Command Center Research Articles

Pakistan's national COVID-19 response: lessons from an emergent response to the pandemic.

In 2020, Pakistan faced the formidable challenge of the COVID-19 pandemic with an existing yet disjointed healthcare infrastructure, that included by over 18,000 public and an estimated 75,000 private health facilities and some elements of an epidemic surveillance and response system. This descriptive study examines how Pakistan developed a COVID-19 response, driven by establishing a central coordination and decision-making mechanism to overcome these systemic challenges. The study is based on interviews and interactions of the many actors in the response by the authors, who also participated in nearly all proceedings of the National Command and Operation Centre (NCOC) and many of the National Coordination Committee (NCC). This information is supplemented by reviewing documents, reports, news items, media and social media, and journal articles. The study highlights the critical role of political arrangement, where the NCC, comprising of ministers, bureaucrats, and military personnel, facilitated federal and provincial integration. The NCC found resources and set policy. Its direction was implemented by the NCOC, a top-down yet inclusive platform, integrated political, military, and civil society actors, to ensure cohesive decision-making and implementation. It provided technical guidance, harnessed data for strategic decisions and held implementers accountable. At its peak, the NCOC boasted nearly 300 personnel, including high-ranking military officers, a stark contrast to the limited staffing in most ministries. In addition, the response's success is attributed to the perception of COVID-19 as an existential threat, leading to unprecedented collaboration and decisive actions that were enforced authoritatively. Pakistan's experience offers valuable insights for proactive management of health emergencies in resource-limited settings. It underscores the necessity for inter-sectoral dialog and data-driven policy implementation, especially in the context of political economies where activity-driven governance often overshadows objective-driven policy execution. However, the lessons from the COVID-19 response, including a blueprint for future epidemic responses and lessons for use of data and evidence in developing country health systems, if not institutionalized, risk being lost in the post-pandemic era.

Terror attacks : Recommendations for cooperation between police, hospitals and non-police security services

The risk of terrorist attacks in the Federal Republic of Germany is present and is currently increasing. Publicly funded acute care hospitals and their owners are involved in disaster control as part of their remit and are responsible for taking comprehensive precautions to ensure their operational capability in the event of disasters. This mandate must also be ensured in the event of terrorist attacks and amok incidents. For this purpose, an optimal cooperation between preclinical and clinical care is indispensable. Recommended actions for collaboration between nonclinical and clinical planning to manage amass casualty incident in terrorist life-threatening response situations are presented. The Inter-Hospital Security Conference Baden-Württemberg (IHSC BW) is an association of representatives of acute hospitals in Baden-Württemberg, the Ministry of the Interior, Digitalization and Migration Baden-Württemberg, the Ministry of Social Affairs and Integration Baden-Württemberg, the State Police Headquarters Baden-Württemberg and the Baden-Württemberg Hospital Association. From 2018 to 2020, the IHSC BW developed recommendations for action on cooperation between police, hospitals and non-police emergency response. The recommendations for action were agreed by the group members in 6 working sessions and initialled in two subsequent video conferences. Arecommendation was considered adopted when the IHSC BW plenary assembly finally gave its approval with an absolute majority. Competence-based interface solutions for asmooth cooperation between prehospital and hospital management in the care of patients who have become victims of aterrorist attack are to be demanded. For preliminary planning, the establishment of alocal safety conference at the county disaster control authority level with the following participants is recommended: disaster control authority, fire department, regional police headquarters, chief emergency physician, rescue services and disaster control officers of affected clinics. It is recommended to set up ajoint command and situation center (CSC), where management personnel from the police, rescue service, fire department and disaster control can meet to organize the handling of the incident jointly, competently and without loss of time. From this CSC, aliaison officer should then provide the clinics with information at regular intervals. Exercises should take place regularly. Cross-organizational exercises are particularly important, and this is one of the tasks of the local safety conference.

Acil servis tanıları ile paramediklerin ilk değerlendirme tanılarının karşılaştırılması.

This study aims to evaluate the accuracy and quality of prehospital assessments and preliminary diagnoses made by Emergency Medical Services (EMS) providers compared to the final diagnoses given by Emergency Department physicians in a metropolitan area. This retrospective observational study utilized records from the Yenimahalle EMS Command Center in Ankara, Türkiye, from January 1, 2021, to December 31, 2022. Data were recorded as cases rather than individual patients, with repeated EMS admissions counted separately. Cases were categorized by EMS call time, reasons for EMS requests, age, gender, nationality, and weekday of hospital arrival to assess socioeconomic impacts and congestion patterns. The study included 2.528 pediatric cases, excluding patients aged 18 and older, those who refused EMS transfer, and cases resolved at the scene. Data analysis was conducted using IBM SPSS 27.0, with statistical significance set at p<0.05. The study included 2.528 cases. The data revealed that EMS providers had an average of 9.9±4.7 years of experience. In 1.839 cases (72.7%), the EMS provider was female, and in 689 cases (27.3%), the EMS provider was male. Patients had an average age of 9.2±5.8 years, with 1.173 (46.4%) being female and 1.355 (53.6%) being male. Preliminary diagnosis accuracy was higher in cases involving younger and male patients. Additionally, a lower preliminary diagnosis accuracy rate was observed during office hours (08: 00-15: 59) compared to non-office hours (16: 00-23: 59). The majority of EMS calls were for medical reasons (1,783 cases, 70.5%), followed by trauma-related calls (745 cases, 29.5%). This study highlights the need for improved on-field training for EMS providers to enhance the accuracy and quality of prehospital assessments and preliminary diagnoses. The findings suggest that younger and male patients have higher preliminary diagnosis accuracy rates, and there is a noticeable decrease in accuracy during office hours, indicating potential areas for targeted training and protocol adjustments.

Public health preparedness, syndromic surveillance, and response during the largest religious gathering at the Catholic pilgrimage center of Velankanni in South India: 2016.

The dynamicity and mobility of the population in a mass gathering setting pose a challenge to traditional disease surveillance methods and strain the local health services. Velankanni is one of the most sacred Christian pilgrimage places located in Nagapattinam, Tamil Nadu, India. We participated in the Velankanni festival to describe the public health preparedness, surveillance, and response activities carried out during the festival. This was a cross-sectional study. We reviewed the national and international guidelines and published literature and discussed with the key stakeholders. We developed a checklist to observe public health preparedness activities. We facilitated the staff and monitored the activities by the implementers. We established the syndromic surveillance in the designated locations of the event and used tracker software to capture the data. Emergency medical teams were formed with trained health personnel to respond to medical emergencies. The team monitored all the public health activities. There are 59 primary care public health facilities and nine ambulatory Mobile Medical Units, with 160 medical officers available at the site. Of the 16,169 persons who attended the medical camps, 9863 (61%) were males and 8408 (52%) were aged 15-44. Acute diarrheal disease was the most frequent of the reported syndromes, followed by injuries, acute febrile illness, and animal bites. There was no outbreak of any disease either identified or reported. Our findings suggest that risk assessments should be used, and establishing an Incident Command Center is vital for executing command and control mechanisms during mass gatherings.

Implementing Pega Collections Command Center for Real-Time Monitoring and Decision Support

The Pega Collections Command Center (PCCC) represents a significant advancement in financial institutions' capabilities for real-time monitoring and decision support. By integrating dynamic dashboards, alerting mechanisms, and predictive analytics, PCCC offers a comprehensive solution for managing collections operations. This technical paper explores the implementation of PCCC, detailing its features and the benefits it provides to financial institutions. The study discusses the rationale behind this technological adoption, the methodologies employed, the results observed, and the broader implications of this implementation. The findings contribute to the existing knowledge base by demonstrating the effectiveness of PCCC in enhancing operational efficiency and decision-making processes.

A study of prehospital EMS response time and influencing factors in the main urban area of Chongqing, China.

Shortening the prehospital emergency medical service (EMS) response time is crucial for saving lives and lowering mortality and disability rates in patients with sudden illnesses. Descriptive analyses of prehospital EMS response time and each component were conducted separately using ambulance trip data from the 120 Dispatch Command Centre in the main urban area of Chongqing in 2021, and then, logistic regression analyses were used to explore the influencing factors. The median prehospital EMS response time in the main urban area of Chongqing was 14.52 min and the mean was 16.14 min. A 44.89% of prehospital EMS response time exceeded 15 min. Response time was more likely to surpass this threshold during peak hours and in high population density areas. Conversely, lower probabilities exceeding 15 min were observed during the night shift, summer, and autumn seasons, and areas with a high density of emergency station. 33.28% of preparation time was >3 min, with the night shift and high population density areas more likely to be >3 min, while for the summer and autumn seasons, high Gross National Product (GDP) per capita areas had a lower likelihood of having preparation time >3 min. 45.52% of travel time was >11 min, with peak hours, summer and autumn, and high GDP per capita areas more likely to have had a travel time >11 min, while night shift and high emergency station density areas had a lower likelihood of travel time >11 min. The primary factors influencing prehospital EMS response time were shifts, traffic scenarios, seasons, GDP per capita, emergency station density, and population density. Relevant departments can devise effective interventions to reduce response time through resource allocation and department coordination, staff training and work arrangement optimisation, as well as public participation and education, thereby enhancing the efficiency of prehospital emergency medical services.

Research on a Vehicle-Mounted Emergency Communication System Using BeiDou Regional Short Message Communication (RSMC) for Firefighting Operations in Forest Areas without a Public Network

The low coverage of public networks in pristine forest areas prevents on-site firefighters from communicating directly with remote command centers during forest fires, reducing firefighting efficiency. In this study, we designed a vehicle-mounted emergency communication system Using BeiDou RSMC (Regional Short Message Communication) for firefighting operations in forest areas without a public network to establish a satellite communication network and Zigbee self-organizing network technology to establish a local self-organizing network. Beidou RSMC is a satellite communication service developed and operated independently by China, and its signals now cover the entire globe. The combination of these two components ensures emergency communication in the event of a fire in a forest area without public network coverage. The performance of the system was tested by simulating a fire, and it was able to establish a reliable communication link between the firefighters on the scene and the remote command center in the absence of a public network. The proposed system solves the emergency communication problem that arises when a fire occurs in a forest area without a public network, enabling the remote command center to monitor fire information and dispatch various resources in real time, thereby improving firefighting efficiency and reducing casualties.

Integrating Inter-Professional Insights for Enhanced Disaster Response: A Cross-Sectional Analysis in Jubail's Royal Commission Hospital, Saudi Arabia.

This study aimed to evaluate disaster preparedness and management among an inter-professional team at the Royal Commission Hospital (RCH) in Jubail, Saudi Arabia. Conducted between May and July 2023, this cross-sectional study involved healthcare providers in both patient-facing and non-patient-facing roles. Participants responded to a comprehensive online questionnaire comprising 22 questions across seven sections covering aspects of emergency response, disaster management, and infection control. The study targeted a minimum sample size of 500 participants, successfully garnering responses from 512 individuals. Of the 512 participants, 59.9% (n=312) were healthcare providers in patient-facing roles, and 40.1% (n=209) were in non-patient-facing roles. The results revealed notable disparities in awareness and preparedness between these two groups. Healthcare providers demonstrated higher awareness levels compared to their non-patient-facing counterparts. For instance, 76.9% of healthcare providers were aware of the hospital's emergency response plan compared to 56.2% of non-healthcare providers (χ² = 52.165, p < 0.001). Similar disparities were observed in understanding the term "disaster" (86.5% vs 54.1%, χ² = 27.931, p < 0.001), and awareness of a command center (73.4% vs 45.2%, χ² = 42.934, p < 0.001). These findings underscore the critical need for enhancing awareness, education, and preparedness within healthcare facilities, emphasizing an integrated approach that includes both healthcare and non-healthcare staff. By addressing these gaps, healthcare facilities can significantly improve their emergency response efficiency, disaster management capabilities, and infection control measures, thereby enhancing the overall safety and quality of patient care.

Avoiding ICU Admission in a Case of Septic Encephalopathy Through Enhanced Connected Care Monitoring: A Case Study

Aim: To report a case of an elderly patient with septic encephalopathy admitted in the wards. With the help of enhanced connected care monitoring, ICU admission was avoided. Materials and Methods: An 81-year-old gentleman who is a known diabetic &amp; hypertensive presented to the Emergency room with complaints of generalized weakness of bilateral upper &amp; lower limbs and a recent history of acute gastroenteritis. The patient was evaluated and admitted to wards for further management. On examination, the patient is drowsy and arousable on call and hemodynamically stable. Stool biofire was sent, which was positive for Ecoli Shiga-toxin. A provisional diagnosis of septic encephalopathy was made. Because of background conditions and multiple issues, the patient was connected to Enhanced Care Monitoring (ECC). The patient was constantly monitored by a nurse and doctor from the command center. Three days after admission, the patient had an alert for desaturation with a low saturation of 74%, and immediately nursing staff was informed by the command center team. Shortly 2 hours later, one more critical alert was generated for Tachycardia HR 178/min. The nursing staff was informed by the command center team. Immediately bedside vitals were rechecked, and the doctor was informed, and the patient improved symptomatically with the management of sepsis and was discharged home. Discussion: Remote patient monitoring can track vital signs, identify deteriorating patterns at an early stage, and alert healthcare staff, reducing ICU admissions. This is illustrated in an elderly patient with septic encephalopathy, where continuous wireless monitoring enabled avoiding ICU admission. Enhanced care monitoring was done through wearable biosensors. Vital data obtained helped identify potential emergencies. Appropriate real-time responses avoided an ICU admission. Conclusion: Wearable and implanted sensors efficiently monitor elderly patients in wards without hindering mobility. The term "immediately" might be misleading, but it's crucial to emphasize that within two hours of observing consecutive signs of deterioration in the patient, swift action was taken. Addressing these concerning signs promptly prevented the need for the patient's transfer to the ICU, showcasing successful management within the ward setting.

Impact of CCTV on Police Operations Outcomes in Nairobi City County, Kenya

The widespread adoption of Closed-Circuit Television (CCTV) systems in major cities globally aims to improve policing outcomes. However, despite Nairobi’s CCTV system being operational since mid-2015, its specific impact remained unclear. This study investigated how CCTV influenced five key police operation outcomes: crime reduction, response times, road safety, officer safety, and cost reduction. Drawing from Rational Choice Theory and Routine Activity Theory, the study employed a convergent mixed-method design combining a cross-sectional survey with a phenomenological design. Participants included 403 police officers from the CCTV command centre and various police stations across the county, selected via cluster and purposive sampling. Data collection utilised questionnaires, key informant interviews and focus group discussions. Quantitative analysis employed binary logistic regression, while qualitative data underwent thematic analysis. The findings revealed that CCTV has significantly reduced crime, enhanced road safety and officer safety, and lowered operational costs. However, response times saw minimal improvement due to limited CCTV coverage and coordination challenges between officers. The study recommends expanding coverage, strengthening collaboration among officers, and publicising the system's successes to maximise CCTV's potential

Design and Implementation of an Intensive Care Unit Command Center for Medical Data Fusion.

The rapid advancements in Artificial Intelligence of Things (AIoT) are pivotal for the healthcare sector, especially as the world approaches an aging society which will be reached by 2050. This paper presents an innovative AIoT-enabled data fusion system implemented at the CMUH Respiratory Intensive Care Unit (RICU) to address the high incidence of medical errors in ICUs, which are among the top three causes of mortality in healthcare facilities. ICU patients are particularly vulnerable to medical errors due to the complexity of their conditions and the critical nature of their care. We introduce a four-layer AIoT architecture designed to manage and deliver both real-time and non-real-time medical data within the CMUH-RICU. Our system demonstrates the capability to handle 22 TB of medical data annually with an average delay of 1.72 ms and a bandwidth of 65.66 Mbps. Additionally, we ensure the uninterrupted operation of the CMUH-RICU with a three-node streaming cluster (called Kafka), provided a failed node is repaired within 9 h, assuming a one-year node lifespan. A case study is presented where the AI application of acute respiratory distress syndrome (ARDS), leveraging our AIoT data fusion approach, significantly improved the medical diagnosis rate from 52.2% to 93.3% and reduced mortality from 56.5% to 39.5%. The results underscore the potential of AIoT in enhancing patient outcomes and operational efficiency in the ICU setting.

The production and performance of status: Behind the scenes of an international summit

This article examines how international summits are produced as status symbols, arguing that a host’s successful management of the event maintains summitry as a high-status practice, while hosting itself serves as a means to acquire status, owing to the complexity and risk involved. Drawing on elements of practice and performance theories, it articulates how and why status symbols can be understood as performative practices, reworking how Veblen is predominantly used in International Relations (IR), shifting from a focus on conspicuous consumption to conspicuous performance, while adopting a more expansive conceptualisation of status symbols, as one finds in Goffman. Exploring the manipulability of summitry as a status symbol, the article draws on an ethnography of the 2018 Charlevoix G7 summit, offering a ‘behind the scenes’ look at how a host produces a summit’s constitutive ‘showpiece moments’, zeroing-in on three key elements: a host’s scenario handbook, command centre and media centre. In addition to proposing theoretical and conceptual innovation in the study of international status, the article expands the scope of summit studies beyond a traditional focus on statespeople negotiating agreements, inviting exploration of summitry’s performative and symbolic dimensions.

Hardware Conceptual Design of Tsunhan-14 Multimodal Robot Observer in Support of TNI Tasks

The development of technology in the military field has changed from time to time. This dynamic must be taken seriously because they are a challenge, and pose a potential threat to the sovereignty of the Unitary State of the Republic of Indonesia (NKRI), As well as the trend of the technology-based warfare today. So it has become a necessity for the Indonesian National Army (TNI) to accept it. One of the popular technologies today, war robt technology(warbo), and including multimodal robots with a variety of basic missions. Furthermore, developing a multimodal robot concept design that can fulfil TNI surveillance needs. The methodology used is in the form of interview, observations, comparison, and literature studies by applying system engineering theory and life cycle models. This research has successfully formulated user requirement objectivies which are then elaborated into robot design concepts including characteristic design, and architecture design of multimodal monitoring robots. The hardware on the robot is design differently from others because it has the ability to fly and walk on the ground. The robot is also conceptualised to have advantages in terms of durability with agility, silence, and operate with various terrain conditions. Equipped with sensors to see, hear, measure ambient temperature, and read surrounding conditions using camera sensors, where the robot moves autonomously equipped with GPS and Lidar can send data in the form of audio visual directly to the Ground Control System (command centre). The concept design of the multimodal monitoring robot called Tsunhan-14 is expected to be the basis for determining technical requirement and further developed into a national innovation that is utilized as part of the TNI’s war strategy.

Bałtyckie dzieje Europy: prawdy i zmyślenia

The subject of this article is a review of the work of Lithuanian pseudo-historians on alleged misinterpretations of European history in the early Middle Ages, resulting from translation errors of 19th-century German historiography. According to Lithuanian Venezuelan researcher J. Statkutė de Rosales, the origin of the misunderstandings was a mistranslation of a passage from Jordanes’ work Getica. The German translation implied that Goths (Germans) who came from Gotland colonized the southern coast of the Baltic Sea. Statkutė de Rosales assumes that the Goths, or Gudas (lit. gudai), were a Baltic people, living on the continent from time immemorial, their command center was Gothiscandza, or present-day Gdansk, and the Baltic Ostrogoths and Visigoths not only conquered Rome, but also colonized the Iberian peninsula. Statkutė de Rosales used linguistic tools, and by ‘correcting’ the translation offered a new interpretation of history to prove the thesis of the Baltic roots of Europe.

An efficient online/offline heterogeneous proxy signcryption for secure communication in UAV networks

The rapid growth of the Internet of Things (IoT) has led to an increased deployment of unmanned aerial vehicles (UAVs) across various sectors. However, efficiency and security issues are persistently among the primary challenges in UAV networks. In addition, significant communication delays can occur when UAVs perform remote tasks far from a command center (CC); in some cases, they may be unable to communicate with the CC. To address these challenges, in this paper, an efficient online/offline heterogeneous proxy signcryption scheme for secure communication in UAV networks (HOOPSC) is proposed. This scheme enables the CC in a certificateless cryptosystem (CLC) environment to delegate a nearby ground control station (GCS) to act as an agent, and directly send commands to the UAV within an identity-based cryptosystem (IBC) when the UAV undertakes remote tasks far from the CC. The UAV then decrypts and verifies commands for authenticity and confidentiality. In the proposed scheme, the signcryption process is split into offline and online phases, with most of the heavy computations conducted without the availability of the messages during the offline phase. Only light computations are performed in the online phase when a message is available. Moreover, a formal security proof is given in a random oracle model. Finally, a performance analysis reveals that HOOPSC outperforms existing relevant schemes, making it ideal for long-range operations in UAV networks.

Investigation of The Factors Affecting the Vaccine Preferences of Pre-Hospital Emergency Healthcare Professionals

Objective: The aim of this study was to examine the factors affecting the vaccine preferences of prehospital emergency health workers and the status of vaccine opposition. Materials and Methods: This study was planned as a descriptive study to examine the factors affecting the vaccine preferences of prehospital emergency health care workers working in 112 emergency health services stations and command and control centers affiliated to the Ministry of Health in Aydın province between April 2022 and January 2023, their anti-vaccine status and their attitudes towards Covid-19 vaccine. The population of the study consisted of physicians, emergency medical technicians/technicians (ATT/Paramedics) and ambulance drivers (drivers) working in 112 emergency health services stations and command control centers affiliated to the Ministry of Health in Aydın province (N: 577). The sample selection method was not used and it was aimed to reach the whole population. Data were collected by sending online questionnaire forms to social media groups. The Case Report Form consisting of 12 (twelve) questions including socio-demographic characteristics such as age, gender, educational status, Attitudes Towards Covid-19 Vaccine Scale and Anti-Vaccine Scale were used. The data obtained in the study were analyzed using the SPSS for Windows 25.0 program. Findings: The population of the study was 577 people. 89.7% (n:427) people participated in our study. 51.5% (n:220) of the participants were female. 48.9% (n:209) were found to have Covid-19 infection. 95.8% (n:427) of the participants were vaccinated. Among the vaccinated participants, 70.4% (n:288) received Biontech, 70.4% (n:288) received Sinovac and 5.1% (n:21) received Turkovac vaccine types. When the scores of the attitudes towards Covid-19 vaccine scale and its dimensions were compared according to the descriptive characteristics of the participants, it was found that the positive attitude dimension scores of male participants (3.81) were higher than those of female participants (3.51). It was determined that the positive attitude dimension scores of the participants with chronic diseases and the participants who were vaccinated, and the positive attitude dimension scores of the participants whose vaccine type was Biontech, Sinovac and Turkovak were higher than those of the participants who were not vaccinated. It was determined that the positive attitude dimension and attitudes towards Covid-19 vaccine scale scores of the participants whose vaccine dose was three doses and more were higher than the participants whose vaccine dose was one dose and two doses, and the positive attitude dimension and attitudes towards Covid-19 vaccine scale scores of the participants who had a death due to Covid-19 infection in the family or close environment were higher than those of the participants who did not. According to the findings of our study, the view that there is no vaccine protection in those with chronic diseases has a higher score. Participants who did not have Covid-19 infection, who were not vaccinated, and who had no death loss in their close environment had higher scores on the anti-vaccination scale. Conclusion: In this study, which examined the hesitancy of prehospital emergency healthcare workers about Covid-19 vaccination, it was found that Covid-19 vaccines were administered at a very high rate. However, it was also found that 4.2% of the employees had high hesitation about vaccines and were not vaccinated. Pre-hospital emergency healthcare workers have an important role and responsibility in the acceptance of Covid-19 vaccine by the public and other healthcare professionals, as in other disaster situations. In a pandemic, vaccination of all members of the society is necessary for the control of the pandemic. For this reason, scientific studies should be conducted for emergency healthcare workers who are not vaccinated and who are hesitant about vaccines, including basic concerns about vaccines and examining potential side effects of vaccines. Training programs should be organized to ensure that healthcare workers are vaccinated with existing Covid-19 vaccines.

Tele-ICU Management of a Trauma Patient at a Peripheral Center

Methods: A 23-year-old male was admitted to a peripheral center following a fall from a tractor. Examination at admission revealed a conscious, stable patient with significant chest pain. The tele-ICU (intensive care unit) was called, and when they received the patient, he was stabilized and managed immediately. The tele-ICU connection was provided through the Command Center in Apollo Hospitals, Jubilee Hills, Hyderabad, India, which is connected to multiple spoke locations at peripheral centers using audio-visual aids. An intensivist is available 24 h daily to provide critical care services to the peripheral centers through audio-visual aids. The tele-ICU connection is provided to the peripheral centers through commercial audio-visual and bedside data transfer devices. The tele-ICU team supervised the primary survey remotely via a central monitor, viewing the patient’s vitals along with the audio/video calling capabilities of the cameras as a part of the tele-ICU program. Results: Chest X-rays showed bilateral pneumothorax, lung compression, and multiple rib fractures. The team at the peripheral center was immediately advised to institute bilateral intercostal drainage (ICD). High-resolution CT chest (HRCT) reveals extensive right and minor left pneumothorax, bilateral lung contusions, a right clavicle medial end fracture, and multiple rib fractures. Ultrasonography of the abdomen showed altered splenic echo texture and moderate left pleural effusion. Flail chest and paradoxical breathing pattern warranted endotracheal intubation. The patient was ventilated for 4 days. On day 3, the patient experienced an air leak from the left ICD, increased drain output, and decreased hemoglobin. The tele-ICU team consulted the cardiothoracic surgeon regarding the air leak and followed their advice to attach a vacuum bottle to the ICD. The patient’s breathing improved gradually. Mechanical ventilator settings (i.e., tidal volume, respiratory rate, and peak airway pressures) were reviewed daily by the tele-ICU team during the regular morning and evening rounds. In addition, the ventilator and the bedside monitor were continuously monitored from the Command Center through video conferencing, which is integrated with electronic software and regularly captures the patient’s vitals. After 4 days of mechanical ventilation, the patient was extubated and started on oxygen therapy. Oxygen was gradually tapered and stopped. After 8 days of uneventful hospitalization, the patient was discharged. Conclusion: Studies show that telemedicine can provide expert-guided mentoring for life-saving procedures, including pre-hospital assessment and triage for polytrauma, tube thoracotomies, and extended focused assessment with sonography in trauma (eFAST). Technology may help resource-constrained places adopt telemedicine and its benefits.

“Focus Flow” An approach to Distraction Free Environment

In the modern landscape of digital work environments, staying focused on tasks amidst a plethora of distractions has become a significant challenge. To address this issue, the "Focus Flow," a desktop application meticulously crafted to optimize productivity by minimizing interruptions from social media, games, and other potential distractions. The core feature, "Focus Mode," empowers users to isolate and prevent access to distracting applications, fostering an environment conducive to concentration. Technical implementation involves the strategic use of file permissions or firewall rules, ensuring a seamless and secure process running in the background. Beyond distraction control, Focus Flow integrates an array of functionalities. From straightforward to- do lists, local task management, and a documents viewer for seamless file accessibility to a unique Test Mode that transforms the system into a secure environment for standardized test- taking, the application aims to provide a holistic solution to enhance productivity. Moreover, the inclusion of an in-app chat feature enables communication within the application, fostering collaboration without external distractions. A central dashboard serves as a command center, offering quick access to Focus Mode, statistics, task management, and other essential features. The application also incorporates progress tracking, allowing users to visualize trends over time and set and monitor productivity goals. In summary, Focus Flow aspires to redefine the way users approach works, providing a comprehensive toolkit to create a distraction-free and productive work environment.

A Comparison of Training and Dispatch Criteria for Security Personnel in 119 Domestic and Overseas General Situation Rooms

This study proposes an efficient way to strengthen work capabilities based on a comparison of the education and training of guard personnel before and after their deployment in the 119 Emergency Operations Center, which is in charge of elementary responses to various disasters and accidents, with that given to advanced foreign situation personnel. Only one area of Gyeonggi-do Province was identified in an internal document on personnel standards for moving into the situation room in Korea, and it was found that most of the situation room agents were used for situation room work through the informal OJT training of senior members of each city and provincial headquarters before deployment. Japan, like Korea, is organized into several prefectures and operates the same Emergency Operations Center or Joint Command Center. However, the most distinctive feature of the Japanese system with respect to Korea is that situation room agents are employed in the day-to-day operations of the command center after education with systematic and clear contents before being put into the work of the Emergency Operations Center. Similarly, the United States comprises 50 states, each with its own laws and emergency management systems. However, the federal government actively controls disaster safety and establishes and operates regulations by state, and each state has education and training, certification standards, and supplementary education regulations for existing agents. In Germany, there is a specific system of vocational education and training to become a worker in the Emergency Operations Center, and the curricula in vocational schools for security personnel, as well as the admission requirements and professional qualifications, are specified by the government.

Understanding the Challenges and Opportunities for Strengthening Incident Response System in India: A Stakeholder Survey

Disaster response is an integral part of disaster management. Recognizing the critical role of effective response in disaster management, India developed the Incident Response System (IRS). The Unified Incident Response System for India is a complete system that aims to improve how the country responds to emergencies and tragedies. IRS operates like a complex orchestra where each stakeholder plays a crucial role in mitigating risk and restoring normalcy. It is meant to bring together all emergency services along with response teams onto a single platform, thereby making it easier to organize for responding to disasters quickly and successfully. The system has a central command and control center, a mobile app for people to share incidents and an online database containing emergency contacts and tools. With this method in place, India will be better able to handle emergencies while making sure its people are safe. It is an effort towards making the country more resilient and ready for emergencies and crises. The present study examines five key elements on incident response, highlighting common challenges like lack of preparedness, inadequate training and sector-specific complexities. It presents opportunities for improvement through investing in training, adopting automation, tailoring plans for different industries and fostering collaboration across organizations and Government.