Local Emergency Research Articles

Assistance for Local Emergency Response Training Grant (DOT)

Assistance for Local Emergency Response Training Grant (DOT)

Visualizing climate change flood risks to community-centric critical infrastructure and local emergency services in the Great Lakes region: Metrics and insights

Visualizing climate change flood risks to community-centric critical infrastructure and local emergency services in the Great Lakes region: Metrics and insights

A helyi rádió szerepe veszélyhelyzetben

During an emergency situation, broadcast radio is the most flexible, and most accessible medium; in local emergency, local radio has a major role, since. During early stages of an emergency, the radio station and the authorities need to cooperate in informing the public concerned; later local radio has a role in the rehabilitation process. This author presents examples on how radio works in emergency, including the temporary community station that was on the air in the Ajka–Devecser area after the industrial catastrophe in 2010.

Barriers and facilitators to global access to life-saving skills training: an international cross-sectional survey

IntroductionEmergency care begins in the community, who are often the first on the scene. Where emergency care systems are nascent or absent, bystanders represent the only prehospital emergency care that...

Characteristics and Outcomes of Pulmonary Embolism Patients Transferred After Activation of Pulmonary Embolism Response Team and Admitted from Local Emergency Department

Background: The primary role of a pulmonary embolism response team (PERT) is to support decision-making processes regarding acute pulmonary embolism (PE) patients and provide advanced rescue therapies when needed. Despite a great need for its availability among physicians, PERT’s usefulness is yet to be proven. Objectives: Our goal was to establish whether patients benefit from qualification by PERT for admission to a tertiary cardiology ward. Methods: Data of all patients hospitalized due to PE for 12 months (July 2023–June 2024) were retrospectively analyzed. We aimed to compare patients admitted primarily via the emergency department with those consulted by PERT and eventually transferred from other hospitals. The primary outcome was the use of advanced therapies. Results: We identified 167 patients (50.3% women) hospitalized with PE. Out of them, 102 (61.1%) came from the emergency department, while 65 (38.9%) patients were transferred after PERT consultation. The transferred patients generally had more severe conditions, as indicated by the ESC death risk group classification (intermediate-high and high risk, OR 19.2, 95% CI 8.3–44.2). They were more often qualified for at least one of the advanced therapies than the emergency department patients (OR 23.2, 95% CI 9.3–58.1). We found no significant differences in in-hospital mortality (6.9% versus 1.5%, OR 4.7, 95% CI 0.6–39.3). Conclusions: Establishing PERT as a reference unit providing advanced treatment resulted in successfully delivering more complex treatment to severely ill PE patients. Despite their unfavorable basic characteristics, neither length of hospitalization nor in-hospital mortality seem to differ when compared to unselected, less compromised cases.

Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012–2017

BackgroundAmbulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socioeconomic disadvantage have higher rates of emergency admissions...

Enablers and barriers to public health practice during COVID-19: Perspectives from local public leadership from across Canada.

Our study investigates the efforts of local medical health officers during COVID-19 in Canada, with a focus on explicating enabling factors and barriers to effectively respond through local public health efforts. We conducted 26 semi-structured interviews with local-level public health leadership from across Canada and analyzed the transcripts for salient facilitators and barriers to effective local public health practice using the Consolidated Framework for Implementation Research. Effective local-level public health practice was facilitated by efforts that potentiated synergistic efforts inside and outside of the public health sector, including trust, buy-in, and ample resources. Barriers to effective practice involved uncertainty associated with governance, human resources, and the complexity of the pandemic itself. Sustained coordinated efforts across organizations together with clear governance mandates are required for robust local emergency management.

Prehospital video triage of suspected stroke patients in Greater Manchester: pilot project report

IntroductionStroke is a leading cause of mortality and morbidity, demanding prompt and accurate identification. However, prehospital diagnosis is challenging, with up to 50% of suspected strokes having other diagnoses. A...

The 2023 dengue outbreak in Lombardy, Italy: A one-health perspective.

Here we reported the virological, entomological and epidemiological characteristics of the large autochthonous outbreak of dengue (DENV) occurred in a small village of the Lombardy region (Northern Italy) during summer 2023. After the diagnosis of the first autochthonous case on August 18, 2023, public health measures, including epidemiological investigation and vector control measures, were carried out. A serological screening for DENV antibodies detection was offered to the population. In the case of positive DENV IgM, a second sample was collected to detect DENV RNA and verify seroconversion. Entomological and epidemiological investigations were also performed. A modeling analysis was conducted to estimate the dengue generation time, transmission potential, distance of transmission, and assess diagnostic delays. Overall, 416 subjects participated to the screening program and 20 were identified as DENV-1 cases (15 confirmed and 5 probable). In addition, DENV-1 infection was diagnosed in 24 symptomatic subjects referred to the local Emergency Room Department for suggestive symptoms and 1 case was identified through blood donation screening. The average generation time was estimated to be 18.3 days (95% CI: 13.1-23.5 days). R0 was estimated at 1.31 (95% CI: 0.76-1.98); 90% of transmission occurred within 500m. Entomological investigations performed in 46 pools of mosquitoes revealed the presence of only one positive pool for DENV-1. This report highlights the importance of synergic surveillance, including virological, entomological and public health measures to control the spread of arboviral infections.

The Role of the Subtropical Jet Stream in Dry Season Severe Caribbean Rainstorms: Climatology and Composite Analyses

Abstract Although high-impact heavy rainfall events in the Caribbean are typically associated with tropical cyclones (TCs) during the wet season, significant heavy rainfall events can also occur during the Caribbean dry season, absent of TCs. Dry season severe Caribbean rainstorms (CRs) can produce rainfall totals that surpass climatological dry season monthly mean rainfall, ranging from 25 to 200 mm, by >3 sigma over a relatively short duration (2–16 days), resulting in infrastructure- and life-threatening flooding and mudslides. This paper introduces a 35-yr (1983–2017) dry season severe CR climatology derived from the PERSIANN-CDR precipitation dataset, revealing that dry season severe CRs occur, on average, eight times per year with some interannual variability and exhibit a seasonality that includes relative maxima in November/December and April/May as well as a relative minimum in February. Self-organizing map (SOM) analyses are applied to detect subtropical jet stream (STJS) flow patterns governing events in this climatology which include an upper-level trough reaching the Caribbean (Trough cases, 23% of all events), a frontal boundary extending into the Caribbean attendant to an extratropical cyclone (EC) at midlatitudes (EC Front cases, 54% of all events), or a potential vorticity stream (PVS) forming near the Caribbean (PVS cases, 7% of all events). In these events, extratropical forcing, occasionally combined with orographic forcing, can promote intense, organized, and widespread deep, moist convection that produces heavy rainfall. The remaining events do not have a discernable extratropical connection and are not considered to be influenced by the STJS (16% of events). Significance Statement High-impact heavy rainfall events in the Caribbean are typically associated with tropical cyclones during the wet season, but significant heavy rainfall events can also occur during the Caribbean dry season without tropical cyclones. Dry season Caribbean rainstorms (CRs) can result in infrastructure- and life-threatening flooding and mudslides from rainfall totals that substantially surpass normal dry season monthly rainfall in a short duration (2–16 days). A 35-yr dry season severe CR climatology is constructed, indicating that these events occur on average eight times per year. The subtropical jet stream is recognized as an important driver and influencer of thunderstorms with heavy rainfall in most (84% of all cases) dry season severe CRs. The results of this study could help Caribbean weather forecasters recognize the nature of dry season severe CRs and associated weather patterns to provide more information and advanced warning to local emergency management and the public.

Long-term Effects of Local Area New Deal Work Relief in Childhood on Late Life Depression.

To investigate whether childhood exposure to local area New Deal emergency employment work relief activity was associated with lower depressive symptoms in late life. This study utilized individual-level data from the Wisconsin Longitudinal Study (WLS) linked to the full count 1940 census. New Deal emergency employment programs were the largest non-wartime expansion in government led infrastructure, services, and employment policy in U.S. history. We used within county variation in WLS participants' exposure to emergency employment work relief activity during childhood (ages 0-3) to examine its association with depressive symptoms in late life. We examined depressive symptoms at three ages, 53-55, 65-67, and 72-74 but with a focus on depressive symptoms at ages 72-74 as a marker for late-life depression. Children who lived in neighborhoods with moderate or high levels of emergency employment work relief activity exhibited 14-18% lower depressive symptom scores at ages 72-74 compared to those from neighborhoods with low activity. These findings were consistent across various measures of late-life depressive symptoms, different model specifications, and after accounting for prior depressive symptoms. The study highlights the long-term mental health benefits of economic policies aimed at mitigating concentrated economic downturns among the most impacted individuals. Childhood exposure to New Deal work relief reduced depressive symptoms in older age, particularly new onsets of depressive symptoms at ages 72-74. These results suggest social policies aimed at maintaining economic activity in downturns can have long-term positive impacts on population mental health.

Seven Challenges for Risk Communication in Today’s Digital Era: The Emergency Manager’s Perspective

Risk communication plays a vital role in transmitting information about hazards and protective actions before and after disasters. While many studies have examined how risk communication and warnings influence household responses to hurricanes, fewer studies examine this from the perspective of the emergency manager. Given the rapid advancements in technology and the adoption of social media platforms, as well as the increasing prevalence of misinformation during disasters, a fresh investigation into risk communication challenges and optional strategies is needed. Therefore, this study addresses three research questions: (1) What channels do emergency managers rely upon to communicate with the public before, during, and after a disaster? (2) How do emergency managers assess and ensure the effectiveness of their messaging strategies? (3) How do emergency managers manage misinformation? The challenges experienced by emergency managers related to each of these issues are also explored. Data were gathered in July–October 2024 through interviews conducted with eleven local emergency managers located in communities along the Texas Gulf Coast. Based on the findings of a qualitative data analysis, this paper presents seven distinct risk communication challenges faced by emergency managers throughout the evacuation and return-entry processes that span the communication aspects of channels, messaging, and misinformation.

The prehospital paediatric emergency care burden managed by a public ambulance service in the Western Cape, South Africa

BackgroundPaediatric mortality rates in low- and middle-income countries account for over 80% of the global burden. In South Africa, one in every 33 children will not reach the age of five. Despite the high mortality rate, there is a paucity of data describing the prehospital paediatric under-five emergency care burden in South Africa. Such data are essential to inform the development of local prehospital emergency care guidelines and targeted prevention strategies.AimThis study describes the prehospital paediatric under-five emergency care burden managed by the Western Cape Government Health and Wellness (WCGHW) Emergency Medical Services (EMS) in South Africa.MethodsA retrospective review of the prehospital records was conducted, extracting epidemiological and clinical data from the WCGHW EMS patient record database. The review included all paediatric cases under-five, managed between 1 January 2022 and 31 December 2023, in the Western Cape of South Africa.ResultsIn the 87 457 cases, there was a similar distribution between the primary cases (50.7%) and interfacility transfers (49.3%). Most activations emanated from rural areas (47 980, 54.9%), with respiratory emergencies (30 934, 35.4%), non-cardiac pain (11 381, 13.0%) and trauma (10 831,12.4%) being the most common presenting complaints. Most cases were prioritised as priority 2 (46 034, 52.6%), with most of these being older children between one and five years old (29 008, 63.0). Low acuity cases accounted for 67.2% (58 818) of the sample, with the highest mortality occurring between 29 days and 12 months (190, 52.9.%). Most patients spent less than one hour in the prehospital setting (64 431, 73.7%), with advanced airway management (748, 43.1%) being the most common airway intervention.ConclusionThis first description of the prehospital paediatric under-five emergency care burden managed by the WCGHW EMS reveals a unique burden, particularly regarding the high interfacility transfer rates. As illustrated in graphical abstract, these findings underscore critical considerations for healthcare planners and the prehospital training environment. Future research among this population should focus on characterising the reasons for the high interfacility transfer rates through assessments of healthcare access, EMS care quality and post-EMS follow-up.Graphical

Towards a New Typology of Digitalized Co-production: Implementing Local Emergency Response Initiatives Nationwide

In Sweden, a decade ago, digitalized co-production emergency response initiatives of a hybrid bottom-up type emerged. They targeted local efforts to recruit groups of citizens to provide first responses for other citizens in accidents. Benefits in terms of shorter response times, saved lives, reduced human suffering, and material damage have been demonstrated. Recently, national authorities recognized the need to support the initiatives to expand to all rescue services, and the potential to scale up the use of citizen first responders, also in large-scale crisis management and as part of civil preparedness. Previous research has studied the initiatives and developed three models aimed at supporting the implementation of digitalized co-production. In this study, we report from the initial phase of the nationwide effort, carry out an initial evaluation, and present revised models. The models are adapted to rural versus urban settings and complemented with a model providing national support. Information and communication technology plays a crucial role in all of them. We define the hybrid type as interdependent digitalized co-production where government citizen sourcing is not direct but includes the intermediate level of the rescue services. Implications are discussed, e.g., on how to achieve a balance between centralization and decentralization.

Patterns in California Ambulance Patient Offload Times by Local Emergency Medical Services Agency

Ambulance offload delays are a timely and crucial issue with implications for patients, emergency medical services (EMS) agencies, hospitals, and communities. Published data on recent patterns in ambulance patient offload times (APOTs) are sparse. To examine patterns in APOT by California local EMS agency and variation between and within local agencies. This cohort study used APOT reports from the California EMS Authority and local EMS agencies between January 1, 2021, and June 30, 2023, to examine patterns in ambulance offload times. County-level population data were collected from the US Census Bureau to calculate mean annual offloads per 1000 population. Ambulance transport to emergency departments. Ambulance offload volumes, mean annual offloads per 1000 population, APOT-1 (a reporting metric that includes the 90th percentile ambulance offload time and number of offloads to a specific hospital) weighted means (SDs), and APOT-1 medians (IQRs). A total of 5 913 399 offloads across 34 California local EMS agencies were analyzed. The APOT-1 weighted mean (SD) across the state was 42.8 (27.3) minutes, and the median (IQR) monthly hospital-level APOT-1 was 28.9 (14.9-46.3) minutes. Nearly one-half of local EMS agencies (16 of 34 [47.1%], accounting for 79.2% of all offloads) experienced an APOT-1 weighted mean greater than the 30-minute standard set by the state. Moreover, 20 of 33 local EMS agencies (60.6%) reported an annual APOT-1 weighted mean that was worse in 2023 than 2021. In this cohort study, approximately half of all agencies consistently reported ambulance offload times greater than the 30-minute state standard, and there was significant variation between and within agencies. These findings may spur collaborative efforts between stakeholders to determine the most effective strategies for addressing systemic issues resulting in long APOT across California.

Implementation of International Human Rights Law during Situations of Violence: The Central Asian Experience

Abstract The Central Asian region is periodically prone to turbulent and destabilizing events. Many human rights challenges arise, with multiple violations and restrictions of individual human rights and freedoms (e.g., civil and political rights) taking place, during, but also as a short-term and long-term result of these tumultuous events. Existing (or non-existent) legal frameworks have played an instrumental part in this status quo. It is important to scrutinize the abovementioned challenges and factors, and propose potentially workable solutions to address the problems in this area. With the use of legal analytical, historical and comparative methods, this paper reviews and systematizes some major situations involving violence which have taken place on the territory of five Central Asian States, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan, since they gained independence in the early 1990s. It will subsequently consider specific types of human rights and freedoms that were affected by the said events, in accordance with the accepted terminology of international human rights law (IHRL). The paper analyzes the relevant general and specific challenges, including those that may be attributed to local contextual factors. The author argues that all the problems and challenges that have been considered may be overcome only upon condition that the suggested strategies and measures – legal, educational, social, etc., are implemented in a systematic and principled way. The piece discusses what exactly the noted trends in the implementation of international human rights standards mean in terms of international law perspectives in the region, and how those regional perspectives may have been affected by local or regional conflicts and emergencies. Finally, the author briefly offers a number of potential solutions to the said challenges, including but not limited to, legislative and IHRL domestic implementation measures (legal), teaching and instructional reforms (educational), and others.

Disaster Mitigation Knowledge Based on Local Wisdom Integration in Elementary Schools

Elementary schools as a basic education environment have limited knowledge and understanding of disaster preparedness, both among students, teachers, and the surrounding community. The lack of effective educational strategies, especially in integrating local knowledge and traditional wisdom, is a major obstacle in preparing elementary schools to face disasters. This study aims to describe and analyze the forms of knowledge obtained from disaster preparedness education based on local wisdom integration for elementary schools. This study uses a qualitative case study method, where participants are selected from various stakeholders involved in elementary education and disaster preparedness. The results of the study indicate that various types of disaster preparedness education knowledge have been identified, including basic knowledge, specific disaster preparedness knowledge, local wisdom knowledge, emergency response and evacuation knowledge, environmental knowledge and prevention, and social knowledge and cooperation. Understanding disaster mitigation can influence students' attitudes and behaviors in facing disasters, so that by providing elementary school students with comprehensive and contextual knowledge about disaster mitigation, equipping them with important and wiser life skills.

Safety Management In Emergency Situations: Implementation of The Apell Method

The research problem was to obtain an answer on how to design a coherent system of response to emerging threats, taking into account the current legal status of the country in the system of the statutory regime of European Union standards in the context of disasters, failures, and other unfavorable, unforeseen events. At the same time, the authors note the lack of a legal concept as well as the lack of discussion of insufficient legal acts in scientific articles, thus a kind of gap appears, i.e. space giving the potential to establish new legal acts or expand the existing ones. It is worth pointing out the need, according to researchers, to develop rescue plans for municipalities and poviats, as well as informing the population about potential threats in a structured and consistent manner with high effectiveness. The research methods used related to the analysis of the content of monographs, legal acts, scientific periodicals and programs resulting in reports on implemented projects and undertakings. The increasing use of hazardous chemicals in industry, commerce and transport – combined with the potential for misuse by terrorists – has increased the risks to workers and local communities. To address these threats, the United Nations Environment Program (UNEP) launched the APELL (Local Emergency Awareness and Preparedness) program in 1988. Developed in response to multiple chemical accidents with devastating human, environmental and economic impacts, the goal of APELL is to: improve community safety and preparedness by increasing awareness and establishing emergency protocols at the local level.

The Severity of Allergic Reactions in a Real-World Environment Is Independent of the Eliciting Amounts of Foods.

Patients with food allergies need personalized information on their risk of reaction in "real-life" situations. This multicentric study aimed to investigate the link during accidental reactions between the nature and amount of food allergens consumed in "real-life situation" and the severity of the symptoms. Patients were prospectively recruited from December 1, 2020, to December 31, 2021, at the emergency departments in the Geneva University Hospitals and local pediatric emergency facilities, through an allergy outpatient clinic, at school and daycare facilities and trough their primary care physicians. Medical history of patients presenting reactions suggestive with immediate food allergy and suspected food samples were collected. Allergy diagnostic tests were retrospectively and prospectively collected. The samples were analyzed for their allergen content. We recruited 147 subjects with an accidental immediate-type allergic reaction to a food. We were able to collect 115 reaction-eliciting food samples allowing to quantify the allergen amount causing the reaction, as well as correlating this amount to the severity of the reaction. Children represented a large part of the reactors, and most reactions were to common food allergens such as tree nuts, cow's milk as well as peanuts and hen's egg. Reactions were mostly to prepackaged foods and seven reactions were to products with precautionary allergy labeling, or without labelling to the eliciting allergen. Reactions were of various degrees of severity, and independent to the amount of allergen ingested. The severity of reactions did not show a direct correlation with allergen quantity, emphasizing individual sensitivity. Some reactions occurred with allergen amounts significantly below the legal limit for mandatory labelling of 1 g/kg (1000 ppm) in Switzerland. The study also highlighted considerable variability in allergen concentrations in foods labeled with possible "contaminations" or "traces". These findings raise questions about the accuracy of allergen labeling and regulations in Switzerland.

The Integration of Nurse Practitioners Into Mass Gathering Medical Teams.

Mass gathering events can greatly impact overburdened emergency medical service systems and emergency departments, which frequently experience staffing shortages and overcrowding. Nurse practitioners (NPs) were introduced into an event medicine team at mass gatherings to reduce emergency transports to local emergency departments as well as offering a "treat and release" disposition for patients presenting to medical tents. This study aimed to examine the impact of NPs at mass gathering events; 147 chart reviews were performed from 05/01/2023 to 09/30/2023 for all patients assessed by an NP at events staffed by an event medicine team; 60% of patients assessed by an NP were treated and released from the event, potentially reducing the number of patient transports and emergency department visits considerably. NPs can provide higher levels of care at events, treating common complaints such as heat-related illness, nausea, vomiting, minor trauma, and laceration repairs. Although this study did not compare data from events where NPs were not present versus when they were utilized to grasp the statistical impact their presence has had since their introduction to the team model, the study clearly shows the benefits NPs bring to mass gathering medical care. This is significant for emergency NPs as this research validates the need to include these providers in this new setting and role in which they can practice. More research is needed to compare patient outcomes with and without NPs present.