Many factors influence the likelihood of bystander cardiopulmonary resuscitation (BCPR) after out-of-hospital cardiac arrest (OHCA), but gender disparities in prehospital care remain under-examined, particularly in relation to the bystander’s connection to the patient.

The objective of this study was to evaluate the association between gender and the likelihood of receiving BCPR in OHCA. The primary outcome of the study was to examine differences in BCPR rates among men and women who experienced OHCA. The secondary outcome was to investigate whether bystanders were more likely to provide CPR based on their relationship to the victim, comparing “true” layperson CPR to CPR administered by family members or friends and how these rates differed between men and women.

This retrospective prehospital chart review included all encounters from a single urban Emergency Medical Services (EMS) agency with a cardiac arrest prior to EMS arrival from January 1, 2017 through June 30, 2022 (n = 701). For each encounter, the presence or absence of BCPR was recorded, along with the relation of the bystander to the patient. “True” BCPR was defined as CPR performed by a layperson unknown to the patient. Patients were excluded if they exhibited signs of obvious death, were physically inaccessible to bystanders, had CPR initiated by trained facility staff or police, had a do not resuscitate (DNR) order present on EMS arrival, received CPR but were not in cardiac arrest, or were younger than 18 years old (n = 174). Odds ratios (OR) with 95% confidence intervals (CI) were used to evaluate data, with statistical significance defined at P < .05.

The study examined 701 cardiac arrest encounters: 250 female (35.7%) and 451 male (64.3%). Overall, men (n = 123; 27.3%) were more likely to receive BCPR than women (n = 48; 19.2%); OR = 1.58; 95%CI, 1.08-2.30; P = .02. Among those who received BCPR, women were significantly more likely to have received it from someone they knew (83.3% versus 65.9%; OR = 2.59; 95%CI, 1.11-6.04; P = .03) while men were more likely to receive “true” layperson BCPR.

This study identifies significant gender disparities in prehospital BCPR and highlights an association between the bystander’s relationship to the patient and the likelihood of intervention.

This study explores the impact of heatwaves on emergency calls for assistance resulting in service attendance in the Australian state of Queensland for the period from January 1, 2010 through December 31, 2019. The study uses data from the Queensland Ambulance Service (QAS), a state-wide prehospital health system for emergency health care.

A retrospective case series using de-identified data from QAS explored spatial and demographic characteristics of patients attended by ambulance and the reason for attendance. All individuals for which there was an emergency call to “000” that resulted in ambulance attendance in Queensland across the ten years were captured. Demand for ambulance services during heatwave and non-heatwave periods were compared. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were constructed exploring ambulance usage patterns during heatwaves and by rurality, climate zone, age groups, sex, and reasons for attendance.

Compared with non-heatwave days, ambulance attendance across Queensland increased by 9.3% during heatwave days. The impact of heatwaves on ambulance demand differed by climate zone (high humidity summer with warm winter; hot dry summer with warm winter; warm humid summer with mild winter). Attendances related to heat exposure, dehydration, alcohol/drug use, and sepsis increased substantially during heatwaves.

Heatwaves are a driver of increased ambulance demand in Queensland. The data raise questions about climatic conditions and heat tolerance, and how future cascading and compounding heat disasters may influence work practices and demands on the ambulance service. Understanding the implications of heatwaves in the prehospital setting is important to inform community, service, and system preparedness.

During mass-casualty incidents (MCIs), prehospital triage is performed to identify which patients most urgently need medical care. Formal MCI triage tools exist, but their performance is variable. The Shock Index (SI; heart rate [HR] divided by systolic blood pressure [SBP]) has previously been shown to be an efficient screening tool for identifying critically ill patients in a variety of in-hospital contexts. The primary objective of this study was to assess the ability of the SI to identify trauma patients requiring urgent life-saving interventions in the prehospital setting.

Clinical data captured in the Alberta Trauma Registry (ATR) were used to determine the SI and the “true” triage category of each patient using previously published reference standard definitions. The ATR is a provincial trauma registry that captures clinical records of eligible patients in Alberta, Canada. The primary outcome was the sensitivity of SI to identify patients classified as “Priority 1 (Immediate),” meaning they received urgent life-saving interventions as defined by published consensus-based criteria. Specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated as secondary outcomes. These outcomes were compared to the performance of existing formal MCI triage tools referencing performance characteristics reported in a previously published study.

Of the 9,448 records that were extracted from the ATR, a total of 8,650 were included in the analysis. The SI threshold maximizing Youden’s index was 0.72. At this threshold, SI had a sensitivity of 0.53 for identifying “Priority 1” patients. At a threshold of 1.00, SI had a sensitivity of 0.19.

The SI has a relatively low sensitivity and did not out-perform existing MCI triage tools at identifying trauma patients who met the definition of “Priority 1” patients.

Blast injuries can occur by a multitude of mechanisms, including improvised explosive devices (IEDs), military munitions, and accidental detonation of chemical or petroleum stores. These injuries disproportionately affect people in low- and middle-income countries (LMICs), where there are often fewer resources to manage complex injuries and mass-casualty events.

The aim of this systematic review is to describe the literature on the acute facility-based management of blast injuries in LMICs to aid hospitals and organizations preparing to respond to conflict- and non-conflict-related blast events.

A search of Ovid MEDLINE, Scopus, Global Index Medicus, Web of Science, CINAHL, and Cochrane databases was used to identify relevant citations from January 1998 through July 2024. This systematic review was conducted in adherence with PRISMA guidelines. Data were extracted and analyzed descriptively. A meta-analysis calculated the pooled proportions of mortality, hospital admission, intensive care unit (ICU) admission, intubation and mechanical ventilation, and emergency surgery.

Reviewers screened 3,731 titles and abstracts and 173 full texts. Seventy-five articles from 22 countries were included for analysis. Only 14.7% of included articles came from low-income countries (LICs). Sixty percent of studies were conducted in tertiary care hospitals. The mean proportion of patients who were admitted was 52.1% (95% CI, 0.376 to 0.664). Among all in-patients, 20.0% (95% CI, 0.124 to 0.288) were admitted to an ICU. Overall, 38.0% (95% CI, 0.256 to 0.513) of in-patients underwent emergency surgery and 13.8% (95% CI, 0.023 to 0.315) were intubated. Pooled in-patient mortality was 9.5% (95% CI, 0.046 to 0.156) and total hospital mortality (including emergency department [ED] mortality) was 7.4% (95% CI, 0.034 to 0.124). There were no significant differences in mortality when stratified by country income level or hospital setting.

Findings from this systematic review can be used to guide preparedness and resource allocation for acute care facilities. Pooled proportions for mortality and other outcomes described in the meta-analysis offer a metric by which future researchers can assess the impact of blast events. Under-representation of LICs and non-tertiary care medical facilities and significant heterogeneity in data reporting among published studies limited the analysis.

Conceptualizations of surge capacity are gaining traction in disaster preparedness and response, particularly in the context of critical and acute care during the pandemic as well as other disaster contexts. In most applications, the surge capacity domains describe the four types of assets required to ensure that surges in demand are addressed. Despite increasing interest and conceptual application, these constructs are yet to be considered or explored in relation to the profound resource scarcity and complex contexts of humanitarian health responses.

The aim of this research is to explore surge capacity domain constructs in the novel context of scarce health resource allocation in humanitarian health care response settings.

This research was conducted according to an exploratory qualitative design. Clinicians and managers with relevant experiences were purposively recruited to include broad perspectives across humanitarian responses and clinical specialties. Interview transcripts were analyzed using a latent deductive pattern approach, using a deductive code book consisting of existing surge capacity domains to explore surge capacity constructs. Analysis of coded data for cross-cutting themes drove identification of new findings regarding surge capacity in the context of humanitarian health responses.

Seventeen participants completed semi-structured interviews. In addition to demonstrating the relevance of existing surge capacity domains (staff, stuff, space, and systems; 4Ss), four new themes emerged: (1) sponsorship; (2) suitability; (3) security; and (4) supply. These four themes informed the conceptualization of surge capacity dimensions which must be satisfied for an asset to render a positive impact with relevance to all four surge capacity domains (4S2 - cumulative 4S domains and the new dimensions).

Although existing surge capacity domains have proven relevant to humanitarian health care response settings, this research produced a revised conceptualization of surge capacity constructs specific to this context. The identification of four surge capacity dimensions supported the conception and development of the Scarce Health Resource Allocation in Humanitarian Response Settings (SHARE-HRS) 4S2 model of surge capacity, thus offering a potential new tool to support humanitarian health response planning and evaluation.

Vital signs are an essential component of the prehospital assessment of patients encountered in an emergency response system and during mass-casualty disaster events. Limited data exist to define meaningful vital sign ranges to predict need for advanced care.

The aim of this study was to identify vital sign ranges that were maximally predictive of requiring a life-saving intervention (LSI) among adults cared for by Emergency Medical Services (EMS).

A retrospective study of adult prehospital encounters that resulted in hospital transport by an Advanced Life Support (ALS) provider in the 2022 National EMS Information System (NEMSIS) dataset was performed. The outcome was performance of an LSI, a composite measure incorporating critical airway, medication, and procedural interventions, categorized into eleven groups: tachydysrhythmia, cardiac arrest, airway, seizure/sedation, toxicologic, bradycardia, airway foreign body removal, vasoactive medication, hemorrhage control, needle decompression, and hypoglycemia. Cut point selection was performed in a training partition (75%) to identify ranges for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), oxygen saturation, and Glasgow Coma Scale (GCS) by using an approach intended to prioritize specificity, keeping sensitivity constrained to at least 25%.

Of 18,259,766 included encounters (median age 63 years; 51.8% male), 6.3% had at least one LSI, with the most common being airway interventions (2.2%). Optimal ranges for vital signs included 47-129 beats/minute for HR, 8-30 breaths/minute for RR, 96-180mmHg for SBP, >93% for oxygen saturation, and >13 for GCS. In the test partition, an abnormal vital sign had a sensitivity of 75.1%, specificity of 66.6%, and positive predictive value (PPV) of 12.5%. A multivariable model encompassing all vital signs demonstrated an area under the receiver operator characteristic curve (AUROC) of 0.78 (95% confidence interval [CI], 0.78-0.78). Vital signs were of greater accuracy (AUROC) in identifying encounters needing airway management (0.85), needle decompression (0.84), and tachydysrhythmia (0.84) and were lower for hemorrhage control (0.52), hypoglycemia management (0.68), and foreign body removal (0.69).

Optimal ranges for adult vital signs in the prehospital setting were statistically derived. These may be useful in prehospital protocols and medical alert systems or may be incorporated within prediction models to identify those with critical illness and/or injury for patients with out-of-hospital emergencies.

The European Resuscitation Council (ERC) establishes guidelines for cardiopulmonary resuscitation (CPR) under standard conditions and special circumstances but without specific instructions for nighttime situations with reduced visibility. The aim of this study was to evaluate the feasibility of performing CPR at night under two different conditions, in darkness with ambient light and with the additional illumination of a headlamp, as well as to determine the quality of the maneuver.

A crossover, randomized pilot study involving nineteen lifeguards was conducted, with each participant performing two five-minute CPR tests: complete darkness with headlamp and natural night environment at the beach without additional lighting. Both tests were conducted with a 30:2 ratio of chest compression (CC) to ventilations using mouth-to-pocket mask technique in the darkness of the night with a 30-minute break between them. Outcome measures included quality of CPR, number of CCs, mean depth of CCs, mean rate of CCs, and number of effective ventilations. Results were reported as the mean or median difference (MD) between the two groups with 95% confidence interval (CI) using techniques for paired data.

There were no statistically significant differences between the two lighting conditions for the outcomes of CPR quality, mean depth of CCs, or number of effective ventilations. The number of CCs was lower when performed without the headlamp (MD: -8; 95%CI, -15 to 0). In addition, the mean rate of CCs was lower when performed without the headlamp (MD: -3; 95%CI, -5 to -1).

The rescuers performed CPR at night with good quality, both in darkness and with the illumination of a headlamp. The use of additional lighting with a headlamp does not appear to be essential for conducting resuscitation.

Natural disasters can increase the risk of infection by severely disrupting access to basic needs, including clean water and sanitation. Hand hygiene, one of the simplest and most effective ways to prevent infections, often becomes a challenge in such situations. The study focused on individuals living in temporary housing following the earthquakes in Turkey on February 6, 2023.

The main objective of this study was to assess the prevalence of hand hygiene practices and the factors affecting these behaviors among individuals affected by disasters.

Data were collected from more than 3,600 randomly selected participants living in container cities in four provinces: Adana, Osmaniye, Hatay, and Gaziantep. Both quantitative and qualitative research methods were used to ensure a comprehensive understanding of hand hygiene behaviors. A detailed questionnaire was used to assess factors such as frequency of hand washing, access to water, and use of hygiene products. In addition, focus group discussions were conducted to explore individual and environmental factors influencing hygiene practices.

The results showed that although most individuals were aware of the importance of hand hygiene, several barriers, such as limited access to clean water, psychological stress, and a lack of hygiene supplies, hindered their ability to maintain proper hygiene. The frequency of hand washing increased slightly after the disaster, but challenges such as forgetfulness, time constraints, and skin irritation from inadequate hygiene products were common.

This study provides important insights into the prevalence of and factors influencing hand hygiene practices in post-earthquake container cities in Turkey. Findings suggest that although individuals have a basic awareness of the importance of hand hygiene, multiple barriers, including access to water, hygiene supplies, and psychological stress, significantly impact their ability to maintain proper hygiene practices after a disaster. This study highlights the critical need for continued education, improved access to hygiene supplies, and psychosocial support to sustain hygiene behaviors in post-disaster settings. By addressing both physical and psychological barriers, public health interventions can be more effective in reducing the risk of infectious diseases in disaster-affected populations. Furthermore, the study emphasizes the importance of preparedness for future disasters by ensuring hygiene resources are readily available and individuals are equipped with the knowledge and skills to maintain hygiene under adverse conditions.

The province of Navosa in Fiji is less developed with water, sanitation, and hygiene (WASH) standards below other provinces in Fiji. In February, 2022 Navosa suffered an outbreak of Leptospirosis cases leading to severe disease, hospitalization, and death. The Fiji Emergency Medical Assistance Team (FEMAT) was activated to respond.

To describe FEMAT response to the Leptospirosis outbreak in a rural island setting.

FEMAT joined the local public health team based out at the Keyasi Hospital with early contact tracing occurred for 26 villagers and 37 of 63 settlements were surveyed for early case detection. It provided additional support to the local clinical team with case management. Health inspectors supported community awareness sessions, and distribution of purification tablets and WASH Kits.

The team was able to treat 12 cases in the community with an additional of 20 acute febrile illnesses in the contact tracing. 87 cases of leptospirosis were treated at the hospital. Therefore, the team treated 99 cases of leptospirosis directly preventing more severe presentation to health facilities. Our health inspectors distributed 200 WASH kits in five communities.

The FEMAT response assisted in the containment and control of the leptospirosis outbreak in the Navosa province while at the same time provided community outreach, preventative care, and surgical management in a rural island community.

EMT2-ITA Regione Piemonte (EMT2-ITA) was classified by WHO as Emergency Medical Team type 2 in 2018. The WHO EMT type 2 standards do not include Intensive Care Unit (ICU) for this type of field hospitals.

On February 2023, after the 7.8 earthquake struck Türkiye and Syria, the EMT2-ITA deployed its field hospital in Antakya (capital of the Hatay province, 1,686,043 inhabitants)

The objective of this study is to report ICU activity of EMT2-ITA in Türkiye, raising interesting points of discussion regarding the essential role of this capacity in a EMT type 2 field hospital.

Starting from the paper patient records and the anesthesiologist logbook, a chart review was conducted: the anonymous data of the patient records were manually entered into an electronic data collection form by healthcare staff (nurses supervised by doctors). Descriptive statistics were used to analyze the database.

A total of 11 patients were admitted in the ICU during the 29 days of field hospital activity with a mean of 1.5 occupied beds per day (with peaks of all the 4 ICU beds occupied for 2 days): almost all the admissions (9; 82%) were patients needing sub-intensive care; 2 patients were critical (treated with intubation and ventilation) and were referred to other facilities after stabilization in the ICU.

The data collected show that an EMT type 2 would benefit from at least 2 ICU beds plus a sub-intensive capacity to treat patients needing higher standards of care than inpatient ward.

The Specialized Care Teams (SCTs) provide additional specialized care supporting an existing local facility or a type 2 or 3 EMTs. The “rescEU EMT” project, funded by European Union, currently under development, aims to become the largest field hospital globally, made of 21 capacities, including EMTs and SCTs. The EMT2-ITA Regione Piemonte is in charge to develop the ICU Truck-based (together with Germany), Portable CT Scan, Dialysis and Oxygen Supply (together with Portugal and Türkiye) SCTs. Even though the WHO is working to publish technical notes for SCTs, at the moment, very few documentation is available.

To describe the process of designing SCTs in a multi-national project.

The working group was composed by medical doctors, nurses, engineers, technicians coming from the partner countries of the project. This multidisciplinary and multinational team carried out a 3-phase process: (1) a literature review searching for publications, international and national guidelines, legislations relevant for the SCTs under development; (2) the definition of standards of care and deployment’s policies for each SCTs; (3) a market survey to reach a realistic budget estimation and to investigate technologies, materials, and products.

The main result is the definition of the technical specifications for each SCT to be used during the next procurement phase. The main challenges were the tight deadlines, the harmonization of different medical practices and the level of the care to provide.

This model can offer valuable guidance and can be applied by other teams involved in the development of SCTs.

Past studies have raised the need for improvements in the Korea Disaster Relief Team (KDRT)'s communication and information management systems.

This study aims to develop guidelines to enhance the technological interoperability of KDRT medical teams, focusing on communication and information management systems at international disaster sites.

A literature review and analysis of KDRT documentation and international research were conducted using PRISMA methodology. The study applied the Interoperability Continuum Framework’s five domains to assess and enhance KDRT’s technological capabilities. The PRISMA flow diagram was used to systematically identify, screen, and include relevant studies and documents.

From 17369 initial documents, 20 were included in the final qualitative synthesis. Key areas for improvement were identified:

1. 1. Governance: Establish a robust structure for clear decision-making and coordination. Create an inter-agency committee and regularly review policies.

2. 2. Standard Operating Procedures (SOPs): Develop and standardize SOPs aligned with WHO standards. Provide regular training for team members.

3. 3. Technology: Integrate advanced communication systems for real-time data sharing. Utilize digital platforms for resource management. Regularly evaluate and update tools.

4. 4. Training & Exercises: Implement comprehensive training programs, including joint exercises. Focus on real-life scenarios and new technologies. Conduct after-action reviews.

5. 5. Usage: Ensure team proficiency in using guidelines and tools. Monitor effectiveness during deployments. Analyze data to improve practices.

Implementing the proposed guidelines will enhance KDRT’s technological interoperability, streamline disaster response, and align with global standards. This will maximize life-saving interventions and improve crisis coordination, addressing current gaps and leveraging advanced technologies for efficient future disaster relief operations.

In May 2024, ICRC and 12 Red Cross-National Societies combined efforts to open a field hospital in Rafah, Gaza, to help address the overwhelming health needs emanating from the ongoing armed conflict. The hospital complements and supports the essential work performed by the Palestine Red Crescent Society (PRCS) in providing urgent care.

MHPSS is an essential part of emergency response, but it is still seen as an optional ‘nice to have’ intervention and therefore not always integrated within emergency health response in a timely manner. ICRC, in line with the International Red Cross and Red Crescent Movement MHPSS Policy and World Health Assembly MHPSS Resolution, decided early on to integrate MHPSS within the health services being provided by the field hospital.

Presentation and discussion on:

• How was MHPSS integrated within the hospital services, including mass casualty management and triage?

• What impact has early access to MHPSS had for patients and their families?

• What do EMTs need to know about MHPSS?

• What were the challenges and lessons learnt from this deployment?

• Sustainable approaches to ensuring MHPSS service provision within emergency health settings

ICRC and Danish Red Cross (DRC) highlighted the importance of early integration of MHPSS into emergency health services and share best practice examples and case stories from the field hospital in Gaza.

Early and appropriate access to MHPSS saves lives.

Meaningful medical data are crucial for response teams in the aftermath of disaster. Electronic Medical Record (EMR) systems have revolutionized healthcare by facilitating real-time data collection, storage, and analysis. These capabilities are particularly relevant for post-disaster and austere environments. fEMR, an EMR system designed for such settings, enables rapid documentation of patient information, treatments, and outcomes, ensuring critical data capture.

Data collected through fEMR can be leveraged to perform comprehensive monitoring and evaluation (M&E) of emergency medical services, assess operational needs and efficiency, and support public health syndromic surveillance.

Analyzing these data identifies patterns and trends or assesses treatment effectiveness. This insight facilitates data-driven decision-making and the optimization of medical protocols. fEMR’s real-time reports enhance situational awareness and operational coordination among response units. The aggregated data can detect trends, classify case-mix, and facilitate after-action reviews, contributing to continuous improvement in emergency preparedness and response strategies. The system also supports fulfilling reporting requirements for health agencies and funding organizations, ensuring accountability and transparency.

EMRs like fEMR are vital for emergency response teams, supporting immediate patient care and ongoing M&E of disaster response efforts. Its robust data management capabilities support evidence-based practices and strategic planning, improving the effectiveness of emergency medical services in disaster scenarios.

The effective use of fEMR in disaster response scenarios highlights its significance in enhancing operational efficiency, ensuring accountability, and improving the overall effectiveness of emergency medical services through comprehensive data management and real-time reporting.

Planning for WYD2023 by INEM began in July 2022, leading to the formation of the WYD2023 Taskforce in September. Over 90 meetings established key collaborations with entities like the Local Organizing Committee, Ministry of Health, Security Forces, Municipality of Lisbon, and His Holiness’ Security Team.

Share knowledge and lessons learnt from planning WYD 2023 and the PT EMT’s role in this event.

Analysis and reflection on lessons learnt from PT EMT’s experience in Portugal’s WYD 2023.

The event’s comprehensive risk assessment anticipated 1.5 million pilgrims over 12 days, guiding strategic and operational response plans. Reinforcements to the Prehospital Medical Emergency Integrated System included ALS Emergency Vehicles and support for main events.

The plan addressed satellite events with varying populations. Health care responses were organized into three levels: aid stations and mobile teams from Pilgrim support and the Portuguese Red Cross; Advanced Medical Posts; and EMT Type 1. Rigorous record-keeping covered admissions, clinical records, vaccination forms, birth certificates, death verifications, informed consents, narcotics controls, and personal belongings.

The response mobilized 500 staff, 124 mobile teams, 94 first aid sites, 4 EMT Type 1, 17 Advanced Medical Posts, and 7 “Calm” tents. This effort assisted 4376 patients within WYD sites, 253 outside, and 153 were evacuated to hospitals.

Key lessons from WYD2023 include the importance of collaborative planning from local to national levels, meticulous record-keeping, diverse logistical and operations levels, and establishing a WHO-classified EMT-based response. Flexibility and dynamic planning were essential for adaptability, and psychological support was integrated across all areas.

The US National Disaster Medical System (NDMS) deploys specialized teams for acute trauma, pediatric care, mortuary services, and veterinary response to manage various disaster scenarios. These teams offer potential models for enhancing the WHO Emergency Medical Teams (EMT) program’s international humanitarian and disaster response capabilities.

This study analyzes the structure, effectiveness, and lessons from NDMS specialized teams, assessing their applicability to the WHO EMT program. It aims to provide recommendations for developing specialized teams for international disaster medical response.

A comprehensive review of NDMS team deployments is conducted, focusing on organization, training, utilization, strategies, and outcomes. Data is collected from NDMS reports and debriefings. Comparative analysis identifies best practices and key lessons for the WHO EMT program.

Preliminary findings indicate that specialized teams effectively address specific disaster needs. Strengths include specialized training, rapid deployment, and targeted medical care. Lessons from NDMS emphasize the importance of specialized skills, interdisciplinary coordination, and flexible operations, enhancing generalized response capabilities. These insights support recommendations for the WHO EMT program to develop specialized teams for diverse humanitarian and disaster challenges.

NDMS specialized teams provide a valuable model for the WHO EMT program. Adopting and adapting this model can enhance the WHO EMT program’s capacity to offer specialized support in international humanitarian and disaster medical responses. Developing trauma, pediatric, mortuary, and veterinary teams within the WHO EMT framework can improve global disaster response effectiveness and efficiency.