Unique Challenges for WHO Emergency Medical Teams in Ukraine: Field Assessment & Global Recommendations.

The purpose of WHO Emergency Medical Teams is to Minor wording edit recommendations: 'to provide timely, high-quality health services.' (removed 'of') 'in the immediate aftermath of disasters and during disease outbreaks and other emergencies, including conflict and insecurity.'improve the timeliness and quality of health services by national and international Emergency Medical Teams in the immediate aftermath of a disaster, outbreak, and other emergencies, including war and conflicts. 'The war in Ukraine has presented all healthcare providers with many unique challenges'. What is meant by this? All Ukrainian HCPs, all HCP operating in Ukraine? Can you be more specific regarding what you are trying to say.The war in Ukraine has presented all healthcare providers with many unique challenges. This assessment addresses would edit to: 'the importance and the complexities of' the importance of and the complexities of the global spread of the Emergency Medical Team system challenges to meet a wide variety of crises including war, those that are unique to this very complex crisis in Ukraine, and the essential role of educational initiatives, not only in professional development but also in teamwork and cultural integration.

COVID-19 as an Accelerator of the Implementation of Emergency Medical Teams Initiative in the AFRO Region.

OBJECTIVE: This study describes the progress that the World Health Organization (WHO) African (AFRO) region has made in establishing National Emergency Medical Teams (N-EMTs), the coordination mechanisms of the EMTs, and the regional training centers. METHODS: It used a retrospective descriptive analysis of the formulation and implementation of the EMTs Initiative from an insider perspective. The analysis is based on the review of available documents such as EMTs mission reports, assessments, surveys, EMT monthly bulletins, and meeting minutes in addition to key informant interviews (n = 5) with the EMT teams' members to validate the findings and share field experiences. RESULTS: The emergence of coronavirus disease 2019 (COVID-19) acted as an accelerator for the implementation of the EMT initiative in the AFRO region. A total of 18 EMT deployments were carried out in 16 countries in the AFRO region through the WHO EMT-network during COVID-19, providing support to countries in managing severe and critical COVID-19 cases. CONCLUSIONS: A Regional Training Center for N-EMTs is being set up in Addis Ababa to train the N-EMTs and strengthen local capacity of health personnel in the region. Challenges include unavailability of mentors to support countries in implementing N-EMTs and the Regional Simulation Training Center, poor funding, and coordination in the rolling out of the N-EMTs.

Introduction.

Since its inception, the World Health Organization's Emergency Medical Teams (EMT) Initiative has strived to save lives, preserve health, and alleviate suffering through inclusiveness, transparency, global cohesion, and regional adaptation of quality standards and methodology.1 The mission of the Global EMT Initiative is to enhance the surge capacity of countries through the promotion of rapid mobilization and efficient coordination of both national and international medical teams and health care workforce to reduce loss of life and prevent long-term disability because of disasters, outbreaks, and other emergencies.1Over the past decade, four EMT Global Meetings have been held and serve as a platform to foster collaboration and support among the global EMT community, which consists of clinicians and non-clinical providers, Member States, and partners. The gatherings in Geneva, Panama, Hong Kong, and Bangkok created momentum for the development of a global network and proved vital in guiding the direction of the initiative.Under the leadership of the EMT Strategic Advisory Group, the 2022 EMT Global Meeting in Yerevan convened over 500 participants from 110 countries and organizations. The event provided the network an opportunity to define a longer EMT strategy - EMT 2030 - which serves to strengthen national EMT and rapid response capacities as part of the global health emergency preparedness, response, and resilience (HEPR) architecture outlined by the 75th World Health Assembly in May 2022.2One of the four core objectives of the EMT 2030 strategy is to Strengthen information systems, evidence, and research. To further this objective, for the first time in 2022, the EMT secretariat introduced a research program into the EMT Global Meeting.The overall aim of research among EMTs is to support improvement of care provided to populations affected by emergencies, and therefore further the mission and vision of the EMT initiative. Even though the adoption of an experience-based strategy has had a positive impact in the past years, there is a need for an evidence-based generalizable guidance, aiming to increase predictability of response, strengthen advanced planning, and facilitate early actions. To this end, since late 2021, the EMT Secretariat has begun compiling a Global EMT Research Agenda, including documenting innovative solutions and products, deployments of national and international teams, and lessons learned from responses. The Secretariat also launched new platforms for advocacy and information exchange among the EMT Network.The 2022 EMT Global Meeting abstracts highlight the vast number of accomplishments that the EMT Network can and has already accomplished. From documenting the process of developing teams to modeling impact of effective responses, to demonstrating regional and sub-regional enhancements in knowledge sharing and after-action reviews of responses, there has been a wealth of experience presented in Yerevan. It is our pleasure to present them here.We look forward to strengthening the evidence base for EMT preparedness and response, with many of these abstracts developed further into manuscripts and more research to come.

First Activation of the WHO Emergency Medical Team Minimum Data Set in the 2019 Response to Tropical Cyclone Idai in Mozambique.

INTRODUCTION: During a disaster, comprehensive, accurate, timely, and standardized health data collection is needed to improve patient care and support effective responses. In 2017, the World Health Organization (WHO) developed the Emergency Medical Team (EMT) Minimum Data Set (MDS) as an international standard for data collection in the context of disasters and public health emergencies. The EMT MDS was formally activated for the first time in 2019 during the response to Cyclone Idai in Mozambique. STUDY OBJECTIVE: The aim of this study was to analyze data collected through the EMT MDS during Cyclone Idai of 2019 and to identify the benefits of and opportunities for its future use. METHODS: The EMT MDS was used for data collection. All 13 international EMTs deployed from March 27 through July 12 reported data in accordance with the EMT MDS form. The collected data were analyzed descriptively. RESULTS: A total of 18,468 consultations, including delivery of 94 live births, were recorded. For children under-five and those five-years and older, the top five reasons for consultation were minor injuries (4.5% and 10.8%, respectively), acute respiratory infections ([ARI] 12.6% and 4.8%, respectively), acute watery diarrhea (18.7% and 7.7%, respectively), malaria (9.2% and 6.1%, respectively), and skin diseases (5.1% and 3.1%, respectively). Non-disaster-related health events accounted for 84.7% of the total health problems recorded. Obstetric care was among the core services provided by EMTs during the response. CONCLUSION: Despite of challenges, the EMT MDS reporting system was found to support the responses and coordination of EMTs. The role of the Mozambican Ministry of Health (MOH), its cooperation with EMTs, and the dedicated technical support of international organizations enabled its successful implementation.

The role of emergency medical teams in Eswatini during the COVID-19 pandemic.

The paper documents experiences and lesson learned in responding to COVID-19 pandemic in Eswatini with the support of the Emergency Medical Teams. WHO databases, operation reports and hospitalization records were reviewed. The WHO Emergency Medical Teams built the capacity of the local response teams in Eswatini. The conclusion is that following the intervention of the WHO Emergency Medical Teams, Eswatini is better prepared to respond to the ongoing COVID-19 pandemic and future outbreaks.

Applying the Haddon Matrix to Frontline Care Preparedness and Response in Asymmetric Warfare.

INTRODUCTION: Asymmetric warfare and the reaction to its threats have implications in the way far-forward medical assistance is provided in such settings. Investments in far-forward emergency resuscitation and stabilization can contribute to saving lives and increase the resilience of health systems. Thus, it is proposed to extend the use of the Haddon Matrix to determine a set of strategies to better understand and prioritize activities to prepare for and set-up frontline care in the form of Trauma Stabilization Points (TSPs). METHODS: An expert consensus methodology was used to achieve the research aim. A small subject matter experts' group was convened to create and validate the content of the Haddon Matrix. RESULTS: The result of the expert group consultations presented an overview of TSP Preparedness and Operational Readiness activities within a Haddon Matrix framework. Main strategies to be adopted within the cycle from pre- to post-event had been identified and presented considering the identified opportunities in the context of the possibility of implementation. Of particular importance was the revision of a curriculum that fits the civilian medical system and facilitates its adaptation to the context and available resources. CONCLUSION: The new framework to enhance frontline care preparedness and response using the Haddon Matrix facilitated the identification of a set of strategies to support frontline health care workers in a more efficient manner. Since the existing approach and tools are insufficient for modern warfare, additional research is needed.

Italian Field Hospital Experience in Mozambique: Report of Ordinary Activities in an Extraordinary Context.

On March 15, 2019, Cyclone Idai made landfall near the port city of Beira in central Mozambique causing significant casualties and serious damage to infrastructure. The Emergency Medical Team Type 2 - Italy Regione Piemonte (EMT2-ITA) was deployed approximately two weeks after the disaster to support the country in need, providing essential medical and surgical care.The EMT2-ITA staff was composed of 77 team members including two rotations and integrating local staff. A total of 1,121 patients (1,183 triage admissions) were treated during the 27 days of field hospital activity; among all the admissions, only few cases (17; 1%) were directly or indirectly attributed to the disaster event. Only three cases of cholera were confirmed and transferred to one of the treatment centers set up in Beira. The EMT2-ITA performed a total of 62 surgical operations (orthopedic, gynecological, general, and plastic surgery), of which more than one-half were elective procedures.The objective of this manuscript is to report the mission of the EMT2-ITA in Mozambique, raising interesting points of discussion regarding the impact of timing on the mission outcomes, the operational and clinical activities in the field hospital, and the great importance to integrate local staff into the team.

The Response by International Emergency Medical Teams Following the Beirut Harbor Explosion in 2020 - Who Were They, When Did They Arrive, What Did They Do, and Were They Needed?

INTRODUCTION: On August 4, 2020, a massive explosion struck the Beirut Harbor in Lebanon. Approximately 220 people were killed and around 7,000 were injured, of which 12% were hospitalized. Despite being weakened by economic crisis and increasing numbers of coronavirus disease 2019 (COVID-19) cases, the national health care system responded promptly. Within a day, international health care assistance in the form of International Emergency Medical Teams (I-EMTs) started arriving. Previous studies have found that I-EMTs have arrived late and have not been adapted to the context and dominating health care needs. The aim of this study was to document the organization, type, activity, and timing of I-EMTs deployed to Beirut and to discuss their relevance in relation to medical needs. METHODS: Data on all deployed I-EMTs were retrieved from all available sources, including internet searches, I-EMT contacts, and from the World Health Organization (WHO) EMT coordination cell (EMT CC) in Lebanon. The WHO EMT classification was used to categorize deployed teams. Information on characteristics, timing, and activities was retrieved and systematically assessed. RESULTS: Nine I-EMTs were deployed to Beirut following the explosion. Five were equivalent to EMT Type 2 (field hospitals), out of which three were military. The first EMT Type 2 arrived within 24 hours, while the last EMT set up one month after the explosion. Four civilian I-EMTs provided non-clinical support as EMT Specialized Care Teams. A majority of the I-EMTs were focused on trauma care. Three of the four I-EMT Specialized Care Teams were rapidly re-tasked to support COVID-19 care in public hospitals. CONCLUSION: A majority of the deployed I-EMT Type 2 were military and focused on trauma care rather than the normal burden of disease including COVID-19. Re-tasking of EMTs requires flexible EMTs. To be better adapted, the I-EMT response should be guided by a systematic assessment of both health care capacities in the affected country as well as the varying health effects of hazards before deployment.

Beirut Explosion: The Largest Non-Nuclear Blast in History.

A massive explosion have ripped Beirut on August 4, 2020, leaving behind more than 6000 casualties, 800 regular floor admissions, 130 intensive care unit admissions, and over 200 deaths. Buildings were destroyed, hospitals in Beirut were also destroyed, others became nonfunctional. A disaster code was initiated in all the hospitals. Victims were transported by the Lebanese Red Cross or by volunteers to the nearest hospital that was still functional. Hospitals were flooded in patients, the coordination between health care centers was missing. Each hospital was functioning to its maximum capacity. With the many challenges we had, a rapid response was initiated. An effective triage done outside the Emergency had the major role in saving lives. After the Beirut Explosion, an assessment of the disaster plan and a major evaluation of the hospitals' coordination is needed.

Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh?

OBJECTIVES: Mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ) identify different populations of children with severe acute malnutrition (SAM) with only some degree of overlap. In an urban slum in Bangladesh, we conducted a prospective cohort study on children assessed as being severely malnourished by WHZ (<-3) but not by MUAC (>115 mm), to: 1. Assess their nutritional outcomes, and 2. Report on morbidity and mortality. METHODS: Children underwent 2-weekly prospective follow-up home visits for 3 months and their anthropometric evolution, morbidity and mortality were monitored. RESULTS: Of 158 children, 21 did not complete follow-up (six were lost to follow-up and 15 changed residence). Of the remaining 137 children, nine (7%) required admission to the nutrition programme because of: MUAC dropping to <115 mm (5/9 children), weight loss ≥ 10% (1/9 children) and severe medical complications (3/9 children, of whom one died). Of the remaining 128 children who completed follow-up, 91 (66%) improved in nutritional status while 37 (27%) maintained a WHZ of <-3. Cough was less frequent among those whose nutritional status improved. CONCLUSIONS: It seems acceptable to rely on MUAC as a single assessment tool for case finding and for admission of children with SAM to nutritional programmes.