A review of the response and the emergency medical teams (EMTs) deployment in Armenia following an explosion at a fuel depot near Stepanakert (Nagorno-Karabakh)/ in Armenia.

Introduction: An explosion at a fuel depot in the region of Berkadzor, around 6 km near Stepanakert in Nagorno-Karabakh, happened on September 25, 2023 resulting in more than 220 lost lives and around 300 injuries. The Ministry of Health of the Republic of Armenia (MoH), collaborating with the WHO, requested assistance for burn specialised care teams and medical evacuation.

Study objectives: To describe the emergency response learnings by reflecting on Armenia's experience managing the incident and the international EMTs' role in responding to it.

Methods: This was an observational study whose data was compiled through a triangulation of data obtained from the EMT teams using information management tools, including an EMT Minimum Data Set (MDS) specifically designed for coordinating burns responses in a daily reporting format and others from the MoH and medical evacuation (Medevac) teams, together with the information and analysis from field coordination meetings and deliberation with MoH.

Results: Four international EMTs (I-EMTs) were deployed to Armenia in coordination with the MoH and WHO. They were well-prepared and self-sufficient, but the response highlighted the need for standardized protocols for Medevac and burns care. Nearly half of the patients were critical on the first day, with 58% in non-ICU centers and 42% in ICU, with 20 patients medically evacuated using draft Medevac guidelines. Severely burned patients in non-ICU units received 24-hour care from intensive care specialists. However, the shortage of ICU and specialized burns beds in Armenian hospitals was evident. The Emergency Medical Teams Coordination Cell (EMTCC) team effectively used information management tools to collect, process, analyze, and disseminate data to the MoH and response teams, facilitating rapid deployment and decision-making. The EMTs collaborated with local hospital staff, ensuring coordination with MoH and hospital management for follow-up and supply delivery. This integrated approach built local capacity, developed essential rehabilitation modules for burned patients, and delivered burn kits and surgical equipment. Early international assistance, coordinated by WHO and MoH, facilitated a rapid response, early EMT CC installation, and improved communication, ensuring the delivery of essential burn kits.

Conclusion: There is a need to set standards for elements such as Medevac and burns care through the WHO EMT Standards and recommendations. In addition, these settings should be integrated into the information management tools under development. The findings and lessons learnt on the specialised care teams have been essential and aligned with the 2030 EMT strategy. Major investments are needed to ensure that more specialised care teams are efficient and effective even in future responses, especially for healthcare facilities that are inadequately capacitated, which would eventually allow local workforce growth and strengthen technical skills through their collaborations in training and collaborative responses. Further, they would guide future fast delivery of surgical equipment and burns treatment kits.