster. Although it is only a case report and the information is limited, severe respiratory distress requiring home oxygen therapy may present a significant risk factor for disaster-related deaths, especially in cases where evacuations are prolonged, such as in nuclear disasters. Due to the challenge of obtaining prompt public support immediately after a disaster, home oxygen therapy patients may need to prioritize self-help and mutual assistance in their disaster preparedness efforts.

Conflict and catastrophe-related severe burn injuries: A challenging setting for antimicrobial decision-making.

Severe burns are a major component of conflict-related injuries and can result in high rates of mortality. Conflict and disaster-related severe burn injuries present unique challenges in logistic, diagnostic and treatment options, while wider conflict is associated with driving local antimicrobial resistance. We present a targeted review of available literature over the last 10 years on the use of systemic antimicrobial antibiotics in this setting and, given limited available data, provide an expert consensus discussion. While international guidelines do not tend to recommend routine use of prophylactic systemic antibiotics, the challenges of conflict settings and potential for polytrauma are likely to have ongoing impacts on antimicrobial decision-making and use. Efforts must be made to develop a suitable evidence base in this unique setting. In the interim, a pragmatic approach to balancing selective pressures of antimicrobial use with realistic access is possible.

A tabletop exercise approach to global disaster preparedness: insights from Nepal's first international conference on disaster preparedness and management.

Considering recent earthquakes and the COVID-19 pandemic, disaster preparedness has come to the forefront of the public health agenda in Nepal. To strengthen the developing health system, many initiatives are being implemented at different levels of society to build resiliency, one of which is through training and education. The first International Conference on Disaster Preparedness and Management convened in Dhulikhel, Nepal on December 1-3, 2023. It brought together international teaching faculty to help deliver didactic and simulation-based sessions on various topics pertaining to disaster preparedness and management for over 140 Nepali healthcare professionals. This paper focuses on the tabletop exercise-based longitudinal workshop portion of the conference on disaster leadership and communication, delivered by United States-based faculty. It delves into the educational program and curriculum, delivery method, Nepali organizer and US facilitator reflections, and provides recommendations for such future conferences, and adaptation to other settings.

Telenursing as a tool in emergencies and disasters: A systematic review.

Telenursing as a tool in emergencies and disasters: a systematic review. BACKGROUND: Telenursing is an innovative strategy that allows nurses to care for patients in various situations with the help of technology. The aim of this systematic review is to analyse the current situation of telenursing in emergencies and disasters by means of a systematic review of the scientific literature. METHODS: A systematic review of the scientific literature was carried out following the PRISMA methodology. A systematic search was conducted using the CINAHL, Pubmed and Cochrane Library databases. Study selection and risk of bias were performed independently by pair of authors. RESULTS: A total of 14 publications were selected. The results of the study focus on two main themes; on the one hand, the benefits offered by telenursing in the field of emergency and disaster situations and, on the other hand, the perspective of professionals who use it or who are likely to do so. CONCLUSIONS: Telenursing brings benefits to the emergency department, such as improved clinical outcomes, fewer unnecessary visits to the department, enhanced nursing autonomy and reduced healthcare costs. Nurses have a positive attitude towards the use of this technology; however, more training and equipment are required to increase its effectiveness.

The disaster liaison for pediatric and perinatal medicine: A new system in Japan.

BACKGROUND: Worldwide, children, newborns, and pregnant or postpartum women are vulnerable to disasters and emergency situations, and providing support to this population is of great concern. Japan is located in a disaster-prone area, so disaster response and risk reduction strategies are important priorities. METHODS: We introduce a system called the Disaster Liaison for Pediatric and Perinatal Medicine (DLPPM). This was created with a specific focus on perinatal children and pregnant women in Japan. We report the details of its activities, discuss its challenges, and draw on lessons learned for the further development of perinatal support systems, particularly for children. RESULTS: The lessons learned from the activities of the DLPPM include the following: (1) establish a support system for emergency specialists beyond those with pediatric and perinatal specialties; (2) mitigate the risk of indirect damage caused by primary disasters; and (3) establish a networking function linked to existing pediatric and perinatal medicine facilities. CONCLUSIONS: By establishing similar systems, we believe that it will be feasible to address pediatric and perinatal care needs in disaster response contexts in other countries and regions around the world.

The Emergency Medical Team Operating System - a vision for field hospital data management in following the concepts of predictive, preventive, and personalized medicine.

In times where sudden-onset disasters (SODs) present challenges to global health systems, the integration of predictive, preventive, and personalized medicine (PPPM / 3PM) into emergency medical responses has manifested as a critical necessity. We introduce a modern electronic patient record system designed specifically for emergency medical teams (EMTs), which will serve as a novel approach in how digital healthcare management can be optimized in crisis situations. This research is based on the principle that advanced information technology (IT) systems are key to transforming humanitarian aid by offering predictive insights, preventive strategies, and personalized care in disaster scenarios. We aim to address the critical gaps in current emergency medical response strategies, particularly in the context of SODs. Building upon a collaborative effort with European emergency medical teams, we have developed a comprehensive and scalable electronic patient record system. It not only enhances patient management during emergencies but also enables predictive analytics to anticipate patient needs, preventive guidelines to reduce the impact of potential health threats, and personalized treatment plans for the individual needs of patients. Furthermore, our study examines the possibilities of adopting PPPM-oriented IT solutions in disaster relief. By integrating predictive models for patient triage, preventive measures to mitigate health risks, and personalized care protocols, potential improvements to patient health or work efficiency could be established. This system was evaluated with clinical experts and shall be used to establish digital solutions and new forms of assistance for humanitarian aid in the future. In conclusion, to really achieve PPPM-related efforts more investment will need to be put into research and development of electronic patient records as the foundation as well as into the clinical processes along all pathways of stakeholders in disaster medicine.

Aftermath Türkiye's double earthquake: detailed analysis of fracture characteristics and acute management from a level I trauma center.

BACKGROUND: This research investigated surgical interventions for the treatment of extremity and pelvic fractures and aimed to provide an analysis of management challenges under crisis conditions in a Level I Trauma Center after Türkiye's February 6, 2023, earthquakes. METHODS: The study was a retrospective examination of the medical records of 243 fracture cases associated with the earthquakes. The age, gender, time of admission, types of extremity and pelvic fractures, anatomical localizations, and surgical treatment methods for fractures were recorded. The results of these parameters were evaluated in detail, together with the results of other surgical treatments performed in the hospital in the first week after the disaster, such as fasciotomy, amputation, and wound debridement. RESULTS: Most of the 243 (119 males and 124 females) patients with extremity fractures and pelvic fractures receiving surgical treatment were adults (n = 182, 74.9%). The most common lower extremity fractures among all fracture cases were tibial shaft (30.8%) and femoral shaft (20.6%) fractures. A total of 33 patients had surgical procedures for the treatment of two or more significant bone fractures involving either the extremity or the pelvic ring. The analysis showed that the median age of patients who underwent surgery due to extremity and pelvic fractures was 36 years, with a range of 1 to 91 years, which was statistically increased compared to patients who received surgery for other musculoskeletal injuries such as fasciotomy, amputation and debridement (p < 0.001). CONCLUSION: Fractures were one of the most common musculoskeletal injuries in the first days after earthquakes, and the management of fractures differs significantly from soft tissue injuries and amputation surgeries as they require implants, special instruments, and imaging devices. The delivery of healthcare is often critically impaired after a severe earthquake. Shortages of consumables such as orthopedic implants, power drills, fluoroscopy equipment, and the need for additional staff should be addressed immediately after the earthquake, ideally by the end of the first day.

February 6th, Kahramanmaras earthquakes and the disaster management algorithm of adult emergency medicine in Turkey: An experience review.

This compilation covers emergency medical management lessons from the February 6th Kahramanmaras earthquakes. The objective is to review relevant literature on emergency services patient management, focusing on Koenig's 1996 Simple Triage and Rapid Treatment (START) and Secondary Assessment of Victim Endpoint (SAVE) frameworks. Establishing a comprehensive seismic and mass casualty incident (MCI) protocol chain is the goal. The prehospital phase of seismic MCIs treats hypovolemia and gets patients to the nearest hospital. START-A plans to expedite emergency patient triage and pain management. The SAVE algorithm is crucial for the emergency patient secondary assessment. It advises using Glasgow Coma Scale, Mangled Extremity Severity Score, Burn Triage Score, and Safe Quake Score for admission, surgery, transfer, discharge, and outcomes. This compilation emphasizes the importance of using diagnostic tools like bedside blood gas analyzers and ultrasound devices during the assessment process, drawing from 6 February earthquake research. The findings create a solid framework for improving emergency medical response strategies, making them applicable in similar situations.

It Was Like Going to a Battlefield: Lived Experience of Frontline Nurses Supporting Two Hospitals in Wuhan During the COVID-19 Pandemic.

Introduction: The literature indicates that pandemics significantly impact the mental health of frontline health workers. While the effects of COVID-19 on the mental health of frontline nurses have been studied, their lived experiences remain insufficiently explored. Objective: This study aims to investigate the lived experience of nurses who were deployed to support Wuhan during the COVID-19 pandemic. Methods: This study adopted a qualitative study design. A purposive sample of fifteen nurses were recruited from a group of nurses who supported Wuhan during COVID-19 pandemic. The data was collected during May and June 2020. Data collection occurred in May and June 2020, employing semistructured interviews conducted via telephone. Interpretative phenomenological analysis (IPA) was utilized to analyze the collected data by two independent researchers. This report follows the COREQ checklist. Results: Frontline nurses supporting Wuhan likened their experience to being on a battlefield. Four superordinate themes emerged: (1) mobilization for combating COVID-19; (2) rapid adaption to a dynamic high-stress environment; (3) navigating psychological distress; and (4) the journey home. Conclusion: This study offers comprehensive insights into the lived experience of nurses deployed from other provinces to assist COVID patients in Wuhan. The findings indicate that despite facing a variety of challenges, these frontline nurses were capable of rapid adaptation and successfully fulfilled their roles. Recommendations for future preparedness in public health emergencies are provided. Additionally, follow-up research is warranted to explore the long-term effects of frontline experience on the mental health of the nurses and their family members.

Optimizing the Clinical Direction of Artificial Intelligence With Health Policy: A Narrative Review of the Literature.

Artificial intelligence (AI) has the ability to completely transform the healthcare industry by enhancing diagnosis, treatment, and resource allocation. To ensure patient safety and equitable access to healthcare, it also presents ethical and practical issues that need to be carefully addressed. Its integration into healthcare is a crucial topic. To realize its full potential, however, the ethical issues around data privacy, prejudice, and transparency, as well as the practical difficulties posed by workforce adaptability and statutory frameworks, must be addressed. While there is growing knowledge about the advantages of AI in healthcare, there is a significant lack of knowledge about the moral and practical issues that come with its application, particularly in the setting of emergency and critical care. The majority of current research tends to concentrate on the benefits of AI, but thorough studies that investigate the potential disadvantages and ethical issues are scarce. The purpose of our article is to identify and examine the ethical and practical difficulties that arise when implementing AI in emergency medicine and critical care, to provide solutions to these issues, and to give suggestions to healthcare professionals and policymakers. In order to responsibly and successfully integrate AI in these important healthcare domains, policymakers and healthcare professionals must collaborate to create strong regulatory frameworks, safeguard data privacy, remove prejudice, and give healthcare workers the necessary training.