This research identified a gap in understanding the lived experience of long-term disaster resilience (LTDR). Increasing disasters could influence more people. Therefore, understanding LTDR becomes imperative. Little research documents men and women’s reflections following disasters. Current research highlights survivors’ mental health, particularly clinical diagnoses like PTSD. Research remains limited on the social impacts long after disasters.

Research aimed to identify a gendered perspective of the lived experience about what contributes to LTDR three years after Ash Wednesday in 1983, the Victorian floods in 1993 and 2010-11, and the 2009 Black Saturday fires.

A comprehensive, systematized search was conducted of peer-reviewed, grey, and secondary literature for a narrative review and thematic analysis.

106 references were identified. After removing duplicates and papers not fitting the inclusion criteria, two papers met the criteria. However, two borderline papers were included due to the closeness of the timeframe and brevity of research available.

Most research is related to the immediate aftermath or short-term resilience. Papers provided no specific attributes to enhance the lived experience of LTDR as it related to gender. However, factors that could enhance the lived experience of LTDR were drawn from six themes in sociological studies. Presumptive interpretations were made about what factors may provide insight into the social and contextual issues of LTDR. The literature dearth identified the need for long-term disaster resilience research. The most striking conclusion drawn from themes tells how people perceived the way a disaster and the ensuing period affected their personal relationships and circumstances. Overall, positive experiences strengthened their resilience while negative experiences hindered their resilience. While the review resulted in a disappointing outcome, the dearth of LTDR research lacked any reference to gender but confirmed research opportunities for innovative research that could influence policy and practice.

Synchronized cardioversion is an internationally accepted standard therapy for unstable tachyarrhythmias, but it is conventionally an in-hospital physician-led intervention. Increasingly, it is being brought forward into the prehospital setting as part of a specialist paramedic scope of practice; however, very little literature exists regarding the epidemiology or efficacy in this setting.

All patients receiving cardioversion within a United Kingdom (UK) ambulance service were identified using an electronic database. The period of inclusion was March 1, 2017 through October 31, 2020. These data were then interrogated to provide demographic, physiological, and efficacy data, and then a sub-group was created to identify those who presented with a primary arrhythmia (as opposed to post-cardiac arrest).

From a total of 93 patients, prehospital synchronized cardioversion successfully terminated the tachyarrhythmia in 96% of patients presenting with a primary arrhythmia (85% in the allcomers group) with a predominance towards males (82% of patients) and an average age of 67 years. Hypotension and reduced level of consciousness were the most commonly documented unstable features (84.4% and 44.4%).

Cardioversion within a paramedic-led service results in efficacy rates of 96% in patients presenting with a primary tachyarrhythmia. This is a similar efficacy rate to traditional doctor-led therapies. Demographic data show that males make up over 80% of the patient population, in keeping with previously published work across the spectrum of cardiac interventions.

Diabetes mellitus, although a chronic disease, also can cause acute, sudden symptoms requiring emergency intervention. In these cases, Emergency Medical Dispatchers (EMDs) must identify true diabetic complaints in order to determine the correct care. In 911 systems utilizing the Medical Priority Dispatch System (MPDS), International Academies of Emergency Dispatch-certified EMDs determine a patient's chief complaint by matching the caller's response to an initial pre-scripted question to one of 37 possible chief complaints protocols. The ability of EMDs to identify true diabetic-triggered events reported through 911 has not been studied.

The primary objective of this study was to determine the percentage of EMD-recorded patient cases (using the Diabetic Problems protocol in the MPDS) that were confirmed by either attending paramedics or the hospital as experiencing a diabetic-triggered event.

This was a retrospective study involving six hospitals, one fire department, and one ambulance service in Salt Lake City, Utah USA. Dispatch data for one year recorded under the Diabetic Problems protocol, along with the associated paramedic and hospital outcome data, were reviewed/analyzed. The outcome measures were: the percentage of cases that had diabetic history, percentage of EMD-identified diabetic problems cases that were confirmed by Emergency Medical Services (EMS) and/or hospital records as true diabetic-triggered events, and percentage of EMD-identified diabetic patients who also had other medical conditions. A diabetic-triggered event was defined as one in which the patient's emergency was directly caused by diabetes or its medical management. Descriptive statistics were used for categorical measures and parametric statistical methods assessed the differences between study groups, for continuous measures.

Three-hundred ninety-three patient cases were assigned to the Diabetic Problems Chief Complaint protocol. Of the 367 (93.4%) patients who had a documented history of diabetes, 279 (76%) were determined to have had a diabetic-triggered event. However, only 12 (3.6%) initially assigned to this protocol did not have a confirmed history of diabetes.

Using the MPDS to select the Diabetic Problems Chief Complaint protocol, the EMDs correctly identified a true diabetic-triggered event the majority of the time. However, many patients had other medical conditions, which complicated the initial classification of true diabetic-triggered events. Future studies should examine the associations between the five specific Diabetic Problems Chief Complaint protocol determinant codes (triage priority levels) and severity measures, eg, blood sugar level and Glasgow Coma Score.

ClawsonJ , ScottG , LloydW , PattersonB , BarronT , GardettI , OlolaC . Outcome Accuracy of the Emergency Medical Dispatcher's Initial Selection of a Diabetic Problems Protocol. Prehosp Disaster Med. 2013:28(6):1-6.

The problems of pre-hospital care and training in the developing world are very similar – resource limitations and training deficiencies. Humanitarian conditions in the Sudan have been among the worst in the world including both man-made and natural disasters. Effectively responding to emergencies is of paramount importance.

The information was collected by a group of Sudanese physicians working in the emergency department at a large urban public hospital in Khartoum, Sudan and in the U.S. for the purpose of establishing structured training programs for pre-hospital responders.

There are currently 37 registered state operated mini-van ambulances serving ∼8 million people in the capital city of Khartoum. There is 1 central dispatching command center operated by the state Ministry of Health (MOH) that serves 29 hospitals. Services are available by calling a central “999” emergency response number. There are no private ambulances in Khartoum; however, most patients are transported by private or public transportation. Ambulance transport teams consist of ∼2 ambulance emergency assistants with limited medical training. Ambulance transport costs are covered either by insurance for the insured; however, the majority of patients are self paid. Emergencies are also managed by the Department of Civil Defense, which is a branch of the Sudanese MOH that responds to natural and man-made disasters. There are 2 layers of this team; 420 physician with masters degrees in DM and emergency rescue workers. These emergency rescue workers do not have formalized training. Other important findings are: lack of training centers for first emergency responders, no standardized practice guide lines among pre-hospital care personnel.

Emergency response in the Sudan is a relatively new practice but has shown a promising trend for the continued development of a highly advanced and functional pre-hospital/emergency response system. More structured training through collaborative efforts and substantial resources are needed.

Human-stampede events are emerging epidemics with large unplanned or impromptu mass gatherings. They are increasing in frequency worldwide, yet little is known of the epidemiology and other characteristics that would allow for communities to prepare, prevent and properly manage medical outcomes. We report a non-traditional methodology to identify a stampede's epidemiological characteristics using news reports, social networking, and systematic search of the internet. This hitherto unused technological dimension is a useful adjunct to obtain crucial data on mortality and morbidity, improve immediate understanding of the pathophysiology of the event, and provides opportunities to develop public education to remove potential bottlenecks and improve crowd control of these preventable tragedies.

A LexisNexis search was followed by sequential searches of multiple internet-based English-language news agencies and the few research reports available in the scientific literature. Date, country, geographical region, time of occurrence, type of event, location, mechanism, number of participants, number injured, and number of deaths were recorded. Descriptive analysis was performed for deaths, injuries and location for this abstract.

Following an extensive search of media accounts and research reports, a total of 263 human stampede events were identified worldwide between 1980 and 2011 resulting in 8,268 deaths and over 16,707 injuries. Major Religious assemblages, particularly in India and the Middle East, accounted for the highest number of fatalities. Precipitants of stampedes follow a geographical pattern; In Africa, sporting and political events and in Europe, entertainment venues sparked stampedes. This case series reports 7 incidents in China. All cases occurred in the recess hour of schools, when students formed a bottleneck at narrow staircases, resulting in 27 deaths and 168 injured.

Understanding the triggers in mass gatherings for a human stampede have been greatly aided by advances in social networking, internet and video mobile phones. Particularly in difficult environments which were previously difficult to document. The patterns identified in this study can appreciably add to community level preparedness, prevention and improved clinical understanding and management at prehospital and hospital levels.

The Gambia is going through a rapid epidemiologic transition with a dual disease burden of infections and non-communicable diseases occurring at the same time. Acute, time-sensitive, medical emergencies such as trauma, obstetric emergencies, respiratory failure, and stroke are leading causes of morbidity and mortality among adults in the country.

Data on medical emergency care and outcomes are lacking in The Gambia. Data on self-reported medical emergencies among adults in a selection of Gambian communities are presented in this report.

A total of 320 individuals were surveyed from 34 communities in the greater Banjul area of The Gambia using a survey instrument estimating the incidence of acute medical emergencies in an adult population. Self-reported travel time to a health facility during medical emergencies and patterns of health-seeking behavior with regard to type of facility visited and barriers to accessing emergency care, including cost and medical insurance coverage, are presented in this report.

Of the 320 individuals surveyed, 262 agreed to participate resulting in a response rate of 82%. Fifty-two percent of respondents reported an acute medical emergency in the preceding year that required urgent evaluation at a health facility. The most common facility visited during such emergencies was a health center. Eighty-seven percent of respondents reported a travel time of less than one hour during medical emergencies. Out-of-pocket cost of medications accounted for the highest expenditure during emergencies. There was a low awareness and willingness to subscribe to health insurance among individuals surveyed.

: There is a high incidence of acute medical emergencies among adults in The Gambia which are associated with adverse outcomes due to a combination of poor health literacy, high out-of-pocket expenditures on medications, and poor access to timely prehospital emergency care. There is an urgent need to develop prehospital acute care and Emergency Medical Services (EMS) in the primary health sector as part of a strategy to reduce mortality and morbidity in the country.

TourayS, SanyangB, ZandrowG, TourayI. Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care. Prehosp Disaster Med. 2018;33(6):650–657.