Elderly in emergency -

Psychosocial support is essential to prevent mental health disorders in the elders subjected to trauma in emergencies that induces to isolation as well as risks or vulnerability for them and their environment. Financial crisis, natural disasters, attacks, poverty, violence and loneliness in the social environment turn threatening for them. Reality becomes hard and produces disorganization in mental health.

Elder people who have gone through one or more of the following situations are the ones who are prone to develop intense or immediate character disorder. With strategies that increase the existing psychosocial protection factors stress at different intervention levels is lowered. Those who have gone through one or more violent experiences are the ones who are prone to develop intense or immediate character disorder. Cultural transferring (between adults and between adults and children) and mutual help between adults and children is held.

Cognitive processing factors associated to each individual's anxiety: stress, depression, loneliness, panic attacks etc. Some techniques have been developed to understand emotions and learn how to manage them: songs, classic tales, puppets, advertisements and anagrams, Kessen cards, etc. All the material and the results were evaluated with clinic tests and professional help.

Additionally, a good cultural understanding of the situation and the adult's feelings are needed in order to provide assistance. The one providing help as well as the one receiving bio-psychosocial help are both part of the link created to overcome the impact of violence, committed to build bridges in the adversity. To prevent post-traumatic stress they are trained in facing disturbing anxiety when facing catastrophes produced by nature or men.

New Zealand is widely known across the globe as an adventure tourism destination. On December 9, 2019, the natural wonders of the country became a major disaster that impacted the lives of many and stretched the resources of the New Zealand healthcare system.

Whakaari/White Island is an uninhabited, privately owned island 50 km off the North Island of New Zealand. It contains two strato-volcanoes, which were and remain a popular tourist destination. While an international tourist group were enjoying their guided tour of the crater, one of the volcanoes erupted, sending superheated debris and gas into the air. Of the 47 individuals on the island at the time, 39 were rescued. Overall, 25 people survived. The mortality of this event was significantly lower than historic volcanic eruptions involving ballistic and pyroclastic injuries. We are fortunate to present information specifically on the chemical and physiological changes noted from exposure to volcanic ash.

Located in New Zealand’s largest city is Middlemore Hospital, home of the National Burns Center. This center is supported by three regional burn centers throughout the country. Prior to Whakaari, mass-casualty plans were in place, however, system-wide adaptations were required on many levels to ensure delivery of healthcare. This included changes in pre-hospital triage, support for regional burns centers and repatriation to home countries.

This poster presentation takes you on the journey of adaptation experienced within the National Burns Service, focusing on operating theater, intensive care and acute burns management.

Case Study

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Chemical, biological, radiological and nuclear (CBRN) cases are seen as an increasing risk because of the increasing threat of international terrorism. Decontamination is one of the basic components of the intervention for CBRN exposure. The introduction portable decontamination unit in the hospital setting is described in this presentation.

The general properties, facilities, and capabilities of the portable decontamination unit, which is present in the GATA CBRN Department of the Turkish Armed Force's Health Command, were evaluated.

The portable decontamination unit in the hospital has a metal frame that is 54 m2 wide. It is composed of two tents that weigh about 300 kg. The metal frame, metal legs, and tent cloth are stored in carrying bags. Four people can construct the tents in 10 minutes. An educated squad of four people can prepare the decontamination system and instructions in 25–30 minutes. The unit consists of two lines: one for outpatients and another for inpatient decontamination, which includes a rail system. Each decontamination line contains an undressing, shower, and dressing section.

Along with metal-framed decontamination tents, there also are inflatable tents. The inflatable decontamination units can be pitched in 5–7 minutes by an electrical air compressor. Metal-framed tents are easy to carry, as the frame, metal legs, and tent cloth are stored in carrying bags. By pitching the decontamination tent on a smooth ground in front of the hospital entrance, decontamination of patients can be completed before they reach the hospital. Another decontamination unit is in place next to the emergency department.

Terrorist attacks that result in mass casualties demonstrate the importance of CBRN preparedness. A decontamination unit and an appropriate CBRN preparedness plan should be constituted into the basic treatment system.

On March 22, 2016, the capital of Europe was hit by two terrorist attacks. As terrorism becomes more and more violent, it is critical to learn and share experiences in order to enhance effectiveness in saving lives.

A field perspective and experience feedback from the Emergency Medical Response.

The first attack hit the departure hall of the airport, which, due to its strategic role, relies upon a dedicated emergency plan. However, it focuses on airplane crashes and not on explosions in a crowded terminal. The second attack hit the subway at rush hour. An attack in such a confined environment is particularly challenging for the rescue teams, as injuries are worsened, access hindered, and exits numerous.

Eleven medical teams were sent in order to perform triage and provide vital care. The medical response was organized by two disaster response teams. Advanced Medical Posts were set up and the mass casualty plans of all hospitals were activated. Managing war injuries for civilian teams was challenging. On-site care consisted essentially in prehospital damage control and burn care in order to ensure rapid evacuations for haemostatic surgery. 313 victims were dispatched to thirty hospitals. Another challenge was safety. Several threats were apparent and explosives were found on both sites. Lessons from Paris had prompted a review of our multiple sites Emergency Plan. One single way of communication was used and the evacuations were managed centrally. Finally, the key factor that helped limit the number of casualties was the acquaintanceship between emergency workers and non-medical teams built during exercises, allowing them to adapt and blend in as one team.

Lessons from previous attacks were crucial to improve our management of the medical response. These should be shared around, as another attack may always occur anywhere and at any time.

Korea Institute Radiological Medical Sciences operates an emergency medical response system in case of a radiological accident or disaster. A radiation accident or disaster can affect large-scale patients and destroy medical infrastructure. However, there is currently a lack of specialized education for treating large-scale patients or high-dose exposure patients. This study aimed to evaluate the efficiency of radiological mass casualty triage education programs and present a new training method to improve the ability of 119 emergency medical teams in the event of a radiological accident or disaster.

The results of mass casualty triage for radiological events were analyzed using the audience response system and questionnaire for paramedics who participated in the radiation accident response training program. For 25 paramedics, a pre-post evaluation was conducted on two items: understanding the mass triage and understanding the radiological mass triage. The data were analyzed using the SPSS WIN 23.0 program.

Thirty simulated patient scenarios were developed with the addition of clinical symptoms of radiation exposure based on the four trauma classifications: immediate, urgent, delayed, and death. The triage results of 30 cases conducted by 119 emergency medical teams were evaluated, and the trainees were asked to respond to the level of improvement in their knowledge of triage through pre- and post-training questionnaires. As a result of the pre- and post-education questionnaire, the degree of understanding of the mass triage was 3.8 before education and 4.4 after education, showing a significant difference (p=.003/MAX=5). The pre- and post-education questionnaire results of radiological mass triage showed a difference between 2.3 before education and 4.1 after education (p=.000/MAX=5).

For effective radiation medical response, 119 emergency medical teams are required to have a repetitive mass triage education program for radiological events. It is especially important to provide a radiological triage system for field application.

This study evaluates the perceptions of preparedness and willingness to work during disasters and public health emergencies among 213 healthcare workers from 10 ministries of health hospitals in the southern region of Saudi Arabia, which is exposed to the risk of disasters such as flash floods in wadis, fires, sandstorms, armed conflicts at the border and ongoing waves of COVID-19 pandemic.

This study employed a quantitative research design by using a survey (Fight or Flight).

The results showed that participants' willingness to work unconditionally during disasters and emergencies varied based on the type of condition: natural disasters (61.97%), seasonal influenza pandemic (52.58%), smallpox pandemic (47.89%), SARS/COVID-19 pandemic (43.56%), special flu pandemic (36.15%), mass shooting (37.56%), chemical incident and bombing threats (31.92%), biological events (28.17%), Ebola outbreaks (27.7%), and nuclear incident (24.88%).

Among several factors that determine healthcare workers’ willingness to work during disasters and public health emergencies, appropriate knowledge and skills to confidently manage an incident and the assurance of their families’ safety are two decisive factors. Although we could only find a significant correlation between education and willingness to work during emergencies, previous reports have confirmed a significant correlation between education, age, and years of experience and the perception of hazards and fear and consequently willingness to work under threatening circumstances. While unsuccessful management of disasters and emergencies may be the result of organizational shortcomings and resource scarcity, healthcare workers’ lack of knowledge, skills, and confidence and emotional distractions due to uncertainty about their own safety and that of their families may also play a significant role. Besides educational initiatives, which increase staff members’ confidence through knowledge acquisition and skill improvement, other measures, which guarantee their families’ safety and well-being during an emergency, should be established and implemented.

The Irish Paramedicine Education and Research Network (IPERN) is dedicated to collaboratively building research culture and research capacity for out-of-hospital care in Ireland and internationally. IPERN is led by an inter-professional team of paramedics, nurses, doctors, allied health professionals and scientists. IPERN supports clinicians to bridge the theory-practice gap through involvement in research training, knowledge generation, knowledge translation, evidence implementation, policy setting, research partnerships, co-production and research leadership. The aim of this study is to quantitatively describe the activity of IPERN in the first two years of it’s foundation (2021-2022).

This is an observational study and data was collected prospectively throughout 2021 and 2022. Data on event attendance was collated via the Event management software EventBrite and supplemented with minutes from IPERN Committee meetings. Data analysis was performed in Microsoft Excel and comprised descriptive statistics.

The IPERN Team comprises 14 inter-professional members of whom nine (64%) are paramedics. To date IPERN has launched seven special interest groups; Medical, Trauma, Pediatrics, Mental Health, Human Factors, Medical Logistics and Equality Diversity & Inclusion. The network hosted 14 CPD events from March 2021 to November 2022. In terms of research capacity building, the work of IPERN has been presented at six international conferences and the IPERN Team has successfully secured four grants since the foundation of the network.

Due to the complex and multidisciplinary nature of out-of-hospital care a strategic and collaborative approach to research capacity-building is essential. Underpinning evidence-based practice is a strong research culture and it is imperative that all clinicians involved in out-of-hospital care have the opportunity to develop knowledge and expertise. IPERN takes a participatory approach to research and our events provide an open and friendly platform for members to engage in research, building a vibrant research community both in Ireland and internationally.