The primary aim of this study is to review the available tools for prehospital triage in case of mass casualty incidents and secondly, to develop a tool which enables lay person first responders (LPFRs) to perform triage and start basic life support in mass casualty incidents.

In July 2019, online databases were consulted. Studies addressing prehospital triage methods for lay people were analyzed. Secondly, a new prehospital triage tool for LPFRs was developed. Therefore, a search for prehospital triage models available in literature was conducted and triage actions were extracted.

The search resulted in 6188 articles, and after screening, a scoping review of 4 articles was conducted. All articles stated that there is great potential to provide accurate prehospital triage by people with no healthcare experience. Based on these findings, and combined with the pre-existing prehospital triage tools, we developed a, not-yet validated, prehospital triage tool for lay people, which may improve disaster awareness and preparedness and might positively contribute to community resilience.

The prehospital triage tool for lay person first responders may be useful and may help professional medical first responders to determine faster, which casualties most urgently need help in a mass casualty incident.

Disaster health literacy is vital for emergency medicine and public health preparedness. Conversely, how health and safety information is communicated has a significant impact on disaster health literacy. A lack of alignment between the disaster response and the public’s reaction was apparent during a Dutch chemical incident. This case study aims to provide insights into why that misalignment occurred.

The case study used readily available Twitter data. The tweets represented both the public and the authorities. The tweets were coded, thematically categorised, analysed, and synthesised to generate an explanatory framework describing the obstacles experienced during the emergency.

The analysis identified four areas of concern with regards to the lack of alignment between the authorities and the public: the alert of the chemical incident, the inadequate communication, the problematic disaster management, and the insufficient disaster health literacy.

The case study showed shortcomings in communication and a lack of alignment in the emergency response of the authorities as well as the public’s disaster health literacy. Immediate action points were apparent, and a more profound evaluation is recommended to avoid further escalation of an emergency in the future. Trust needs to be built before the next incident strikes.

To predict the short-term mortality of the serum lactate level and the National Early Warning Score + lactate (NEWS+L) at the time of first admission to the emergency department in COVID-19 patients.

This retrospective analysis was performed by screening the data of COVID-19 patients over a 6-month period (from January 15, 2021, to June 15, 2021). The demographic, comorbidities, vital parameters, and lactate values, as well as C- reactive protein (CRP), blood urea nitrogen (BUN), and 28-day mortality data were recorded.

A total of 70 patients were included in our study. The median (25th - 75th percentile) age was 58 (47.3 - 73.5) years, and 33 (47.1%) patients were female. The mean lactate value was 1.6 (1.2 - 1.98) mmol/L, the mean NEWS was 6 (4-7.75), and the mean NEWS+L was 7.24 ± 2.54. Mortality occurred in 13 (18.2%) of the 70 patients at 28 days. Lactate, NEWS, and NEWS+L had no significant relationship with mortality. None of these parameters was able to predict mortality (P = 0.132, 0.670, and 0.994, respectively).

Our findings showed that the NEWS+L, NEWS, and lactate level could not predict short-term mortality in COVID-19 patients at the time of first admission.

On April 27, 2011, a train derailed and crashed in Taiwan, causing a mass casualty incident (MCI) that was similar to a previous event and with similar consequences. In both disasters, the emergency operating centers (EOCs) could not effectively integrate associated agencies to deal with the incident. The coordination and utilization of resources were inefficient, which caused difficulty in command structure operation and casualty evacuation.

This study was designed to create a survey questionnaire with problem items using disaster management phases mandated by Taiwan’s Emergency Medical Care Law (EMCL), use statistical methods (t test) to analyze the results and issues the EOCs encountered during the operation, and propose solutions for those problems.

Findings showed that EOCs lacked authority to intervene or coordinate with associated agencies. Also, placing emphasis on the recovery phase should improve future prevention and response mechanisms.

To improve the response to MCIs, the EMCL needs to be amended to give EOCs the lead during disasters; use feedback from the recovery phase to improve future disaster management and operation coordination; and establish an information-sharing platform across agencies to address all aspects of relief work.(Disaster Med Public Health Preparedness. 2014;0:1-6)

A number of multiple-casualty incidents during 2014 and 2015 brought changes to Korea’s disaster medical assistance system. We report these changes here.

Reports about these incidents, revisions to laws, and the government’s revised medical disaster response guidelines were reviewed.

The number of DMAT (Disaster Medical Assistance Team) staff members was reduced to 4 from 8, and the mobilization method changed. An emergency response manual was created that contains the main content of the DMAT, and there is now a DMAT training program to educate staff. The government created and launched a national 24-hour Disaster Emergency Medical Service Situation Room, and instead of the traditional wireless communications, mobile instant smart phone messaging has been added as a new means of communication. The number of disaster base hospitals has also been doubled.

Although there are still limitations that need to be remedied, the changes to the current emergency medical assistance system are expected to improve the system’s response capacity. (Disaster Med Public Health Preparedness. 2017;11:526–530)

Using data collected from a Community Assessment for Public Health Emergency Response (CASPER) conducted in Fairfax Health District, Virginia, in 2016, we sought to assess the relationship between household-level perceived preparedness and self-reported preparedness behaviors.

Weighted population estimates and 95% confidence intervals were reported, and Pearson’s chi-squared test was used to investigate differences by group.

Examining responses to how prepared respondents felt their household was to handle a large-scale emergency or disaster, an estimated 7.4% of respondents (95% CI: 4.3–12.3) reported that their household was “completely prepared,” 37.3% (95% CI: 31.4–43.7) were “moderately prepared,” 38.2% (95% CI: 31.6–45.2) were “somewhat prepared,” and 14.4% (95% CI: 10.2–20.0) were “unprepared.” A greater proportion of respondents who said that their household was “completely” or “moderately” prepared for an emergency reported engaging in several behaviors related to preparedness. However, for several preparedness behaviors, there were gaps between perceived preparedness and self-reported readiness.

Community assessments for public health preparedness can provide valuable data about groups who may be at risk during an emergency due to a lack of planning and practice, despite feeling prepared to handle a large-scale emergency or disaster.

Efficient emergency and disaster response is challenged by environmental conditions exceeding test reagent storage and operating specifications. We assessed the effectiveness of vial and foil packaging in preserving point-of-care (POC) glucose and lactate test strip performance in humid conditions.

Glucose and lactate test strips in both packaging were exposed to mean relative humidity of 97.0 ± 1.1% in an environmental chamber for up to 168 hours. At defined time points, stressed strips were removed and tested in pairs with unstressed strips using whole blood samples spiked to glucose concentrations of 60, 100, and 250 mg/dL (n = 20 paired measurements per level). A Wilcoxon signed rank test was used to compare stressed and unstressed test strip measurements.

Stressed glucose and lactate test strip measurements differed significantly from unstressed strips, and were inconsistent between experimental trials. Median glucose paired difference was as high as 12.5 mg/dL at the high glucose test concentration. Median lactate bias was −0.2 mmol/L. Stressed strips from vial (3) and foil (7) packaging failed to produce results.

Both packaging designs appeared to protect glucose and lactate test strips for at least 1 week of high humidity stress. Documented strip failures revealed the need for improved manufacturing process. (Disaster Med Public Health Preparedness. 2014;0:1–7)

Experience of a major disaster can potentially impact on tobacco consumption. Our objective was to explore the determinants of increasing tobacco consumption after the Great East Japan Earthquake (GEJE).

We conducted a cross-sectional study using data from the Miyagi Prefectural Health Survey 2014: a total of 2632 people were randomly selected from residents aged ≥20 years in Miyagi, Japan. Of 2443 respondents (response rate = 92.8%), 551 current smokers (411 men) were included in the analysis. Odds ratios (OR) and 95% confidence interval (CI) for increasing tobacco consumption were calculated using multivariable logistic regression models including variables of age, sex, disaster-related job status change, education status, self-rated health, and age at smoking initiation.

After adjustments for all variables, significantly higher ORs for increasing tobacco consumption after the GEJE were observed in women (OR = 1.87; 95% CI = 1.10–3.15), 20–39 years old (OR = 5.18; 95% CI = 2.28–11.75), 40–59 years old (OR = 3.97; 95% CI = 1.76–8.94) and respondents who had lost their jobs (OR = 3.42; 95% CI = 1.06–11.05) than the counterpart categories.

This study found 3 determinants of increasing tobacco consumption after a major disaster: being a woman, being of working age, and experiencing disaster-related job loss.

The aim of this study was to compare the ability of the Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) to predict 30-d mortality in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection aged 65 y and over.

This prospective, single-center, observational study was carried out with 122 volunteers aged 65 y and over with patients confirmed to have SARS-CoV-2 infection according to the reverse transcriptase-polymerase chain reaction (RT-PCR) test, who presented to the emergency department between March 1, 2020, and May 1, 2020. Demographic data, comorbidities, vital parameters, hematological parameters, and MEWS, REMS, and RAPS values of the patients were recorded prospectively.

Among the 122 patients included in the study, the median age was 71 (25th-75th quartile: 67-79) y. The rate of 30-d mortality was 10.7% for the study cohort. The area under the receiver operating characteristic curve values for MEWS, RAPS, and REMS were 0.512 (95% confidence interval [CI]: 0.420-0.604; P = 0.910), 0.500 (95% CI: 0.408-0.592; P = 0.996), and 0.675 (95% CI: 0.585-0.757; P = 0.014), respectively. The odds ratios of MEWS (≥2), RAPS (>2), and REMS (>5) for 30-d mortality were 0.374 (95% CI: 0.089-1.568; P = 0.179), 1.696 (95% CI: 0.090-31.815; P = 0.724), and 1.008 (95% CI: 0.257-3.948; P = 0.991), respectively.

REMS, RAPS, and MEWS do not seem to be useful in predicting 30-d mortality in geriatric patients with SARS-CoV-2 infection presenting to the emergency department.

The role of the community is becoming increasingly recognized as a crucial determinant of human health, particularly during a disaster and during disaster recovery. To identify disaster-vulnerable communities, we sought factors related to communities in need of support by using census information from before the Great East Japan Earthquake.

We identified vulnerable communities by using a needs-assessment survey conducted 6 to 12 months after the Great East Japan Earthquake in Ishinomaki City, Miyagi Prefecture, as indicated by higher proportions of households with at least 1 of 3 major support needs (medical, elderly, psychological, and dwelling environment). The associations between the need for support and 9 demographic characteristics of the community from census data prior to the Great East Japan Earthquake were examined for 71 communities by use of logistic regression analysis.

The need for elderly support was positively associated with the proportions of aged people (odds ratio [OR]=1.5; 95% confidence interval [CI]: 1.2–1.8) and one-person households (OR=1.3; 95% CI: 1.0–1.7), whereas the need for psychological support was associated with the proportion of people engaged in agriculture (OR=4.6; 95% CI: 1.0–20.7). The proportion of fisheries was negatively associated with the need for dwelling environment support (OR=0.5; 95% CI: 0.3–0.9).

The consideration of simple demographic characteristics from the census may be useful for identifying vulnerable communities and preparing for future disasters. (Disaster Med Public Health Preparedness. 2015;9:19-28)