Triage is an essential process used to adequately allocate resources and thus increase chances of survival in case of mass-casualty incidents (MCIs). Several triage scales are currently used, but data regarding their performance remain scarce. The objective was to compare the performance of two prehospital triage algorithms (Sieve versus SwissPre) using a validated physiological simulator.

This was a web-based, randomized open-label study. A real-time evolutive simulator based on a heart-lung-brain interaction model embedding functional blocks was used to simulate the evolution of vital parameters. Participants, who were randomly allocated to either algorithm, were asked to triage 30 patients in random order. The primary outcome was the triage score (each correct decision was awarded one point). The “Immediate patients” were defined as those who would die within the first hour according to the physiological model. The secondary outcome was the duration of patient triage.

Out of 71 participants, 67 (94.4%) were included in the final analysis. The Sieve group achieved a mean score of 17.1 out of 30 (95%CI, 16.3 to 17.8). The SwissPre group scored 15.5 out of 30 (95%CI, 14.5 to 16.5). The mean difference between groups was 1.6 points (95%CI, 0.4 to 2.8; P = .011) in favor of the Sieve algorithm. Triage duration did not differ significantly between the Sieve (mean 43 minutes, SD = 10) and SwissPre (mean 46 minutes, SD = 23) groups, with a mean difference of three minutes (95%CI, −12 to 6; P = .507).

The simpler Sieve algorithm may slightly outperform the more complex SwissPre in accurately categorizing critically injured patients who would likely die within 60 minutes if left untreated. No significant difference was observed in triage speed. However, these exploratory findings should be interpreted cautiously, considering the mean difference was modest and the controlled simulated setting, limiting generalizability.

The Syrian Civil War (SCW) began in 2011 and has resulted in numerous cases of war-related civilian injuries. The modified Rapid Emergency Medicine Score (mREMS) is widely used as an effective tool for assessing clinical status and mortality risk, particularly in intensive care units (ICUs) and emergency departments (EDs). However, to date, no study has evaluated the ability of mREMS to predict mortality in patients injured during the SCW.

The primary objective of this study was to evaluate the performance of mREMS in predicting in-hospital mortality among adult trauma patients injured during the SCW. The secondary objective was to analyze the epidemiological characteristics of both adult and pediatric populations affected by the SCW.

This single-center, retrospective observational study included patients who were injured during the SCW and presented to the ED from January 2012 through January 2016. Data from 4,074 adult patients and 1,379 pediatric patients were analyzed. The diagnostic and prognostic performance of the mREMS was specifically assessed in the adult cohort. Additionally, an epidemiological evaluation of the demographic and clinical characteristics of both cohorts was conducted.

Among the 4,074 adult patients included in the study, a total of 3,657 (89.8%) were male and 417 (10.2%) were female. In-hospital mortality occurred in 484 patients (11.9%). Adult patients admitted to the ICU exhibited a mortality rate 7.6-times higher than those who were not admitted (odds ratio [OR] = 7.6; 95% confidence interval [CI], 6.2–9.3). The analysis of the mREMS revealed a median score of eight for survivors and fourteen for non-survivors, demonstrating a statistically significant difference (P < .001).

The present study demonstrated that the majority of civilians injured during the SCW were young males. Furthermore, this study’s findings indicated that the mREMS exhibits excellent performance in predicting in-hospital mortality among trauma patients injured during the SCW.

Targeted identification, effective triage, and rapid hemorrhage control are essential for optimal outcomes of mass-casualty incidents (MCIs). An important aspect of Emergency Medical Service (EMS) care is field triage, but this skill is difficult to teach, assess, and research.

This study assessed triage efficacy and hemorrhage control of emergency responders from different professions who used the Sort, Assess, Life-Saving Treatment (SALT) triage algorithm in a virtual reality (VR) simulation of a terrorist subway bombing.

After a brief just-in-time training session on the SALT triage algorithm, participants applied this learning in First VResponder, a high-fidelity VR simulator (Tactical Triage Technologies, LLC; Powell, Ohio USA). Participants encountered eleven virtual patients in a virtual scene of a subway station that had experienced an explosion. Patients represented individuals with injuries of varying severity. Metrics assessed included triage accuracy and treatment efficiency, including time to control life-threatening hemorrhage. Independent Mann-Whitney analyses were used to compare two professional groups on key performance variables.

The study assessed 282 participants from the ranks of EMS clinicians and medical trainees. Most (94%) participants correctly executed both global SALT sort commands. Participants triaged and treated the entire scene in a mean time of 7.8 decimal minutes, (95%CI, 7.6-8.1; SD = 1.9 decimal minutes) with a patient triage accuracy rate of 75.8% (95%CI, 74.0-77.6; SD = 15.0%). Approximately three-quarters (77%) of participants successfully controlled all life-threatening hemorrhage, within a mean time of 5.3 decimal minutes (95%CI, 5.1-5.5; SD = 1.7 decimal minutes). Mean time to hemorrhage control per patient was 0.349 decimal minutes (SD = 0.349 decimal minutes). Overall, EMS clinicians were more accurate with triage (P ≤ .001) and were faster at triage, total hemorrhage control (P < .01), and hemorrhage control per patient (P < .004) than medical trainees.

Through assessments using VR simulation, it was observed that more experienced individuals from the paramedic (PM) workforce out-performed less experienced medical trainees. The study also observed that the medical trainees performed acceptably, even though their only formal training in SALT triage was a 30-minute, just-in-time lecture. Both of these findings are important for establishing evidence that VR can serve as a valid platform for assessing the complex skills of triage and treatment of an MCI, including the assessment of rapid hemorrhage control.

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.

Understanding the disaster profile of WHO-regions is crucial for anticipating future needs for mobilizing emergency medical teams and enhancing healthcare surge during disasters.

This study provides an overview of disaster profile and associated health needs globally and regionally.

Secondary data were retrieved from multiple open data sources. 50-year disaster trends were assessed. Global and regional disaster patterns, cumulative crude and standardized incidence and health impact for the last 16 years were calculated, and regional disparities were compared.

Climate-related disasters have significantly increased globally, especially floods and storms. They, along with droughts, lead to the highest humanitarian needs and displacement, increasing healthcare demands. Conflicts, notably in the Eastern-Mediterranean region, have also increased, causing substantial health impacts.

Epidemics caused the highest morbidity and earthquakes caused the highest mortality, especially in fragile and conflict-affected states (FCAS), where disaster frequencies per population are significantly higher than in non-FCAS. Storms and extreme temperatures also contribute significantly to disaster-mortality, especially in Southeast-Asia and Europe.

Africa experienced the highest number of disasters, while the Western-Pacific bore the highest crude health impact. However, Southeast-Asia, Eastern-Mediterranean, and African regions - where access to healthcare is limited- showed a higher disaster incidence rate and health impact per 100,000 population. Within regions, disparities are prominent, with some FCAS exhibiting exceptionally high disaster rates and impacts, exceeding regional and global averages.

Investment in regional and national emergency medical teams and equivalent rapid response capacities, adapting tailored strategies to regional disaster profiles, is urgently needed, especially for FCAS in Southeast-Asia, Eastern-Mediterranean, Africa regions.

Powered equipment for patient handling was designed to alleviate Emergency Medical Service (EMS) clinician injuries while lifting patients. This project evaluated the organizational rationale for purchasing powered equipment and the outcomes from equipment use.

This project analyzed secondary data obtained via an insurance Safety Intervention Grant (SIG) program in Ohio USA. These data were primarily in reports from EMS organizations. Investigators applied a mixed-methods approach, analyzing quantitative data from 297 grants and qualitative data from a sample of 64 grants. Analysts abstracted data related to: work-related injuries or risk of musculoskeletal-disorders (MSD), employee feedback regarding acceptance or rejection, and impact on quality, productivity, staffing, and cost.

A total of $16.67 million (2018 adjusted USD) was spent from 2005 through 2018 for powered cots, powered loading systems, powered stair chairs, and non-patient handling equipment (eg, chest compression system, powered roller). Organizations purchased equipment to accommodate staff demographics (height, age, sex) and patient characteristics (weight, impairments). Grantees were fire departments (n = 254) and public (n = 19) and private (n = 24) EMS organizations consisting of career (45%), volunteer (20%), and a combination of career and volunteer (35%) staff. Powered equipment reduced reported musculoskeletal injuries, and organizations reported it improved EMS clinicians’ safety. Organization feedback was mostly positive, and no organization indicated outright rejection of the purchased equipment. Analyst-identified design advantages for powered cots included increased patient weight capacity and hydraulic features, but the greater weight of the powered cot was a disadvantage. The locking mechanism to hold the cot during transportation was reported as an advantage, but it was a disadvantage for older cots without a compatibility conversion kit. Around one-half of organizations described a positive impact on quality of care and patient safety resulting from the new equipment.

Overall, organizations reported improved EMS clinicians’ safety but noted that not all safety concerns were addressed by the new equipment.

The dynamic nature of the prehospital environment poses a challenge for maintaining optimal storage conditions for medicines and other products. Failure to ensure adequate temperature control can impact drug efficacy, potentially compromising effective prehospital care. This study aims to monitor temperature variations in vehicles operated by a helicopter Emergency Medical Service (EMS) in the east of England to evaluate temperature variation and the potential exposure of therapeutic products to extreme temperatures.

This was a prospective observational study over a 12-month period (September 2022 through August 2023). ALTA Industrial Wireless temperature sensors were deployed across five Volvo XC90 rapid response vehicles (RRVs) and an AgustaWestland 169 (AW169) helicopter operated by Essex & Herts Air Ambulance (EHAAT). One RRV (RRV02) remained permanently outside for the period of observation. Sensors recorded at 30-minute intervals, triggering alerts if temperatures exceeded 25°C or dropped below 2°C. Ambient data were obtained from the Writtle Weather Station, via the Met Office Integrated Data Archive System (MIDAS). The study did not involve any patients and ethical board review was not required.

A total of 102,524 readings were recorded; temperatures ranged from −9°C to 46.8°C. The RRV02 recorded the lowest monthly mean (7.9°C) while the AW169 recorded the highest (24.9°C). Overall, daily maximum temperatures ranged from 17.7°C to 46.8°C, with the AW169 reaching 46.8°C in May. Daily minimum values ranged from −9°C to 19.6°C, with the RRV02 recording −9°C in December.

Temperatures inside the vehicles and aircraft frequently exceed recommended limits for environmental temperatures. Indoor RRV storage provides some protection from extreme temperatures, particularly mitigating against low temperatures. The AW169 aircraft demonstrated the poorest overall temperature control. These results can be used to guide effective storage protocols and climate control strategies to ensure the integrity of therapeutic products.

For suspected acute myocardial infarction (AMI) and unstable angina patients, prehospital aspirin (ASA) administration has been the standard of care by Emergency Medical Services (EMS) field providers. Recently, Emergency Medical Dispatchers (EMDs), using Medical Priority Dispatch System (MPDS), provide telephone instructions to qualifying suspected AMI patients to take ASA, prior to EMS field provider arrival. No formal studies exist that measure time saved from earlier Dispatcher-Directed Aspirin Administration (DDAA).

The primary objectives of the study were: (1) to determine the amount of time saved, if any, using DDAA; and (2) to describe the frequency of DDAA and Field Provider-Directed Aspirin Administration (FPAA).

The retrospective study analyzed EMD and EMS data collected during a six-month period at three dispatch services and three EMS agencies in the United States. The frequency and mean (plus 95% confidence interval [CI]) time of DDAA and FPAA were calculated. Reasons why patients who qualified to take ASA per dispatch protocol but did not take it were also assessed.

A total of 108,459 EMS cases were analyzed; EMD/EMS delivered ASA to 4.0% (n = 4,113) of these patients. The most frequent primary impressions were: cardiac chest pain (angina), cardiovascular (CV)-chest pain (presumed cardiac), ST-segment elevation myocardial infarction (STEMI), and CV-chest pain – acute coronary syndrome (ACS; 50.0%). Overall, DDAA saved 13 minutes mean time (95% CI, 11.4-14.6; P < .001) (median: 12.3 minutes) from the case creation time.

It was found that DDAA provides measurable time savings in ASA delivery to patients. Further studies will need to assess if the reduction of ASA delivery time by EMDs has the potential to improve overall care and survival for patients. The study identified beneficial new knowledge for possible future enhancements to medical dispatch protocols and for EMS providers.

Many Emergency Medical Services (EMS) agencies modified their protocols during the height of the COVID-19 pandemic, particularly those involving procedures that lead to an increased risk of airborne exposure, such as intubation. In 2020, local Advanced Life Support (ALS) providers’ first-line airway management device was the supraglottic airway (SGA), and tracheal intubations (TIs) were rarely performed.

This study’s aim was to investigate the potential clinical effect of this pandemic-related protocol change on first-pass TI success rates and on overall initial advanced airway placement success.

This study was a retrospective prehospital chart review for all ALS encounters from a single urban EMS agency that resulted in the out-of-hospital placement of at least one advanced airway per encounter from January 1, 2019 through June 30, 2021 (n = 452). Descriptive statistics and chi square tests were used to evaluate data. Statistical significance was defined at P < .05.

Significantly fewer TIs were attempted in 2020 (n = 16) compared to 2019 (n = 80; P < .001), and first-pass TI success rates significantly decreased in 2021 (n = 22; 61.1%) compared to 2019 (n = 63; 78.8%; P = .047). Also, SGA placement constituted 91.2% of all initial airway management attempts in 2020 (n = 165), more than both 2019 (n = 114; 58.8%; P < .001) and 2021 (n = 87; 70.7%; P < .001). Overall first-attempt advanced airway placement success, encompassing both supraglottic and TI, increased from 2019 (n = 169; 87.1%) to 2020 (n = 170; 93.9%; P = .025). Conversely, overall first attempt advanced airway placement success decreased from 2020 to 2021 (n = 104; 84.6%; P = .0072).

Lack of exposure to TI during the COVID-19 pandemic likely contributed to this local agency’s decreased first-pass TI success in 2021. Moving forward, agencies should utilize simulation labs and other continuing education efforts to help maintain prehospital providers’ proficiency in performing this critical procedure, particularly when protocol changes temporarily hinder or prohibit field-based psychomotor skill development.

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.

Patients with thoracic trauma require rapid decision making and early intervention, especially during natural disasters when the influx of patients complicates hospitalization decisions. Identifying the characteristics of these patients can improve triage protocols, optimize resource allocation, and enhance outcomes in future disaster scenarios.

The aim of this study was to determine the characteristics of hospitalized patients after the February 2023 earthquakes in Türkiye and to contribute to Disaster Medicine.

This retrospective, cross-sectional study was conducted in a university hospital’s emergency department (ED) located in the earthquake area. All patients over 18 years old with earthquake-related thoracic trauma were included. Demographic information, mechanisms of injury, associated injuries, laboratory results, and treatments were recorded. Patients were divided into two groups: discharged and hospitalized.

The study included 179 patients, with a median age of 45 years. Overall, 80.4% were trapped under debris, and 43.8% were rescued on the first day. Hospitalization rates were higher in patients trapped under debris and those rescued after the first day. Blunt thoracic trauma was observed in 95.5% of patients. One hundred and three patients (57.5%) underwent Extended Focused Assessment with Sonography in Trauma (E-FAST) in the ED, 152 patients (84.9%) underwent x-ray, and 129 patients (72.1%) underwent computed tomography (CT). Imaging studies revealed rib fractures in 49.7% and lung parenchymal injuries in 48.6% of patients. Patients with lung parenchymal injury had higher hospitalizations rates. Hospitalized patients had higher levels of white blood cells (WBCs), potassium, blood urea nitrogen (BUN), creatinine, creatinine kinase (CK), creatine kinase-myocardial band (CKMB), and troponin I.

This study highlights the prevalence of blunt thoracic trauma and the importance of imaging in the assessment of thoracic injuries following earthquakes. While few patients needed surgery, many required hospitalizations and had abnormal laboratory results, emphasizing the need for careful monitoring for complications like muscle damage and infection.

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.