La Defensa Pasiva y su división médica de emergencia / Passive Defense and its emergency medical division / Passive Defence e sua divisão médica de emergência

Durante la Segunda Guerra Mundial el gobierno de Uruguay intentó prepararse para una eventual defensa militar del territorio y la defensa de la población civil en caso de sufrir ataques aéreos. La Defensa Pasiva, fue la estructura gubernamental que junto a la voluntad en todas las clases sociales, funcionó en todo el territorio nacional con la finalidad de proteger a la población civil de los ataques aéreos y guerra química, generando un espíritu de solidaridad a través de su División Médica de Emergencia.

During the Second World War, the government of Uruguay tried to prepare for an eventual military defense of the territory and the defense of the civilian population in case of air raids. The Passive Defense was the governmental structure that, together with the will of every social class, operated throughout the national territory with the purpose of protecting the civilian population from air raids and chemical weapons, generating a spirit of solidarity through its Emergency Medical Division.

Durante a Segunda Guerra Mundial, o governo uruguaio tentou se preparar para uma eventual defesa militar do território e para a defesa da população civil em caso de ataques aéreos. A Defesa Passiva era a estrutura governamental que, juntamente com a vontade de todas as classes sociais, operava em todo o território nacional com o objetivo de proteger a população civil de ataques aéreos e da guerra química, gerando um espírito de solidariedade por meio de sua Divisão Médica de Emergência.

La Dama de la Lámpara y las emergencias en el mundo: un recuento histórico / A Dama da Lâmpada e as emergências no mundo: um relato histórico / The Lady with the Lamp and emergencies in the world: a historical account

Objective: To describe chronologically, the historical recount of the role that nursing has played since its inception as a profession, in emergencies and disasters of greater magnitude, relevance, that have occurred in the world and in Colombia. Methodology: The methodology used washistorical narration following the hermeneutical synthesis method. The study sub-method waschronological and geographical. Results: The nursing profession has been undergoing an importanttransformation, due to the demands of society and technological developments. Among the maindisasters that have occurred, nursing has played a very important role in preventing some of them and minimizing their collateral effects. Conclusion: It is possible to see how the different emergency events that have occurred throughout history and in different geographical locations around the world have favorably marked the development of nursing as a profession. (AU)

Objetivo: Describir de manera cronológica, el recuento histórico del papel que ha desempeñado enfermería desde sus inicios como profesión, en las emergencias y desastres de mayor magnitud, relevancia, ocurridos en el mundo y en Colombia. Metodología: La metodología empleadafue la narración histórica siguiendo el método de síntesis hermenéutico. El submétodo de estudiofue cronológico y geográfico. Resultados: La profesión de enfermería ha venido sufriendo una transformación importante, debida a las exigencias de la sociedad y a las novedades tecnológicas. Dentrode los principales desastres ocurridos, la enfermería ha jugado un papel muy importante en la prevención de alguno de ellos y minimizando los efectos colaterales de estos. Conclusión: Es posiblever cómo los distintos eventos de emergencias ocurridos a lo largo de la historia y en distintas ubicaciones geográficas del mundo, han marcado favorablemente el desarrollo de la enfermería como profesión. (AU)

Objetivo: Descrever, cronologicamente, o relato histórico do papel que a enfermagem desempenhou desde seu início como profissão, em emergências e desastres de maior magnitude, relevância, ocorridos no mundo e na Colômbia. Metodologia: A metodologia utilizada foi a narraçãohistórica seguindo o método de síntese hermenêutica. O submétodo do estudo foi cronológico egeográfico. Resultados: A profissão de enfermagem vem passando por uma importante transformação, devido às demandas da sociedade e à evolução tecnológica. Dentre os principais desastres ocorridos, a enfermagem tem desempenhado um papel muito importante na prevenção de alguns delese na minimização de seus efeitos colaterais. Conclusão: É possível perceber como os diferentes eventos de emergência ocorridos ao longo da história e em diferentes localizações geográficas do mundo marcaram favoravelmente o desenvolvimento da enfermagem como profissão. (AU)

Tras el tsunami del COVID-19, ¿de vuelta a la normalidad? / After the COVID-19 tidal wave: Should things go back to normal?

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The Emergency Use Authorization of Pharmaceuticals: History and Utility During the COVID-19 Pandemic.

The Emergency Use Authorization (EUA) originated in 2004 because of the need for emergency medical countermeasures (MCMs) against potential bioterrorist attacks. The EUA also proved useful in dealing with subsequent pandemics and has emerged as a critical regulatory pathway for therapeutics and vaccines throughout the Coronavirus Disease 2019 (COVID-19) pandemic. With the EUA process in the USA, we witnessed emergency authorizations, their expansions, as well as withdrawal of previously authorized products, which exemplifies the dynamic nature of scientific review of EUA products. EUAs proved vital for the first group of COVID-19 vaccines, including the temporary pause of one vaccine while emergency safety issues were evaluated. Although this review on the EUA is primarily focused on the USA, distinctions were made with other jurisdictions such as Europe and Canada with respect to the emergency authorizations of the vaccines. Finally, we discuss some important differences following EUA and formal new drug/vaccine application (NDA/BLA) approvals.

Hippocratic concepts of acute and urgent respiratory diseases still relevant to contemporary medical thinking and practice: a scoping review.

BACKGROUND: The collected works of Hippocrates were searched for concepts on the diagnosis, prognosis, and treatment of acute and urgent respiratory diseases, with the objective to trace their origins in the Hippocratic Collection. METHODS: A scoping review was performed to map out key concepts of acute and severe respiratory diseases in the entire Hippocratic Collection. The digital library Thesaurus Lingua Graeca (TLG) was researched for references in the entire Hippocratic Collection regarding the epidemiology, pathophysiology, prognosis, diagnosis and treatment of acute respiratory diseases; then, the relevant texts were studied in their English translation by the Loeb Classical Library. RESULTS: Hippocratic physicians followed principles of treatment for pneumonia and pleurisy, still relevant, such as hydration, expectoration, analgesia and prompt mobilisation. Other approaches, including the inhalation of "vapours through tubes" in angina, can be considered as forerunners of modern medical practice. Thoracic empyema was diagnosed by shaking the patient and direct chest auscultation after "applying your ear to his sides". In case of an emergency from upper airway obstruction, urgent insertion of primitive airway equipment, such as a small pharyngeal tube, was applied. CONCLUSIONS: The main Hippocratic concepts on four still common acute and urgent respiratory diseases -pneumonia, pleurisy, thoracic empyema and upper airway obstruction- were identified and most of them were found to be in agreement with contemporary medical thinking and practice.

Biomedical Research in Times of Emergency: Lessons From History.

Coronavirus disease 2019 (COVID-19) has sickened millions, killed hundreds of thousands, and utterly disrupted the daily lives of billions of people around the world. In an effort to ameliorate this devastation, the biomedical research complex has allocated billions of dollars and scientists have initiated hundreds of clinical trials in an expedited effort to understand, prevent, and treat this disease. National emergencies can stimulate significant investment of financial, physical, and intellectual resources that catalyze impressive scientific accomplishments, as evident with the Manhattan Project, penicillin, and the polio vaccines in the 20th century. However, pressurized research has also led to false promises, disastrous consequences, and breaches in ethics. Antiserum in the 1918 flu epidemic, contaminated yellow fever vaccines in World War II, and unethical human experimentation with mustard gas offer just a few cautionary exemplars. It is critical to continue biomedical research efforts to address this pandemic, and it is appropriate that they receive priority in both attention and funding. But history also demonstrates the importance of treating early results-such as those associated with hydroxychloroquine-with caution as we only begin to understand the biology, epidemiology, and potential target points of COVID-19.

Terapia ocupacional en situaciones de emergencia: reflexiones desde la historia / Occupational therapy in emergency situations: reflections from history

La pandemia por COVID-19 ha desencadenado una situación de emergencia mundial sin precedentes. La historia demuestra que crisis graves como esta pueden resultar determinantes para dar origen a transformaciones importantes en la sociedad. El objetivo principal de este artículo es aportar reflexiones sobre las posibles consecuencias de la pandemia por COVID-19 en el futuro de la terapia ocupacional a partir del análisis de otras situaciones de emergencia ocurridas en la primera mitad del siglo XX

The COVID-19 pandemic has triggered an unprecedented global emergency. History shows that serious crises such as this can be instrumental in bringing about major transformations in society. The main objective of this article is to provide reflections on the potential impact of the VOC-19 pandemic on the future of occupational therapy based on the analysis of other emergencies that occurred in the first half of the 20th century

Enfermedades médicas, trepanación y cirugía de emergencia durante el sitio de Gibraltar (1779-1783). Las operaciones de Joaquín de Villalba (1752-1807) / Medical diseases, trepanning, and emergency surgery during the 1779-1783 Siege of Gibraltar: the surgeries of Joaquín de Villalba (1752-1807)

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Preparation for the next major incident: are we ready? A 12-year update.

OBJECTIVES: A major incident is any emergency that requires special arrangements by the emergency services and generally involves a large number of people. Recent such events in England have included the Manchester Arena bombing and the Grenfell Tower disaster. Hospitals are required by law to keep a major incident plan (MIP) outlining the response to such an event. In a survey conducted in 2006 we found a substantial knowledge gap among key individuals that would be expected to respond to the enactment of an MIP. We set out to repeat this survey study and assess any improvement since our original report. METHODS: We identified NHS trusts in England that received more than 30 000 patients through the emergency department in the fourth quarter of the 2016/2017 period. We contacted the on-call anaesthetic, emergency, general surgery, and trauma and orthopaedic registrar at each location and asked each individual to answer a short verbal survey assessing their confidence in using their hospital's MIP. RESULTS: Of those eligible for the study, 62% were able to be contacted and consented to the study. In total 50% of respondents had read all or part of their hospital's MIP, 46.8% were confident that they knew where their plan was stored, and 36% knew the role they would play if a plan came into effect. These results show less confidence among middle-grade doctors compared with 2006. CONCLUSIONS: Confidence in using MIPs among specialty registrars in England is still low. In light of this, we make a number of recommendations designed to improve the education of hospital doctors in reacting to major incidents.

Somos jóvenes. Educamos a nuestros hijos / We're still young: let's educate the next generation

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Centers for Disease Control and Prevention Public Health Response to Humanitarian Emergencies, 2007-2016.

Humanitarian emergencies, including complex emergencies associated with fragile states or areas of conflict, affect millions of persons worldwide. Such emergencies threaten global health security and have complicated but predictable effects on public health. The Centers for Disease Control and Prevention (CDC) Emergency Response and Recovery Branch (ERRB) (Division of Global Health Protection, Center for Global Health) contributes to public health emergency responses by providing epidemiologic support for humanitarian health interventions. To capture the extent of this emergency response work for the past decade, we conducted a retrospective review of ERRB's responses during 2007-2016. Responses were conducted across the world and in collaboration with national and international partners. Lessons from this work include the need to develop epidemiologic tools for use in resource-limited contexts, build local capacity for response and health systems recovery, and adapt responses to changing public health threats in fragile states. Through ERRB's multisector expertise and ability to respond quickly, CDC guides humanitarian response to protect emergency-affected populations.

Emergencies and acute diseases in the collected works of Hippocrates: observation, examination, prognosis, therapy.

The collected works οf Hippocrates include a wealth of references to emergencies and acute conditions; if the physician could treat these, he would be considered superior to his colleagues. Works most relevant to current Emergency Medicine are presented. They indicate Hippocrates' remarkable insight and attention to the value of close observation, meticulous clinical examination, and prognosis. Hippocrates and his followers disdained mystery and were not satisfied until they had discovered a rational cause to diseases. They assigned great significance to distressing signs and symptoms - the famous Hippocratic face, the breathing pattern, pain, seizures, opisthotonus - pointing to a fatal outcome, which they reported to their patient. The principles of treatment of emergencies, such as angina, haemorrhage, empyema, ileus, shoulder dislocations and head injuries, are astonishingly similar to the ones used nowadays.

La evolución personal a lo largo del ejercicio profesional / Professional development over the course of a physician's career

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¿Ha aumentado la presencia de los padres durante los procedimientos invasivos en urgencias en los últimos años? / Has the presence of parents during invasive procedures in the emergency department increased in the last few years?

INTRODUCCIÓN: En los últimos años los padres están adquiriendo un protagonismo cada vez mayor en los servicios de urgencias pediátricos (SUP), manifestando su deseo de presenciar los procedimientos invasivos (PI) realizados a sus hijos. OBJETIVOS: 1) Comparar la presencia de los padres durante los PI en SUP españoles entre 2008 y 2012; 2) comparar los argumentos para restringir la presencia y los problemas derivados; y. 3) conocer si ha cambiado la opinión del personal sanitario. METODOLOGÍA: Estudio descriptivo multicéntrico comparativo. En 2008 y 2012 se envían 42 encuestas vía correo electrónico a los responsables de SUP españoles, incluyéndose en el estudio los que responden en ambos periodos. RESULTADOS: Veintidós hospitales participan en el estudio. La presencia de los padres en los SUP espa˜noles aumenta entre 2008 y 2012 para todos los PI, significativamente en la analítica sanguínea y en el sondaje vesical. En 2012 los responsables argumentan menos frecuentemente el nerviosismo de los niños, la ansiedad de los padres y el temor del personal a un peor rendimiento para restringir la presencia. En ambos periodos los problemas son ocasionales, disminuyendo el peor comportamiento de los niños. Según los responsables el acuerdo del personal sanitario no ha cambiado en estos años. CONCLUSIONES: La presencia de los padres durante los PI en los SUP ha aumentado en los últimos 4 a˜nos, aunque es aún escasa durante los procedimientos más invasivos. Los responsables argumentan menos problemas conductuales, aunque el grado de acuerdo del personal no ha cambiado, siendo necesario continuar trabajando en el tema

INTRODUCTION: In the recent years, parents are playing an important role in Pediatric Emergency Department (PED), and wish to be present when invasive procedures (IP) are performed. OBJECTIVES: 1) To compare the presence of parents during IP in PED in Spain between 2008 and 2012. 2) To compare the arguments to restrict the presence and problems arising from this, and 3) To determine whether the views of health personnel have changed on this subject. METHODOLOGY: A descriptive multicenter comparative study was conducted in 2008 and 2012. A total of 42 questionaires were sent by email to PED managers, with the responding hospitals being included in the 2 periods of the study. RESULTS: A total of 22 hospitals participated in the study. The presence of parents in the PED increased between 2008 and 2012 for all IP, significantly in the blood test and urine catheterization. In 2012, managers state that children are not so nervous, and anxiety of the parents and staff fear of a poorer performance, as an argument to restrict family presence. There were few problems during the 2 periods, with the poor behavior of the children decreasing. According to managers, the opinion of health personnel has not changed in the last four years. CONCLUSIONS: The presence of parents during the IP in the PED has increased in the last four years, although the presence is low for more invasive procedures. Managers argue the presence of fewer behavior problems to restrict family presence. The opinion of the staff has not changed in the last four years, although more studies are required on this issue

Factores desencadenantes de insatisfacción e ira en padres de niños atendidos en servicios de urgencias / actors related to dissatisfaction and anger in parents of children treated at paediatric emergency services

OBJETIVOS: La ira en pacientes y familiares durante su estancia en servicios de urgencias ha merecido la atención de investigadores desde hace tiempo. El objetivo del presente estudio es explorar la ira de los padres durante la atención a sus hijos en servicios de urgencias pediátricas, sondeando dimensiones específicas de insatisfacción que pueden predecir la aparición de ira. MATERIAL Y MÉTODOS: Se trata de un estudio descriptivo transversal mediante autoinforme en 711 progenitores de ni˜nos atendidos en servicios de urgencias de pediatría. Los instrumentos utilizados fueron el Inventario de Expresión de Ira Estado-Rasgo -2 (STAXI-2) y la Escala de Satisfacción con los Servicios Sanitarios. Los análisis estadísticos incluyeron análisis descriptivos, correlaciónales, de varianza y de regresión lineal múltiple. RESULTADOS: Un total de 53 progenitores (7,5%) mostraron niveles de ira altos o medios. La puntuación media en satisfacción fue 37.12 (SD = 7.33). Se encontró que mayores niveles de satisfacción global se asociaron significativamente a menores niveles de ira (r = -.29, p = .00). Entre las variables estudiadas, una menor satisfacción con el acceso al servicio (B = -.172, p = .00) y con el personal sanitario (B = -.121, p = .01) y una mayor gravedad percibida del estado de salud del menor (B = .157, p = .00), predijeron mayores niveles de ira. CONCLUSIONES: Es importante continuar trabajando para mejorar el acceso de los pacientes y sus familiares a los servicios de urgencias, los procesos de información y la comunicación con el personal sanitario, entre otras iniciativas

AIM: Anger in patients and relatives is very frequent in health emergency services and is often associated with aggressiveness and emotional alterations. The aim of the present study is to explore anger in parents while their children are receiving care in paediatric emergency services, seeking the specific dimensions of dissatisfaction that may predict the onset of anger in parents. MATERIALS AND METHODS: A cross-sectional descriptive study using a self-report questionnaire in 711 parents of children seen in paediatric emergency departments. The self-report questionnaires used were the State-Trait Anger Expression Inventory-2 (STAXI-2) and the Satisfaction with Healthcare Services Scale. The statistical analysis included descriptive, correlational, variance and multiple linear regression models. RESULTS: A total of 53 parents (7,5%) showed a moderate or high anger level. The mean score for satisfaction was 37.12 (SD = 7.33). It was found that higher levels of overall satisfaction were significantly associated with lower levels of anger (r = −.29, p = .00). Among the variables studied, dissatisfaction with access to the service (ˇ = −.172, p = .00), with the healthcare staff (ˇ = −.121, p = .01), and perceived severity of the child's health status ( = .157, p = .00) predicted higher levels of anger. CONCLUSIONS: On the basis of our results, it is important to continue working to substantially improve access for patients and their families to the emergency department, as well as the information and communication process with the healthcare staff should be included in intervention initiatives