To determine if lockdown measures related to the COVID-19 pandemic changed the frequency and epidemiology of geriatric patient emergency medical service (EMS) facilitated visits to the emergency department (ED) in Hamilton, Ontario, Canada.

A retrospective chart review was conducted comparing ED presentations of patients over 65 years of age presenting to two academic hospitals in Hamilton, Ontario via EMS between March 17, 2020, and July 15, 2020 (the first wave of the COVID-19 pandemic) to March 17, 2019, and July 15, 2019 (pre-pandemic).

Total EMS facilitated geriatric ED number of visits decreased by 17.3% during the first wave of COVID-19 in 2020, relative to the same seasonal time frame in 2019 (March 17- July 15). Visits were more dramatically decreased in the first 8 weeks after the pandemic was declared but then recovered to pre-pandemic levels thereafter. More geriatric patients visiting the ED via EMS were admitted during the initial stages of the COVID-19 pandemic, relative to 2019. However, the acuity and epidemiology of visits remained the same during the first wave of the COVID-19 pandemic, relative to 2019.

Lockdown measures during the first wave of the COVID-19 pandemic coincided with decreased geriatric EMS ED visits in the initial two months after the pandemic was declared. Visit numbers recovered as the first wave ended. The epidemiology, as well as the overall acuity, did not change.

Accurate triage is crucial for pediatric patients because their physiological differences make them more vulnerable to traumatic injury and mortality. However, pediatric trauma patients are challenging for EMS personnel for several reasons including infrequent clinical encounters and inadequate training. Despite the need for increased training, little is known about EMS readiness to perform triage and lifesaving interventions during pediatric mass casualty incidents (MCIs). Simulation skills assessment correlates with EMS performance in the field and can be used to determine MCI readiness.Pediatric patients are often omitted from MCI training and protocols. Feedback from EMS clinicians who participate in pediatric MCI simulations may be useful for educators seeking to optimize pediatric mass shooting triage training.

This was an observational study assessing EMS clinician accuracy in triaging eight children and two adults in a mass shooting simulation involving intimate partner violence (IPV) set at a private residence. Participating EMS clinicians were attendees of continuing education classes at Yale New Haven Health Centers for EMS. Participants worked in pairs, and triage decisions were documented during the simulation with an evaluation tool and video recording. After the simulation, pairs completed the demographic survey and completed a semi-structured debriefing. Facilitator prompts included correct triage level for each patient, the role IPV plays in mass shootings, and the participants feedback. Recordings of the debriefings were transcribed and analyzed using grounded theory. During the evaluation process, the major themes will be identified and coded. The transcriptions will be re-evaluated and any additional sub-themes will be identified and coded.

As of November 2022, eight paramedics have participated with more sessions scheduled for spring 2023. A preliminary review indicates potential themes will fall under the categories of simulation implementation and clinical approach to triage.

These findings may assist EMS agencies with their pediatric MCI training and response.

Mass casualty incident (MCI) management was usually taught by lectures and then tested by exercises. However, the lecture may not be interesting and tabletop exercise (TTx) may not adequately engage participants, especially senior medical students. To solve these two problems, we think that a TTx using 3D models can be a good teaching method of MCI management for medical students.

A TTx of MCI in the emergency room (ER) was designed for senior medical students based on five core capabilities of MCI management: incident management system, event recognition and initiation of response, patient triage, surge capacity and capability, and recovery and demobilization. 3D models containing miniatures of the ER, hospital staff, patients, and other personnel were used in the TTx. No lecture was conducted before or during the exercise. Students needed to discuss how to respond to events in the incident and show their responses using the 3D models, and the instructor facilitated the discussion and gave feedback right after the students’ decision.

Knowledge of each core capability was tested by four multiple-choice questions. The interest in learning disaster medicine and willingness to participate in MCI management were evaluated by questionnaire, along with quantitative feedback to the exercise. The same test and questionnaire were conducted before and after the TTx.

From September 2018 to May 2022, 326 students completed both pre- and post-exercise evaluations. The test scores of all five core capabilities, levels of interest, and willingness increased significantly after the exercise. Students thought the exercise was interesting and a good learning tool. Most students wanted to be notified of further training.

A tabletop exercise using 3D models is an effective way to teach senior medical students MCI management and disaster medicine while increasing their interest in learning and willingness to participate.

Moulage is the art of creating faked injuries on actors for training purposes. Moulage is commonly used in disaster and emergency medicine training, as it is believed to improve learning through enhanced realism.

The aim of the current study was to test the effect of moulage on perceived realism and learning during a joint exercise featuring students from the police, rescue service, and ambulance service.

The scenario was a car accident with two victims. Students (n = 135) were divided into 12 groups. Moulage was applied to the victim actors for half the groups (n = 67), whereas the other half (n = 68) experienced the scenario without moulage. Victim cards were used in both scenarios. Immersion, realism, and learning was measured on a 100-point scale immediately post-scenario using a questionnaire.

Two (moulage group) by three (student population and police, rescue service, or ambulance) ANOVAS on realism, immersion, and learning found no effects on realism or immersion (all p>0.10). There was an effect of student group on learning, F(2, 92) = 3.518, p = 0.034, partial eta square = 0.071, such that the rescue service students had overall lower scores on learning (M = 53.87, SD = 28.29) compared to the police (M = 66.07, SD = 27.55) and ambulance students (M = 74.99, SD = 24.51). Cohen’s ds for moulage effect was calculated to 0.144 for immersion, 0.112 for realism, and 0.003 for learning.

The current study did not find any effects of moulage on immersion, realism, or learning. The effect sizes indicate that any effect of moulage on realism and immersion, should it exist, is in the approximate size of 2-3 points on a 100-point scale. The lack of effect may be due to limitations in the study design, but may also indicate that the use of moulage in addition to victim cards is not necessarily beneficial for novice students’ learning.

The acute care of stroke involves the administration of a clot-dissolving drug (thrombolysis) and/or its removal using endovascular clot retrieval. Earlier intervention results in significantly improved patient outcomes. Clinical assessment scores have limitations, and studies have shown that even the most robust scores have a reported false-negative rate of >20% for large vessel occlusive strokes that may be eligible for clot retrieval, while inappropriate bypass may delay delivery of thrombolysis.1 Quantitative Electroencephalography (QEEG) has been shown to have a very high sensitivity and specificity in the identification of acute stroke versus matched controls in an in-hospital setting.(2,3)

The SPIDER study commenced in Brisbane, Queensland on September 3, 2018, and is investigating the use of an EEG recorder to gather data on acute stroke patients presenting to a metropolitan ambulance service.

The data collected will guide the development of a simple numerical output reference to guide decision making. The data may aid in identifying large vessel occlusive stroke and patients eligible for endovascular intervention. The QEEG will provide a more accurate and cost-effective tool for the prehospital clinician over other imaging technologies and can guide early destination decisions. This presentation discusses the implementation of a pre-hospital research platform, integration with the clinical dispatch matrix, staff engagement, patient recruitment, and the success of the project so far.

To evaluate three prototype versions of semi-quantitative end-tidal CO2 monitors with different alarm features during prehospital or inter-facility use.

Subjects were 43 adult, non-pregnant patients requiring intubation, or who already were intubated and required transport. Teams at one AirEvac and seven Advanced Life Support (ALS) paramedic stations were trained in the use of the monitors. Team members at each station evaluated each model for eight days. Participants completed questionnaires following each use.

The monitors performed properly in all cases, but in one case, vomit in the airway adapter tube prevented obtaining a readout. The monitors aided management in 40 of 43 cases (93%); in one, the monitor reading was reported as variable (between 20 and 30 mmHg) although the teams knew the monitors were semi-quantitative; in another, the monitor was not required, but performed properly; and the third was the one in which vomit in the tube prevented a reading. In 26 of 43 cases (60.4%), the monitor was used to confirm endotracheal tube placement (there were no instances of incorrect placement). In all cases, the devices were used to monitor respiration and oxygen saturation. Alarms were audible in the environment, but only preferred in the AirEvac situation. The “breath beep” feature was useful, particularly in patients in whom chest movements during respiration were difficult to observe.

“Breath beeps” were clearly audible and were a useful feature in all prehospital and transport environments, while audible alarms were desired only in the AirEvac situation. Semi-quantitative CO2 detection is valuable in the ALS/AirEvac environment, even for teams with high intubation success rates.

The Republic of Palau, like other small, island, developing states, is particularly vulnerable to climate change due to a number of factors, including: (1) small size; (2) remoteness; (3) limited natural resources; and (3) vulnerability to disasters and extreme weather events. Other factors include social and economic factors such as: (1) economies sensitive to external shocks; (2) high population growth rates and densities; (3) poorly developed infrastructure; (4) limited financial and human resources; and (5) emigration. The (US) Centers for Disease Control and Prevention (CDC) partnered with the Republic of Palau Ministry of Health (MoH) and Southern Illinois University (SIU) to investigate public health consequences in Palau. The goal of the project is to reduce morbidity and mortality due to climate change in Palau by improving awareness using three tools: (1) a photojournalism book to document the local experience in Palau; (2) a marketing campaign to increase awareness in Palau about climate change as it relates to human health; and (3) a Website to raise regional and international awareness of the findings, and act as a forum for discussion and resource-sharing.

The CDC, SIU, and Palau MoH conducted interviews with community members including government officials, traditional leadership, fishermen, gardeners, physicians, scientists and local residents to explore their experiences concerning climate change in their community. Photojournalists took thousands of images documenting locally identified effects of climate change that were perceived as having direct or indirect health consequences for the people of Palau.

Coral bleaching, beach erosion, irregular rainfall, sea level rise, and salt water inundation directly impact food security and tourism in Palau, while other less obvious, but important consequences, such as potential loss of traditional practices and cultural identity were also identified.

The people of Palau reported significant impact from climate change on agriculture, economics, health, and culture.

A destructive 7.9 magnitude earthquake struck the Sumatra Island of Indonesia on 30 September 2009. A Russian mobile hospital was implemented on 04 October in the village of Lupu-Alu, 20 km from the city of Padang.

The mobile hospital consisted of 20 pneumo modules equipped with technical systems. Personnel included 9 engineers and 25 medical specialists comprised of surgeons, therapists, traumatologists, children's surgeons, a pediatrician, and anesthesiologists. An air-mobile hospital was equipped with modern medical equipment (X-ray, ultrasonic diagnostics, etc.). Work at the hospital was complicated by almost daily tropical rains. The language barrier was addressed by using local translators who spoke Russian or English languages.

Medical aid was rendered to 479 patients. The intensive care department experienced the heaviest patient load (n = 11). Trauma (n = 54, 2%) and proinflammatory complications prevailed among surgical patients (n = 131). Treatment of bone fractures represented significant difficulties due to the late delivery of care. Of the 479 patients, 207 (43.2%) were children; among them, 49 (7%) had diseases of the upper airways, and 30 (4%) experienced trauma. Psychologists consulted with 52 children with post-traumatic stress syndrome. Telemedical consultations were conducted by the following specialists: (1) orthopedist (n = 2); (2) dermatologist (n = 2); (3) neurosurgeon (n = 1); and (4) plastic surgeon (n = 1).

Following the earthquake, medical personnel at the Russian mobile hospital in Indonesia experienced: (1) a large number of outpatients with various diseases who lacked medical care as a result of the non-functioning network of local public health services; (2) the admission of the patients with complications of trauma; (3) a significant number of children with inflammatory diseases of the upper airways; and (4) an opportunity of use telemedical consultations.

Airway injuries are the second leading cause of potentially survivable battlefield death and often require airway management strategies. Airway suction, the act of using negative pressure in a patient’s upper airway, removes debris that can prevent respiration, decreases possible aspiration risks, and allows clearer viewing of the airway for intubation. The most important characteristics for a portable airway suction device for prehospital combat care are portability, strong suction, and ease of use.

This market review searched academic papers, military publications, Google searches, and Amazon to identify devices. The search included specific characteristics that would increase the likelihood that the devices would be suitable for battlefield use including weight, size, battery life, noise emission, canister size, tubing, and suction power.

Sixty portable airway suction devices were resulted, 31 of which met inclusion criteria – 11 manually powered devices and 20 battery-operated devices. One type of manual suction pump was a bag-like design with a squeezable suction pump that was extremely lightweight but had limited suction capabilities (vacuum pressure of 100mmHg). Another type of manual suction pump had a trigger-like design which is pulled back to create suction with a firm collection canister that had increased suction capabilities (vacuum pressures of 188-600mmHg), though still less than the battery operated, and was slightly heavier (0.23-0.458kg). Battery-operated devices had increased suction capabilities and were easier to use, but they were larger and weighed more (1.18-11.0kg).

Future research should work to lighten and debulk battery-operated suction devices with high suction performance.