Assessing Health-Related Quality of Life in Non-Directed Versus Directed Kidney Donors: Implications for the Promotion of Non-Directed Donation.

Living kidney donation has increased significantly, but little is known about the post-donation health-related quality of life (HRQoL) of non-directed donors (NDs) vs. directed donors (DDs). We thus examined the outcomes of 112 living kidney donors (82 NDs, 30 DDs). For the primary outcomes-namely, the mean physical component summary (PCS) and mental component summary (MCS) scores of the 12-item Short Form Survey (SF-12) questionnaire-scores were significantly higher for the NDs vs. the DDs (PCS: +2.69, MCS: +4.43). For secondary outcomes, NDs had shorter hospital stays (3.4 vs. 4.4 days), returned to physical activity earlier (45 vs. 60 days), exercised more before and after donation, and continued physical activity post-donation. Regression analyses revealed that donor type and white blood cell count were predictive of the PCS-12 score, and donor type was predictive of the MCS-12 score. Non-directed donation was predictive of a shorter hospital stay (by 0.78 days, p < 0.001) and the odds of having PCS-12 and MCS-12 scores above 50 were almost 10 and 16 times higher for NDs, respectively (p < 0.05). These findings indicate the safety and potential benefits of promoting non-directed donation. However, careful selection processes must be maintained to prevent harm and exploitation.

Impact of dispatcher assisted CPR on ROSC rates: A National Cohort Study.

INTRODUCTION: Out of hospital cardiac arrest (OHCA) is a leading cause of mortality. Bystander CPR is associated with increased OHCA survival rates. Dispatcher assisted CPR (DA-CPR) increases rates of bystander CPR, shockable rhythm prevalence, and improves ROSC rates. The aim of this article was to quantify and qualify DA-CPR (acceptance/rejection), ROSC, shockable rhythms, and associations between factors as seen in MDA, Israel, during 2018. METHODS: All 2018 OHCA incidents in Israel's national EMS database were studied retrospectively. We identified rates and reasons for DA-CPR acceptance or rejection. Reasons DA-CPR was rejected/non-feasible by caller were categorized into 5 groups. ROSC was the primary outcome. We created two study groups: 1) No DA-CPR (n = 542). 2) DA-CPR & team CPR (n = 1768). RESULTS: DA-CPR was accepted by caller 76.5% of incidents. In group 1, ROSC rates were significantly lower compared to patients in group 2 (12.4% vs. 21.3% p < .001). Group 1 had 12.4% shockable rhythms vs. 17.1% in group 2 (DA-CPR and team CPR). Of the total 369 shockable cases, 42.3% (156) achieved ROSC, in the non-shockable rhythms only 14.8% achieved ROSC. CONCLUSIONS: OHCA victims receiving dispatcher assisted bystander CPR have higher rates of ROSC and more prevalence of shockable rhythms. MDA dispatchers offer DA-CPR and it is accepted 76.5% of the time. MDA patients receiving DA-CPR had higher ROSC rates and more shockable rhythms. MDA's age demographic is high, possibly affecting ROSC and shockable rhythm rates.

An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19.

BACKGROUND: COVID-19 created lifestyle changes, and induced a fear of contagion affecting people's decisions regarding seeking medical assistance. Concern surrounding contagion and the pandemic has been found to affect the number and type of medical emergencies to which Emergency Medical Services (EMS) have responded. AIM: To identify, categorize, and analyze Magen David Adom (MDA), Israel's national EMS, pre-hospital activities including patients' refusal to hospital transport, during the COVID-19 pandemic crises. METHODS: A comparative before and after design study of MDA incidents during March/April 2019 and March/April 2020. Medical type, frequency, demographic, location, and transport refusal proportions and outcomes were analyzed. RESULTS: A decrease of 2.6% in the total volume of incidents was observed during March and April 2020 compared with the equivalent period in 2019. This contrasted with the retrospective trend of annually increase observed through 2016-2019. Medical categories showing increase in 2020 were infectious disease, cardiac arrest, psychiatric, and labor and deliveries, with out-of-hospital deliveries increasing by 14%. Decreases in 2020 were seen in neurology and trauma, with trauma incidents occurring at home showing an 8.6% increase. Patients' refusal to transport rose from 13.4% in 2019 to 19.9% in 2020. Cases of refusals followed by death within 8 days were more prevalent in 2020. CONCLUSION: EMS must be prepared for changes in patients' behavior due to COVID concerns. Targeting populations at risk for refraining or refusing hospital transport and implementing diverse models of EMS, especially during pandemic times, will allow EMS to assist patients safely, either by reducing truly unnecessary ED visits minimizing contagion or by increasing hospital transports for patients in urgent or emergent conditions.

Heatwave-protective knowledge and behaviour among urban populations: a multi-country study in Tunisia, Georgia and Israel.

BACKGROUND: There is an expected increase in heatwaves globally. As such, it is imperative to have sufficient levels of heatwave-protective knowledge and behaviour in areas regularly affected by heatwaves. Our study assessed this among urban populations in Tunisia, Georgia and Israel. METHODS: We undertook a cross-sectional population survey in the three countries. The questionnaire focused on obtaining information on respondents' knowledge level regarding 1) symptoms due to overheating, 2) risk groups for heatwaves, 3) actions to take when someone is overheated, and 4) heatwave-protective measures. Furthermore, we asked respondents about protective measures they applied during the last heatwave. We compared the results between the countries. RESULTS: Heatwave-protective knowledge was highest in Israel, and lowest in Georgia, for all indicators except for heatwave-protective measures, for which knowledge was highest in Tunisia. Most respondents who named certain protective measures had also applied these during the last heatwave: more than 90% for all measures except for one in Tunisia and Israel, and more than 80% for all measures in Georgia. CONCLUSION: There is a need to further improve heatwave-protective knowledge in Tunisia, Georgia and Israel. One potential solution to achieve this is by implementing a National Heat Health Action Plan. Improving knowledge is a vital step before adaptive behaviour can take place.

Differences in levels of psychological distress, perceived safety, trust, and efficacy amongst hospital personnel during the COVID-19 pandemic.

The COVID-19 pandemic poses significant challenges to healthcare systems worldwide. A key consideration is the adverse psychological impact on healthcare workers (HCWs). This study aimed to investigate the variable levels of psychological distress, perceived safety, trust, and self- and collective-efficacy during the COVID-19 crisis amongst varied HCWs. A survey was disseminated to nurses, physicians, interns, and administrative and logistical staff at an acute-care hospital in Israel during the first wave of COVID-19. The survey consisted of items on a 5-point Likert scale, measuring HCW's perceptions concerning the aforementioned variables as well as demographic information. A total of 716 hospital personnel completed the survey. Nurses reported higher levels of psychological distress and lower levels of trust in the hospital's COVID-19 guidelines compared to physicians (2.3 vs. 2.0 and 3.7 vs. 4.0, respectively). Nurses and interns felt the least safe when working in the hospital. Nurses reported the highest levels of concern regarding fear of uncontrollable spread, infection, and family transmission of the virus. Interns reported the lowest levels of self- and collective-efficacy. In a regression model, the variables that predicted 32% of distress among nurses were age, gender, level of religiosity, indices of perceived safety, and self-efficacy. This study demonstrated differences in distress and perceived safety, trust, and efficacy between varied HCWs during COVID-19. This variability should be considered when designing policies to protect HCWs' wellbeing during future pandemics.

Injuries among all-terrain vehicle users: a population-based study.

BACKGROUND: The use of off-road vehicles such as all-terrain vehicles (ATVs) and recreational off-highway vehicles has increased in recent years. A higher percentage of patients hospitalised following ATV crashes suffered severe injuries, compared with those hospitalised following other MVCs. OBJECTIVE: To identify incidence of ATV-related injury and characterise groups with higher prevalence. METHODS: A retrospective study of the Israel National Trauma Registry data between years 2008 and 2016. ATV crash victims were compared with other types of MVC casualties according to demographics, injuries and hospital resource utilisation. Identifying groups with greater prevalence for severe injuries caused by ATV crashes was conducted using logistic regressions. RESULTS: An increase of 49% in the number of casualties hospitalised following an ATV crash was observed between 2013 and 2016. Non-Jews, males and users 15-29 years old were hospitalised at a higher rate compared with their proportion in the population. ATV crash casualties were more severely injured compared with other MVC casualties (22% vs 14%), had longer hospital length of stay (8+ days) (25% vs 18%), more admissions to intensive care units (16% vs 10%) and underwent more surgery (39% vs 26%, respectively). Males, non-Jews and casualties who did not wear a helmet were about two times more likely to suffer from severe head injury (95% CI 1.20 to 3.60, 1.41 to 2.75 and 1.27 to 4.73, respectively). CONCLUSIONS: An increase in ATV-related casualties was observed. A customised safety intervention programme is needed that targets demographic groups identified with higher injury incidence. Awareness of legislated and common sense ATV safety practices, specifically helmet use, should be raised.

Identifying and minimizing abuse of emergency call center services through technology.

BACKGROUND: To identify and minimize unnecessary calls to emergency numbers and to assess the effectiveness of call-tracking technology in addressing the problem. METHODS: A retrospective, interventional study was conducted of all emergency calls made to Magen David Adom (MDA), Israel's national Emergency Medicine Service (EMS) during years 2012-2016. In 2015 a tiered technological intervention was developed and implemented by MDA. The call-tracking technology self-identified harassment calls by call duration and frequency. The system automatically diverted harassing calls to a non-emergency number system in order not to lose any call. The rates of harassment calls were analyzed by shift, region, and season. Trends were compared before and after intervention. RESULTS: During the years 2012-2016, 53,527 shifts took place, and 8.2% (4277) of shifts identified as receiving incoming harassment calls. The evening shift (11.5%), the Jerusalem region (16.9%), and the summer season (9.6%) were most prone to harassment calls. After implementing an intervention using specialized call-tracking technology, the prevalence of harassment calls decreased significantly (from 10.9% to 2.9% p < .001). The Jerusalem region showed the greatest decrease of 92% (from 26.5%-2.0% p < .001). CONCLUSIONS: MDA's call tracking technology has been shown to identify and minimize harassment calls and can be implemented by emergency organizations to reduce abuse of emergency call services.

Comparison between traumatic brain injury with and without concomitant injuries: an analysis based on a national trauma registry 2008-2016.

Objective: To compare demographic, injury and hospitalization characteristics and mortality between Isolated and Non-Isolated traumatic brain injury.Methods: A retrospective study based on the Israeli National Trauma Registry of patients hospitalized for traumatic brain injury (TBI) between 2008 and 2016. Isolated TBI was defined as no other anatomic region was having concomitant injury with AIS ≥2. X2 test and multivariate logistic regression analysis were used for data analysis.Results: Of the 23566-study population, 40.4% were admitted for isolated TBI. Isolated TBI was significantly more frequent in elderly aged ≥65 years, female, Jews, and injuries sustained at home or in residential institution. The Non-isolated TBI was greater in road traffic injuries, particularly among pedestrians and motor cyclists, and in violence injuries. The Non-isolated TBI group had greater injury severity and hospital resource utilization. In-hospital mortality was higher in the patients with Non-isolated TBI [OR: 1.56(95% CI: 1.33-1.83)], particularly in patients with GCS 13-15; elderly aged 65+ years; and patients with concomitant injuries to abdomen, spine or external body regions.Conclusion: In a patient with TBI, concomitant injuries with AIS ≥2 matter, and awareness of the identified factors has relevance for guiding injury prevention efforts and indeed for potentially improving care and outcome.

Professional characteristics and work attitudes of hospital nurses who leave compared with those who stay.

AIM: To compare characteristics and attitudes of nurses who resigned and those who remained in two Israeli hospitals and assess the reasons for leaving. BACKGROUND: Nurse turnover is a current global problem in health care system, especially given the severe nurse shortages. Retention of nurses requires an understanding of the characteristics of the resigning nurses, their attitudes and their reasons for leaving. METHODS: A matching case-control study was conducted among 100 resigning nurses and 200 matched remaining nurses. Questionnaires were used to survey the professional characteristics and attitudes of the participating nurses. In addition, exit interviews were used to assess the reasons to leave of resigning nurses. RESULTS: Resigning nurses had higher education, less seniority and fewer managerial positions compared with remaining nurses. In addition, resigning nurses had lower professional autonomy and higher aspirations for professional advancement. The reasons to leave cited by the resigning nurses were distance of the workplace from home and working conditions as well as aspiring for professional advancement. CONCLUSIONS: The interface between high education and having few opportunities for advanced positions may lead to resignation. IMPLICATIONS FOR NURSING MANAGEMENT: We recommend organisational interventions for training new hospital nurses through professional career path development, such as mentoring programme.

Reported safety environment predicts injuries among children aged 1-6 years in specific communities.

AIM: To measure individual and environmental risk factors predicting reported child injuries. METHODS: A prospective, follow-up study was performed including 380 parents of children aged 1-6 years, living in various communities throughout Israel. Parents were interviewed three times, 3 months apart. Injuries were defined as including minor injuries that required parental attention and medically attended injuries: doctor or nurse visit, emergency medical services or hospitalisation. Parents reported the level of safety for both indoor and outdoor environments, covering 11 items pertaining to safety elements dedicated to prevent child injury. Socio-demographic and parents' attitudes towards child injury were also measured. RESULTS: During the 6-month follow-up period, 37% of parents reported that their child was injured, and 29% of them received medical attention. Reported outdoor safety environment was found to be a predictor of child injury, suggesting that the risk of child injury is higher among children living in unsafe outdoor environments. However, this depended on levels of religiosity (with an odds ratio of 2.48 and 95% confidence interval of 1.09-5.64 for traditional families and an odds ratio of 3.65 and 95% confidence interval of 1.58-8.46 for religious families). CONCLUSIONS: Safe environments play a major role in decreasing the risk of injury among children. In order to decrease injury rates among young children, attention should be given to the immediate outdoor environment in which children grow up and play. Decision makers might particularly want to pay closer attention to the influence of religious backgrounds on child safety through safe environments.

Characteristics and circumstances of injuries vary with ethnicity of different population groups living in the same country.

OBJECTIVE: To examine whether characteristics and circumstances of injuries are related to ethnicity. DESIGN: The study was based on the Israeli National Trauma Registry data for patients hospitalized between 2008 and 2011. Data included demographics, injury, hospital resource utilization characteristics and outcome at discharge. Univariate analysis followed by logistic regression models were undertaken to examine the relationship between injury and ethnicity. RESULTS: The study included 116,946 subjects; 1% were Ethiopian Born Israelis (EBI), 11% Israelis born in the Former Soviet Union (FSUBI) and 88% the remaining Israelis (RI). EBI were injured more on street or at work place and had higher rates of penetrating and severe injuries. However, FSUBI were mostly injured at home, and had higher rates of fall injuries and hip fracture. Adjusted analysis showed that EBI and FSUBI were more likely to be hospitalized because of violence-related injuries compared with RI but less likely because of road traffic injuries. Undergoing surgery and referral for rehabilitation were greater among FSUBI, while admission to intensive care unit was greater among EBI. CONCLUSION: Targeted intervention programmes need to be developed for immigrants of different countries of origin in accordance with the identified characteristics.

Short-term morbidities and neurodevelopmental outcomes in preterm infants exposed to magnesium sulphate treatment.

AIM: The aim of the study is to examine whether baseline serum Mg concentration has an impact on short-term and long-term outcomes in preterm infants exposed antenatally to MgSO4. METHODS: Participants included all infants admitted to the neonatal intensive care unit at <32 weeks of gestational age. Infant serum Mg concentration (iMgC) was examined immediately after birth in those exposed to maternal MgSO4. Data for short-term outcomes were collected from the infants' computerised charts. Neurodevelopmental outcomes at 6-12 months corrected age were assessed using the Griffiths Mental Developmental Scales. RESULTS: Of 197 eligible infants, 145 were exposed to MgSO4. Baseline iMgC was available for 88 infants. Mean iMgC was 3.5 ± 0.88 mg/dL (1.6-5.7 mg/dL). Baseline iMgC was not associated with an increased risk for neither early morbidities nor adverse long-term outcome. However, iMgC above the mean (>3.5 mg/dL) was associated with significantly lower scores on locomotor (P = 0.016) and personal-social (0.041) scales in the first year of life. CONCLUSIONS: In a cohort of preterm infants antenatally exposed to MgSO4, elevated baseline iMgC (>3.5 mg/dL) was associated with lower locomotor scores. Further research is needed in order to study the relationship between supra-physiologic iMgC and its effect on the developing brain.

Incidence and injury characteristics of traumatic brain injury: Comparison between children, adults and seniors in Israel.

AIM: To assess the incidence and injury characteristics of hospitalized trauma patients diagnosed with TBI. METHODS: A retrospective study of all injured hospitalized patients recorded in the National Trauma Registry at 19 trauma centres in Israel between 2002-2011. Incidence and injury characteristics were examined among children, adults and seniors. RESULTS: The annual incidence rate of hospitalized TBI for the Israeli population in 2011 was 31.8/100,000. Age-specific incidence was highest among seniors with a dramatic decrease in TBI-related mortality rate among them. Adults, in comparison to children and seniors, had higher rates of severe TBI, severe and critical injuries, more admission to the intensive care unit, underwent surgery, were hospitalization for more than 2 weeks and were discharged to rehabilitation. After adjusting for age, gender, ethnicity, mechanism of injury and injury severity score, TBI-related in-hospital mortality was higher among seniors and adults compared to children. CONCLUSION: Seniors are at high risk for TBI-related in-hospital mortality, although adults had more severe and critical injuries and utilized more hospital resources. However, seniors showed the most significant reduction in mortality rate during the study period. Appropriate intervention programmes should be designed and implemented, targeted to reduce TBI among high risk groups.

Maxillofacial Trauma Following Road Accidents and Falls.

INTRODUCTION: Motor vehicle accidents (MVA) and falls are major causes of maxillofacial injuries posing real challenges for the medical staff. PURPOSE: To describe the demographic and injury characteristics, as well as the treatment procedures of casualties diagnosed with maxillofacial injuries. METHODS: The investigators implemented a multicenter retrospective study composed of hospitalized maxillofacial trauma patients recorded in the Israel Trauma Registry for 2000 to 2011. The predictor variable was mechanism of injury and the outcome variable was type of injury, severity, and hospital resources utilization. Descriptive and bivariate statistics with P values was set at 0.05. RESULTS: The study included 11,592 reported hospitalized maxillofacial trauma patients (39.4% of them were MVA, 33.5% were falls), with a male predominance of a 3:1 ratio. The high-risk age groups were the first 3 decades of life in both etiologies, while age groups above 75 years were also frequent in falls. Severity of maxillofacial injuries, multiple injuries, admission to intensive care units, hospitalization for more than 15 days, inpatient mortality, and rehabilitation after discharge was significantly higher in MVA compared with falls. Conversely, maxillofacial surgeries were performed slightly more among patients injured in falls (34.1% and 31.1% respectively), as tongue and mouth are more prone targets in falls, compared with zygoma, maxilla, mandible, and teeth in MVA. CONCLUSION: The results of this study suggest that the etiologies present an entire separate pattern of trauma. A better understanding and proper identification of their high-risk groups should lead to appropriate prevention programs and treatment protocols.

Perceived functional resilience in schools according to key stakeholders.

Amid the COVID-19 outbreak, Israel and numerous other governments closed schools as a precaution, leading to a sudden shift to online learning. The aim of the current study is to provide foundational insight into the perceived readiness of the school system to withstand future adversities, based on the challenges, complexities, as well as successes in adaptation faced by stakeholders during COVID-19. In this cross-sectional study, we assess the perceived levels of functional resilience of the school system among the key stakeholders of the Israeli education system-high school students, parents, teachers, and principals, as well as a composite functional resilience scale. The composite functional resilience consists of 10 main indexes: communication during distance learning (DL) and frontal learning (FL); Perceived stress scale-4 (PSS); psychosocial aspects during distance learning (DL) and frontal learning (FL); digital literacy; pedagogic support; resources; infrastructure; and distance versus frontal learning. The study findings demonstrate differences according to the stakeholders with regard to the perceived functional resilience and the composite functional resilience scores (e.g., students with respect to both of these scores exhibit the lowest results, while teachers display the highest scores). Furthermore, no one variable was significant across the board for all stakeholders in predicting the perceived functional resilience, with the most common predictors among the stakeholders being digital literacy, pedagogic support, PSS, as well as communication during distance and frontal learning. The findings of this study reveal areas for recommended priority actions to be conducted among school system stakeholders.

Elevated hemoglobin levels in renal transplant recipients with polycystic kidney disease versus other etiologies: exploring mechanisms and implications for outcomes.

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD)-related end-stage kidney disease (ESKD) often necessitates transplantation. However, the impact of ADPKD on post-transplant outcomes, specifically hemoglobin levels, remains unknown. METHODS: We retrospectively analyzed 513 Kidney Transplant Recipients (KTRs), of whom 81 had ESKD due to ADPKD (20 with pre-transplant native nephrectomy and 61 without). Hemoglobin levels were evaluated at multiple time intervals post-transplant. RESULTS: Kidney transplant recipients with ADPKD vs. KTRs with ESKD due to other causes exhibited significantly higher hemoglobin levels in repeated measurement analysis. Multivariable analyses confirmed ADPKD as an independent predictor for elevated hemoglobin levels. In a multivariable logistic regression analysis, the odds for maximum hemoglobin > 15 mg/dL at 3-12 months post-transplant were more than twice as high in ADPKD patients vs. all the other KTRs (Odds Ratio [OR] 2.31, 95% Confidence Interval [CI] 1.3-4.13, p < 0.001). Pre-transplant native nephrectomy revealed a trend toward lower hemoglobin levels. Elevated hemoglobin levels were linked to improved estimated glomerular filtration rate (eGFR) at one year post-transplant. Patient survival was enhanced among KTRs with ADPKD compared to other ESKD causes. CONCLUSIONS: Kidney transplant recipients with ADPKD exhibited elevated hemoglobin levels post-transplant, possibly due to prolonged native kidney erythropoietin production. These elevated hemoglobin levels were linked to improved outcomes, including allograft function and patient survival. Future research should further investigate the underlying mechanisms driving favorable ADPKD KTR outcomes.

Ethnicity and road traffic injuries: differences between Jewish and Arab children in Israel.

OBJECTIVE: To examine the differences and characteristics of road traffic injuries (RTIs) among Jewish and Arab children, ages 0-17 years, in Israel. DESIGN: A retrospective study based on data from the Israeli National Trauma Registry between 2001 and 2010. This study relates specifically to traffic-related hospitalizations among children ages 0-17 years. Data include demographic, injury, and hospitalization characteristics. Descriptive statistics and adjusted logistic regression were used to examine the differences of RTIs between the two ethnic groups. RESULTS: A total of 18,884 children were included, of which Arab children comprised 38.2% of the total and 44.1% of the severely injured. Among Arab children 41.8% were pedestrians compared to 33.4% among Jewish children (p<0.0001). Arab children were younger, had more severe injuries and more traumatic brain injury (TBI) compared to Jewish children. Adjusted logistic regression analysis shows that the probability of an Arab child, relative to a Jewish child, to undergo surgical procedures was 1.2 (p<0.0001), to be hospitalized in intensive care units (ICUs) was 0.8 (p=0.003), and to be transferred to rehabilitation was 0.5 (p<0.0001). There was no significant difference in inpatient mortality between the two ethnic groups. CONCLUSIONS: Arab children in Israel are more likely to be hospitalized due to road accidents in comparison to Jewish children. Intervention programs should focus on Arab children and their unique characteristics.

An innovative tool to assess the functional resilience of a school system: learning from the COVID-19 pandemic.

Introduction: Preparing the school system for a future crisis requires the ability to examine the effectiveness of schools' functioning during distant learning and their level of preparedness for future crises. Functional resilience (FR) is defined as the ability to maintain vital operational continuity in the face of disturbance. The study objectives included to develop a FR index of schools and to evaluate and validate it. Methods: To enable examination of the study objectives, the study design included tool development, followed by a validation process among 20 content experts. Concurrently, an eDelphi process for building an inclusive index, based on various components of resilience was conducted. The final study tool consists of four tailored questionnaires to examine perceptions of key stakeholders, i.e.- teachers, principals, parents, and highschool students regarding communication, psychosocial aspects, perceived stress, infrastructure, resources, pedagogic support, digital literacy, and perceived FR. Using an internet panel, the tool was disseminated cross-sectionally among the four groups of stakeholders. Results: The results showed high reliability of most of the scales developed. Furthermore, a high consensus level was reached on the relative importance of each component/ stakeholder to the schools FR. The findings further suggest that there were no significant differences in the composite FR score based on characteristics such as school type/ size/geographic location. However, the findings revealed interesting variations among stakeholders, with findings suggesting greater vulnerability among some. Discussion: To increase resilience and preparedness for future adversities that school systems may face, it is recommended to periodically incorporate an assessment based on a structured tool.

Do first responders and populations perceive risks similarly? A comparative study of seven countries.

Introduction: Risk perception illustrates the subjective evaluation of individuals concerning the characteristics, severity, and capacity to cope with potential hazards. Risk perception influences attitudes and actions individuals take to protect themselves from future threats. Risk perceptions might change among different stakeholder groups such as society and first responders. Identifying risk perceptions of stakeholders is essential to establish effective protective measures. Method: This study investigated the commonalities and diversities in risk perception among first responders and the public, within and between seven European and beyond countries. A self-administered questionnaire was used to gather data from both first responders and civilians. They were asked to assess their risk perception level for five categories of risks (Extreme weather-related events, nature-related events, social disruptions, critical services dependencies, and pandemics). Results: Using Univariate Analysis of Variance showed disparity concerning both the levels of risk perception between the public and first responders, as well as their relative ranking. For example, concerning extreme weather-related and nature-related events, risk perception levels of the first responders is higher than that of the population in six out of the seven studied countries. In contrast, the population's risk perception is higher compared to the first responders in six out of the seven countries, concerning critical infrastructure dependencies and pandemics. Discussion: The relative gaps between the first responders versus the population, within each country, vary considerably. Norway for example presents significant differences between the two internal populations concerning all risks (except for extreme weather), while in Sweden, no significant gaps were identified, concerning all five risks.

The Role of Israel's Emergency Medical Services During a Pandemic in the Pre-Exposure Period.

OBJECTIVE: The scientific literature on coronavirus disease (COVID-19) is extensive, but little is written about the role of emergency medical services (EMS). The objective of this study is to describe the role of Magen David Adom (MDA), Israel's national emergency prehospital medical organization, in the pre-exposure period, before widespread governmental action. These efforts were based on (1) phone diagnosis, dispatch, and transport; and (2) border management checkpoints. METHODS: This is a descriptive study of MDA's role in pandemic response during the pre-exposure period. Medical emergency telephone calls from either individuals or medical sources were identified by a dispatcher as "suspected COVID-19" based on symptoms and travel exposure. Data were also collected for travelers approaching the MDA border checkpoint at Ben-Gurion International Airport. RESULTS: The total number of protected transports during this time was 121. Of these, 44 (36.3%) were referred by medical sources, and 77 (63.7%) were identified as "suspected COVID-19" by dispatchers. The checkpoint was accessed by 156 travelers: 87 were sent to home-quarantine; 12 were transported to the hospital; 18 were refused entry; and 39 required no further action. CONCLUSION: EMS can work effectively in the pre-exposure period through instructing home quarantine, providing protected transport, and staffing border control checkpoints.