The 2019 coronavirus disease (COVID-19) pandemic created overwhelming demand for critical care services within Maryland’s (USA) hospital systems. As intensive care units (ICUs) became full, critically ill patients were boarded in hospital emergency departments (EDs), a practice associated with increased mortality and costs. Allocation of critical care resources during the pandemic requires thoughtful and proactive management strategies. While various methodologies exist for addressing the issue of ED overcrowding, few systems have implemented a state-wide response using a public safety-based platform. The objective of this report is to describe the implementation of a state-wide Emergency Medical Services (EMS)-based coordination center designed to ensure timely and equitable access to critical care.

The state of Maryland designed and implemented a novel, state-wide Critical Care Coordination Center (C4) staffed with intensivist physicians and paramedics purposed to ensure appropriate critical care resource management and patient transfer assistance. A narrative description of the C4 is provided. A retrospective cohort study design was used to present requests to the C4 as a case series report to describe the results of implementation.

Providing a centralized asset with regional situational awareness of hospital capability and bed status played an integral role for directing the triage process of critically ill patients to appropriate facilities during and after the COVID-19 pandemic. A total of 2,790 requests were received by the C4. The pairing of a paramedic with an intensivist physician resulted in the successful transfer of 67.4% of requests, while 27.8% were managed in place with medical direction. Overall, COVID-19 patients comprised 29.5% of the cohort. Data suggested increased C4 usage was predictive of state-wide ICU surges. The C4 usage volume resulted in the expansion to pediatric services to serve a broader age range. The C4 concept, which leverages the complimentary skills of EMS clinicians and intensivist physicians, is presented as a proposed public safety-based model for other regions to consider world-wide.

The C4 has played an integral role in the State of Maryland’s pledge to its citizens to deliver the right care to the right patient at the right time and can be considered as a model for adoption by other regions world-wide.

The majority of pediatric medications are dosed according to weight and therefore accurate weight assessment is essential. However, this can be difficult in the unpredictable and peripatetic prehospital care setting, and medication errors are common. The Handtevy method and the Broselow tape are two systems designed to guide Emergency Medical Services (EMS) providers in both pediatric patient weight estimation and medication dosing. The accuracy of the Handtevy method of weight estimation as practiced in the field by EMS has not been previously examined.

The primary objective of this study was to examine the field performance of the Handtevy method and the Broselow tape with respect to prehospital patient weight estimation.

This was a retrospective chart review of trauma and non-trauma patients transported by EMS to the emergency department (ED) of a quaternary care children’s hospital from January 1, 2021 through June 30, 2021. Demographic data, ED visit information, prehospital weight estimation, and medication dosing were collected and analyzed. Scale-based weight from the ED was used as the standard for comparison.

A total of 509 patients <13 years of age were included in this study. The EMS providers using the Broselow method estimated patient weight to within +/-10% of ED scale weight in 51.3% of patients. When using the Handtevy method, the EMS providers estimated patient weight to within +/-10% of ED scale weight in 43.7% of patients. When comparing the Handtevy versus Broselow method of prehospital weight estimation, there was no significant association between method and categorized weight discrepancy (over, under, or accurate estimates – defined as within 10% of ED scale weight; P = .25) or percent weight discrepancy (P = .75). On average, prehospital weight estimation was 6.33% lower than ED weight with use of the Handtevy method and 6.94% lower with use of the Broselow method.

This study demonstrated no statistically significant difference between the use of the Handtevy or Broselow methods with respect to prehospital weight estimation. While further research is necessary, these results suggest similar field performance of the Broselow and Handtevy methods.

Terrorist attacks against hospitals and health care providers have disproportionally increased during the last decades. A significant proportion of these attacks targeted abortion clinics and abortion providers. In the light of the overturning of Roe v. Wade in 2022, an increase of anti-abortion terrorist attacks is anticipated. Therefore, it becomes imperative to gain further insight into the risk and characteristics of past terrorist attacks. This study aimed to review terrorist attacks against health care targets providing abortion services from 1970 through 2020.

Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database functions for all terrorist attacks against abortion health care providers from January 1, 1970 - December 31, 2020. Temporal factors, location, attack and weapon type, and number of casualties or hostages were analyzed using descriptive statistics.

In total, 262 terrorist attacks were identified in five different countries. The majority (96.6%) occurred in the United States, with the highest counts during the last 20 years of the 20th century. Facility and infrastructure attacks were the most common attack types, followed by bombings and explosions. The attacks resulted in 34 injuries and nine fatalities. Kidnapping took place in three incidents. Of all successful attacks, 96.9% resulted in property damage.

Abortion-related health care facilities and providers have repeatedly been the target of terrorists over the past decades. Nearly all of these attacks took place in the United States, with the highest counts during the last 20 years of the 20th century.

World events continue to compel hospitals to have agile and scalable response arrangements for managing natural and instigated disasters. While many hospitals have disaster plans, few exercise these plans or test their staff under realistic scenarios.

This study explores changes in perceived preparedness of multidisciplinary hospital-wide teams to manage mass casualty incidents.

Two Emergo Train System (ETS) mass casualty exercises involving 80 and 86 “victims,” respectively, were run at two southeast Queensland hospitals: one large teaching hospital and one smaller regional hospital. Pre- and post-exercise surveys were administered, capturing participants’ confidence, skills, and process knowledge anonymously on 5-point Likert scales. A waiver of ethics review was obtained. Changes in individuals’ pre- and post-scores were analyzed using paired t-tests. Open-ended questions and a “hot debrief” occurring immediately post-exercise allowed for capture of improvement ideas.

Nearly 200 unique healthcare staff (n=193) participated in one exercise. At least one survey was returned by 159 staff (82.4%). Pre- and post- surveys were available for 89 staff; two-thirds (n=59) were nurses or doctors, and 46% overall were emergency department clinicians. Ninety-seven percent reported the exercise was valuable, also recommending additional simulations. Analysis of the 89 matched-pairs showed significant (p<.001) increases in self-confidence, skills, and knowledge (point increases on a five-point Likert scale (95% confidence intervals): 0.8 (0.6-0.9) for confidence and 0.4 (0.2-0.5) for both skills and knowledge. The exercise was critically appraised and a summary of operational learnings was developed. The most common criticism of ETS was its lack of real patients.

Involvement in simulated exercises (e.g. ETS) can increase confidence, knowledge, and skills of staff to manage disasters, with the biggest improvement in confidence. Whilst validating and testing plans, simulations can also uncover opportunities to improve processes and systems.

Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration.

This was a quality assurance project that monitored training of combat medics to administer parenteral medications and to ensure patient safety. Combat medics were provided training that included direct supervision during medication administration. Once proficiency was demonstrated, combat medics would prepare the medications under direct supervision, followed by indirect supervision during administration. As part of the quality assurance and safety processes, combat medics were required to document all medication administrations, supervising provider, and unexpected adverse events. Additional quality assurance follow-up occurred via complete chart review by the project lead.

During the project period, the combat medics administered the following medications: ketamine (n=13), morphine (n=8), ketorolac (n=7), fentanyl (n=5), ondansetron (n=4), and other (n=6). No adverse events or patient safety events were reported by the combat medics or discovered during the quality assurance process.

In this limited case series, combat medics safely administered parenteral medications under indirect provider supervision. Future research is needed to further develop this training model for both the military and civilian setting.

SchauerSG, CunninghamCW, FisherAD, DeLorenzoRA. A Pilot Project Demonstrating that Combat Medics Can Safely Administer Parenteral Medications in the Emergency Department. Prehosp Disaster Med. 2017;32(6):679–681.

Housing has always been a source of stress for people in Hong Kong (HK), especially to those living in sub-optimal settings. About 210,000 people are forced to live in subdivided flats in HK. Most of these flats cannot meet health standards set by the UN even for prisoners, in terms of the floor space, climatic conditions, lighting, air quality, and ventilation. Fire and public safety equipment are lacking. Most believed that the substandard environment has a negative impact on one’s mental health.

To investigate how the living condition in a subdivided flat affects a person’s mental health.

104 households living in the subdivided flats in Kwai Tsing, one of the 18 Districts of HK, were surveyed by HKJCDPRI’s Collaborating Partner, HKSKH Lady MacLehose Centre in February 2017; while a follow-up study with purposive sampling was conducted in October 2017 to interview 10 households on their mental health status. A mixed Methods was used combining the quantitative Results of the WHO Quality of Life-BREF scale and Depression Anxiety Stress Scale 21, and qualitative Results of face-to-face interviews.

80% of 104 households surveyed suffered from mental distress. The follow-up study revealed that seven of them displayed signs of depression and/or anxiety, while two were diagnosed with a mental disorder. Distress is proven to associate with the environmental and health risks, including fire and disease outbreak, as well as chronic issues resulting from poor indoor air quality and extreme weather.

Low level of perception and preparedness among HK people is making these public health risks more apparent. The already desperate housing and land policy don’t seem to offer any help in the near future. Public educations efforts need tremendous enhancement, to engage, mobilize and empower individuals and communities, to actively plan and prepare for future shocks.

Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM).

The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC).

A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking.

In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were “Human Resources” (n = 15), “Planning and Coordination” (n = 7), and “Community Capacities for Health EDRM” (n = 6) in the LMIC group. “Policies, Strategies, and Legislation” (n = 7) and “Human Resources” (n = 7) were the components with the most recommendations for the HIC group.

The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.

Due to the heatwave in Japan, the number of patients with heatstroke transported via ambulance hit the highest record according to the Tokyo fire department in 2018. Now, heatwaves are thought to be a natural disaster. Emergency medical professionals located in a Tokyo suburb covering 40,000 individuals experienced a wide range of challenges in patient care with heatstroke.

To assess the impact of the 2018 Japan heatwave on community emergency medical service.

Patients (aged ≥ 16 years) with heatstroke and who were transported to our hospital by ambulance from June to September of 2018 were included. Data were derived from prehospital records and electronic medical records. Weather data was referenced from a Japanese meteorological agency.

The number of all-cause cases was 1,764, and the total number of heatstroke cases was 51 (2.9%). Heatstroke cases were concentrated in July and August of 2018. The rate of males was 69%. The average age was 63 ± 23 years. Physical labor was associated with 31% of cases, such as sports in 7.8%. Hospitalization was required in 24%. ICU admission was required in 9.8%. There was no fetal case directly caused by heatstroke in this survey.

The risk factors of heatstroke considered to be male and elderly. About one-half of heatstroke patients were over 70 years old, and it may have been related to regional characteristics. As mentioned in the Heatstroke STUDY 2012 (Miyake, 2014), most cases which occurred inside residences were found that there was no air conditioner use. There was also an increased number of patients with heatstroke who made emergency visits by themselves. Further investigation is needed annually to estimate the effect of climate change. It is important to make a strong recommendation from public health agency about heatstroke prevention, including air conditioner use during hot weather.

When the world is faced with a new potential pandemic outbreak, the media report heavily about it. Media are an important disseminator of health threat information. This study examined potential media effects during the 2009 outbreak of A/H1N1 influenza.

To examine the relationship between media reports of the swine flu and self-registrations in an emergency department (ED) of a tertiary hospital in Flanders, Belgium.

All articles concerning swine flu published in seven Flemish newspapers were selected during the biggest flu peak in Belgium. This number was compared with the number of patients who presented themselves with a self-diagnosis of swine flu symptoms during the same time frame. The Pearson's correlation coefficient was selected to determine the relationship. The cross-correlation function determined the direction of this relationship.

A strong correlation was found between the number of potential patients (n = 308) and the number of articles in the Flemish press (n = 1657). The number of patients was the leading indicator; increases in the volume of written press followed increases in the number of patients.

Media reporting is extensive when a new infectious disease breaks out and intensifies when it is feared that pandemic levels are reached. This was also the case with the swine flu outbreak in Flanders. These findings suggest that a rise in the number of media reports follows a rise in the number of cases, rather than the reverse.

NelissenS , BeullensK , SabbeM , Van den BulckJ . The Swine Flu Emergency Department: The Relationship Between Media Attention for the Swine Flu and Registrations in an Emergency Medicine Unit. Prehosp Disaster Med. 2014;29(2):1-5.

Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.

This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.

In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.

This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.