Natural and man-made catastrophes have caused significant destruction and loss of lives throughout human history. Disasters accompany various events with multiple causes and consequences, often leading to a cascade of health-related events. Ethiopia, amongst the developing countries in the horn of Africa, is vulnerable to natural and man-made disasters. Over the last few years, Ethiopia learned the hardest way to transform its disaster management from a mere apparatus of response and recovery to preparedness and mitigation.

Review the challenges and opportunities for establishing the Ethiopian EMT and its disaster response experience.

This was a mixed-methods, cross-sectional Intra-Action Review of activities of country EMT. It included a review of documents and key informant interviews. All data were analyzed thematically.

In May 2022, the Ethiopian Federal MOH, in collaboration with WHO, adapted the WHO EMT initiative to tackle the identified challenges. Ethiopia’s EMT implementation plan was created, which included ten steps and 50 detailed activities. This initiative aims to have a classified Type I fixed EMT in the coming six months. Based on the objective evaluation of the last four months’ performance toward plan implementation, activities show that 65% of the overall plan has been completed.

Implementing the EMT initiative in Ethiopia has positively impacted the clinical quality of care, enhanced coordination, and improved health outcomes for the population served at times of great need. However, the implementation requires collaboration in support, guidance, and experience sharing from stakeholders and partners, including twinning with other organizations.

Tables and Figures (optional)

Table 1.

Ethiopian EMT Ten Steps Implementation

The Hyogo and Sendai Frameworks for Disaster Reduction are well known and have been influential globally. However, less is known of their broader contexts.

A recent opportunity to visit Kobe, Japan, provided an opportunity to experience the rich, and largely unknown tapestry behind the scenes of the Hyogo and Sendai Frameworks. This paper aims to illuminate the journey of the Kobe Legacy and its global influence.

An experiential visit to Kobe and exploring its rich resources relating to disaster risk reduction.

The First World Conference on Natural Disasters, was held in Yokohama, Japan, in 1994. Almost immediately, Kobe experienced the Great Hanshin Earthquake, January 17, 1995, resulting in 6,434 dead, 43,792 injured, and 249,180 homes damaged. The United Nations International Strategy for Disaster Reduction (2000 – 2005) culminated in the Second World Conference on Disaster Reduction, Kobe, 2005 and the Hyogo Framework for Action 2005 – 2015. The Great East Japan Earthquake occurred on March 11, 2011, with 18,453 dead or missing, 6157 injured, 1.1M homes damaged, with a tsunami and nuclear accidents. The Third World Conference on Disaster Risk Reduction followed in Sendai in 2015 with the Sendai Framework for Disaster Risk Reduction 2015 – 2030 agreed on. Subsequently, the Sendai Framework has further evolved. However, behind the scenes, Kobe has developed a rich tapestry of insightful and valuable resources which will be outlined in this presentation.

In the words of the Mayor of Kobe, Mr. Tatsuo Yada in 2010, “I would like to reaffirm my determination to never allow our experiences of the disaster to fade away. It is our responsibility to make the utmost effort for disaster prevention and mitigation and keep passing on our experiences and the lessons learned to future generations”. This is the real legacy of Kobe.

The smart glasses were implemented as an innovative communication tool to enhance effectiveness in the field. The traditional mode of communication for Emergency Medical Services (EMS) was radio, which had significant restrictions, primarily that they were unable to transmit any visual data. To enhance efficiency, the smart glasses were used for a more accurate assessment of the condition of patients during transportation. At this time, however, no prior study has shown significant benefits of employing smart glasses into EMS.

The primary objective of this study is to compare the duration of patient care in an ambulance between the use and non-use of smart glasses. The secondary objective is to identify the characteristics of data communication between the ambulance and the hospital.

This retrospective study utilized data gathered from closed-circuit television (CCTV) in ambulances at Srinagarind Hospital, Thailand. The data were collected over a six-month period, specifically from July through December 2021. The study included two groups: the smart glasses group and no smart glasses groups, both used during EMS operations. The primary data collected focused on the duration of patient care in the ambulance. Additionally, the type and characteristics of data transfers via smart glasses during EMS operations were also recorded.

Out of the 256 EMS operations included in this study, 53.1% (N = 68) of the participants in the smart glasses group were male. The majority of operations were performed during the afternoon shift in both groups. The average patient care time in the smart glasses group was 10.07 minutes, while it was 5.10 minutes in the no smart glasses group (P <.001), indicating a significant difference. Visual data communication between the ambulance and the hospital via smart glasses predominantly involved vital signs (100.0%), physical examination (56.3%), and neurological examination (42.2%). The use of audio data from the hospital to the ambulance primarily included taking additional patient history (26.6%) and performing physical examinations (19.5%).

The implementation of smart glasses in EMS operations resulted in an increase in patient care time in the ambulance. Furthermore, the use of smart glasses facilitated an effective channel of real-time two-way communication between the ambulance and the hospital.

Simulation is an “educational method that can be applied to the training of processes, technical, and non-technical skills.” Literature underlines how simulating with the maximum realism possible improves the quality of training.

To describe the methodology used by CRIMEDIM to create a high-quality database of clinical cases to improve the realism of the EU MODEX exercises.

In 2021, CRIMEDIM created a new database of clinical cases with disaster and non-disaster-related injuries and diseases to be used for the EU MODEX exercises. Each clinical case has four temporal stages: prehospital, T0, T1, and T2, and each of them has two possible variations: Type A (improvement) and Type B (deterioration). Timing and treatments received (or not received) determine the evolution between one step and the following one. Each clinical case consists of past medical history, disaster-related history, drugs, and allergies. There are also various exams (eg, blood tests [blood count, ABG, biochemical test, coagulation], imaging [ultrasound, XR, CT], and EKG) and other clinical information. The database allows printing casualty cards, each containing instructions for role players and make-up artists.

At this moment, the database consists of 1,174 clinical cases, with the possibility to create new cases according to different disaster scenarios, training needs, and learning objectives.

According to participants’ feedback, the introduction of such an innovative and comprehensive database seemed to have improved the quality and the realism of the Medical EU MODEX.

The Illinois EMSC Pediatric Facility Recognition Program was implemented in 1998. The objective was to identify the capability of a hospital to provide optimal pediatric emergency and critical care. Beginning in 2004, steps were taken to integrate pediatric disaster preparedness into the facility recognition process.

The goal of this study was to identify the impact of the EMSC Pediatric Preparedness Checklist across time in Chicago hospitals undergoing Pediatric Facility Recognition.

Chicago hospitals were evaluated during the 2012 and 2016 Pediatric Facility Recognition Program. The following components were surveyed as they relate to pediatrics: Overall Emergency Operations Plan (EOP), Surge Capacity, Decontamination, Reunification/Patient Tracking, Security, Evacuation, Mass Casualty Triage/JumpSTART, Children with Special Health Care Needs/Children with Functional Access Needs, Pharmaceutical Preparedness, Recovery, Exercise/Drills/Trainings. Data from 2012 and 2014 checklist categories were compared and p-values were computed utilizing Fisher’s Exact Test. A p-value <0.05 was considered statistically significant.

Stockpiling of staging areas or having ready access to resuscitation supplies increased 46% (p < 0.05), testing of pediatric surge capacity in previous 24 months decreased 43% (p < 0.05), maintaining warmed water source for decontamination decreased 43% (p < 0.05), and having familiarity of evacuation procedures in ED, pediatric, and nursery personnel decreased 42% (p < 0.05). Although not statistically significant, the training of pediatric staff with JumpSTART triage increased 59%, EOP containing a pediatric reunification process increased by 36%, the presence of specific staff plans to allow care of dependents increased for children (29%), elderly (32%) and pets (35%), integration of a pediatric component into hospital EOP increased by 29%, and identification of an alternate treatment site for children decreased by 25%.

Integrating the EMSC Pediatric Preparedness Checklist surveys into the facility recognition process impacts pediatric disaster preparedness and planning, and identifies areas of improvement in hospitals.

With the move into Gold Coast University Hospital, a new disaster plan was developed in 2017. To assess preparedness for the Commonwealth Games (April 2018), a number of mass casualty exercises were conducted, including a large multi-agency exercise with Queensland Police and Ambulance Services. During this preparation phase, senior clinicians from the perioperative area clarified their sub-plans and developed a novel model of periop response.

This study assesses this model of response and evaluates it within the context of periop disaster exercises.

The periop response model evolved through multi-disciplinary key stakeholder engagement into a defined model of surgical, anesthetic, and periop nursing responses with dedicated roles and parallel communication streams from ED to OR by the respective specialties. Throughout different disaster exercises, this model of response was tested, refined, and evaluated by formal post-exercise debriefs and group meetings.

Since May 2017, seven different mass casualty exercises with periop response were performed; firstly, a table-top (EmergoTrainSystem) format was used, which revealed communication and logistical deficiencies. After model refinement, further exercises were accomplished, all within the clinical environment, including movements of mock patients from ED to OR. These exercises generated improvements in communication, coordination, and logistics. Every exercise was also used to test more detailed information, communication, and organizational tasks of the various involved craft groups, such as notification, call-in lists, whiteboard structure, transport facilitation, and many more. Overall, our newly developed periop response model proved to be robust and successful, even with rotating personnel through different roles.

Apart from the success of the periop response model, other hospital areas (ICU, bed and ward management) became involved. With growing interest and staff turn-over a regular periop disaster response exercise program has now been established. This model of periop response has potential for use in other health systems.