Original Research
The Development of PRIMA - A Belgian Prediction Model for Patient Encounters at Mass Gatherings
- Kris Spaepen, Winne AP Haenen, Ives Hubloue
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- Published online by Cambridge University Press:
- 29 July 2020, pp. 554-560
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Introduction:
Mass gatherings (MGs) grow in frequency around the world. With the intrinsic potential for significant health risks for all involved, MGs pose a challenge for those responsible for the provision of on-site medical care. Belgian law obliges local governments to identify and analyze the risks involving a MG. Though medical risk factors are long known, all too often, resourcing for in-event health services is based on anecdotal and previous experiences.
Problem:Despite the fast-evolving science on MGs, the lack of reliable tools – based on empirical and analytical approaches – to predict patient presentation rates (PPRs) at MGs remains.
Methods:A two-step method was followed to develop, update, and support a Plan Risk Manifestation (PRIMA) program. First, a continuous systematic literature review was conducted. Once developed, the model was run using data obtained from Belgian Federal Public Service (FPS; Brussels, Belgium) Health, Food Chain Safety, and Environment (HFCSE); event organizers; and municipalities.
Results:In total, 231 studies and documents were included to form the program. With the data provided, three variables were computed to run the calculation model to predict the PPR. Three medical risk axes were defined for this model: (1) isolation risk; (2) population risk; and (3) risk at illness. A combined dataset was derived from the prediction of the PRIMA program combined with the actual data obtained after the MG. This proved a solid basis for the calculation model of the PRIMA program.
Conclusion:Despite that validation is needed, the PRIMA program and its prediction model for PPRs at MGs carries the promise of a general, applicable prediction and risk analysis tool for a multitude of events.
Systematic Review
Psychosocial Influences on Patient Presentations: Considerations for Research and Evaluation at Mass-Gathering Events
- Alison Hutton, Jamie Ranse, Katherine Lena Gray, Sheila Turris, Adam Lund, Matthew Brendan Munn
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- 31 January 2020, pp. 197-205
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Aim:
This review discusses the need for consistency in mass-gathering research and evaluation from a psychosocial perspective.
Background:Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to determine required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A standardized approach to data collection is important to identify a consistent reporting standard for the psychosocial domain.
Method:This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing minimum data set as a framework.
Results:In total, 31 manuscripts met the inclusion criteria. The main variables identified were use of alcohol or drugs, crowd behavior, crowd mood, rationale, and length of stay.
Conclusion:Upon interrogating the literature, the authors have determined that the variables fall under the categories of alcohol or drugs; maladaptive and adaptive behaviors; crowd behavior, crowd culture, and crowd mood; reason for attending event (motivation); duration; and crowd demographics. In collecting psychosocial data from mass gatherings, an agreed-upon set of variables that can be used to collect de-identified psychosocial variables for the purpose of making comparisons across societies for mass-gathering events (MGEs) would be invaluable to researchers and event clinicians.
Special Report
Disaster Planning for Homeless Populations: Analysis and Recommendations for Communities
- Stephen C. Morris
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- Published online by Cambridge University Press:
- 04 March 2020, pp. 322-325
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Homelessness is a growing problem, with perhaps greater than a 150 million homeless people globally. The global community has prioritized the problem, as eradicating homelessness is one of the United Nation’s sustainability goals of 2030. Homelessness is a variable entity with individual, population, cultural, and regional characteristics complicating emergency preparedness. Overall, there are many factors that make homeless individuals and populations more vulnerable to disasters. These include, but are not limited to: shelter concerns, transportation, acute and chronic financial and material resource constraints, mental and physical health concerns, violence, and substance abuse. As such, homeless population classification as a special or vulnerable population with regard to disaster planning is well-accepted. Much work has been done regarding best practices of accounting for and accommodating special populations in all aspects of disaster management. Utilizing what is understood of homeless populations and emergency management for special populations, a review of disaster planning with recommendations for communities was conducted. Much of the literature on this subject generates from urban homeless in the United States, but it is assumed that some lessons learned and guidance will be translatable to other communities and settings.
Brief Report
Rationale for Military Involvement in Humanitarian Assistance and Disaster Relief
- Deon V. Canyon, Benjamin J. Ryan, Frederick M. Burkle, Jr
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- 06 December 2019, pp. 92-97
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Good relations and trust are the foundation of soft power diplomacy and are essential for the accomplishment of domestic interventions and any bilateral or multilateral endeavor. Military use for assistance and relief is not a novel concept, but it has increased since the early 1990s with many governments choosing to provide greater numbers of forces and assets to assist domestically and internationally. The increase is due to the growing lack of capacity in global humanitarian networks and increasingly inadequate resources available to undertake United Nations humanitarian assistance and disaster relief (HADR) missions. In response, the military has been more proactive in pursuing the improvement of military-to-military and military-to-civilian integration. This trend reflects a move towards more advanced and comprehensive approaches to security cooperation and requires increased support from the civilian humanitarian sector to help meet the needs of the most vulnerable. Military assistance is progressing beyond traditional methods to place a higher value on issues relating to civil cooperation, restoring public health infrastructure, protection, and human rights, all of which are ensuring a permanent diplomatic role for this soft power approach.
Special Report
Developing New Information Sheets for Evacuees and Evacuation Centers to be Used During All Natural Disaster Phases
- Hiroyuki Kitano, Mayumi Kako, Kazuhiro Tsuga, Hiroki Nikawa, Yukio Mikami, Hidehisa Yamashita, Minako Mori, Hiroki Ohge
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- 15 September 2020, pp. 683-687
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Introduction:
Evacuees’ quality of life can be improved by investigating both their health problems and the conditions of evacuation centers during natural disasters.
Study Objective:This study aims to develop new evacuee and evacuation center information sheets that focus on infection control, oral health and dentures, mental health, and rehabilitation during natural disasters.
Methods:The analysis was conducted with the Delphi method by questioning doctors from various fields (infectious disease, psychiatry, rehabilitation, and dentistry) about the information that may be needed for evacuees and in the evacuation center environment.
Results:Two information sheets were created in this study. One is an evacuation center environmental health assessment sheet that includes information about the overview of evacuees’ health and the evacuation center environment. The other is an evacuee registration sheet that would be completed by the evacuees themselves.
Conclusion:The information sheets developed in this study will be useful in times of disaster because they have the potential to improve evacuee health conditions, as well as evacuation center environments.
Systematic Review
The Impact of Mass Gatherings on Emergency Department Patient Presentations with Communicable Diseases Related to Syndromic Indicators: An Integrative Review
- Yunjing (Shirley) Qiu, Julia Crilly, Peta-Anne Zimmerman, Jamie Ranse
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- 19 February 2020, pp. 206-211
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Background:
Mass-gathering events (MGEs) are commonly associated with a higher than average rate of morbidity. Spectators, workers, and the substantial number of MGE attendees can increase the spread of communicable diseases. During an MGE, emergency departments (EDs) play an important role in offering health care services to both residents of the local community and event attendees. Syndromic indicators (SIs) are widely used in an ED surveillance system for early detection of communicable diseases.
Aim:This literature review aimed to develop an understanding of the effect of MGEs on ED patient presentations with communicable diseases and their corresponding SIs.
Method:An integrative literature review methodology was used. Online databases were searched to retrieve relevant academic articles that focused on MGEs, EDs, and SIs. Inclusion/exclusion criteria were applied to screen articles. The Standard Quality Assessment Criteria for Evaluating Primary Research (QualSyst) assessment tool was used to assess the quality of included papers.
Results:Eleven papers were included in this review; all discussed the impact of an MGE on patient presentations with communicable diseases at EDs/hospitals. Most included studies used the raw number of patients who presented or were admitted to EDs/hospitals to determine impact. Further, the majority of studies focused on either respiratory infections (n = 4) or gastrointestinal infections (n = 2); two articles reported on both. Eight articles mentioned SIs; however, such information was limited. The quality of evidence (using QualSyst) ranged from 50% to 90%.
Conclusions:Limited research exists on the impact of MGEs on ED presentations with communicable diseases and related SIs. Recommendations for future MGE studies include assessing differences in ED presentations with communicable diseases regarding demographics, clinical characteristics, and outcomes before, during, and after the event. This would benefit health care workers and researchers by offering more comprehensive knowledge for application into practice.
Original Research
Validation of a Belgian Prediction Model for Patient Encounters at Music Mass Gatherings
- Kris Spaepen, Winne AP Haenen, Leonard Kaufman, Kevin Beens, Philippe Vandekerckhove, Ives Hubloue
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- Published online by Cambridge University Press:
- 29 July 2020, pp. 561-566
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Introduction:
A Belgian predictive medical resource tool, Plan Risk Manifestations (PRIMA), for the prediction of the number of patient encounters at mass gatherings (MGs) has recently been developed, in addition to the existing models of Arbon and Hartman. This study presents the results of the validation process for the PRIMA model for music MGs.
Methods:A retrospective study was conducted using data gathered from music MGs in the province of Antwerp (Belgium) during the period of 2012-2016. Data from 87 music MGs were used for the study. The forecast of medical resources for these events was determined by entering the characteristics of individual events into the Arbon, Hartman, and PRIMA models. In order to determine if the PRIMA model is under- or over-predictive, the data gathered were retrospectively compared to the predicted number of resources needed using the aforementioned models. Statistical analysis included means, medians, and interquartile ranges (IQRs). Nonparametric related samples test (Wilcoxon Samples Signed Rank Test) for comparison of the median in deviations in predictions of patient presentation rates (PPRs) was performed using SPSS version 23 (IBM Corp.; Armonk, New York USA). Confidence interval levels were set at 95% and results were deemed statistically significant at P <.05. This triple comparison was used to determine the overall performance of all three models.
Results:All three models had an acceptable rate of over-prediction of number of patient encounters ([Arbon 25.29%; 95% CI, 30.91-43.74]; [Hartman 29.89%; 95% CI, 57.10-68.90]; and [PRIMA 19.54%; 95% CI, 57.80-76.20]). But all models also had a high rate of under-prediction of number of patient encounters ([Arbon 74.71%; 95% CI, 453.31-752.52]; [Hartman 70.11%; 95% CI, 546.90-873.77]; and [PRIMA 78.16%; 95% CI, 288.91-464.89]). Only the PRIMA model succeeded in the correct prediction of the number of patient encounters on two occasions (2.3%).
Conclusion:Results of this study are in-line with existing literature. When comparing the predicted patient encounters, all three models had high rates of under-prediction and moderate rates of over-prediction. When comparing mean deviations, the PRIMA model had the lowest mean deviation of all predicted PPRs. Belgian events of the types included in the presented data may use the PRIMA model with confidence to predict PPRs and estimate the in-event health services (IEHS) requirements.
Brief Report
Epidemiological and Accounting Analysis of Ground Ambulance Whole Blood Transfusion
- Julian G. Mapp, Eric A. Bank, Lesley A. Osborn, Michael L. Stringfellow, David W. Reininger, Christopher J. Winckler, Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME2) Group
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- 18 December 2019, pp. 98-103
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Introduction:
In October 2017, the American Association of Blood Bankers (AABB; Bethesda, Maryland USA) approved a petition to allow low-titer group O whole blood as a standard product without the need for a waiver. Around that time, a few Texas, USA-based Emergency Medical Services (EMS) systems incorporated whole blood into their ground ambulances. The purpose of this project was to describe the epidemiology of ground ambulance patients that received a prehospital whole blood transfusion. The secondary aim of this project was to report an accounting analysis of these ground ambulance prehospital whole blood programs.
Methods:The dataset came from the Harris County Emergency Service District 48 Fire Department (HCESD 48; Harris County, Texas USA) and San Antonio Fire Department (SAFD; San Antonio, Texas USA) whole blood Quality Assurance/Quality Improvement (QA/QI) databases from September 2017 through December 2018. The primary outcome of this study was the prehospital transfusion indication. The secondary outcome was the projected cost per life saved during the first 10 years of the prehospital whole blood initiative.
Results:Of 58 consecutive prehospital whole blood administrations, the team included all 58 cases. Hemorrhagic shock from a non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. In the non-traumatic hemorrhagic shock cohort, gastrointestinal hemorrhage was the underlying etiology of hemorrhagic shock in 66.7% (95% CI, 47.8%-81.4%) of prehospital whole blood transfusion recipients. The projected average cost to save a life in Year 10 was US$5,136.51 for the combined cohort, US$4,512.69 for HCESD 48, and US$5,243.72 for SAFD EMS.
Conclusion:This retrospective analysis of ground ambulance patients that receive prehospital whole blood transfusion found that non-traumatic etiology accounted for 46.5% (95% CI, 34.3%-59.2%) of prehospital whole blood recipients. Additionally, the accounting analysis suggests that by Year 10 of a ground ambulance whole blood transfusion program, the average cost to save a life will be approximately US$5,136.51.
Special Report
Common Domains of Core Competencies for Hospital Health Care Providers in Armed Conflict Zones: A Systematic Scoping Review
- Zakaria A. Mani, Lisa Kuhn, Virginia Plummer
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- Published online by Cambridge University Press:
- 27 April 2020, pp. 442-446
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Introduction:
High rates of mortality and morbidity result from disasters of all types, including armed conflicts. Overwhelming numbers of casualties with a myriad of illnesses and patterns of injuries are common in armed conflicts, leading to unpredictable workloads for hospital health care providers (HCPs). Identifying domains of hospital HCPs’ core competency for armed conflicts is essential to inform standards of care, educational requirements, and to facilitate the translation of knowledge into safe and quality care.
Objective:The objective of this study is to identify the common domains of core competencies among HCPs working in hospitals in armed conflict areas.
Methods:A scoping review was conducted using the Joanna Briggs Institute framework. The review considered primary research and peer-reviewed literature from the following databases: Ovid Medline, Ovid EmCare, Embase, and CINAHL, as well as the reference lists of articles identified for full-text review. Eligibility criteria were outlined a priori to guide the literature selection.
Results:Four articles met the inclusion criteria. The studies were conducted in different countries and were published from 2011 through 2017. The methods included three surveys and one Delphi study.
Conclusion:This review maps the scope of knowledge, skills, and attitudes required by HCPs who are practicing in hospitals in areas of major armed conflict. Incorporation of identified core competency domains can improve the future planning, education, and training, and may enhance the HCPs’ response in armed conflicts.
General Practitioner House Call Network (SOS Médecins): An Essential Tool for Syndromic Surveillance – Bordeaux, France
- Laure Meurice, Thierry Chapon, Frédéric Chemin, Laurence Gourinchas, Stéphane Sauvagnac, Sébastien Uijttewaal, Stéphanie Vandentorren
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- Published online by Cambridge University Press:
- 05 March 2020, pp. 326-330
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Introduction:
In the French mainland administrative region Nouvelle-Aquitaine, syndromic surveillance is based on hospital emergency data, mortality data, and data from associations belonging to the SOS Médecins network. The aim of the present article is to describe the functioning of this network and to illustrate its use for syndromic surveillance in Nouvelle-Aquitaine.
Method:The SOS Médecins network participates in the syndromic surveillance system SurSaUD, developed by Santé publique France (SpF; the French National Public Health Agency; Saint-Maurice, Paris, France). Near real-time data are automatically transmitted daily to a data server and analyzed by SpF’s Nouvelle Aquitaine’s regional unit to identify, monitor, and evaluate the impact of expected and unexpected health events in the region.
Results:The SOS Médecins network has five local associations spread across the region with 146 participating physicians. Data have been recorded for more than 10 years and represented nearly 481,000 visits in 2017. The resulting database has helped to identify and monitor seasonal epidemics and unexpected events, as well as measure the health impact of these events.
Conclusion:The data from the SOS Médecins network are an essential source in syndromic surveillance. They complement surveillance data from other sources. More specifically, mortality and emergency unit traffic reflect the most severe cases, while SOS Médecins data help early detection of epidemics and health events in the general population. The network has shown its responsiveness and its reliability, not only for the surveillance of seasonal epidemics, but also for the detection of unusual signals. It therefore constitutes an essential link in syndromic surveillance in France, and specifically in the Nouvelle-Aquitaine region.
Prospective Study on the Potential Use of Satellite Data for Disaster Prevention, Preparedness, and Mitigation in Poland
- Krzysztof Goniewicz, Maciej Magiera, Frederick M. Burkle, Jr., Mariusz Goniewicz
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- 18 March 2020, pp. 331-334
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Considering climate change, the risk of natural disasters requires a comprehensive approach on the part of all entities dealing with crisis management. Despite the advanced technologies available to predict weather phenomena, it is often unmanageable to take remedial measures, and the best solution is to suitably prepare for, and efficiently operate after, the occurrence of any given crisis. Nevertheless, it is imperative to implement the latest techniques and solutions which will allow for better preparation and responsiveness in the event of natural disasters. This manuscript presents results of initial analysis concerning the currently tested project, which is aimed at, among other things, improving safety in the event of natural disasters in Poland. There were two reasons for creating the manuscript. First, to present the potential of the system currently being built in Poland, which aims to reduce the risks associated with natural disasters and minimize the problems related to crisis management in Poland. And second, to open discussions and create grounds for information exchange between countries implementing similar solutions, especially neighboring countries, with which joint actions could be taken in the event of disasters in border areas.
Consular Crisis Management Operations: Special Considerations and Challenges
- Karin Hugelius
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- Published online by Cambridge University Press:
- 29 May 2020, pp. 447-450
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Assisting the increasing number of tourists and foreign nationals exposed to crises situations in third countries—many of them far from home and extremely vulnerable—presents significant challenges. Despite the need to explore consular crisis management from an operational perspective, there are few studies that address the issue. This paper aims to describe the characteristics and context of consular crisis management operations based on personal experiences, scientific papers, grey literature, and key informant interviews.
Consular crisis management operations are conducted in a context where the stakeholders and the legal environment may differ from humanitarian or civil protection operations. The physical distance causes logistical challenges and demands specific considerations for both civilian and medical evacuation. Consular crisis management operations often include medical care, psychosocial support activities, and disaster victim identification (DVI) activities. Political and media interest may also add significant challenges to such operations. Therefore, specific knowledge, skills, and preparations are needed for both diplomatic crisis management professionals and health professionals. Further research on consular crisis management activities—as well as the concept of consular crisis management itself—is strongly needed.
Moral Distress among Disaster Responders: What is it?
- Martina E. Gustavsson, Filip K. Arnberg, Niklas Juth, Johan von Schreeb
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- Published online by Cambridge University Press:
- 28 January 2020, pp. 212-219
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Introduction:
Current research of moral distress is mainly derived from challenges within high-resource health care settings, and there is lack of clarity among the different definitions. Disaster responders are prone to a range of moral challenges during the work, which may give rise to moral distress. Further, organizations have considered increased drop-out rates and sick leaves among disaster responders as consequences of moral distress. Therefore, initiatives have been taken to address and understand the impacts of moral distress and its consequences for responders. Since there is unclarity among the different definitions, a first step is to understand the concept of moral distress and its interlinkages within the literature related to disaster responders.
Hypothesis/Problem:To examine how disaster responders are affected by moral challenges, systematic knowledge is needed about the concepts related to moral distress. This paper aims to elucidate how the concept of moral distress in disaster response is defined and explained in the literature.
Methods:The paper opted to systematically map the existing literature through the methods of a scoping review. The searches derived documents which were screened regarding specific inclusion criteria. The included 16 documents were analyzed and collated according to their definitions of moral distress or according to their descriptions of moral distress.
Results:The paper provides clarity among the different concepts and definitions of moral distress within disaster response. Several concepts exist that describe the outcomes of morally challenging situations, centering on situations when individuals are prevented from acting in accordance with their moral values. Their specific differences suggest that to achieve greater clarity in future work, moral stress and moral distress should be distinguished.
Conclusion:Based on the findings, a conceptual model of the development of moral distress was developed, which displays a manifestation of moral distress with the interplay between the responder and the context. The overview of the different concepts in this model can facilitate future research and be used to illuminate how the concepts are interrelated.
Case Report
A Late COVID-19 Complication: Male Sexual Dysfunction
- Saeed Shoar, Siamak Khavandi, Elsa Tabibzadeh, Aydin Vaez, Ali Khabbazi Oskouei, Fatemeh Hosseini, Mohammad Naderan, Nasrin Shoar
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- Published online by Cambridge University Press:
- 22 September 2020, pp. 688-689
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Since the beginning of the coronavirus infectious disease 2019 (COVID-19) pandemic, an exponentially large amount of data has been published to describe the pathology, clinical presentations, and outcomes in patients infected with the severe acute respiratory syndrome novel coronavirus 2 (SARS-CoV-2). Although COVID-19 has been shown to cause a systemic inflammation predisposing the involvement of multiple organs, its mechanism affecting the urogenital system has not been well-documented. This case report presents the clinical course of two male patients with COVID-19 who developed sexual dysfunction, as anorgasmia, following recovery from the infection. Although no evidence of viral replication or inflammatory involvement could be identified in these cases’ urogenital organs, a lack of other known risk factors for anorgasmia points to the role of COVID-19 as the contributing factor.
Systematic Review
Diagnostic Performance of Prehospital Point-of-Care Troponin Tests to Rule Out Acute Myocardial Infarction: A Systematic Review
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- Abdulrhman Alghamdi, Ahmed Alotaibi, Meshal Alharbi, Charles Reynard, Richard Body
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- Published online by Cambridge University Press:
- 09 July 2020, pp. 567-573
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Introduction:
Chest pain is one of the most common reasons for 999 calls and transfers to the emergency department (ED). In these patients, acute myocardial infarction (AMI) is often the diagnosis that clinicians are seeking to exclude. However, only a minority of those patients have AMI, causing a substantial financial burden to health services. Cardiac troponin (cTn) is the reference standard biomarker for the diagnosis of AMI. Several commercially available point-of-care (POC) cTn assays are portable and could feasibly be used in an ambulance. The aim of this paper is to systematically review existing evidence for the use of POC cTn assays in the prehospital setting to rule out AMI.
Methods:A systematic search was conducted on EMBASE, MEDLINE, and CINAHL Plus databases, reference lists, and relevant grey literature, including combinations of the relevant terms. Papers published in English language since the year 2000 were eligible for inclusion. A narrative synthesis of the evidence was then undertaken.
Results:The initial search and cross-referencing revealed a total of 350 papers, of which 243 were excluded. Seven papers were included in the systematic literature review.
Conclusion:Current evidence does not support the use of POC troponin assays to exclude AMI due to issues with diagnostic accuracy and insufficient high-quality evidence.
Brief Report
Advantage and Limitation of Using a Visual Feedback Device during Cardiopulmonary Resuscitation Training
- Chan Woong Kim, Je Hyeok Oh
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- 08 January 2020, pp. 104-108
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Introduction:
Recent cardiopulmonary resuscitation (CPR) guidelines recommend the use of CPR prompt/feedback devices during CPR training because it can improve the quality of CPR.
Problem:Chest compression depth and full chest recoil show a trade-off relationship. Therefore, achievement of both targets (adequate chest compression depth and full chest recoil) simultaneously is a difficult task for CPR instructors. This study hypothesized that introducing a visual feedback device to the CPR training could improve the chest compression depth and ratio of full chest recoil simultaneously.
Methods:The study investigated the effects of introducing a visual feedback device during CPR training by comparing the results of skill tests before and after introducing a visual feedback device. The results of skill tests from 2016 through 2018 were retrospectively reviewed. The strategy of emphasizing chest compression depth was implemented during the CPR training in 2017, and a visual feedback device was introduced in 2018. The interval between the CPR training and skill tests was seven days. Feedback was not provided during the skill tests.
Results:In total, 159 students completed skill tests. Although the chest compression depth increased significantly from 50 mm (42–54) to 60 mm (59–61) after emphasizing chest compression depth (P < .001), the ratio of full chest recoil decreased simultaneously from 100% (100–100) to 81% (39–98; P < .001). The ratio of full chest recoil increased significantly from 81% (39–98) to 95% (77–100) after introducing a visual feedback device (P = .018). However, the students who did not achieve 80% of the ratio of full chest recoil remained significantly higher than in 2016 (1% in 2016, 49% in 2017, and 27% in 2018; P < .001).
Conclusions:Although introducing a visual feedback device during CPR training resulted in increasing the ratio of full chest recoil while maintaining the adequacy of chest compression depth, 27% of the students still did not achieve 80% of the ratio of full chest recoil. Another educational strategy should be considered to increase the qualities of CPR more completely.
Special Report
Profile of Chest Injuries and Oxygen Therapy in Trauma Patients with Acute Respiratory Failure after the Jiangsu Tornado in China: A Retrospective Study
- Gen hua Mu, Zhong qian Lu, Xing Li, Ping fa Chen, Lei He, Yun hao Sun, Shan shan Hou, Yi jun Deng
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- 23 March 2020, pp. 335-340
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Background:
The aim of this study was to analyze the profile of chest injuries, oxygen therapy for respiratory failure, and the outcomes of victims after the Jiangsu tornado, which occurred on June 23, 2016 in Yancheng City, Jiangsu Province, China.
Methods:The clinical records of 144 patients referred to Yancheng City No.1 People’s Hospital from June 23 through June 25 were retrospectively investigated. Of those patients, 68 (47.2%) sustained major chest injuries. The demographic details, trauma history, details of injuries and Abbreviated Injury Scores (AIS), therapy for respiratory failure, surgical procedures, length of intensive care unit (ICU) and hospital stay, and mortality were analyzed.
Results:Of the 68 patients, 41 (60.3%) were female and 27 (39.7%) were male. The average age of the injured patients was 57.1 years. Forty-six patients (67.6%) suffered from polytrauma. The mean thoracic AIS of the victims was calculated as 2.85 (SD = 0.76). Rib fracture was the most common chest injury, noted in 56 patients (82.4%). Pulmonary contusion was the next most frequent injury, occurring in 12 patients (17.7%). Ten patients with severe chest trauma were admitted to ICU. The median ICU stay was 11.7 (SD = 8.5) days. Five patients required intubation and ventilation, one patient was treated with noninvasive positive pressure ventilation (NPPV), and four patients were treated with high-flow nasal cannula (HFNC). Three patients died during hospitalization. The hospital mortality was 4.41%.
Conclusions:Chest trauma was a common type of injury after tornado. The most frequent thoracic injuries were rib fractures and pulmonary contusion. Severe chest trauma is usually associated with a high incidence of respiratory support requirements and a long length of stay in the ICU. Early initiation of appropriate oxygen therapy was vital to restoring normal respiratory function and saving lives. Going forward, HFNC might be an effective and well-tolerated therapeutic addition to the management of acute respiratory failure in chest trauma.
The Haiti Humanitarian Response Course: A Novel Approach to Local Responder Training in International Humanitarian Response
- Nirma D. Bustamante, Shada A. Rouhani, Sean Kivlehan, Keegan A. Checkett, Kerling Israel, Sterman Toussaint, Stephanie Kayden
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- Published online by Cambridge University Press:
- 19 February 2020, pp. 220-224
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Introduction:
Countries most affected by disasters are often those with limited local capacity to respond. When local capacity is overwhelmed, international humanitarian response often provides needs-based emergency response. Despite global progress in education and the development of international humanitarian response standards, access to training and integration of local actors in response mechanisms remains limited. In May 2017, the Haiti Humanitarian Response Course (HHRC) was implemented in Mirebalais, Haiti to increase local capacity and allow for effective future engagement with international humanitarian actors in a country prone to disasters.
Report:In collaboration with the Hôpital Universitaire de Mirebalais’ (HUM; Mirebalais, Haiti) Department of Medical Education and Emergency Medicine (EM) residency program, four physicians from the Division of Global Emergency Care and Humanitarian Studies at Brigham and Women’s Hospital (Boston, Massachusetts USA) facilitated the course, which included 53 local physicians and staff. Following 15 hours of online pre-course preparation, through didactics and practical small-group exercises, the course focused on key components of international humanitarian response, minimum standards for effective response, and the roles of key response players. The course was free to participants and taught in English and French.
Discussion:The HHRC reduced the barriers often faced by local actors who seek training in international humanitarian response by offering free training in their own community. It presents a novel approach to narrow critical gaps in training local populations in international humanitarian response, especially in environments prone to crises and disasters. This approach can help local responders better access international humanitarian response mechanisms when the local response capacity is exhausted or overwhelmed.
Conclusion:The HHRC demonstrates a potential new model for humanitarian and disaster training and offers a model for similar programs in other disaster-prone countries. Ultimately, local capacity building could lead to more efficient resource utilization, improved knowledge sharing, and better disaster response.
Case Report
An Important Dilemma: Fibrinolytic Treatment in Bleeding Diathesis
- Mustafa Emin Canakci, Volkan Ercan, Nurdan Acar, Serdar Efe
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- 07 October 2020, pp. 690-692
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Pulmonary embolism is a clinical condition with high mortality rates in all age groups. The treatment includes anticoagulation and fibrinolytic therapy, and clinical management is challenging in cases of bleeding diathesis. Sepsis-induced coagulopathy (SIC), which has been recently defined to cause disruption of coagulation cascade accompanied by organ dysfunctions, is regarded as a major cause of mortality. It is noteworthy that there is no decrease in fibrinogen levels, unlike disseminated intravascular coagulopathy (DIC). This study aimed to present the management of a 70-year-old female patient who was admitted to emergency department with atypical complaints and diagnosed with pulmonary embolism due to deep vein thrombosis and septic shock. The clinical success of fibrinolytic therapy following the administration of fresh frozen plasma (FFP), although the patient had elevated international normalized ratio (INR), is presented in this case report. Since elevated INR and thrombocytopenia, which are observed in SIC, are caused by the inhibition of fibrinolysis, fibrinolytic therapy can be a rational treatment choice considering the profit/loss rate.
Special Report
Health Impacts of Volcanic Activity in Oceania
- Joseph Cuthbertson, Carol Stewart, Alison Lyon, Penelope Burns, Thompson Telepo
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- Published online by Cambridge University Press:
- 16 July 2020, pp. 574-578
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Volcanoes cause a wide range of hazardous phenomena. Close to volcanic vents, hazards can be highly dangerous and destructive and include pyroclastic flows and surges, ballistic projectiles, lava flows, lahars, thick ashfalls, and gas and aerosol emissions. Direct health impacts include trauma, burns, and exacerbation of respiratory diseases. Far-reaching volcanic hazards include volcanic ashfalls, gas and aerosol dispersion, and lahars. Within Oceania, the island arc countries of Papua New Guinea (PNG), the Solomon Islands, Vanuatu, Tonga, and New Zealand are the most at-risk from volcanic activity. Since 1500ad, approximately 10,000 lives have been lost due to volcanic activity across Oceania, with 39 lives lost since 2000. While volcano monitoring and surveillance save lives, residual risks remain from small, sudden, unheralded eruptions, such as the December 9, 2019 eruption of Whakaari/White Island volcano, New Zealand which has a death toll of 21 at the time of writing. Widespread volcanic ashfalls can affect the habitability of downwind communities by contaminating water supplies, damaging crops and buildings, and degrading indoor and outdoor air quality, as well as disrupting transport and communication networks and access to health services. While the fatality rate due to volcanic eruptions may be low, far greater numbers of people may be affected by volcanic activity with approximately 100,000 people in PNG and Vanuatu displaced since 2000. It is challenging to manage health impacts for displaced people, particularly in low-income countries where events such as eruptions occur against a background of low, variable vaccination rates, high prevalence of infectious diseases, poor sanitation infrastructure, and poor nutritional status. As a case study, the 2017-2018 eruption of Ambae volcano, Vanuatu caused no casualties but triggered two separate mandatory off-island evacuations of the entire population of approximately 11,700 people. On the neighboring island of Santo, a health disaster response was coordinated by local government and provided acute care when evacuees arrived. Involving primary care clinicians in this setting enhanced local capacity for health care provision and allowed for an improved understanding of the impact of displacement on evacuee communities.