American journal of disaster medicine最新文献

{"title":"Evaluation of just-in-time trauma training for international surgical military preparedness at a US Civilian Levell Trauma Center: A proof of concept.","authors":"Jane J Keating, Jonathan D Gates, Matthew Tichauer, Thomas Nowicki, Monika Nelson, Alfred Croteau, Greg Frani, Matthew Lissauer, Lenworth M Jacobs","doi":"10.5055/ajdm.0484","DOIUrl":"https://doi.org/10.5055/ajdm.0484","url":null,"abstract":"<p><strong>Background: </strong>Increasing global conflicts continue to heighten the need for increased focus on preparedness for military physicians and surgeons. Simulation has recently been adopted by civilian surgical trainees to offset the problem of increased work hour restrictions and shift the current focus toward minimally invasive techniques. We hypothesized that just-in-time trauma training, incorporating both focused clinical and simulated experience at our civilian Level I Trauma Center, would increase the competence and confidence of international military physicians in trauma care.</p><p><strong>Methods: </strong>We performed a feasibility study of five Ukrainian physicians (four surgeons and one anesthesiologist) undergoing an intensive 2-week trauma course taught by 25 American clinicians. The training consisted of several previously validated courses including Advanced Trauma Life Support (ATLS^®), Advanced Surgical Skills for Exposure in Trauma (ASSE'J^®), Advanced Trauma Operative Management (ATO ), and Basic Endovascular Skills for Trauma (BES'J^®), among several additional simulated and clinical experiences. Pre- and post-course surveys were analyzed using paired t-tests to assess improvement in trauma care.</p><p><strong>Results: </strong>All five physicians had significant improvement in confidence following the completion of the course, including the management of injuries to the neck, chest, abdomen, and extremities. Additionally, each clinician significantly improved in their confidence to perform common ATLS procedures and resuscitative endovascular balloon occlusion of the aorta skills. Overall, the mean confidence over all survey responses improved significantly following the completion of the course, 2.28 (precourse confid ence range 1.25-3.35) to 3.66 (post-course confidence range 2.95-4.22), p-value = 0.002. All five Ukrainian physicians successfully passed the corresponding post-tests and were certified as having completed ATLS, ATOM, ASSET, and BEST Conclusions: A military and civilian partnership in trauma preparedness is feasible to improve surgeon confidence in trauma care.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"19 3","pages":"187-196"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Hurricane Maria on the mortality of patients admitted to the MICU at the VA Caribbean Healthcare System in Puerto Rico.","authors":"Alba Rivera-Diaz, Rebeca Vazquez-Nieves, Vanessa Fonseca-Ferrer, Juan Irizarry-Nieves, Luis Irizarry-Nieves, William Rodriguez-Cintron","doi":"10.5055/ajdm.0486","DOIUrl":"https://doi.org/10.5055/ajdm.0486","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the impact of Hurricane Maria on mortality rates and patient conditions in the Medical Intensive Care Unit (MICU) at the Veterans Affairs Caribbean Healthcare Hospital in San Juan, Puerto Rico (PR). The focus is on the 2 months before and after the hurricane's landfall.</p><p><strong>Design: </strong>This is a retrospective, transversal study.</p><p><strong>Setting: </strong>The intensive care unit at the Veteran Affairs Caribbean Healthcare System in San Juan, PR.</p><p><strong>Participants: </strong>A total of 202 patients, sampled using a time-defined method, aged 21-90 years, were admitted to the MICU between July 16, 2017, and November 16, 2017.</p><p><strong>Main outcome measure(s): </strong>The primary measure is the mortality rate of MICU patients during the specified period. Secondary measures include the severity of patient conditions and changes in the causes of death, particularly cardiovascular deaths.</p><p><strong>Results: </strong>The overall mortality rate in the MICU did not significantly change following Hurricane Maria. However, there was an increase in cardiovascular-related deaths. In addition, patient conditions showed higher severity post-hurricane, as indicated by Apache II scores, along with prolonged hospital stays and altered admission patterns for specific conditions.</p><p><strong>Conclusions: </strong>While Hurricane Maria did not significantly alter overall mortality rates in the MICU, the increase in cardiovascular deaths and more severe post-hurricane patient conditions underscore the need for enhanced disaster preparedness and response strategies in critical care settings.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"19 3","pages":"197-206"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human well-being and animal welfare: Is there an ethical link to be implemented from the COVID-19 pandemic into the practice of emergency management?","authors":"Asante Msimang, Shelley Edwards, Sergio Alloggio, Roman Tandlich","doi":"10.5055/ajdm.0481","DOIUrl":"https://doi.org/10.5055/ajdm.0481","url":null,"abstract":"<p><p>Through the definition of risk management and its interpretation in multidimensional protection of humans and animals in emergencies and during disasters, in this article, the authors focus on the ethical links between human well-being and animal welfare in emergency and disaster risk management. Coronavirus disease 2019 and its impact on animal welfare are used to consistently demonstrate the link between human well-being and animal welfare. Examples of international legal and ethical norms are provided to demonstrate the need for protecting humans and animals in emergencies and disasters, such as the proposed Universal Declaration of Animal Welfare. The proposed link is ultimately an expression of duty of care required for emergency and disaster risk managers.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"19 3","pages":"237-250"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in disaster healthcare: A review through a pandemic lens.","authors":"Angela Pettit Cornelius, Sharon E Mace, Douglas Mark Char, Constance Doyle, Samantha Noll, Vivian Reyes, Jennie Wang","doi":"10.5055/ajdm.0482","DOIUrl":"https://doi.org/10.5055/ajdm.0482","url":null,"abstract":"<p><strong>Objective: </strong>To provide an overview of the literature on the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare disparities in various groups, in relation to social determinants of health (SDOH) and longstanding social disparities.</p><p><strong>Design: </strong>The Disaster Preparedness and Response Committee of the American College of Emergency Physicians (ACEP) addressed the impact of health disparities in disaster planning and response. A workgroup composed of seven physicians with academic and deployment disaster medicine experience was formed. A literature review focusing on healthcare disparities during the COVID-19 pandemic was conducted. Search strategies included medical sources such as PubMed, Medline, and Google Scholar and nonmedical publications focused on COVID-19. The group combined the literature found and identified general themes. A framework using recognized SDOH was applied to organize the material and allow for ease of reporting. We also noted the unmet burden and challenges that underserved communities struggled with prior to the pandemic onset. The workgroups' report was presented to the ACEP Board of Directors.</p><p><strong>Results: </strong>COVID-19 significantly impacted groups burdened with poor SDOH to a much greater degree than the general population. Many healthcare disparities that existed prior to COVID-19 were worsened during the pandemic. Little information exists about how these inequities are being addressed.</p><p><strong>Conclusions: </strong>COVID-19 magnified and more fully exposed healthcare disparities. These disparities, although common, can be partially mitigated. Efforts are needed to better understand healthcare disparities brought about by the COVID-19 pandemic and to find solutions to address future pandemics across all four phases of a disaster.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"19 3","pages":"251-263"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The successful implementation of Stop the Bleed^® in Guatemala.","authors":"Juan P Cóbar, Miranda Matzer, Isabella Santamarina, Amelia Levi, Sabrina Asturias, Carlos R Cordon, Lenworth Jacobs, Amir Ebadinejad, Jane J Keating","doi":"10.5055/ajdm.0483","DOIUrl":"10.5055/ajdm.0483","url":null,"abstract":"<p><strong>Objective: </strong>This project aimed to successfully implement the Stop the Bleed^® (STB) program in Guatemala by targeting key providers in various communities across the country.</p><p><strong>Setting: </strong>The course was conducted in rural community centers, fire stations, tertiary care centers, and medical school facilities.</p><p><strong>Participants: </strong>We included agricultural occupational health workers, firefighters, medical providers, and medical students throughout the course.</p><p><strong>Results: </strong>We successfully trained 247 people in Guatemala in STB and certified 13 instructors and four associate instructors. Through pre- and postcourse surveying, we determined that the course improved the participants' comfort level in managing bleeding emergencies.</p><p><strong>Conclusions: </strong>Creating partnerships with key providers at different community levels leads to the successful implementation of public health initiatives. Further research should be geared at determining the course's dissemination by new instructors.</p>","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"19 3","pages":"217-223"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disaster healthcare disparities solutions: Part 3—Recovery and mitigation","authors":"A. P. Cornelius, D. M. Char, Leah Gustafson Ista, Samantha Noll, Frank Quintero, Heather Rybasack-Smith, Jennie Wang, Robert P. Weinberg, Sharon E. Mace","doi":"10.5055/ajdm.0474","DOIUrl":"https://doi.org/10.5055/ajdm.0474","url":null,"abstract":"The purpose of this study was to explore the potential solutions for disaster healthcare disparities. This paper is the third of a three-part series that was written by the Disaster Healthcare Disparities Workgroup of the American College of Emergency Physicians Disaster Preparedness and Response Committee. The committee conducted a literature review and chose articles most representative and demonstrative of solutions to disaster healthcare disparities found in a past workgroup product. Many solutions for disaster healthcare disparities seen during recovery and mitigation were found. Some of these solutions have been successfully implemented and some remain theoretical. Solutions for disaster healthcare disparities seen during recovery and mitigation are achievable but there is still much work to do. Many of these solutions can be advocated for by nondisaster specialists.","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"76 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Jerusalem tribune collapse incident: Challenges in the management of a pediatric mass casualty incident","authors":"N. Pines, S. Hashavya, Miklosh Bala, Kedar Asaf, Lea Ohana-Sarna-Cahan, Giora Weiser, Bat-El Shalem, David Rekthman, Shaden Salameh","doi":"10.5055/ajdm.0479","DOIUrl":"https://doi.org/10.5055/ajdm.0479","url":null,"abstract":"Objectives: Children comprise up to 30-50 percent of all disaster victims. Pediatric disaster medicine is a poorly established field, and most protocols are designed without adequate emphasis on the special needs of the pediatric population. During the 2021 Shavuot holiday in Israel, the collapse of temporary steel bleachers in a partially constructed synagogue resulted in a mass casualty incident (MCI) with a majority of pediatric casualties. This study analyzed the differences in post-incident casualty management, treatment, and outcomes in three Jerusalem medical centers. \u0000Methods: Multicenter retrospective data were collected from two tertiary level 1 trauma centers and one secondary hospital in Jerusalem. The data included demographics, triage scores, injury mechanisms, medical workups, and the management of the pediatric patients. \u0000Results: A total of 171 children and adolescents aged 9-18 years presented to three centers. In two institutions, the triage was performed by a senior emergency medicine physician, and in the third institution, by a senior trauma physician. Different protocols were applied, resulting in significant differences in triage, identification and documentation, admission strategies, adherence, and analgesic treatment. Most patients presented with orthopedic injuries (115/171, 67 percent). A small number had head, chest, abdominal, and multisystem injuries (11, 5, 2, and 2 percent, respectively). \u0000Conclusion: Pediatric MCI management presents specific challenges. The lack of consistency in triage, registry, and management highlights the need for robust pediatric MCI training programs.","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"175 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140761541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stop the Bleed® in medical schools: Early advocacy and promising results","authors":"Jeremy Fridling, Brad Chernock, Tessa Goebel, Alyssa Tutunjian, Adam D. Fox, Jane Keating, Lenworth Jacobs","doi":"10.5055/ajdm.0477","DOIUrl":"https://doi.org/10.5055/ajdm.0477","url":null,"abstract":"Objective: We hypothesized that medical students would be empowered by hemorrhage-control training and would support efforts to include Stop the Bleed® (STB) in medical education. \u0000Design: This is a multi-institution survey study. Surveys were administered immediately following and 6 months after the course. \u0000Setting: This study took place at the Association of American Medical Colleges-accredited medical schools in the United States. \u0000Participants: Participants were first-year medical students at participating institutions. A total of 442 students completed post-course surveys, and 213 students (48.2 percent) also completed 6-month follow-up surveys. \u0000Intervention: An 1-hour, in-person STB course. \u0000Main outcomes measures: Student empowerment was measured by Likert-scale scoring, 1 (Strongly Disagree) to 5 (Strongly Agree). The usage of hemorrhage- control skills was also measured. \u0000Results: A total of 419 students (95.9 percent) affirmed that the course taught the basics of bleeding control, and 169 (79.3 percent) responded positively at follow-up, with a significant decrease in Likert response (4.65, 3.87, p < 0.001). Four hundred and twenty-three students (97.0 percent) affirmed that they would apply bleeding control skills to a patient, and 192 (90.1 percent) responded positively at follow-up (4.61, 4.19, p < 0.001). Three hundred and sixty-one students (82.8 percent) believed that they were able to save a life, and 109 (51.2 percent) responded positively at follow-up (4.14, 3.56, p < 0.001). Four hundred and twenty-five students (97.0 percent) would recommend the course to another medical student, and 196 (92.0 percent) responded positively at follow-up (4.68, 4.31, p < 0.001). Six students (2.8 percent) used skills on live patients, with success in five of the six instances. \u0000Conclusions: Medical students were empowered by STB and have used hemorrhage-control skills on live victims. Medical students support efforts to include STB in medical education.","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"12 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140797099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating health and treatment measures during the Arbaeen procession 2022: A qualitative study","authors":"Saeed Nazari, Hassan Araghizadeh, Afzal Shamsi, Mahdi Ghorbani, Mahboobeh Afzali, Hosein Mahdian","doi":"10.5055/ajdm.0453","DOIUrl":"https://doi.org/10.5055/ajdm.0453","url":null,"abstract":"Aims: The Arbaeen procession is one of the largest religious gatherings in which tens of millions of people participate every year. The presence of many people in this religious gathering highlights the necessity of planning to reduce incidents related to pilgrims in the field of health and to ensure their timely access to health and treatment services. The current research was conducted with the aim of investigating and analyzing the health field in the Arbaeen procession of 2022. \u0000Methodology: This was a qualitative study, in which in-depth and semistructured interviews were conducted. The target population comprised healthcare policymakers, managers, and providers of the Arbaeen procession in 2022. The interview and data collection guide were developed using the World Health Organization’s recommendations. Data collection was continued till data saturation. Directed content analysis was used to analyze the data. Different strategies were applied to increase the validity and reliability of the results of this study. \u0000Finding: Data saturation was reached after 33 interviews. In total, eight main topics were identified, including follow-up of disease and trauma, promotion of public health, education and health system, cooperation and coordination in the field of health, information and communication management, response operations, support and resource management, and security and safety. \u0000Conclusion: Essential health issues in Arbaeen procession were identified in this research, which may be considered as an evidence-based guide for planners, planners, and executive managers of this religious community. The findings of this research may be used in other marches and public gatherings.","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"350 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical capacity is disaster preparedness: A scoping review of how surgery and anesthesiology departments responded to COVID-19","authors":"Matthew T. Hey, Madeleine Carroll, Lili B. Steel, Mayte Bryce-Alberti, Radzi Hamzah, Rachel E. Wittenberg, Anam Ehsan, Hodan Abdi, Latoya Stewart, Raina Parikh, Raisa Rauf, Jacqueline Cellini, Kiana Winslow, Isaac G. Alty, Craig D. McClain, Geoffrey A. Anderson","doi":"10.5055/ajdm.0466","DOIUrl":"https://doi.org/10.5055/ajdm.0466","url":null,"abstract":"Objective: This study evaluated how surgical and anesthesiology departments adapted their resources in response to the coronavirus disease 2019 (COVID-19) pandemic. \u0000Design: This scoping review used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol, with Covidence as a screening tool. An initial search of PubMed, Embase, Web of Science, Global Index Medicus, and Cochrane Systematic Reviews returned 6,131 results in October 2021. After exclusion of duplicates and abstract screening, 415 articles were included. After full-text screening, 108 articles remained. \u0000Results: Most commonly, studies were retrospective in nature (47.22 percent), with data from a single institution (60.19 percent). Nearly all studies occurred in high-income countries (HICs), 78.70 percent, with no articles from low-income countries. The reported responses to the COVID-19 pandemic involving surgical departments were grouped into seven categories, with multiple responses reported in some articles for a total of 192 responses. The most frequently reported responses were changes to surgical department staffing (29.17 percent) and task-shifting or task-sharing of personnel (25.52 percent). \u0000Conclusion: Our review reflects the mechanisms by which hospital surgical systems responded to the initial stress of the COVID-19 pandemic and reinforced the many changes to hospital policy that occurred in the pandemic. Healthcare systems with robust surgical systems were better able to cope with the initial stress of the COVID-19 pandemic. The well-resourced health systems of HICs reported rapid and dynamic changes by providers to assist in and ultimately improve the care of patients during the pandemic. Surgical system strengthening will allow health systems to be more resilient and prepared for the next disaster.","PeriodicalId":40040,"journal":{"name":"American journal of disaster medicine","volume":"41 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}