As wildfires and air pollution become more common across the United States, it is increasingly important to understand the burden they place on public health. Previous studies have noted relationships between air quality and use of Emergency Medical Services (EMS), but until now, these studies have focused on day-to-day air quality. The goal of this study is to investigate the effect of sustained periods of poor air quality on EMS call characteristics and volume.

Using a time-stratified case-crossover design, the effect of exposure to periods of poor air quality on number and type of EMS calls in California, USA from 2014-2019 was observed. Poor air quality periods greater than three days were identified at the United States Environmental Protection Agency’s (EPA’s) Air Quality Index (AQI) levels of Unhealthy for Sensitive Groups (AQI 100) and Unhealthy (AQI 150). Periods less than three days apart were combined. Each poor air quality period was matched with two one-week controls, the first being the closest preceding week that did not intersect a different case. The second control was the closest week at least three days after the case and not intersecting with a different case. Due to seasonal variation in EMS usage, from the initial cases, cases were used only if it was possible to identify controls within 28 days of the case. A conditional Poisson regression calculated risk ratios for EMS call volume.

Comparing the case periods to the controls, significant increases were found at AQI >100 for total number of calls, and the primary impressions categories of emotional state or behavior, level of consciousness, no patient complaint, other, respiratory, and abdominal. At an AQI >150, significance was found for the primary impressions categories of other, pain, respiratory, and digestive.

These data demonstrate increased EMS calls during sustained poor air quality, and that several EMS primary impression categories are disproportionately affected. This study is limited by the imprecision of the primary impression’s classification provided by the EMS clinician responding to the EMS call. More research is needed to understand the effects of periods of poor air quality on the EMS system for more efficient deployment of resources.

RCHIS is an Electronic Medical Record (EMR) and Health Information System (HIS) that has been purpose built for use by Red Cross Red Crescent (RCRC) Emergency Response Units (ERUs), which are the equivalent of Type 1 (fixed and mobile) and Type 2 facilities in the Emergency Medical Teams (EMT) classification.

To share the main lessons learned from the pilot to inform development and implementation of similar systems in other EMTs.

A three-day, in-person super user training was held with 13 participants: nine first aid volunteers, two nurses, and two medical doctors; seven delegates had experience using an EMR. These super users served as trainers for staff at the pilot.

The pilot occurred with the Portuguese Red Cross (PRC) for the Peregrinação de Fátima, where 200,000 people were in attendance. The PRC was part of a wider coordination cell with the civil defense authority, who required live reporting from the three clinics PRC had set up.

77 user accounts and 243 patient files were created during the four-day pilot.

The delegates shared feedback directly and through a survey. 88% stated that RCHIS was very easy to use with the majority of delegates requiring less than 30 minutes of training. 95% of delegates stated that they had sufficient training to use RCHIS to its full extent.

The civil defense authority was able to utilize the real-time reporting to assist in their operational response.

The first RCHIS pilot was very successful from both a technical and organizational perspective.

Disaster Medical Response is a challenging field where opportunities for advancement are welcomed. Small Unmanned Aerial Vehicle (sUAV) technology (i.e., drones) has made enormous strides in the past few years and is poised for utilization in the early disaster response phase.

To discuss current uses of UAVs, proposed utilization and logistical details, technological advancements, current deficits, and training.

Our Foundation, Luman Medical, is working in the field of UAV integration for small to large scale disaster response. The concept is to equip first responders with small, relatively inexpensive, programmable drones that come equipped with hardware and software that are easy to use for inexperienced as well as skilled sUAV pilots.

These UAVs could increase ease and speed of deployment for early assessments of disaster area mapping, thermal imaging, ingress and egress routes, the discovery of survivors, communications, and delivery of supplies. Drone technology offers a new and growing type of tool in the disaster response arena. It is our hope to explore an integration that is easy, safe, and affordable to augment and enhance existing disaster response planning.

Appropriate pain management indicates the quality of casualty care in trauma. Gender bias in pain management focused so far on the patient. Studies regarding provider gender are scarce and have conflicting results, especially in the military and prehospital settings.

The purpose of this study is to investigate the effect of health care providers’ gender on pain management approaches among prehospital trauma casualties treated by the Israel Defense Forces (IDF) medical teams.

This retrospective cohort study included all trauma casualties treated by IDF senior providers from 2015-2020. Casualties with a pain score of zero, age under 18 years, or treated with endotracheal intubation were excluded. Groups were divided according to the senior provider’s gender: only females, males, or both female and male. A multivariate analysis was performed to assess the odds ratio of receiving an analgesic, depending on the presence of a female senior provider, adjusting for potential confounders. A subgroup analysis was performed for “delta-pain,” defined as the difference in pain score during treatment.

A total of 976 casualties were included, of whom 835 (85.6%) were male. Mean pain scores (SD) for the female only, male only, and both genders providers were 6.4 (SD = 2.9), 6.4 (SD = 3.0), and 6.9 (SD = 2.8), respectively (P = .257). There was no significant difference between females, males, or both female and male groups in analgesic treatment, overall and per specific agent. This remained true also in the multivariate model. Delta-pain difference between groups was also not significant. Less than two-thirds of casualties in this study were treated for pain among all study groups.

This study found no association between IDF Medical Corps providers’ gender and pain management in prehospital trauma patients. Further studies regarding disparities in acute pain treatment are advised.

Mass gatherings are growing in frequency. Religious, or in this case, “mass” mass gatherings are also growing in complexity, requiring considerable effort from nations hosting a Papal Mass. Ireland hosted a papal mass in 1979 when the prospect of terrorism at such events was significantly lower. Large high-profile events such as a Papal Mass offer a platform via the media and social media to gain widespread coverage of adverse events. In 2018, a predicted 500,000 guests were scheduled to attend a Papal Mass gathering in Phoenix Park, Dublin, a bounded 1,700-hectare park in the center of Dublin.

To develop a medical plan estimating numbers of people requiring medical attention at a Papal Mass held in Ireland late August 2018, and compare same with actual numbers treated post-event. This study aims to reduce the medical impact of such an event on local receiving hospitals through plans that effectively manage medical- and trauma-related presentations on site.

A literature review of medical reports regarding medical care at Papal Mass gatherings worldwide found a range of predicted medical attendance from 21-61 per 10,000 attendees. On that basis we had prepared on-site facilities, facilities on travel routes and access point system for medical care for a crowd of 500,000 were selected.

One of 6 receiving hospitals in Dublin had an increase in average presentations on the day. Attendance was reduced significantly due to weather. 261 patients were treated on site, falling in line with lower rate predicted of 31 patients treated in hospital on site and 17 transports off-site.

A predictable number of patients presented for medical care. On-site medical services reduced transports to hospital. Reduced attendance ensured facilities were sufficient, but could have been under the pressure of the predicted attendance of 500,000.

In October 2021, Hillel Yaffe, MC, suffered a ransomware attack which shutdown most hospital computer systems, including patient EMR, pharmacy, communications, administration and backup systems. Staff were left in a state of “cyber-shock” without access to essential information for maintaining safety, quality and continuity of care. The aim of this presentation is to share the hospitals' experience and insights of this cyber-attack, outlining preparedness and response strategies.

This attack required a multifaceted emergency response strategy, including:

• Immediate response activated according to specific pre-prepared emergency scenario action lists

• Leadership decision making in real time under conditions of uncertainty

• Identifying the extent of systems affected

• Establishing alternative communication across the organization

• Distributing real-time status updates and proactive guidelines, based on pre-existing emergency preparedness protocols

• Finding alternative access to patient health histories

• Adaptation and distribution of alternative hardcopy versions of patient evaluation and documentation normally done by EMR

• Distribution of instruction materials for staff via alternative communication, ensuring quick and correct adoption of alternative protocols

• Special emphasis on patient safety, risk management, quality and continuity of care

Recognition, support and resilience-building for staff facing uncertainty and unprecedented conditions

Required preparations include pre-prepared standing orders and procedures, exercises and simulations. Advanced preparation of alternative documentation and care protocols will enable uninterrupted, safe, high-quality patient care. Familiarity with pen-and-paper documentation may minimize shock and disorientation from “digital withdrawal”, especially among younger workers lacking manual documentation experience. Staff members should also be instructed in maintaining “digital hygiene”, such as using strong passwords and awareness about cyber-security threats.

Hospitals must prepare for potential cyber-attacks and EMR/digital system shutdowns. Cyber-attack should be treated by organizations as an emergency event, and they should prepare incident response and contingency plans, to assure business continuity and quick disaster recovery.