The challenges that the health systems face in the last years increased exponentially. No matter if we are talking about the impact of the COVID-19 pandemic or the Russian military action in Ukraine, the European health ecosystem is facing new problems. In the light of these uncertainties, we assessed which could be the next trends that can impact the healthcare systems, in order to better prepare and adapt to the new contexts.

Using two foresights exercises (FSE), one in 2018 and the second one in 2022, we identified the most important trends in the political, economic, social, technological, security, environmental and medical sectors that could have an impact on health.

53 people participated in the first FSE and 40 in the second one. The respondents identified cyber security, an increased reliance on digital technologies for communications, CBRNE management of the patients, centrally coordinated attacks, demographic aging, reduced economic resources, violence against emergency medical staff and the increased need and demand for psychosocial support as the most important trends. Moreover, they considered that wars, hybrid threats, the fake news, pandemics and the influence of artificial intelligence could impact the healthcare systems.

Many of the trends identified in 2018 as having a possible impact on the health system proved to be relevant four years later. Therefore, we consider the FSE a relevant tool in foreseeing the main areas that could have an impact on health and its results could guide the preparedness for the future.

Dogs left behind in the restricted area by the Great East Japan Earthquakes of 2011 (Fukushima Prefecture, Japan) were initially rescued at a temporary first response shelter under chaotic conditions: poor housing and husbandry was maintained by unfamiliar/untrained staff, and lack of exercise was associated with deterioration of the mental and physical health of the impounded dogs. The objectives of this study were to report characteristics, disposition, and health status of dogs rescued in the Fukushima Prefecture, and to perform a retrospective epidemiological evaluation of factors associated with disposition and disease incidence at shelters.

The problems addressed in this study were shelter-related health issues at the first response shelter and reasons for retained adoption at the secondary shelter that caused delayed closure of the shelter.

A retrospective cohort study was performed with all dogs that were rescued from the restricted area in the Fukushima Prefecture. Kaplan-Meier time-to-event analysis was performed to estimate the median days to outcomes. A chi-square test of homogeneity was used to determine whether ownership status was associated with breed. Cox proportional hazards regression models were used to assess the association between time-to-adoption with ownership status, age, sex, and breed, the association between time to onset of diarrhea with age and breed, and between duration of diarrheic symptoms with the number of antibiotics and the number of medications.

Five-hundred and twenty-nine dogs were admitted to the Ihno and Miharu shelters (Fukushima Prefecture), including 179 that had detailed medical records. Seventy-six percent of dogs were mixed breed. Twenty-six percent of dogs had verified ownership, and almost 16% of dogs were reclaimed by their owners. Sixty-six percent of dogs developed diarrhea, and 17 different antibiotics were used to treat it. Using three or more different antibiotics was associated with prolonged signs of diarrhea. Dogs with verified ownership took longer for adoption than those without verified ownership. Breed and sex were not significantly associated with time to adoption. Age was associated with prolonged time to adoption.

To improve the welfare of dogs in disasters, responsible owner education, a well-organized registered volunteer training program for care of animals at shelters, proper disease management protocols, and enrichment strategies to prevent stress and disease in shelter setting are essential.

TanakaA, Martinez-LopezB, KassP.Epidemiological Evaluation of Dogs Rescued in the Fukushima Prefecture Following the Great East Japan Earthquakes of 2011. Prehosp Disaster Med. 2018;33(5):478–583.

Current literature suggests that a large percentage of the health workforce may be unwilling to work during a disaster. The willingness of pharmacists to work during a disaster is under-researched internationally and non-existent in Australia.

To determine if Australian pharmacists are willing to work in a disaster and the factors that affect the willingness to work.

A 13-question survey was developed from the current literature and released nationally through professional organizations and social media.

Sixty Australian pharmacists completed the survey. Most participants believed their pharmacy was an essential service for their community. Pharmacists reported they would be likely to report to work during a pandemic or biological disaster (73%) or natural disaster (78%). The two major factors likely to prevent pharmacists from working in a disaster are family and safety concerns. Pharmacists perceived that their duty of care to their patients would make them likely to work during a disaster. Most pharmacists noted they would work even if they were expected to work outside their scope of practice, or if their place of work lacked electricity or was damaged.

Depending on the disaster, up to 27% of the pharmacy workforce may be unwilling to work in a disaster. Family and safety concerns were the primary barriers to pharmacists reporting to work in the aftermath of a disaster. Providing guidelines on how pharmacists can prepare their family for a disaster may assist in ensuring pharmacists are willing to work. The pharmacists surveyed demonstrated a strong commitment to their duty of care with the majority stating they would be likely to work in austere work environments. This research raises questions of the safety of pharmacists working outside their scope and in austere environments and whether it is safe for them, their patients, and the broader community.

Health care providers are on the forefront of delivering care and allocating resources during a disaster; however, very few are adequately trained to respond in these situations. Furthermore, there is a void in the literature regarding the specific care needs of patients with ventricular assist devices (VADs) in a disaster setting. This project aimed to develop an evidenced-based protocol to aid health care providers during the evacuation of patients with VADs during a disaster.

This is a qualitative study that used expert review, tabletop discussion, and a survey of health care professionals to develop and evaluate an evacuation protocol. The protocol was revised after each stage of review in order to reach a consensus document.

The project concluded with the finalization of a protocol which addresses evacuation and patient triage, and also includes an algorithm to determine which staff members should be evacuated with patients, transportation resources, evacuation documentation, and items patients need during evacuation. The protocol also addressed steps to be taken in the event that evacuation efforts fail and how to manage outpatient VAD patients seeking assistance.

This protocol provides guidance for the care of VAD patients in the event of a disaster and evacuation. Protocols such as this address difficult scenarios and should be created prior to a disaster to assist staff in making difficult decisions. These documents should be created using multi-disciplinary feedback via the consensus model as well as the Institute of Medicine (IOM; National Academy of Medicine; Washington, DC USA) “Crisis Standards of Care.”

DavisKJ, SuyamaJ, LinglerJ, BeachM. The Development of an Evacuation Protocol for Patients with Ventricular Assist Devices During a Disaster. Prehosp Disaster Med. 2017;32(3):333–338.

An activity or situation that produces conditions which are not real, but have the appearance of being real, used especially for testing something. Longman Dictionary of Contemporary English. Simulation has evolved over the centuries but has not been applied to medicine until the 20th century with the introduction of virtual reality and computers. Prior to the 20th century simulation took the forms of physical models and cadavers. With the introduction of flight simulation there was an effort to move similar approaches into medicine. This was pushed by the demands of minimally invasive surgery and the introduction of robotics in surgery. In the 21st century in addition to cognitive task analysis tools we are beginning to see the migration of advanced intelligence tools to simulation. We are just at the beginning of how we will use adversarial reasoning in the medical environment and in high risk time constrained situations like Emergency Medicine. The practitioner of emergency medicine is at high risk for errors because of multiple factors including high decision density, high levels of diagnostic uncertainty, high patient acuity, and frequent distractions. Some authors have suggested that instructing physicians in “cognitive forcing strategies” or “metacognition” will help reduce the amount of cognitive error in medical practice. It has been said ‘‘[There is an] ethical obligation to make all efforts to expose health professionals to clinical challenges that can be reasonably well simulated prior to allowing them to encounter and be responsible for similar real-life challenges.’' TYPES OF SIMULATION • Verbal • Tactile • Visual • Situational • Environmental TYPES OF SIMULATION TRAINING • Standardized patients (role play) • Basic models (partial task trainers) • Simple level • Higher level • Mannequins • Low fidelity • High fidelity • Virtual patients • Screen-based; computer-based • COMBINATIONS • Augmented sp encounters with technology • Crises management HUMAN PATIENT SIMULATION • Realistic • Suitable for all levels • Safe • Wide variety of training programs • Expensive ADVANTAGES OF SIMULATION • Patients are never at risk • Serious but infrequent events, in predictable times and places • Errors can be allowed to occur, and play-out • Rehearsal, repetition, mastery • Crisis management simulation, planning • Reduces institutional liability • Increases operational confidence • Produces rapid results • Allows team training • Increases institutional prestige The use of high fidelity simulations to train multidisciplinary teams in critical environments is well established.

In the southern Philippines, human-induced disasters, such as terrorist attacks, have caused unprecedented damage to the economic, social, and political life of the attacked and nearby areas. More gruesome is the direct impacts to human life and wellbeing. This study focuses on the 2017 Marawi armed siege, the longest urban battle in the Philippines. The 154-day siege took a heavy toll, including 1,132 deaths among militants, soldiers, police, and civilians, and caused the displacement of some 400,000 local inhabitants. The city is in total ruins leaving its economic center as “Ground 0.” The aftermath of the siege demands major interventions to address physical and economic damages, but more importantly, to ameliorate the human impacts caused by the brutalities of war. The displaced peoples need to recover from health impacts – psychological trauma, as well as social, environmental, and cultural. The Sendai Framework for Disaster Risk Reduction (DRR) 2015-2030 states that DRR requires society-wide engagement. Everyone, regardless of their age, gender, ethnicity, religion, or socio-economic position, should be involved in thinking, planning, and deciding about DRR. Studies on youth participation in disaster recovery are still scarce.

This current research aims to help fill this gap and to contribute to providing the much-needed evidence base for the formulation and implementation of future policies to enable and improve youth participation in post-disaster initiatives in the Philippines.

Initial findings reveal that the following are crucial factors for youth mobilization: (1.) avenues for volunteering, (2.) access to adequate resources and support including information, funds, manpower, and social capital, (3.) opportunities for the youth to participate in the form of events or activities, (4.) legal mandate for youth participation in local, national, and international policies and frameworks. The study also looked at barriers or challenges to youth participation and their motivations.

Poisoning is a public health problem that effects all ages, genders, and ethnicities, but certain populations are at increased risk. Unintentional poisoning disproportionately affects lower- and middle-income countries. The epidemiological pattern of poisoning can differ significantly within countries. In Thailand, national poisoning data is collected by voluntary reporting to a poison control center in the capital, Bangkok. Limited poisonings are reported from Chiang Mai, a province in Northern Thailand, though it has the highest suicide rate in the country.

The aim of this study is to describe poisoning epidemiology, examine differences between intentional and unintentional poisonings and, to develop a multivariate predictive model of intentional poisonings in Northern Thailand.

A total of 550 poisoning admissions were identified at Chiang Mai's University Hospital from 01 January 2005 to 31 December 2005. Demographic data were collected retrospectively by manual chart review. Chi-square and t-tests were used to examine differences in poisoning by intent. A step-wise logistic regression analysis was performed to develop a predictive model of intentional poisonings. Factors significantly associated with intentional poisoning were used in a logistic progression model to identify predictors of intentional poisoning.

Younger age was significantly associated with intentional poisoning. There was no demonstrated difference in gender and poisoning intent. Predictors of intentional poisonings were use of chemical agents, high-risk medications (analgesics and psychiatric), unemployment, and younger age.

Interventions should focus on factors that put young adults and the unemployed at greater risk for intentional poisonings. Further interventions are also needed to limit access to potentially lethal doses of chemical agents and high risk medications.

Despite United States national learning objectives referencing research fundamentals and the critical appraisal of medical literature, many paramedic programs are not meeting these objectives with substantive content.

The objective was to develop and implement a journal club educational module for paramedic training programs, which is all-inclusive and could be distributed to Emergency Medical Services (EMS) educators and EMS medical directors to use as a framework to adapt to their program.

Four two-hour long journal club sessions were designed. First, the educator provided students with four types of articles on a student-chosen topic and discussed differences in methodology and structures. Next, after a lecture about peer-review, students used search engines to verify references of a trade magazine article. Third, the educator gave a statistics lecture and critiqued the results section of several articles found by students on a topic. Finally, students found an article on a topic of personal interest and presented it to their classmates, as if telling their paramedic partner about it at work. Before and after the series, students from two cohorts (2017, 2018) completed a survey with questions about demographics and perceptions of research. Students from one cohort (2017) received a follow-up survey one year later.

For the 2016 cohort, 13 students participated and provided qualitative feedback. For the 2017 and 2018 cohorts, 33 students participated. After the series, there was an increased self-reported ability to find, evaluate, and apply medical research articles, as well as overall positive trending opinions of participating in and the importance of prehospital research. This ability was demonstrated by every student during the final journal club session. McNemar’s and Related-Samples Cochran’s Q testing of questionnaire responses suggested a statistically significant improvement in student approval of exceptions from informed consent.

The framework for this paramedic journal club series could be adapted by EMS educators and medical directors to enable paramedics to search for, critically appraise, and discuss the findings of medical literature.

The incidence and mortality of traumatic brain injury (TBI) has increased rapidly in the last decade in China. Appropriate ambulance service can reduce case-fatality rates of TBI significantly. This study aimed to explore the factors (age, gender, education level, clinical experience, professional title, organization, specialty before prehospital care, and training frequency) that could influence prehospital doctors’ knowledge level and practices in TBI management in China, Hubei Province.

A cross-sectional questionnaire survey was conducted in two cities in Hubei Province. The self-administered questionnaire consisted of demographic information and questions about prehospital TBI management. Independent samples t-test and one-way ANOVA were used to analyze group differences in the average scores in terms of demographic character. General linear regression was used to explore associated factors in prehospital TBI management.

A total of 56 questionnaires were handed out and 52 (93%) were returned. Participants received the lowest scores in TBI treatment (0.64; SD=0.08) and the highest scores in TBI assessment (0.80; SD=0.14). According to the regression model, the education level was associated positively with the score of TBI identification (P=.019); participants who worked in the emergency department (ED; P=.011) or formerly practiced internal medicine (P=.009) tended to get lower scores in TBI assessment; participants’ scores in TBI treatment were associated positively with the training frequency (P=.011); and no statistically significant associated factor was found in the overall TBI management.

This study described the current situation of prehospital TBI management. The prehospital doctors’ knowledge level and practices in TBI management were quantified and the influential factors hidden underneath were explored. The results indicated that an appropriate continuing medical education (CME) program enables improvement of the quality of ambulance service in China.

KouK , HouXY , SunJD , ChuK . Doctor’s Knowledge and Practices of Traumatic Brain Injury Management in Chinese Prehospital Settings. Prehosp Disaster Med. 2015;30(6):560–568.

Weather-related natural disasters are increasing in frequency and intensity, severely impacting communities. The patient demographic requiring assistance in a disaster is changing from acute traumas to chronic disease exacerbations. Adequate management requires a multidisciplinary healthcare approach. Pharmacists have been recorded in various disaster roles in literature. However, their roles within these disaster health teams are not well-established and do not fully utilize their skill sets.

To identify where pharmacists roles are within the four phases of a disaster – prevention, preparedness, response, and recovery (PPRR), and to determine the barriers to pharmacists being better integrated into disaster teams.

Semi-structured interviews were conducted with 28 international key stakeholders and pharmacists. Interviews were transcribed and analyzed using both open and axial manual coding, as well as the text-analytics software Leximancer®. The use of these two methods provided triangulation of methods for reliability of results. This research project was covered by QUT ethics approval number 1700000106.

The themes identified were community, government, "disaster management," "pharmacy," and "barriers and facilitators." The Leximancer® analysis compared the different disaster perspective and experience levels of the participants. The more experienced disaster health professionals who had worked closely with pharmacists believed they were capable of undertaking more roles in a disaster.

Pharmacists have been placed in the logistics "silo" for their role in disaster management supply chain operations. However, pharmacists have the expertise, knowledge, and skills which transcend this "silo" to work across the multiple health roles in disasters. Pharmacists are identified as a critical piece to the puzzle in the disaster management throughout the PPRR cycle. They are capable of undertaking more roles in disasters in addition to the established logistics role. The barriers identified need to be addressed for the better integration of pharmacists into disaster teams.

Earthquakes rank among the most deadly natural disasters, and children are particularly affected due to their inherent vulnerability. Following an earthquake, there is a substantial increase in visits to emergency services. These visits stem not only from patients seeking care for physical traumas resulting from the earthquake and its subsequent complications, but also from individuals affected by the circumstances created by the disaster.

This study aims to determine the characteristics and outcomes of children who presented to the pediatric emergency department (PED) after the earthquake and to evaluate children who had crush injuries at a referral tertiary university hospital away from the earthquake area.

The medical records of children who presented to the PED from the earthquake area from February 6 through March 7, 2023 were retrospectively reviewed. Children rescued from under rubble were categorized as Group 1, those affected by earthquake conditions as Group 2, and patients seeking medical attention due to the follow-up of chronic illnesses were considered as Group 3. Patient data, including sociodemographic characteristics, time period under rubble (TPR), laboratory findings, and details of medical and surgical procedures, developing acute kidney injury (AKI), and the requirement for hemodialysis were recorded.

A total of 252 children were enrolled in the study, with 52 (20.6%) in Group 1, 180 (71.4%) in Group 2, and 16 (6.0%) in Group 3. The median age was six (IQR = 1.7-12.1) years. In the first group (n = 52), 46 (85.2%) children experienced crush injuries, 25 children (46.3%) developed crush syndrome, and 14 of them (14/25; 56.0%) required dialysis. In the second group, the most common diagnoses were upper respiratory tract infections (n = 69; 37.9%), acute gastroenteritis (n = 23; 12.6%), simple physical trauma (n = 16; 8.8%), and lower respiratory tract infections (n = 13; 7.1%). For children in the third group, pediatric neurology (n = 5; 33.3%), pediatric oncology (n = 4; 25.0%), and pediatric nephrology (n = 3; 18.8%) were the most frequently referred specialties.

Crush injuries, crush syndrome, and AKI were the most common problems in the early days following the earthquake. Along with these patients, children who were affected by the environmental conditions caused by the earthquake, as well as children with chronic illnesses, also accounted for a significant portion of visits to the PED, even if they were distant from the disaster area.

Early in the Russian-Ukrainian conflict, the Ukrainian Ministry of Health (MoH) implemented policy reform to allow for pre-hospital whole blood transfusion (pWBT). Team Rubicon (TR) worked with a multinational group of experts to disseminate training that accelerated the implementation of pWBT across the country.

TR utilized an assess, align, and act (A3) approach to drive the pWBT implementation. TR established relationships with Ukrainian providers to understand current needs, restrictions, and protocols for pWBT. TR aligned pWBT advocacy efforts, working with the disaster medicine program at Ivano-Frankivsk Medical National University to create a local lead advocate. Existing and novel coordination mechanisms were used to unite and inform MoH, World Health Organization, Non-Governmental Organizations, and local health systems. Finally, TR coordinated a multispecialty, multi-national team of healthcare providers who developed and delivered a training package in alignment with national guidelines utilizing a combination of didactics, videos, and demonstrations. From August to October of 2022, TR conducted pWBT trainings across Ukraine. Pre- and post-surveys were utilized to determine comfort with pWBT and usefulness of the training.

TR emerged as the point of reference for pWBT in Ukraine. 109 individuals from over 14 organizations were trained. Participants included 69 physicians, 23 paramedics, 7 nurses, and 10 other professionals. 95% of those surveyed had not received prior pWBT training. Participants reported increased comfort levels, with average pre- and post-course comfort scores of 1.7 and 3.2 (4=very comfortable), respectively. The majority of participants found the training useful (average score of 3.8, 4=very useful). Feedback demonstrated high satisfaction ratings and an increased awareness of the regulatory changes.

TR utilized the A3 model to drive a coalition that supported policy reform and trauma system improvements in Ukraine. TR’s ability to leverage international medical expertise, work collaboratively with MoH, and provide material resources supported local implementation of pWBT.