To quantitatively assess key performance indicator changes between selected pre-pandemic and pandemic periods at the Sant’Anna Hospital emergency department (ED) in Como, Italy through the retrospective use of Hospital Surge Preparedness and Response index (HSPRI).

This study collected the average length of stay (LOS), time-to-physician initial assessment (TPIA), and left-without-being seen (LWBS) rates for 2 pre-pandemic (control group) and 3 pandemic periods (study group) in the COVID ED (C-ED) dedicated to treat COVID-19 patients and the non-COVID ED (NC-ED) dedicated to non-COVID cases. Quantitative analysis was based on hypothesis testing. A retrospective qualitative theme and subtheme analysis based on the HSPRI was conducted on baseline strategies before each pandemic period and on the actions implemented thereafter.

LOS increased across all pandemic periods. TPIA decreased in the first 2 pandemic periods in comparison to pre-pandemic. LWBS decreased between pre-pandemic and pandemic periods. Of the 22 action items listed in the HSPRI, 8 were implemented in the first pandemic period, 8 in the second and 1 in the third, for a total of 17 items.

The HSPRI demonstrated value as a tool for a hospital staff to actively utilize during a pandemic to identify KPI triggers to formulate actions to maintain pre-pandemic care or ameliorate the deterioration of care during the pandemic.

The scoping review aims to provide an overview of the existing literature to inform an understanding of pharmacists’ roles, skills, and knowledge requirements for Emergency Medical Teams responding to disasters or humanitarian crises.

The methodology utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, with methodology adapted by the Joanna Briggs Institute. Six databases were searched for sources published after 2000: PubMed, Mednar, Scopus, Defense Technical Information Centre, LILACS, and CINAHL. A manual search of grey literature was conducted to discover additional sources of information outside of the electronic databases.

Of the 427 initial studies and reports, 36 were selected for inclusion. Five key themes on role requirements were identified: supply chain management; establishment and operationalization of pharmacies; stakeholder communication, collaboration, and liaison; direct patient care; and response management and coordination. Each theme was delineated into subthemes linked with requisite skills and knowledge.

This scoping review identifies key roles, skills, and knowledge requirements of pharmacist contributions to Emergency Medical Teams responding to disasters or emergencies.

The SDMPH 10-year anniversary conference created an opportunity for a researcher to present at a professional association conference to advance their research by seeking consensus of statements using Delphi methodology.

Conference attendees and SDMPH members who did not attend the conference were identified as Delphi experts. Experts rated their agreement of each statement on a 7- point linear numeric scale. Consensus amongst experts was defined as a standard deviation < = 1. Presenters submitted statements relevant to advancing their research to the authors to edit to fit Delphi statement formatting.

Statements attaining consensus were included in the final report after the first round. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for opportunity to reconsider their rating for that round. If reconsideration attained consensus, these statements were included in the final report. This process repeated in a third and final round.

37 Experts agreed to participate in the first round; 35 completed the second round, and 34 completed the third round; 35 statements attained consensus; 3 statements did not attain consensus.

A Delphi technique was used to establish expert consensus of statements submitted by the SDMPH conference presenters to guide their future education, research, and training.

In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of-care ultrasound (POCUS) on the accuracy of secondary triage conducted at an advanced medical post (AMP) to enhance the detection of patients who, despite their apparent clinically stable condition, could benefit from immediate life-saving interventions or priority earlier transport to definitive care.

A mass casualty simulated event consisting of a bomb blast in a remote area was conducted with 10 simulated casualties classified as YELLOW at the primary triage scene; patients were evaluated by 4 physicians at an AMP. Three patients had, respectively, hemoperitoneum, pneumothorax, and hemothorax. Two of the four physicians were provided the use of POCUS.

All 4 physicians were able to suspect hemoperitoneum, but only physicians utilizing POCUS detected pneumothorax and hemothorax.

This study suggests that POCUS-enhanced secondary MCI triage at an AMP may represent an effective methodology to accurately detect nonapparent injuries that require time-dependent priority transport or life-saving interventions. Further studies with larger samples conducted in varied MCI scenarios are warranted.

Mass casualty incidents (MCIs) come unannounced, mandating the immediate shift from the daily routine to crisis mode through the implementation of an MCI response plan (plan). On August 4, 2020, a massive explosion devastated the Lebanese capital, Beirut, causing 8643 injuries and 200 deaths.1 The private Lebanese American University Medical Center in Beirut has an an estimated 10,000 emergency department (ED) visits per year. The purpose of this study is to analyse the plan of this private hospital in a low resource country in response to a blast MCI.

A retrospective analysis of the expected outcome of the pre-existing plan was performed.

Major flaws were noted. Triage was impossible using the START method and will be done outside the ED dividing patients into walking and non-walking. Identification and registration of patients was impossible. Patients will be assigned a number and be registered later. Colored jackets were created to recognize response team members for better organization.t Radiologic imaging will be ordered only when they change the patients’ disposition.

This analysis showed failure of the plan at different levels and adjustments were made to advance the plan. Periodic exercises and annual review are needed for continuous improvement.

To perform a scoping review identifying the criteria for the deployment of the United States National Guard (USNG) to domestic sudden-onset natural disasters to identify the body of literature on which further research and policy decisions may be based.

On January 23, 2023 authors performed a search to identify texts relevant to the involvement of the USNG response to sudden-onset domestic natural disasters. English language texts from any year were considered. Independent reviewers screened titles and abstracts, then full-texts, then extracted data from included texts.

From 886 search results, 34 texts were included. Fifteen criteria for USNG deployment were identified. Lack of security, power failure, and logistical coordination were the most common criteria. Hurricanes were the most common disaster type in the included results.

Disaster response coordinators may use these results to develop policies optimizing the use of the USNG in disaster response.

Asymmetric warfare, conflict and terrorist attacks involving children raise concerns regarding the preparedness to respond to mass casualty incidents involving pediatric patients. The objective of this project was to assess the resources available in the metropolitan Milan area to develop a priority dispatch plan for a mass casualty incident with pediatric patients.

A focused search of the medical literature and clinical guidelines established a minimal standard requirements of care of pediatric patients involved in an MCI to determine the surge capabilities in terms of number of patients and severity of injuries for each study hospital in the metropolitan Milan area.

The hospitals that took part in the study were either adult trauma centers or pediatric hospitals in the metropolitan Milan area. The overall surge capability identified was of 40-44 pediatric patients involved in an MCI involving pediatric patients, distributed based on age and severity and based on the hospital resources and expertise.

The findings from the metropolitan Milan area shows the basis for non-Pediatric Trauma Center adult and pediatric hospitals to work in synergy to develop MCI response plans involving pediatric patients. Simulations exercises will need to be carried out to evaluate and validate the plans.

While many medical practitioners value the interactive nature of in-person conferences, results of these interactions are often poorly documented. The objective of this study was to pilot the Delphi method for developing consensus following a national conference and to compare the results between experts who did and did not attend.

A 3-round Delphi included experts attending the 2023 Society of Disaster Medicine and Health Preparedness Annual Meeting and experts who were members of the society but did not attend. Conference speakers provided statements related to their presentations. Experts rated the statements on a 1–7 scale for agreement using STAT59 software (STAT59 Services Ltd, Edmonton, Alberta, Canada). Consensus was defined as a standard deviation of ≤ 1.0.

Seventy-five statements were rated by 27 experts who attended and 10 who did not: 2634 ratings in total. There was no difference in the number of statements reaching consensus in the attending group (26/75) versus that of the nonattending group (27/75) (P = 0.89). However, which statements reached consensus differed between the groups.

The Delphi method is a viable method to document consensus from a conference. Advantages include the ability to involve large groups of experts, statistical measurement of the degree of consensus, and prioritization of the results.

A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder (FR) competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain FR competencies. The translational science (TS) T0 question was asked: how can FRs achieve similar MCI competencies as a FSEx through the use of MCI simulation exercises?

T1 stage (Scoping Review): PRISMA-ScR was conducted to develop statements for the T2 stage modified Delphi (mD) study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.

T2 stage (mD study): Selected experts were presented with 27 statements derived from T1 data with instruction to rank each statement on a 7-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤ 1.0.

After 3 mD rounds, 19 statements attained consensus and 8 did not attain consensus.

MCI simulation exercises can be developed to achieve similar competencies as FSEx by incorporating the 19 statements that attained consensus through the TS stages of a scoping review (T1) and mD study (T2), and continuing to T3 implementation, and then T4 evaluation stages.

While there are accepted triage and treatment guidelines for the entrapped and mangled extremity in civilian and military resource rich environments, there are none for resource-scarce environments.

A PRISMA systematic literature review was performed to elucidate the current triage and treatment of the entrapped and mangled extremity to understand the factors that contribute to the decision to amputate, or not amputate, and to extract data to develop clinical guidelines.

A lead researcher followed the PRISMA systematic literature review search strategy inclusion and exclusion criteria.

A first reviewer was randomly assigned sources. One of the two lead researchers was the second reviewer. Each determined the Level of Evidence (LOE) and Quality of Evidence (QE) from each source.

Five-hundred ninety-seven (597) records were screened. Fifty-eight (58) articles were entered into the final study. There was one study determined to be LOE-1, 29 LOE-2, and 28 LOE-3 with 15 determined to achieve QE-1, 37 QE-2, and six QE-3.

Data extracted included relevant information to develop clinical guidelines to include physiologic parameters, injury patterns or procedures, imaging, rehabilitation, ethics, and the informed consent process.

This systematic literature review showed that there is a lack of studies producing strong evidence to support the triage and treatment of an entrapped or mangled extremity in resource-scarce environments. A Delphi method study is suggested to adapt and modify available evidence extracted to create clinical guidelines in the resource-scarce environment.

Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments. Whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSE).

What is appropriate SMR in RSE?

The first round of this Modified Delphi (mD) study was a structured focus group. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the 20 mD statements presented to the experts.

Experts rated their agreement with each statement on a scale from one to seven. Consensus amongst experts was defined as SD≤1.0. Statements that were in agreement reaching consensus were included in the final report. Those not reaching consensus advanced to the next mD round.

For these subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement.

Twenty-two experts completed the first mD round, 19 completed the second mD round, and 16 completed the third mD round. Eleven statements reached consensus (Table 1). Nine statements did not reach consensus (Table 2).

Experts reached consensus offering 11 statements to be incorporated into the creation of SMR clinical guidelines in RSE.

Tables and Figures (optional)

Table 1.

Table 2.

Asymmetric warfare and the reaction to its threats have implications in the way far-forward medical assistance is provided in such settings. Investments in far-forward emergency resuscitation and stabilization can contribute to saving lives and increase the resilience of health systems. Thus, it is proposed to extend the use of the Haddon Matrix to determine a set of strategies to better understand and prioritize activities to prepare for and set-up frontline care in the form of Trauma Stabilization Points (TSPs).

An expert consensus methodology was used to achieve the research aim. A small subject matter experts’ group was convened to create and validate the content of the Haddon Matrix.

The result of the expert group consultations presented an overview of TSP Preparedness and Operational Readiness activities within a Haddon Matrix framework. Main strategies to be adopted within the cycle from pre- to post-event had been identified and presented considering the identified opportunities in the context of the possibility of implementation. Of particular importance was the revision of a curriculum that fits the civilian medical system and facilitates its adaptation to the context and available resources.

The new framework to enhance frontline care preparedness and response using the Haddon Matrix facilitated the identification of a set of strategies to support frontline health care workers in a more efficient manner. Since the existing approach and tools are insufficient for modern warfare, additional research is needed.

In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of-care ultrasound on the accuracy of secondary triage conducted at an advanced medical post to enhance the detection of patients who, despite their apparent clinically stable condition, could benefit from earlier evacuation to definitive care or immediate life-saving treatment.

A mass casualty simulated event consisting of a bomb blast in a remote area was conducted with 10 simulated casualties classified as YELLOW at the primary triage scene; patients were evaluated by 4 physicians at an advanced medical post. Three patients had, respectively, hemoperitoneum, pneumothorax, and hemothorax. Only 2 physicians had sonographic information.

All 4 physicians were able to suspect hemoperitoneum as a possible critical condition to be managed first, but only physicians with additional sonographic information accurately detected pneumothorax and hemothorax, thus deciding to immediately evacuate or treat.

Hospitals are expected to operate at a high performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. This becomes particularly evident during the on-going coronavirus disease 2019 (COVID-19) pandemic. More resilient resource allocation strategies, that is, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital’s adaptive resource allocation strategies in responding to a sudden onset disaster mass casualty incident (MCI).

A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan.

In the daytime scenario, during the recovery phase of the disaster, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies.

The present study offers a robust approach, effective strategies and new insights to design more resilient plans to cope with MCIs. It becomes particularly relevant when considering the risk of indirect damage of emergencies, where all the available resources are shifted from the care of the ordinary to the “disaster” patients, like during the on-going COVID-19 pandemic. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities such as operational coordination mechanisms among multiple hospitals in the same geographic area.