Difficulties of Spanish Primary Health Care nurses to assist emergencies: A cross-sectional study.

BACKGROUND: The competence of a Primary Health Care nurse to handle emergency situations depends largely on prior acquisition of theoretical knowledge to make appropriate decisions, combined with the corresponding practical skills to carry out swift and effective interventions. METHODS: Cross-sectional study conducted in through a survey auto-administered to a simple random sample of 269 nurses (n) with replacement of Asturias, Spain from the total nursing staff of 730 members (N) in Asturias. RESULTS: In rural areas, the most frequently mentioned reasons were the lack of practical skills (18.9%) and the absence of adequate material (14.4 %). In the semi-urban area, the most common reasons were the lack of practical skills (13.2 %) and the lack of theoretical knowledge (10.3 %). Finally, in the urban area, the main reasons were the lack of practical skills (14.4 %) and the absence of adequate material (7.2 %). The differences were significant (p = 0.025). CONCLUSIONS: Despite the requirement that they acquire the necessary theoretical and practical skills, not all PHC nurses perceive themselves to be sufficiently prepared. The degree of self-perceived acquisition of this knowledge and skills, which is so important and necessary, is heterogeneous, with clear differences according to the respective field of work.

A Review of Mpox Outbreak and Public Health Response in Spain.

Objective: In May 2022, an unprecedented Mpox outbreak was reported in several non-endemic countries with unknown epidemiological links. Since May 2022, more than 20,000 cases have been reported in Europe. Spain has been the most affected country in Europe. We aim to describe the Mpox epidemiological profile in Spain, identify its outbreak risks, and describe public health interventions implemented by the Spanish authorities. Methods: A literature review was conducted, using specific selection criteria to obtain relevant publications describing Mpox clinical presentation and risk factors and the public health response in Spain to the ongoing outbreak. Results: 63.1% of the cases presented an anogenital rash, considered a specific and early symptom in this outbreak. Low case fatality rate is observed, mainly in risk groups, such as the immunocompromised population. Patients evolution was generally favorable, although 3-8% required hospitalization and two deaths occurred; 40% of patients were previously diagnosed with HIV infection. Most of the cases were seen among young population and concentrated in men who had sex with other men, mainly with multiple sexual partners, who did not practice safe sex such as using condoms, and those attending mass event parties. Conclusion: To date, the Mpox outbreak is not considered a public health emergency of international concern. The epidemiological trend of the virus in Spain shows that public health response interventions (health education, contact tracing, vaccination, etc.) have adequately controlled the epidemic curve in high-risk populations and avoided spreading the virus to other groups within the community.

Comparative Analysis of META and SALT Disaster Triage in an Adult Trauma Population: A Retrospective Observational Study.

BACKGROUND: Medical professionals can use mass-casualty triage systems to assist them in prioritizing patients from mass-casualty incidents (MCIs). Correct triaging of victims will increase their chances of survival. Determining the triage system that has the best performance has proven to be a difficult question to answer. The Advanced Prehospital Triage Model (Modelo Extrahospitalario de Triaje Avanzado; META) and Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT) algorithms are the most recent triage techniques to be published. The present study aimed to evaluate the META and SALT algorithms' performance and statistical agreement with various standards. The secondary objective was to determine whether these two MCI triage systems predicted patient outcomes, such as mortality, length-of-stay, and intensive care unit (ICU) admission. METHODS: This retrospective study used patient data from the trauma registry of an American College of Surgeons Level 1 trauma center, from January 1, 2018 through December 31, 2020. The sensitivity, specificity, and statistical agreement of the META and SALT triage systems to various standards (Revised Trauma Score [RTS]/Sort Triage, Injury Severity Score [ISS], and Lerner criteria) when applied using trauma patients. Statistical analysis was used to assess the relationship between each triage category and the secondary outcomes. RESULTS: A total of 3,097 cases were included in the study. Using Sort triage as the standard, SALT and META showed much higher sensitivity and specificity in the Immediate category than for Delayed (Immediate sensitivity META 91.5%, SALT 94.9%; specificity 60.8%, 72.7% versus Delayed sensitivity 28.9%, 1.3%; specificity 42.4%, 28.9%). With the Lerner criteria, in the Immediate category, META had higher sensitivity (77.1%, SALT 68.6%) but lower specificity (61.1%) than SALT (71.8%). For the Delayed category, SALT showed higher sensitivity (META 61.4%, SALT 72.2%), but lower specificity (META 75.1%, SALT 67.2%). Both systems showed a positive, though modest, correlation with ISS. For SALT and META, triaged Immediate patients tended to have higher mortality and longer ICU and hospital lengths-of-stay. CONCLUSION: Both META and SALT triage appear to be more accurate with Immediate category patients, as opposed to Delayed category patients. With both systems, patients triaged as Immediate have higher mortality and longer lengths-of-stay when compared to Delayed patients. Further research can help refine MCI triage systems and improve accuracy.

Factors Associated with the Number of Injured and Fatalities in Motor Vehicle Intentional Mass-Casualty Incidents: A Timely Aid for Scaling the Emergency Response.

INTRODUCTION: Intentional mass-casualty incidents (IMCIs) involving motor vehicles (MVs) as weapons represent a growing trend in Western countries. This method has resulted in the highest casualty rates per incident within the field of IMCIs. Consequently, there is an urgent requirement for a timely and accurate casualty estimation in MV-induced IMCIs to scale and adjust the necessary health care resources. STUDY OBJECTIVE: The objective of this study is to identify the factors associated with the number of casualties during the initial phase of MV-IMCIs. METHODS: This is a retrospective, observational, analytical study on MV-IMCIs world-wide, from 2000-2021. Data were obtained from three different sources: Targeted Automobile Ramming Mass-Casualty Attacks (TARMAC) Attack Database, Global Terrorism Database (GTD), and the vehicle-ramming attack page from the Wikipedia website. Jacobs' formula was used to estimate the population density in the vehicle's route. The primary outcome variables were the total number of casualties (injured and fatalities). Associations between variables were analyzed using Spearman's correlation coefficient and simple linear regression. RESULTS: Forty-six MV-IMCIs resulted in 1,636 casualties (1,430 injured and 206 fatalities), most of them caused by cars. The most frequent driving pattern was accelerating whilst approaching the target, with an average speed range between four to 130km/h and a distance traveled between ten to 2,260 meters. The people estimated in the MV-IMCI scenes ranged from 36-245,717. A significant positive association was found of the number affected with the estimated crowd in the scene (R2: 0.64; 95% CI, 0.61-0.67; P <.001) and the average vehicle speed (R2: 0.42; 95% CI, 0.40-0.44; P = .004). CONCLUSION: The estimated number of people in the affected area and vehicle's average speed are the most significant variables associated with the number of casualties in MV-IMCIs, helping to enable a timely estimation of the casualties.

Sudden-Onset Disaster Mass-Casualty Incident Response: A Modified Delphi Study on Triage, Prehospital Life Support, and Processes.

The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.

Effects of mass casualty incidents on anxiety, depression and PTSD among doctors and nurses: a systematic review protocol.

INTRODUCTION: Both doctors and nurses showed a greater risk of being exposed to different mental health conditions following mass casualties. This systematic review aims to synthesise the existing evidence on the prevalence of anxiety, depression and post-traumatic stress disorder and their associated risk factors among doctors and nurses following mass casualty incidents. METHODS AND ANALYSIS: Seven electronic databases (PubMed, PsycINFO, MEDLINE Ovid, Embase, CINAHL, Web of Science and Nursing & Allied Health database) will be searched from 2010 to 2022 with peer-reviewed articles in English language using the predefined keywords. Two reviewers will independently screen the titles and abstracts, as well as review the full texts using the eligibility criteria, then extract data independently. The National Institutes of Health Quality Assessment Tools (NIH-QAT) for quantitative studies, the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies and the Mixed-Methods Appraisal Tool (MMAT) for mixed-method studies will be used to measure the quality appraisal of eligible studies. A third reviewer will resolve the discrepancies when the two reviewers cannot reach an agreement in any step. The result from the eligible studies will be described following narrative synthesis with the key characteristics and findings of the included studies, and meta-analysis will be performed, if applicable. ETHICS AND DISSEMINATION: This systematic review deals with existing published studies without any personally identifiable information of participants. Therefore, ethical approval from the research committee is not required. Findings from this review will be disseminated in peer-reviewed journals and presented at relevant international conferences. PROSPERO REGISTRATION NUMBER: CRD42023412852.

Outbreaks Following Natural Disasters: A Review of the Literature.

Understanding the relationship between infectious disease outbreaks and natural disasters is important in developing response and disaster risk reduction strategies. The aim of this study was to identify outbreaks associated with natural disasters during the past 20 y, and outline risk factors and mechanisms for postdisaster outbreaks. Review of the international disaster database (EM-DAT) and systematic review of the literature were conducted. The records of disaster events in EM-DAT during the past 20 y were screened. A literature search was carried out in the databases PubMed and Embase. Articles in English language published between 2000 and 2020 were searched. Data were extracted from articles and Narrative synthesis was used to summarize the findings. We found 108 events associated with epidemics, the majority being floods. We found 36 articles, most of them focused on outbreaks after floods. Risk factors and mechanisms that contributed to the outbreaks were mainly related to the consequences of disaster and its impact on the environment and living conditions of population. Infrastructure readiness and postdisaster measures play important roles in controlling the spread of epidemics after natural disasters. More evidence and research are required for better understanding of the association between natural disasters and infectious diseases outbreaks.

The Role of Social Work for Emergency Medical Services (EMS): A Systematic Review.

INTRODUCTION: Emergency Medical Services (EMS) are integrated services involving doctors, paramedics, nurses, and social workers. This research was carried out to synthesize the evidence concerning social work roles for EMS. The aim of this study was to synthesize literature on the social worker's role in EMS settings. METHODS: The study was a systematic review. Data were collected through selected databases. The researcher used Scopus, Sociology Database, Social Science Database, and Public Health Database related to EMS and social work settings. English papers were selected, without restrictions on publication time, place, and year. The searched keywords were: "Social Work AND Emergency Medical Services AND Ambulance Services," "Social Worker AND Emergency Medical Systems AND Ambulance Services," "Social Work AND EMS," "Social Worker AND EMS," "Social Work OR Social Worker," "Social Work Role AND EMS," Social Worker AND EMS," "Emergency Medical Services OR/AND Emergency Medical Systems." RESULTS: The study synthesized the literature about the social work role in pre-EMS, during emergency, and post-EMS. The following themes were highlighted: social workers act as cultural liaisons, effective communicators, emergency workers, and mental health practitioners, collaborating with other disciplines and researchers, for this study. In pre-emergency stages, social workers have roles as educators, communicators, advocates, and awareness builders. During an emergency, social workers act as search and rescue workers, advocates, facilitators, networkers, psychosocial assessors, consultants, counselors, and liaisons for referral activities. And in the post-emergency period, social workers have roles as planners, liaisons, interdisciplinary collaborators, researchers, evaluators, and individuals responsible for follow up. CONCLUSION: This study synthesizes the roles of social workers in EMS settings. It is the first study on this topic, aiming to produce new knowledge, evidence, and an EMS practice framework for the social worker.

Equipos de búsqueda y rescate urbano (USAR) en estructuras colapsadas en el terremoto de Turquía de 2023 / Urban search and rescue operations (USAR) in collapsed buildings after the 2023 earthquake in Türkiye

Los terremotos ocurridos en Turquía en febrero de 2023 han sido unos de los de mayor impacto en los últimos años. Las autoridades del país, tras activar sus recursos locales y nacionales, hicieron una solicitud de ayuda internacional. Dentro de la Organización de Naciones Unidas (ONU) se encuentra el Grupo Asesor Internacional de Búsqueda y Rescate (INSARAG), cuyos objetivos son establecer las normas internacionales mínimas para los equipos de rescate e implementar una metodología para la coordinación internacional ante terremotos, maremotos y otros desastres naturales, especialmente la coordinación operativa sobre el terreno. El objetivo de este trabajo es ofrecer una visión sobre la epidemiología de los terremotos, la gestión de los equipos de emergencias, la Asociación de Ayuda a Desastres y Emergencias (AFAD) de Turquía, y abordar cómo es el rescate en estructuras colapsadas. Además, se expone la experiencia de Bomberos Unidos Sin Fronteras (BUSF) en dicho terremoto y se describe un rescate que duró 14 horas. (AU)

The earthquakes that occurred in February 2023 in Türkiye had some of the worst consequences of recent years. The Turkish authorities first deployed local resources and then appealed for international help. The International Search and Rescue Group of the United Nations aims to establish minimum international standards for search and rescue teams and a methodology for coordinating responses to earthquakes, tsunamis, and other natural disasters. A main concern of the group is to coordinate operations on the ground. This article offers perspectives on the epidemiology of earthquakes, the management of emergency response teams and Türkiye’s disaster management agency (AFAD); it also explains how rescues are carried out in collapsed buildings. The experience of Firefighters Without Borders after the recent earthquakes and a rescue that took 14 hours are also described. (AU)

Urban search and rescue operations (USAR) in collapsed buildings after the 2023 earthquake in Türkiye. / Equipos de búsqueda y rescate urbano (USAR) en estructuras colapsadas en el terremoto de Turquía de 2023.

TEXT: The earthquakes that occurred in February 2023 in Türkiye had some of the worst consequences of recent years. The Turkish authorities first deployed local resources and then appealed for international help. The International Search and Rescue Group of the United Nations aims to establish minimum international standards for search and rescue teams and a methodology for coordinating responses to earthquakes, tsunamis, and other natural disasters. A main concern of the group is to coordinate operations on the ground. This article offers perspectives on the epidemiology of earthquakes, the management of emergency response teams and Türkiye's disaster management agency (AFAD); it also explains how rescues are carried out in collapsed buildings. The experience of Firefighters Without Borders after the recent earthquakes and a rescue that took 14 hours are also described.

TEXTO: Los terremotos ocurridos en Turquía en febrero de 2023 han sido unos de los de mayor impacto en los últimos años. Las autoridades del país, tras activar sus recursos locales y nacionales, hicieron una solicitud de ayuda internacional. Dentro de la Organización de Naciones Unidas (ONU) se encuentra el Grupo Asesor Internacional de Búsqueda y Rescate (INSARAG), cuyos objetivos son establecer las normas internacionales mínimas para los equipos de rescate e implementar una metodología para la coordinación internacional ante terremotos, maremotos y otros desastres naturales, especialmente la coordinación operativa sobre el terreno. El objetivo de este trabajo es ofrecer una visión sobre la epidemiología de los terremotos, la gestión de los equipos de emergencias, la Asociación de Ayuda a Desastres y Emergencias (AFAD) de Turquía, y abordar cómo es el rescate en estructuras colapsadas. Además, se expone la experiencia de Bomberos Unidos Sin Fronteras (BUSF) en dicho terremoto y se describe un rescate que duró 14 horas.

Impact of the COVID-19 Pandemic on the Profile of Patients in SAMU-Asturias EMS (Spain): A Two-Year Retrospective Analysis of Advanced Life Support Unit Data.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic had important consequences on the health system. Emergency Medical Services (EMS) were a key element in the response and were forced to modify their daily procedures. The main objective of this study was to find out if there were differences in response times and in the profile of patients treated by the Advanced Life Support (ALS) units of Servicio de Asistencia Médica Urgente (SAMU)-Asturias, the EMS of the Principality of Asturias, between the pre-pandemic period and the pandemic period. METHODOLOGY: This was a descriptive, cross-sectional, observational, and retrospective study that included all patients treated by SAMU-Asturias ALS from January 1, 2019 through December 31, 2020. RESULTS: The pandemic has had an impact on daily activity of SAMU-Asturias, with a 9.2% decrease in daily ALS services during the pandemic, longer prehospital times during the pandemic period (mean = 54'35"; SD = 0'48"; P = 0.00) mainly due to an increase in scene time (mean = 28'01"; SD = 12'57"; P = 0.00), and a slight increase in the average age of patients during the pandemic in relation to the pre-pandemic period. No differences were found between the types of incidents for ALS or between the resolution of the patients. CONCLUSIONS: The COVID-19 pandemic mainly affects prehospital times in an emergency service, with no differences being observed in types of incidents; in EMS future pandemic planning, this should be taken into consideration.

Novel Google Maps and Google Earth application for chemical industry disaster risk assessment during complex emergencies in Eastern Ukraine.

The war in Ukraine has led to complex emergencies, humanitarian crises, and other severe consequences, such as chemical industry disasters. The chemical industry is one of the principal sectors of Ukraine's economy. In 2019, Ukraine had a total volume of hazardous chemical accumulation of more than a 5.1billion tons. Therefore, an attack on chemical industrial facilities will lead to catastrophic consequences such as chemical disasters. This paper aims to study the disaster risk of chemical industrial facilities and its effects on public health and the environment during complex emergencies in Eastern Ukraine. Observational cross-sectional risk assessment method was utilized to assess hazard, vulnerability, and exposure of the chemical industry in Eastern Ukraine in Donetsk Oblast and Luhansk Oblast. Data on chemical factories in Eastern Ukraine was collected on Google Maps and Google Earth on May 2022. Lastly, the semi-quantitative risk assessment method was utilized to describe the risk from the perspective of consequences for life and health, the environment, property, and speed of development. Our disaster risk assessment found more than 1 million people (1,187,240 people) in Donetsk Oblast and more than 350 thousand people (353,716 people) in Luhansk Oblast are exposed to potential hazards from the chemical facilities clusters. The aggregation risk of bombardment of chemical facilities cluster in Eastern Ukraine is also high due to ongoing war. Therefore, the chemical industry disaster risks for Eastern Ukraine during complex emergencies in Donetsk Oblast and Luhansk Oblast are high in terms of likelihood and consequences to life and health, environment, property, and speed of development.

Hospital Disasters Preparedness for Mass-Casualty Incidents at Emergency Units in Northwest of Ethiopia: A Cross-Sectional Study.

BACKGROUND: Ethiopian policy and strategy aim to make health care systems capable of dealing with emergencies. However, Ethiopian health care still lacks a comprehensive "all-hazard" approach and a disaster preparedness program. Thus, this study aimed to assess the level of disaster preparedness in selected public hospitals for mass-casualty incidents (MCIs) in Amhara Regional State, Northwest Ethiopia. METHODS: A descriptive cross-sectional study was conducted at general and comprehensive specialized hospitals (CSHs) in Amhara Regional State, Ethiopia using a World Health Organization (WHO) hospital emergency response checklist that included a domain on mass-casualty management (MCM) adapted from a literature review. RESULTS: Seventeen (17) hospitals were evaluated (response rate: 81%). Five (29.4%) were teaching hospitals (tertiary health care) and 12 (70.5%) were non-teaching (secondary health care) hospitals. With an average mean of 97.3 (SD = 33.68; range 31-160), most hospitals under WHO required an Acceptable level of preparedness. Two were at an Unacceptable (0-67) level of preparedness, 12 (70.5%) hospitals were at an Insufficient (68-134) state, while the other three had an Acceptable (135-192) level of preparedness. CONCLUSION: The preparedness level of hospitals is Insufficient for potential MCIs in this region and needs prior attention in implementing existing strategic guidelines to develop and activate hospital disaster plans if and when needed.

Disasters in Spain from 1950 - 2020: Impact on Public Health.

OBJECTIVE: The aim of this study was to establish the frequency and profile of disasters and to analyze trends in disasters and their impact on Spanish public health. METHODS: Retrospective observational study of disasters that occurred in Spain from 1950 through 2020 was conducted. The variables studied for each episode were number of people affected, number of injured/sick, and number of deaths. Absolute and relative frequencies, population rates, mean, median, standard error of the mean (SEM), and 95% confidence intervals (CI) were used, and trend analysis was performed using exponential smoothing and linear regression. RESULTS: A total of 491 disasters were identified in Spain. Of these, 255 (51.9%) were natural disasters, 224 (45.7%) technological disasters, and 12 (2.4%) man-made disasters. The average number of disasters per year was 7.01 (95% CI, 5.99-9.34). These disasters affected a total of 820,489 people, with an average of 3,491 people (SEM = 2.18) per episode. There was a significant increase (P <.001) in the total frequency of disasters in Spain during the period studied. CONCLUSIONS: Spain has a disaster profile of mixed type, combining natural with technological disasters. From 1950 through 2020, there was a significant increase in the number of disasters, with an overall profile similar to that of Europe, with climatological disasters being the most frequent type.

The Epidemiological Profile of Multiple Casualty Incidents in Northern Spain: 2014-2020.

OBJECTIVE: To describe the epidemiological profile of multiple casualty incidents (MCI) and contribute to the better understanding of their impacts in Northern Spain. METHOD: Retrospective, population-based observational study of MCI between 2014 and 2020 in 5 autonomous communities (Aragón, Castilla y León, Galicia, the Basque Country and Principado de Asturias) that participated in the MCI Database of Northern Spain. Inclusion criteria was any incident with 4 or more patients needing ambulance mobilization. A total of 54 variables were collected. This study presents the most relevant results. RESULTS: There were 253 MCI. Of these, 79.8% were road traffic accidents, 12.3% fires or explosions, 2.0% poisonings and 5.9% defined as others. Monthly average was 2.9 (SD = 0.35; EEM = 15.90), average of victims by MCI was 6.8 (CI95% 6.16 - 7.60). There were significantly (P < 0.05) more victims in 3 types of MCI (fires, poisonings, and others). We saw 37.7% of MCI involved 4 victims, 18.8% 5 victims, and 37.9% more than 5. Mean response time was 30.8 minutes (95% CI 28.6 - 33.1), longer in maritime incidents. A total of 67% (95% CI 64.5 - 69.5) of victims were mild. CONCLUSIONS: Road traffic accidents are the most frequent MCI and minor injuries predominate. More than 50% of the MCI have 5 or fewer patients. Fires had significantly more mild patients and significantly more resources deployed. Maritime incidents had a significantly longer response time.

Point-of-care ultrasonography in diagnosing necrotizing fasciitis-a literature review.

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the fascial layer with a high mortality rate. It is a life-threatening medical emergency that requires urgent treatment. Lack of skin finding in NF made diagnosis difficult and required a high clinical index of suspicion. The use of ultrasound may guide clinicians in improving diagnostic speed and accuracy, thus leading to improved management decisions and patient outcomes. This literature search aims to review the use of point-of-care ultrasonography in diagnosing necrotizing fasciitis. METHOD: We searched relevant electronic databases, including PUBMED, MEDLINE, and SCOPUS, and performed a systematic review. Keywords used were "necrotizing fasciitis" or "necrotising fasciitis" or "necrotizing soft tissue infections" and "point-of-care ultrasonography" "ultrasonography" or "ultrasound". No temporal limitation was set. An additional search was performed via google scholar, and the top 100 entry was screened. RESULTS: Among 540 papers screened, only 21 were related to diagnosing necrotizing fasciitis using ultrasonography. The outcome includes three observational studies, 16 case reports, and two case series, covering the period from 1976 to 2022. CONCLUSION: Although the use of ultrasonography in diagnosing NF was published in several papers with promising results, more studies are required to investigate its diagnostic accuracy and potential to reduce time delay before surgical intervention, morbidity, and mortality.