The Russian invasion of Ukraine began on February 24, 2022. UNHCR reported, as of April 6th, more than 4.3 million refugees have fled Ukraine, with 401,704 refugees arriving in the Republic of Moldova, around 100,000 of whom have remained in the country. JICA investigated whether Moldova's healthcare needs were burdened by accepting a large number of Ukrainian refugees, and examined the way to support them.

JICA dispatched the 3rd team as a survey team. The 2nd team consisted of two medical doctors, one nurse/midwife, one clinical engineer (CE), one Japan DMAT logistician, and two JICA staff. The dispatch period was three weeks when five major hospitals were visited in the capital, evaluating the current situation and the need for support for the future.

As of April 6, 2022, 3,853 people were staying in refugee accommodation centers, while the rest lived in ordinary Moldovan families. Evacuees, like Moldovan citizens, were covered by health insurance, and evacuees had access to medical care. Medical institutions were not overwhelmed by medical needs due to the Ukraine crisis. There was no epidemic of infectious diseases even at evacuation centers. However, since there was no system to share emergency information between hospitals, we held a disaster medical seminar to introduce the current situation of disaster support in Japan and supporting EMTCC.

As a survey team, not only doctors but also nurses, midwives, and CEs surveyed, making it easier to understand the specific medical needs at medical facilities. Most of the evacuees stayed in ordinary Moldovan homes, and it is possible that avoiding a crowded environment at the evacuation shelters prevented the epidemic of infectious diseases.

Disaster medicine education is a huge challenge, but essential to disaster preparedness. While natural disasters have always been a part of world events, recent large-scale natural and man-made disasters have drawn attention to disaster medicine. As a consequence, medical schools in many parts of the world have begun to incorporate disaster-related topics into their curricula. However, in the territory of the former USSR, disaster medicine has just begun its development, and at the moment it is represented only in a couple countries, including Kazakhstan.

Data collection was performed using a database search through the Ministry of Education and Ministry of Healthcare of the Republic of Kazakhstan, Uzbekistan, Kyrgyzstan, Russian Federation, Belarus, and Ukraine. Disaster Medicine curricula on different education levels, including bachelor, graduate, and postgraduate levels were reviewed and analyzed.

Even though Kazakhstan is the ninth largest country in the world, education in the field of disaster medicine is currently represented only in one medical university in the country: specialists in disaster and emergency medicine are trained in residency and master's programs. In the Republics of Uzbekistan and Kyrgyzstan, education in the disaster medicine field is not provided, but there are electives for bachelor students. The Federal Center for Disaster Medicine, located in Moscow, offers doctors advanced training in disaster medicine, also disaster medicine education is provided at the bachelor and residency levels all over the Russian Federation. In Ukraine, at the moment, there is no training of specialists in disaster medicine, while in Belarus there are curricula at all levels of education.

Despite the fact that our life is impossible without catastrophes, most of the post-soviet countries are not having educational programs in disaster medicine. Using international experience could be beneficial so that every country will be prepared to face any disaster both locally and globally.

Acute blood loss represents a leading cause of death in both civilian and battlefield trauma, despite the prioritization of massive hemorrhage control by well-adopted trauma guidelines. Current Tactical Combat Casualty Care (TCCC) and Tactical Emergency Casualty Care (TECC) guidelines recommend the application of a tourniquet to treat life-threatening extremity hemorrhages. While extremely effective at controlling blood loss, the proper application of a tourniquet is associated with severe pain and could lead to transient loss of limb function impeding the ability to self-extricate or effectively employ weapons systems. As a potential alternative, Innovative Trauma Care (San Antonio, Texas USA) has developed an external soft-tissue hemostatic clamp that could potentially provide effective hemorrhage control without the aforementioned complications and loss of limb function. Thus, this study sought to investigate the effectiveness of blood loss control by an external soft-tissue hemostatic clamp versus a compression tourniquet.

The external soft-tissue hemostatic clamp would be non-inferior at controlling intravascular fluid loss after damage to the femoral and popliteal arteries in a normotensive, coagulopathic, cadaveric lower-extremity flow model using an inert blood analogue, as compared to a compression tourniquet.

Using a fresh cadaveric model with simulated vascular flow, this study sought to compare the effectiveness of the external soft-tissue hemostatic clamp versus the compression tourniquet to control fluid loss in simulated trauma resulting in femoral and posterior tibial artery lacerations using a coagulopathic, normotensive, cadaveric-extremity flow model. A sample of 16 fresh, un-embalmed, human cadaver lower extremities was used in this randomized, balanced two-treatment, two-period, two-sequence, crossover design. Statistical significance of the treatment comparisons was assessed with paired t-tests. Results were expressed as the mean and standard deviation (SD).

Mean intravascular fluid loss was increased from simulated arterial wounds with the external soft-tissue hemostatic clamp as compared to the compression tourniquet at the lower leg (119.8mL versus 15.9mL; P <.001) and in the thigh (103.1mL versus 5.2mL; P <.001).

In this hemorrhagic, coagulopathic, cadaveric-extremity experimental flow model, the use of the external soft-tissue hemostatic clamp as a hasty hemostatic adjunct was associated with statistically significant greater fluid loss than with the use of the compression tourniquet.

Paquette R, Bierle R, Wampler D, Allen P, Cooley C, Ramos R, Michalek J, Gerhardt RT. External soft-tissue hemostatic clamp compared to a compression tourniquet as primary hemorrhage control device in pilot flow model study. Prehosp Disaster Med. 2019;34(2):175–181

Terrorism remains a major threat and concern in many countries around the world. Pediatric populations represent approximately 30% of the world population, and in the event of a terrorist attack, can either be primary targets, to include the possibility of abduction, or unintended victims. They are unique in their vulnerabilities and, therefore, require special consideration.

This study is a semi-quantitative, epidemiological analysis of all terrorism-related pediatric fatalities and injuries sustained from 1970-2019. Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). Summaries of events including search terms associated with pediatric population were individually reviewed and those describing the deaths, injuries, or abductions were tallied.

Of the over 200,000 terror events, 2,302 events met inclusion criteria. This represented 1.14% of total events which involved death, injury, or abduction. Of 2,032 events, a total of 2,275 pediatric fatal injuries (FI) were recorded, as well as 2,280 pediatric non-fatal injuries (NFI). The most common weapons used in all attacks involving the pediatric population were explosives (1,539 [66.8%]), firearms (543 [23.5%]), other (169 [7.3%]), and melee (83 [3.6%]). A total of 275 of the 2,032 events were related to abductions, with 71 cases involving the abduction of 10 individuals or more.

Pediatric casualties in terrorist events represent a small proportion of overall victims. However, it should be understood that the pediatric population has unique vulnerabilities, and when directly impacted by terrorism, can have long-term physical and psychosocial sequelae, as well as a devastating emotional impact on the community.

Infection countermeasures that consider patient characteristics are needed at psychiatric hospitals.

Based on the experience of implementing countermeasures against infection by COVID-19, which has become a pandemic disaster over the past few years. This report is on the current situation and issues of infection countermeasures in psychiatric hospitals.

Reasons for why it is difficult to take COVID-19 countermeasures in psychiatric hospitals included the following: for patient predispositions–it is difficult to promote understanding and practice of infection countermeasures such as proper wearing of masks, hand hygiene enforcement, zoning, etc. For environmental predispositions–it is difficult to ventilate because windows and doors cannot be opened, and it is difficult to isolate infected individuals as there are few private rooms. Countermeasures included the following: recreation should be limited to that which does not involve speaking and having everybody face the same direction, ensuring sufficient space between people during meals, installing ventilation equipment in hospital wards, handle care in private rooms until the hospitalized patient is judged to be not infectious, and conducting zoning and isolation on a hospital ward level. Results showed that although COVID-19 outbreaks occasionally occurred in hospital wards, this did not result in spread throughout the hospital.

Future challenges include improving the quality of infection countermeasures in hospitals through thoroughly educating hospital personnel who are unaccustomed to taking infection countermeasures.

The New South Wales (NSW) Biocontainment Centre (NBC) is the first high-level isolation unit in Australia. This state-wide referral facility, located at Westmead Hospital, Sydney, will provide care for patients with high-consequence infectious diseases (HCIDs), including viral hemorrhagic fevers (VHF). In preparation, a tabletop exercise with key stakeholders was held to introduce and socialize the NBC’s capacity to support NSW’s preparedness for the management of a patient with HCID.

Invitations were provided to key stakeholders within Westmead Hospital (facility executive, emergency and ICU services, security, switchboard); NSW Preparedness and Response Branch; retrieval services; peripheral hospitals; pediatric hospital network; and NSW Public health units (state and district).

The scenario presented was an unwell patient with suspected VHF arriving at a peripheral hospital emergency department.

Discussion during the four-hour long exercise was facilitated with directed questions and injects, and was recorded. Recommendations and key learnings from the exercise and debrief provided opportunities to enhance current response assumptions.

Forty-five people participated both face-to-face and virtually. Participant discussion showed increasing appreciation of patient presentations to any part of the NSW health system and available assistance. Recommendations included: enhanced access to NBC support with a direct “1-800 number”, coordination for communication, treatment, and transport, and if required, deployment of an NBC team to peripheral sites. Areas for future collaborative work were identified.

This exercise successfully achieved collaboration of key stakeholders to develop an updated, comprehensive and robust plan for management of HCID patients within NSW, regardless of their presentation site. It has created an opportunity to brainstorm and optimize how the NBC can interact with other agencies to maximize the NSW HCID response.

Cricothyrotomy and chest needle decompression (NDC) have a high failure and complication rate. This article sought to determine whether paramedics can correctly identify the anatomical landmarks for cricothyrotomy and chest NDC.

A prospective study using human models was performed. Paramedics were partnered and requested to identify the location for cricothyrotomy and chest NDC (both mid-clavicular and anterior axillary sites) on each other. A board-certified or board-eligible emergency medicine physician timed the process and confirmed location accuracy. All data were collected de-identified. Descriptive analysis was performed on continuous data; chi-square was used for categorical data.

A total of 69 participants were recruited, with one excluded for incomplete data. The paramedics had a range of six to 38 (median 14) years of experience. There were 28 medical training officers (MTOs) and 41 field paramedics. Cricothyroidotomy location was correctly identified in 56 of 68 participants with a time to identification range of 2.0 to 38.2 (median 8.6) seconds. Chest NDC (mid-clavicular) location was correctly identified in 54 of 68 participants with a time to identification range of 3.4 to 25.0 (median 9.5) seconds. Chest NDC (anterior axillary) location was correctly identified in 43 of 68 participants with a time to identification range of 1.9 to 37.9 (median 9.6) seconds. Chi-square (2-tail) showed no difference between MTO and field paramedic in cricothyroidotomy site (P = .62), mid-clavicular chest NDC site (P = .21), or anterior axillary chest NDC site (P = .11). There was no difference in time to identification for any procedure between MTO and field paramedic.

Both MTOs and field paramedics were quick in identifying correct placement of cricothyroidotomy and chest NDC location sites. While time to identification was clinically acceptable, there was also a significant proportion that did not identify the correct landmarks.

This study aims to explore the evaluation of lactic acid (Lac) and neutrophil gelatinase-associated lipocalin (NGAL) on the condition and prognosis of patients with diquat (DQ) poisoning.

A total of 79 cases of DQ poisoning treated in one hospital from January 2019 through February 2023 were included: 10 cases of mild poisoning, 49 cases of moderate to severe poisoning, and 20 cases of fulminant poisoning. According to the Kidney Disease: Improving Global Outcomes-acute kidney injury (KDIGO-AKI) criteria, the patients were divided into 60 cases in the AKI group and 19 cases in the non-acute kidney injury (NAKI) group. According to the AKI diagnostic indicators, AKI patients were divided into Grade I, Grade II, and Grade III. According to prognosis, the patients were divided into survivor group and non-survivor group. During the same period, 30 healthy subjects were selected as the healthy group. The changes of blood Lac, NGAL, cystatin C (CysC), and serum creatinine (Scr) levels of patients were detected, the 28-day survival of patients was recorded, and the correlation between blood Lac, NGAL levels, and renal injury grade in patients with AKI caused by DQ poisoning was analyzed. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value and prognostic value of Lac, NGAL, and their combination in patients with AKI caused by DQ poisoning.

There were significant differences in AKI grade, Lac, NGAL, CysC, and Scr levels among different degrees of poisoning groups (P < .05). There were significant differences in the levels of Lac, NGAL, CysC, and Scr among patients with different AKI grades (P < .05). The levels of Lac, NGAL, CysC, and Scr in the survivor group were significantly lower than those in the non-survivor group (P < .05). The blood Lac and NGAL levels were positively correlated with AKI grades in patients with DQ poisoning (r = 0.752, 0.836; P = .000, .000). The combined detection of blood Lac and NGAL had higher predictive value for AKI and assessed value for death in DQ poisoning than either of them alone.

The combined detection of Lac and NGAL have a certain clinical value in AKI grading and evaluating AKI prognosis caused by DQ poisoning.

There are 60 Poison Centers in the United States that manage over 2.5 million poison exposure calls each year. A poison center can be reached 24 hours a day by dialing a national 800 hotline. Poison Centers are staffed by Specialists in Poison Information who are highly trained in clinical toxicology and are very skilled in telephone triage.

ATSDR and the Poison Centers in HHS/FEMA Region 6 developed draft guidance for incorporating Poison Centers into the National Response Plan. That framework was used to incorporate Poison Centers into the gulf oil spill response of 2010. The National Poison hotline was promoted to provide medical support for those with health effects or health questions related to the spill. During the response the surveillance capabilities of the National Poison Data System (NPDS) were highlighted. The Louisiana Poison Center (LPC) and the other gulf states Poison Centers provided information on health effects related to the spill. Information was provided by the LPC to the Louisiana Department of Health and Hospitals, Office of Public Health Section of Epidemiology and Environmental Toxicology, public information officer to assist in briefing the Governor, the Louisiana Governors Office of Homeland Security and Emergency Preparedness to post to the Virtual Louisiana website, as well as ATSDR, CDC, EPA, and other agencies participating in the gulf response unified command. Poison Centers, for the first time, participated in a response on a national level, providing medical support for those with symptoms or medical questions related to the spill. In addition to assisting in the medical care of those exposed to substances related to the oil spill and the response efforts, Poison Centers also responded to questions about air and water quality and seafood safety.

Poison Centers are a valuable resource to assist in emergency response plans.