Emergency preparedness and response for the elderly population in mass casualty incidents and disasters: Challenges and strategies

71 Had the Time Square Bomb Exploded: What Would Your Emergency Department Have Done?

Reimagining health preparedness in the aftermath of COVID-19

Mass-casualty incidents (MCIs), specifically incidents with chemical, biological, radiological, and nuclear agents (CBRN) or terrorist attacks, challenge medical coordination, rescue, availability, and adequate provision of prehospital and hospital-based emergency care. In the Netherlands, a new model for Mass Casualty and Disaster Management (MCDM) along with a Terror Attack Mitigation Approach (TAMA) was introduced in 2016. The objective of this study was to provide insight in the first experiences of health policy advisors and managers with a medical rescue coordinator and ambulance nursing background regarding the new MCDM and TAMA in order to identify strengths and pitfalls in emergency preparedness and to provide recommendations for improvement. The study had a qualitative design and was performed from January 2017 through June 2018. Purposeful sampling was used and the inclusion comprehended health policy advisors and managers with a medical rescue coordinator and ambulance nursing background involved in emergency preparedness. The respondents were interviewed semi-structured and the researchers used a topic list that was based on the literature and content of the newly introduced model and approach. All interviews were typed out verbatim and qualitative content analyzing was used in order to identify relevant themes. Respondents based their perceptions on large-scale training exercises, as MCDM and TAMA were not yet used during MCIs. Perceived issues of MCDM were the two-tiered triage system, the change in focus from "stay and play" towards "scoop and run," difficulties with new tasks and roles of professionals, and improvement in material provision. Regarding TAMA, all respondents supported the principles (do the most for the most; scoop and run; acceptable personal risk; never walk alone; and standard operational procedure); however, the definitions were lacking clarity while the awareness of optimal personal safety of professionals was absent.As there are currently regional differences in the level of implementation of MCDM and TAMA, this may pose a risk for an optimal inter-regional collaboration. The conclusions refer to experiences of professionals in the Netherlands. Elements of the MCDM and TAMA were highly appreciated and seemed to improve emergency preparedness, while other aspects needed further attention, training, and integration in daily routine. The Netherlands' MCDM model and TAMA will need continuous systematic evaluation based on (inter)national performance criteria in order to underpin the useful and effective elements and to improve the observed pitfalls in emergency preparedness.

Review Question: This review aims to answer the following specific question: What are nurses’ experiences of preparing for and managing the ethical challenges posed by catastrophic public health emergencies and health care disasters? Review Purpose/Objectives: The purpose of this systematic review is to systematically review and synthesise research literature reporting nurses’ experiences of ethical preparedness for dealing with catastrophic public health emergencies and health care disasters and the ethical quandaries that may arise during such events. INCLUSION CRITERIA: Types of Participants: The review will consider publications that include nurses registered or authorised under a given country’s state of emergency provisions to practice in jurisdictions in which a public health emergency (e.g. pandemic influenza) or sudden‐onset mass casualty health care disaster (e.g. flood, hurricane, earthquake, tsunami, volcanic eruption, terrorist attack) have occurred, or may occur. Phenomena of interest: This review will examine the phenomenon of nurses’ experiences of preparing for and/or managing ethical issues arising during a public health emergency or health care disaster. Consideration will be given to, but not be limited to nurse preparation for and management of ethical issues associated with: development of local public health emergency (including pandemic influenza) and sudden‐onset health care disaster plans provision of first health care contact for the general public personal protection and correct use of safety equipment providing front line clinical care providing community and primary health care assistance with containment measures triaging in a range of settings, including general practices, community health centres, and local hospitals maintaining infection control vaccinations informing the public work attendance.

This qualitative study explores whether Australian mass casualty and disaster plans explicitly acknowledge or implicitly draw upon ethical principles. Federal, state and territory governmental websites were searched to identify mass casualty incident and/or disaster plans. The authors examined the documents to identify whether ethical principles were overtly stated or implied, and what those values or principles were. Ten governmental documents were identified - two federal and one for each of the eight States and Territories. One of the documents had an explicit statement of the ethical values that informed the mass casualty and disaster planning decisions which were present. Utilitarianism was the dominant ethical principle informing the document in another seven documents. In Australian government documents for mass casualty and disaster management, although ethics is definitely considered, the ethical principles on which decisions are made are rarely explicit. Mass casualty and disaster decision-making could be improved by making the ethical basis for decision-making clear, transparent and comprehensively reasoned.

Mass Casualty Incidents (MCIs) pose significant challenges to health care systems, especially regarding emergency preparedness and response. This study aims to analyze the epidemiological characteristics and burden of MCIs in Spain from 2014 to 2022, focusing on the type, frequency, and impact of these incidents on public health and emergency services. A population-based retrospective observational study examined MCIs in Spain between January 2014 and December 2022. Data were collected from various emergency services. Incidents involving 4 or more victims requiring medical assistance and ambulance mobilization were included. The study categorized MCIs into 5 types: road traffic accidents, fires and explosions, chemical poisonings, maritime accidents, and others. A total of 1618 MCIs resulting in 8556 victims were identified, averaging 15 (95% CI, 11-19) incidents per month, with 79% due to road traffic accidents and 13% to fires and explosions, which also had the highest average of 7.6 victims per incident. Despite maritime accidents comprising only 1.9% of incidents, they had the highest fatality rate. MCIs were more frequent on weekends, in January and July, and between 3:00 PM and 9:00 PM. The average response time was 38 minutes, with 35% of victims sustaining severe injuries. Despite a slight decrease in annual MCIs from 2014 to 2022 in Spain, the trend is not statistically significant. The study highlights the need for a national registry and standardized data collection to enhance emergency preparedness and response planning and facilitate the reduction of the MCI burden.

Objectives We performed a systematic review and meta-analysis to examine the prevalence and antecedents/consequences of chronic loneliness and social isolation (i.e. enduring or persistent experience that extends over a certain period of time) among older adults. Moreover, we conducted a meta-regression to explore sources of heterogeneity. Method A search was conducted in four electronic databases. We included observational studies that reported prevalence and, where available, antecedents/consequences of chronic loneliness or chronic social isolation amongst older adults. Key characteristics of the studies were extracted. Results Across 17 studies included in the meta-analysis, the estimated prevalence of chronic loneliness was 20.8% (95% CI: 16.1–25.5%), including 21.7% among women (95% CI: 16.1–27.4%) and 16.3% among men (95% CI: 10.6–21.9%). One study reported chronic social isolation (13.4%) and found that chronic social isolation predicted higher depression scores. Meta-regressions indicated that loneliness was less prevalent when assessed with single-item measures. Regarding antecedents/consequences, spousal loss can contribute to chronic loneliness which in turn may contribute to adverse health-related outcomes. Conclusion About one in five older adults experiences chronic loneliness reflecting the need to address chronic loneliness. More longitudinal research is needed on chronic loneliness and social isolation, particularly from low and middle-income countries.

We tested the Analytical Hierarchy Process tool for its use in public health to identify potential gaps in emergency preparedness by local health departments (LHDs) in California and Hawaii during a radiological emergency. We developed a dedicated tool called All-Hazards Preparedness Squared (AHP2) that can be used by those who are responsible for all-hazards preparedness planning and response to guide them while making strategic decisions both in preparing for and responding to a slow-moving incident while it is unfolding. The tool is an Internet-based survey that can be distributed among teams responsible for emergency preparedness and response. Twenty-eight participants from 16 LHDs in California and Hawaii responsible for coordinating preparedness and response in a radiological emergency participated in using the tool in 2013. We used the data to compare the perceived importance of different elements of preparedness among participants and identify gaps in preparedness of their organizations for meeting the challenges presented by a radiological incident. Clarity of information and transfer of information (to and from agency to public, state, and federal partners) were public health officials' dominant concerns while responding to an emergency. Participants also found that there were gaps in the adequacy of training and awareness of the chain of command during a radiological emergency. This preliminary study indicates that the AHP2 tool could be used for decision making in all-hazards preparedness planning and response.

BackgroundEffective preparedness to respond to mass casualty incidents and disasters requires a well-planned and integrated effort by all involved professionals, particularly those who are working in healthcare, who are equipped with unique knowledge and skills for emergencies. This study aims to investigate and evaluate the level of knowledge and skills related to mass casualty and disaster management in a cohort of healthcare professionals.MethodsA cross-sectional brief study was conducted using a validated and anonymous questionnaire, with a sample of 134 employees at a clinical hospital in Lublin, Poland.ResultsThe findings of this study may indicate a need for standardization of training for hospitals employees. It also suggests a knowledge gap between different professional groups, which calls for adjusting such general training, to at least, the weakest group, while special tasks and mission can be given to other groups within the training occasion.ConclusionPre-Training gap analyses and identification of participants’ competencies and skills should be conducted prior to training in mass casualty incidents and disasters. Such analyses provides an opportunity to develop training curriculum at various skill and knowledge levels from basic to advance. All training in mass casualty incidents and disasters should be subject to ongoing, not just periodic, evaluation, in order to assess continued competency.

Mass casualty incidents (MCIs) present significant challenges to emergency response systems, often overwhelming healthcare resources. This article highlights the critical role of integrating postexposure prophylaxis (PEP) into emergency protocols to mitigate immediate and secondary health risks occurring due to mass casualty. The aim is to underscore the importance of PEP in MCI management and advocate for its systematic incorporation into emergency preparedness and response. This is a perspective article drawing upon existing literature, guidelines from organizations such as UNAIDS, and expert opinion to synthesize the importance of PEP in the context of MCIs. It discusses the rationale for PEP, challenges in its implementation, particularly in resource-limited settings, and proposes strategies for its integration into emergency protocols. The analysis underscores that prompt PEP administration significantly reduces the risk of bloodborne pathogen transmission following potential exposure during MCIs. Effective MCI response necessitates hospital preparedness, robust Emergency Medical Services (EMS), interagency collaboration, and trained personnel. The potential for HIV transmission in crash emergencies is often overlooked, highlighting the urgent need for PEP inclusion in emergency protocols. Key recommendations include establishing robust surveillance systems, training first responders, ensuring the availability of personal protective equipment and point-of-care test kits, establishing blood bank networks, and ensuring widespread access to PEP with a low threshold for its administration. Integrating PEP into emergency response strategies is imperative for enhancing the resilience and preparedness of healthcare systems, especially in resource-constrained settings. This proactive approach can significantly reduce morbidity, mortality, and the public health burden associated with infectious disease transmission following MCIs. Therefore, the systematic incorporation of PEP into emergency protocols, supported by interagency collaboration, training, and resource allocation, is strongly recommended.

The goal of this study is to test an implementation and examine users' perceptions about the usefulness of telemedicine in mass casualty and disaster settings and to provide recommendations for using telemedicine in these settings. Ninety-two US Army Forward Surgical Team (FST) members participated in a high-fidelity mass casualty simulation at the Army Trauma Training Center (ATTC). Telemedicine was implemented into this simulation. Only 10.9% of participants chose to use telemedicine. The most common users were surgeons and nurses. Participants believed it somewhat improved patient care, attainment of expert resources, decision-making, and adaptation, but not the timeliness of patient care. Participants reported several barriers to using telemedicine in the mass casualty setting, including (1) confusion around team roles, (2) time constraints, and (3) difficultly using in the mass casualty setting (eg, due to noise and other conditions). There appear to be barriers to the use and usefulness of telemedicine in mass casualty and disaster contexts. Recommendations include designating a member to lead the use of telemedicine, providing telemedical resources whose benefits outweigh the perceived cost in lost time, and ensuring telemedicine systems are designed for the conditions inherent to mass casualty and disaster settings.

Objective:Emergency preparedness and response operations for all types of catastrophes rely heavily on healthcare facilities and their staff. On the other hand, hospital employees suffer significant gaps in emergency preparedness knowledge and skills when it comes to treating mass casualties. The objective of this study was to assess the nurses’ and physicians’ familiarity with emergency preparedness and identify the associated factors.Methods:A facility-based cross-sectional survey was conducted by census utilizing a self-administered questionnaire among all nurses and physicians working in emergency departments in East Gojjam zone public hospitals. The collected data were entered into Epi-data version 4.2 and exported to SPSS 25.0 for further analysis. Frequency, mean, and standard deviation were computed to describe individual and other characteristics of the sample. A simple and multiple linear regression model was fitted to identify factors associated with familiarity with emergency preparedness. An unstandardized adjusted beta (β) coefficient with a 95 % confidence level was used to report the result of the association at a p-value of 0.05 statistical significance.Results:In this study, a total of 237 individuals completed the questionnaire, yielding a response rate of 94 %. The mean score of familiarity with emergency preparedness was 106.1 ± 31.8 (95% CI: 102, 110.1), with approximately 52.3 % scoring higher than the mean score. Self-regulation (B = 3.8, 95% CI: 2.6, 5), health care climate (B = 1.4, 95% CI: 0.4, 2.43) and participation in actual major disaster event (B = 15.5, 95% CI: 7.8, 23.2) were significant predictors of familiarity.Conclusion:According to the findings of this study, nurses’ and physicians’ expertise in emergency and disaster preparedness is inadequate. Previous engagement in actual disaster events, self-regulation, and the healthcare climate were significant predictors of familiarity. As a result, the responsible stakeholders should develop strategy to enhance self-regulation (motivation), job satisfaction of emergency department employees, and drills and hands-on training in mass casualty management.

Актуальність. Збільшення кількості надзвичайних ситуацій із масовим ураженням людей, зокрема через аварії на транспорті або терористичні напади, призводить до одночасного надходження значної кількості постраждалих осіб до закладів охорони здоров’я та потребує збільшення готовності системи охорони здоров’я до медичного реагування через постійний перегляд і опрацювання Плану реагування та взаємодії під час виникнення надзвичайних ситуацій і ліквідації їх наслідків. Під поняттям «події з масовим ураженням людей» (для закладу охорони здоров’я) у поданій статті розуміють ситуацію, через яку виникає невідповідність між одночасним надходженням значної кількості постраждалих і можливостями надання їм медичної допомоги без впровадження змін у повсякденні форми та методи роботи, на відміну від надзвичайної ситуації потреба залучення зовнішніх ресурсів закладом охорони здоров’я відсутня або мінімальна. Мета. Оптимізація інформаційного забезпечення системи управління медичною допомогою постраждалим при подіях із масовим ураженням людей. Матеріали та методи. Робота ґрунтується на власному досвіді організації та безпосередньому наданні медичної допомоги постраждалим при подіях із масовим ураженням людей і надзвичайних ситуаціях в Україні та за її межами, участі у міжнародних проектах і навчаннях, зокрема під егідою Європейської комісії гуманітарної допомоги та цивільного захисту. Під час проведення дослідження застосовано бібліографічний і семантичний методи пізнання. Узагальнено організаційні аспекти медичного забезпечення 46 випадків масового ураження людей, які відбулись у світі впродовж 1979–2015 рр., із них унаслідок терористичних нападів з використанням вибухових пристроїв — 33 (71,7 %), вогнепальної зброї проти незахищеного цивільного населення — 6 (13 %), пожежі в закладах відпочинку — 3 (6,5 %), сильнодіючих отруйних речовин — 2 (4,3 %) і внаслідок транспортних аварій — 2 (4,3 %). Результати. Організація медичної допомоги постраждалим внаслідок подій із масовим ураженням має ґрунтуватись на принципах 4С кризового менеджменту відповідно до введеного режиму функціонування органів і закладів охорони здоров’я. В системі охорони здоров’я України доцільно впровадити режими, що існують в країнах Європейського Союзу: 1) готовність до можливого надходження значної кількості постраждалих («зелений рівень»); 2) часткова мобілізація («жовтий рівень»); 3) повна мобілізації («червоний рівень»). Первинне медичне сортування постраждалих на догоспітальному етапі передбачає розподіл на дві основні групи: термінові та нетермінові. Нетермінових постраждалих слід доставити до лікарень, які географічно розташовано недалеко від місця події, але не до найближчого закладу, який має бути готовим до надання екстреної медичної допомоги терміновим хворим і тим, хто звернувся самостійно (самозвернення), кількість яких може суттєво перевищувати тих, кого доставлено бригадами екстреної (швидкої) медичної допомоги. До групи управління закладу охорони здоров’я включають відповідальних чергових — лікаря-хірурга та лікаря-анестезіолога. До форм інформаційного забезпечення системи управління надання медичної допомоги на догоспітальному етапу належать: 1) сили та засоби на місці події; 2) розподіл постраждалих на місці події; 3) потреба підсилення догоспітального етапу. На госпітальному етапі визначають можливості проведення хірургічних операцій та кількість вільних лікарняних ліжок: 1) операційний блок; 2) лікарняні ліжка. Висновки. В систему охорони здоров’я України при подіях із масовим ураженням людей доцільно впровадити відповідні рівні функціонування, що використовують в країнах Європейського Союзу. Перерозподіл наявних ресурсів охорони здоров’я при наданні медичної допомоги постраждалим при подіях із масовим ураженням людей на догоспітальному та госпітальному етапах критично важливе для збереження життя та здоров’я постраждалих. Управління надання медичної допомоги при масовому ураженні людей потребує відповідного інформаційного забезпечення догоспітального та госпітального етапів, впровадження галузевої та міжвідомчої взаємодії.

Summary of Suggestions From the Task Force for Mass Critical Care Summit, January 26–27, 2007

Background: During mass casualty events, hospitals must be ready to receive and provide patient care for both children and adults. However, many studies have shown that due to a lack of funding, resources, training, and time, nurses consistently report feeling unprepared to care for children during mass casualty events. Methods: To improve understanding of how prepared pediatric-trained nurses are to respond to mass casualty events involving children, Registered Nurses (RN) completed a survey with questions that included four domains: professional demographics and employment history, experience working as an RN in a mass casualty event, knowledge questions related to current organizational mass casualty procedures, and perceptions on professional preparedness.Results: Seventy-four percent of participants agree that a mass casualty event primarily involving children, requiring what is known as a Code Orange activation, will occur at some point during their career. Nurse participants do not currently receive regular training related to a Code Orange activation, and are overall dissatisfied with the little training provided. Nurses believe emergency preparedness is important to their professional development.Discussion: Increasing nurses’ preparedness to respond to a mass casualty event involving children is important and may require additional training across nurses’ career trajectory.