San Francisco (California USA) is a relatively compact city with a population of 884,000 and nine stroke centers within a 47 square mile area. Emergency Medical Services (EMS) transport distances and times are short and there are currently no Mobile Stroke Units (MSUs).

This study evaluated EMS activation to computed tomography (CT [EMS-CT]) and EMS activation to thrombolysis (EMS-TPA) times for acute stroke in the first two years after implementation of an emergency department (ED) focused, direct EMS-to-CT protocol entitled “Mission Protocol” (MP) at a safety net hospital in San Francisco and compared performance to published reports from MSUs. The EMS times were abstracted from ambulance records. Geometric means were calculated for MP data and pooled means were similarly calculated from published MSU data.

From July 2017 through June 2019, a total of 423 patients with suspected stroke were evaluated under the MP, and 166 of these patients were either ultimately diagnosed with ischemic stroke or were treated as a stroke but later diagnosed as a stroke mimic. The EMS and treatment time data were available for 134 of these patients with 61 patients (45.5%) receiving thrombolysis, with mean EMS-CT and EMS-TPA times of 41 minutes (95% CI, 39-43) and 63 minutes (95% CI, 57-70), respectively. The pooled estimates for MSUs suggested a mean EMS-CT time of 35 minutes (95% CI, 27-45) and a mean EMS-TPA time of 48 minutes (95% CI, 39-60). The MSUs achieved faster EMS-CT and EMS-TPA times (P <.0001 for each).

In a moderate-sized, urban setting with high population density, MP was able to achieve EMS activation to treatment times for stroke thrombolysis that were approximately 15 minutes slower than the published performance of MSUs.

As natural disasters continue to cause human suffering and contribute to health inequalities, Mobile Health Units (MHU) provide medical aid to people deprived of health care. However, the service modality has received criticism related to logistical difficulties, irregular service provision, and adaptability. Although MHUs may be of value, there is a significant knowledge gap regarding their usefulness on addressing health needs in natural disasters.

To elucidate the use of MHUs in natural disasters in adherence to WHO Classification for Emergency Medical Teams.

A scoping review was conducted following the framework by Arksey and O’Malley. Twenty-six bibliographic databases and websites were screened for white and grey literature published from 2000-2021 reporting on the use of MHUs in natural disasters.

Thirteen publications were included in the final analysis, highlighting seven themes: key characteristics, services, staff, benchmark indicator, operational availability, self-sufficiency, and pre-deployment preparedness. All documents described the mobile approach to increase access to health services in the absence of regular health care. MHUs were mostly reported to provide out-patient care with medical needs primarily related to non-communicable diseases. Basic trauma care was less reported on. The main challenges concerned transportation, coordination, and communication.

Data on the use of MHUs in natural disasters are scarce with inconsistent reporting of key aspects. The literature adhered to previous research and WHO guidelines to some extent. Further research is deemed necessary to evaluate the interventions and outcomes of MHUs following natural disasters.

The motorcycle ambulance is used for quick access to patients. The response time to reach the patient takes less time than with a van ambulance. Moreover, accidents involving ambulances tend to be higher. However, at present, there is no study regarding the appropriate situation used of motorcycle ambulances in Emergency Medical Services (EMS) in Thailand.

This study aims to optimize the travel distance and the operation time of motorcycle ambulances used.

This study was a prospective, randomized controlled study at the EMS unit of Srinagarind Hospital, Thailand. The data collection period was from November 2021 through May 2022. All data involving dispatch of both ambulances in need were collected.

A total of 2,398 cases of EMS operation were examined. The mean age of the patients in the motorcycle ambulance group was 42.5 (SD = 6.5) years, and 51.3% (n = 616) were male. The response time for motorcycle ambulances and van ambulances during the operation time between 6:00am-9:00am was 6.2 minutes and 9.1 minutes, respectively. The response times for motorcycle ambulances and van ambulances regarding distance traveled from 0-5km were 4.2 minutes and 7.5 minutes, respectively (P <.001); distance traveled from 5-10km were 6.3 minutes and 8.2 minutes, respectively (P = .010).

The motorcycle ambulance can reach patients faster than the ambulance at the operation time from 6:00am-9:00am and 3:00pm-6:00pm. This study focused on the distance less than 10 kilometers.

Chemical, Biological, Radiological, and Nuclear (CBRN) emergencies need specific hospital preparedness and resource availability.

Preparing to evaluate and manage victims from CBRN exposure events in one aspect of hospital preparedness, is often underestimated. Specific skills and capabilities are required to manage these events. Emergency department (ED) and hospital staff need adequate training to provide safe and effective care.

The Hospital Complex of Valtellina and Alto Lario (with three hospitals), in consideration of the geographic location amid mountains, far from urban hospital centers, decided to develop an intensive training program for the hospital emergency staff. Firstly, it was based on an eight-hour initial training program, using a combined civilian military approach that included hazard recognition, substance identification, site safety, response roles, PPE use, and decontamination procedures. The CBRN Operational Unit (for prevention of chemical-biological-radiological-nuclear risks) of the 1st Territorial Unit of the Auxiliary Military Corps of the Order of Malta Italy led such training session showing that a military approach to CBRN threats can be used with civilian and military competencies and tools in managing specific hazardous events hospital first responders may face.

A drill exercise was performed on a radiological fall-out incident to test the hospital’s emergency response staff preparedness. Hospital management and decontamination procedures were analyzed to treat victims as well as first responders and to train hospital staff with few resources available.

Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. Skills and competencies of military personnel can be a resource in these kinds of events to train civilian personnel who are not normally acquainted to or confident to manage this kind of CBRN events, and can represent a new model and challenge of interagency cooperation in the disaster management of complex emergencies involving hazardous materials.

During the COVID-19 outbreak in May 2021, Taipei City has transformed many vacant hotels to augmented quarantine hotels, recruiting retired medical staff to provide medical care, in order to preserve hospitals’ medical capabilities. In an augmented quarantine hotel at Caesar Park Hotel Taipei, the complexity of COVID quarantine, quarantine status of the residents, and hotel staff working with medical staff has made the original emergency response plan inappropriate. Henceforth, a series of modifications were made to ensure the emergency response readiness of Caesar Park Hotel Taipei.

The enhancements of emergency response capability of the augmented quarantine hotel at the Caesar Park Hotel Taipei, were made in accordance with the following list: 1. Revise evacuation plan, 2. Setup emergency equipment cart, 3. Modify emergency response procedure, 4. Update staff training and resident notice, 5. Routine stock count of medical supplies and emergency equipment.

The enhanced emergency response plan has ensured the safety of all personnel, plans were made in accordance with the COVID-19 quarantine status, and the staff has a clear perception of their duty with a picture of the overall emergency response plan.

The enhanced emergency response plan was completed and under implementation in June 2021, and at the end of that month there was a fire that took four lives with 22 injured at a quarantine hotel in Changhua County. A review of the enhanced emergency response plan was made by the staff and corresponding hospital; many problems that happened at the Chunghua County quarantine hotel fire had already been considered or prevented in the enhanced emergency response plan. Such a method for building an enhanced emergency response plan has the potential to be implemented in more locations, and possibly in different scenarios.

This report tries to capture the impact of the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) in each ASEAN Member State (AMS) and Japan as a result of the ARCH Project implementation since July 2016.

Impact on AMS: The analysis of the impact on AMS was based on a comparison of the impact of the project on management and coordination of Emergency Medical Teams (EMTs), and application of the project outcome in actual emergency operations compared to the previous status in each AMS.

Impact on Japan: The history of the development of disaster medicine in Japan was reviewed, with an aim to analyze the impact of supporting AMS through the ARCH Project on Japan, and the possibility of bi-directional cooperation in the future.

Impact on AMS: Since the initiation of the ARCH Project, AMS has made significant progress in WHO EMT accreditation, strengthening EMTCC capacity for receiving international assistance, as well as the development of legislation or strategic plans related to DHM, and application of the Project products such as standard operating procedures or regional tools in actual disasters/emergencies.

Impact on Japan: Disaster medicine in Japan originated from the Cambodian refugees’ relief mission in 1979. Since then, the management system has been strengthened including the foundation of the Japan Disaster Relief (JDR) Team, a structure with a legal foundation. The experience gained through international operations has contributed to the development of Japan’s domestic disaster response system. Japan learned the operational effectiveness of the post-disaster health surveillance system through the disaster response operation in 2013 Typhoon Yolanda Disaster in Philippines and introduced a modified system in Japan for domestic disaster response, which was later refined and proposed for an international standard.

ARCH Project is highly appreciated by AMS as the opportunity to share knowledge and experience among countries and thereby contributing to achieving the “One ASEAN, One Response” concept, as well as the driving force for each AMS to develop its capacity in DHM. While the ARCH Project started to support AMS to strengthen its regional capacity in disaster health management, it is important to build a bi-directional relationship between ASEAN and Japan in terms of mutual learning and support to tackle future disasters.

Public sector challenges have initiated new forms of collaboration between emergency response organizations, occupations from other societal sectors, and civil citizens, not the least in socio-economically vulnerable areas. As collaborations emerge, there is a need to explore the tasks, needs, and challenges of the new resources when providing medical emergency response.

To explore two cases of 1) security guards and 2) organized civil volunteers collaborating with the ambulance services and municipal rescue services, and identifying relevant tasks, needs and challenges. The presentation will focus on their dispatch on medical alerts. A brief comparison of the two groups will also be performed.

A case study approach was applied involving interviews and workshops with security guards, civil volunteers, ambulance services, and rescue services personnel.

The civil volunteers are dispatched on medical alerts concerning heart failures and accidents requiring first aid, including stopping major bleedings. The scope of tasks of security guards is broader since they are also dispatched on suicide and assault alerts. Needs in both cases include, e.g., proper training, joint exercises, equipment in terms of defibrillators, torquedos, and first aid kits, and proper ICT/GPS positioning support for dispatching. Challenges are mainly organizational and legal where security guards are somewhat protected by their own employer (e.g., through agreements, trauma support, and safety measures such as receiving a hepatitis vaccine) while civil volunteers do not have sufficient protection in any of these respects.

Both groups are useful resources in future medical emergency response since they are often close to the incident site and can provide first response while waiting for the professional resources, thereby saving lives and reducing consequences of trauma. However, they need to be better integrated into the professional emergency response system.