This paper provides a large-scale, per Major League Baseball (MLB) game analysis of foul ball (FB) injury data and provides estimates of injury frequency and severity.

This study’s goal was to quantify and describe the rate and type of FB injuries at MLB games.

This was a retrospective review of medical care reports for patients evaluated by on-site health care providers (HCPs) over a non-contiguous 11-year period (2005-2016). Data were obtained using Freedom of Information Act (FOIA) requests.

Data were received from three US-based MLB stadiums.

The review reported 0.42-0.55 FB injuries per game that were serious enough to warrant presentation at a first aid center. This translated to a patients per 10,000 fans rate (PPTT) of 0.13-0.23. The transport to hospital rate (TTHR) was 0.02-0.39. Frequently, FB injuries required analgesics but were overwhelmingly minor and occurred less often than non-FB traumatic injuries (5.2% versus 42%-49%). However, FB injured fans were more likely to need higher levels of care and transport to hospital (TH) as compared to people suffering other traumatic injuries at the ballpark. Contusions or head injuries were common. Finally, FB injured fans were often hit in the abdomen, upper extremity, face, or head. It was found that FB injuries appeared to increase with time, and this increase in injuries aligns with the sudden increase in popularity of smartphones in the United States.

These data suggest that in roughly every two or three MLB games, a foul ball causes a serious enough injury that a fan seeks medical attention. This rate is high enough to warrant attention, but is comparable in frequency to other diagnostic categories. Assessing the risk to fans from FBs remains difficult, but with access to uniform data, researchers could answer persistent questions that would lead to actionable changes and help guide public policy towards safer stadiums.

During the world-wide coronavirus disease 2019 (COVID-19) outbreak, there is an urgent need to rapidly increase the readiness of hospitals. Emergency departments (EDs) are at high risk of facing unusual situations and need to prepare extensively in order to minimize risks to health care providers (HCPs) and patients. In situ simulation is a well-known method used in training to detect system gaps that could threaten safety.

One objective is to identify gaps, test hospital systems, and inform necessary modifications to the standard processes required by patients with COVID-19 presenting at the hospital. The other objective is to improve ED staff confidence in managing such patients, and to increase their skills in basic and advanced airway management and proper personal protective equipment (PPE) techniques.

This is a quasi-experimental study in which 20 unannounced mock codes were carried out in ED resuscitation and isolation rooms. A checklist was designed, validated, and used to evaluate team performances in three areas: donning, basic and advanced airway skills, and doffing. A pre- and post-intervention survey was used to evaluate staff members’ perceived knowledge of ED procedures related to COVID-19 and their airway management skills.

A total of 20 mock codes were conducted in the ED. Overall, 16 issues that posed potential harm to staff or patients were identified and prioritized for immediate resolution. Approximately 57.4% of HCPs felt comfortable dealing with suspected/confirmed, unstable COVID-19 cases after mock codes, compared with 33.3% beforehand (P = .033). Of ED HCPs, 44.4% felt comfortable performing airway procedures for suspected/confirmed COVID-19 cases after mock codes compared with 29.6% beforehand. Performance of different skills was observed to be variable following the 20 mock codes. Skills with improved performance included: request of chest x-ray after intubation (88.0%), intubation done by the most experienced ED physician (84.5%), and correct sequence and procedure of PPE (79.0%).

Mock codes identified significant defects, most of which were easily fixed. They included critical equipment availability, transporting beds that were too large to fit through doors, and location of biohazard bins. Repeated mock codes improved ED staff confidence in dealing with patients, in addition to performance of certain skills. In situ simulation proves to be an effective method for increasing the readiness of the ED to address the COVID-19 pandemic and other infection outbreaks.

High rates of mortality and morbidity result from disasters of all types, including armed conflicts. Overwhelming numbers of casualties with a myriad of illnesses and patterns of injuries are common in armed conflicts, leading to unpredictable workloads for hospital health care providers (HCPs). Identifying domains of hospital HCPs’ core competency for armed conflicts is essential to inform standards of care, educational requirements, and to facilitate the translation of knowledge into safe and quality care.

The objective of this study is to identify the common domains of core competencies among HCPs working in hospitals in armed conflict areas.

A scoping review was conducted using the Joanna Briggs Institute framework. The review considered primary research and peer-reviewed literature from the following databases: Ovid Medline, Ovid EmCare, Embase, and CINAHL, as well as the reference lists of articles identified for full-text review. Eligibility criteria were outlined a priori to guide the literature selection.

Four articles met the inclusion criteria. The studies were conducted in different countries and were published from 2011 through 2017. The methods included three surveys and one Delphi study.

This review maps the scope of knowledge, skills, and attitudes required by HCPs who are practicing in hospitals in areas of major armed conflict. Incorporation of identified core competency domains can improve the future planning, education, and training, and may enhance the HCPs’ response in armed conflicts.

All over the world, migration is affecting millions of people who either choose or are forced to leave their countries of origin. Health is considered to be one of the important aspects of migration that is highly influenced by the circumstances created by mobility within or across countries. In the context of forced migration, it is well-established that refugees are susceptible to various diseases and other health conditions which might occur or deteriorate based on the health systems and health care provision in receiving countries. There is a considerable amount of research on the challenges encountered by refugees in receiving countries, in terms of health care systems and services. However, there seems to be little focus on the health care providers’ perspectives of the challenges in health care provision in refugee settings. This review aims to explore some of the articles discussing the challenging issues surrounding refugee health from a provider’s perspective.

A systematic review was conducted through five main online databases: Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); Science Direct (Elsevier; Amsterdam, Netherlands); Scopus (Elsevier; Amsterdam, Netherlands); Sage (Sage Publications; Thousand Oaks, California USA); and Google Scholar (Google Inc.; Mountain View, California USA), including only the articles published in English. In addition, grey literature resources available online were used.

Forty-eight articles were included in this review, mainly based on the amount of emphasis they placed on providers’ viewpoints in refugee health settings. Most of the articles were retrieved based on their availability in the databases which Hacettepe University (Ankara, Turkey) is subscribed to. Almost all of the articles mentioned the challenges caused by linguistic and cultural barriers, and some focused on providers’ limited knowledge and skills, as well as inefficient health care systems. There was little emphasis on ethical discussions, and the physical and emotional impact of caring for refugees on health care professionals. In the few articles discussing ethical and personal dimensions, issues concerning stress, burnout, and safety risks were found to be the recurring themes.

Evidence gathered suggests that the challenges faced by health care providers involve a variety of factors that are specific to health care settings involving refugees, such as linguistic and cultural barriers, and a lack of proper support and training. It seems that the challenges that health care providers face in refugee settings could be further investigated both from professional and personal aspects for a better understanding of refugee health care.

Kavukcu N, Altıntaş KH. The challenges of the health care providers in refugee settings: a systematic review. Prehosp Disaster Med. 2019;34(2):188–196

Military health care providers (HCPs) have an integral role during disaster, humanitarian, and civic assistance (DHCA) missions. Since 50% of patients seen in these settings are children, military providers must be prepared to deliver this care.

The purpose of this systematic, integrative review of the literature was to describe the knowledge and clinical skills military health care providers need in order to provide care for pediatric outpatients during DHCA operations.

A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed and CINAHL were conducted using terms such as Disaster*, Geological Processes, and Military Personnel. Thirty-one articles were included from database and manual searches.

Infectious diseases, vaccines, malnutrition, sanitation and wound care were among the most frequently mentioned of the 49 themes emerging from the literature. Concepts included endemic, environmental, vector-borne and vaccine-preventable diseases; enhanced pediatric primary care; and skills and knowledge specific to disaster, humanitarian and civic assistance operations.

The information provided is a critical step in developing curriculum specific to caring for children in DHCA. While the focus was military HCPs, the knowledge is easily translated to civilian HCPs who provide care to children in these situations.

JohnsonHL, GaskinsSW, SeibertDC. Clinical Skill and Knowledge Requirements of Health Care Providers Caring for Children in Disaster, Humanitarian and Civic Assistance Operations: An Integrative Review of the Literature. Prehosp Disaster Med.2013;28(1):1-8.

The provision of medical care in environments with high levels of ambient noise (HLAN), such as concerts or sporting events, presents unique communication challenges. Audio transmissions can be incomprehensible to the receivers. Text-based communications may be a valuable primary and/or secondary means of communication in this type of setting.

To evaluate the usability of text-based communications in parallel with standard two-way radio communications during mass-gathering (MG) events in the context of HLAN.

This Canadian study used outcome survey methods to evaluate the performance of communication devices during MG events. Ten standard commercially available handheld smart phones loaded with basic voice and data plans were assigned to health care providers (HCPs) for use as an adjunct to the medical team's typical radio-based communication. Common text messaging and chat platforms were trialed. Both efficacy and provider satisfaction were evaluated.

During a 23-month period, the smart phones were deployed at 17 events with HLAN for a total of 40 event days or approximately 460 hours of active use. Survey responses from health care providers (177) and dispatchers (26) were analyzed. The response rate was unknown due to the method of recruitment. Of the 155 HCP responses to the question measuring difficulty of communication in environments with HLAN, 68.4% agreed that they “occasionally” or “frequently” found it difficult to clearly understand voice communications via two-way radio. Similarly, of the 23 dispatcher responses to the same item, 65.2% of the responses indicated that “occasionally” or “frequently” HLAN negatively affected the ability to communicate clearly with team members. Of the 168 HCP responses to the item assessing whether text-based communication improved the ability to understand and respond to calls when compared to radio alone, 86.3% “agreed” or “strongly agreed” that this was the case. The dispatcher responses (n = 21) to the same item also “agreed” or “strongly agreed” that this was the case 95.5% of the time.

The use of smart phone technology for text-based communications is a practical and feasible tool for MG events and should be explored further. Multiple, reliable, discrete forms of communication technology are pivotal to executing effective on-site medical and disaster responses.

LundA, WongD, LewisK, TurrisSA, VaislerS, GutmanS. Text Messaging as a Strategy to Address the Limits of Audio-Based Communication During Mass-Gathering Events with High Ambient Noise. Prehosp Disaster Med.2013;28(1):1-7.