Emergency Medical Preparedness Research Articles

Designing a model of emergency medical services preparedness in response to mass casualty incidents: a mixed-method study

BackgroundEmergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that overwhelms the local health care system. This study aimed to identify and validate the components of emergency medical services readiness in mass casualty incidents which ultimately led to designing a conceptual model.MethodsThis research was an explanatory mixed-method study conducted in five consecutive stages in Iran between November 2021 and September 2023. First, a systematic review was carried out to extract the components of emergency medical services preparedness in mass casualty incidents based on the PRISMA guideline. Second, a qualitative study was designed to explore the preparedness components through in-depth semi-structured interviews and analyzed using the content analysis approach. Third, the integration of the components extracted from the two stages of the systematic review and qualitative study was done by an expert panel. Fourth, the obtained components were validated using the Delphi technique. Two rounds were done in the Delphi phase. Finally, the conceptual model of emergency medical services preparedness in mass casualty incidents was designed by a panel of experts.Results10 articles were included in the systematic review stage and sixteen main components were extracted and classified into four categories. In the second stage, thirteen components were extracted from the qualitative study and classified into five categories. Then, the components of the previous two phases were integrated into the panel of experts and 23 components were identified. After validation with the Delphi technique, 22 components were extracted. Lastly, the final components were examined by the panel of experts, and the conceptual schematic of the model was drawn.ConclusionsIt is necessary to have an integrated framework and model of emergency medical service readiness in the planning and management of mass casualty incidents. The components and the final model of this research were obtained after the systematic scientific steps, which can be used as a scheme to improve emergency medical service preparedness in response to mass casualty incidents.

Evaluation of Awareness and Preparedness for Medical Emergencies among Dental Practitioners in Twin Cities of Punjab: A Cross-sectional Study

OBJECTIVE: The purpose of this study was to evaluate the awareness of medical emergencies among dental practitioners, to assess the degree of expertise and readiness of dental professionals to handle medical crises in their dental practices and to ascertain if medical emergency medications are offered in dental offices. METHODOLOGY: A prospective study including 208 practitioners were given access to the survey through Google Form, along with information on the study and a consent form .The questionnaire consisted of demographic details, years of experience, and specialty of practitioners and 20 closed-ended questions with 10 assessing knowledge and rest evaluating the competence and preparedness to handle medical emergencies. An emergency whether medical or dental is a serious, acute, and unexpected event that requires a quick and timely intervention. Since some diseases and their treatments increase the likelihood of a medical emergency during dental treatment. The most often encountered medical emergencies in a dental office are vasovagal syncope, angina pectoris, hypoglycemia, and hypertensive crisis. One of the mainstays of prevention of medical emergencies is by taking a thorough and detailed history, and vital signs monitoring and modifying the treatment plan. RESULTS: A response rate of 96% was achieved by including all 200 of the study’s 450 dental professionals. Just 69% of the participants had emergency kits on hand, even though roughly 77.5% of the dentists in the study felt confident in their ability to handle emergencies in the dental office. CONCLUSION: In this study, dental professionals demonstrated a moderate level of understanding in medical situations, and many of them have low to moderate perceived competency in managing medical emergencies. Every dental clinic should have well-communicated emergency protocols in place that should be updated periodically. KEYWORDS: Medical emergency, Dental Practitioner, Emergency kit, BLS, Dental Clinics

Emergency medical services preparedness in mass casualty incidents: A qualitative study.

The effective response of emergency medical services in mass casualty incidents (MCIs) calls for sufficient preparation. The components of preparation must be determined first to achieve this goal. This study aimed to describe the elements of preparedness of emergency medical services for MCIs. A qualitative study was carried out on emergency medical service systems in Iran (from April 2022 to mid-March 2023), using in-depth semistructured interviews with participants who were managers and members of the incident command team, experts, technicians, paramedics, and telecommunicators of emergency medical services. Interviews were carried out face-to-face and via telephone. The data were collected using voice recorder and transcript and analyzed by content analysis method. This study was conducted using the consolidated criteria for reporting qualitative research. Thirty-six participants were included in the study. A total of 834 codes were analyzed. Thirteen components were extracted from the study and classified as five categories including "Strengthening management and organization,""individual and group empowerment,""capacity expansion,""technology and infrastructure development,"and "operational response measures." Emergency medical service preparedness in response to MCIsis a critical issue. For improving preparedness, the main components must be identified. The study results described the elements of emergency medical service preparedness, which could be used as a framework for developing the national model of emergency medical service preparedness in MCIs.

Development of radiation countermeasure agents for acute radiation syndromes.

The risk of internal and external exposure to ionizing radiation (IR) has increased alongside the development and implementation of nuclear technology. Therefore, serious security issues have emerged globally, and there has been an increase in the number of studies focusing on radiological prevention and medical countermeasures. Radioprotective drugs are particularly important components of emergency medical preparedness strategies for the clinical management of IR-induced injuries. However, a few drugs have been approved to date to treat such injuries, and the related mechanisms are not entirely understood. Thus, the aim of the present review was to provide a brief overview of the World Health Organization's updated list of essential medicines for 2023 for the proper management of national stockpiles and the treatment of radiological emergencies. This review also discusses the types of radiation-induced health injuries and the related mechanisms, as well as the development of various radioprotective agents, including Chinese herbal medicines, for which significant survival benefits have been demonstrated in animal models of acute radiation syndrome.

Children's Welfare Concern in a Full-scale Disaster Pediatric Drill

Introduction:Children are almost systematically involved in mass casualty events, especially in the context of terrorist attacks. Unfortunately, the emergency medical responder preparedness is quite often low when it comes to pediatrics, on both technical and emotional sides. Preliminary training is indispensable, and full-scale simulations are arguably the best solution to tackle the needs of the first responders. The purpose of the study was to describe a simulation-based pediatric training with pediatric psychological support set up for the drill.Method:A full-scale exercise involving children between five and fifteen years old was conducted in the Toulouse municipal stadium during the preparation of the 2016 UEFA (European Football Championship) in France. As children welfare was the primary concern, a psychological support team was present at each stage of the drill and assessed any mental harm that could have happened. Children were asked about their feelings at the end of the exercise with a 5-point Likert rating scale and their parents had to report any perceived changes in the following week.Results:Out of 16 children participating in the drill, four were in an immediate situation (P1), four were in an emergent situation (P2), and eight were in an urgent situation (P3). One hundred percent of them rated their experience as very good and expressed no stress to their parents in the week that followed, and no harm was detected by the psychological support team during the exercise.Conclusion:The results of the study show that involving children as victims in pediatric disaster drills is possible in these conditions without impacting the mental welfare of children.

Teacher Preparedness for Medical Emergencies in Belgian Classrooms: Studying Objective and Subjective First-Aid Knowledge.

About one in seven accidents involving children occurs at school. Roughly 70% of these accidents involve children under the age of 12 years. Thus, primary school teachers may be confronted with accidents where first aid could improve the outcome. Despite the importance of first-aid knowledge among teachers, little is known about this topic. To fill this gap, we conducted case-based survey research on the objective and subjective first-aid knowledge of primary school and kindergarten teachers in Flanders, Belgium. An online survey was distributed to primary school and kindergarten teachers. It included 14 hypothetical first-aid scenarios in a primary school context to assess objective knowledge, along with one item to assess subjective knowledge. A total of 361 primary school and kindergarten teachers completed the questionnaire. The participants achieved an average knowledge score of 66%. Those who had completed a first-aid course had significantly higher scores. Knowledge regarding child CPR was amongst the lowest, with only 40% correct answers. Structural equation modeling showed that only previous first-aid training, recent experience with first aid, and subjective first-aid knowledge were linked to teachers' objective first-aid knowledge-particularly for basic first aid. This study shows that completing a first-aid course and completing a refresher course can predict objective first-aid knowledge. We therefore recommend that first-aid training and regular refresher courses should be mandatory in teacher training, given that a large share of teachers may need to apply first aid to a pupil at some point during their career.

Evacuation of Non-ST Elevation Myocardial Infarction in West Africa: 19 Hours of Lessons Learned in Prolonged Casualty Care and En Route Care.

Trauma casualty care has historically been the cornerstone of special operations military medical training. A recent case of myocardial infarction at a remote base of operations in Africa highlights the importance of foundational medical knowledge and training. A 54-year-old government contractor supporting operations in the AFRICOM area of responsibility (AOR) presented to the Role 1 medic with substernal chest pain with onset during exercise. Abnormal rhythm strips concerning for ischemia were obtained from his monitors. A MEDEVAC to a Role 2 facility was arranged and executed. At the Role 2 a non-ST-elevation myocardial infarction (NSTEMI) was diagnosed. The patient was emergently evacuated on a lengthy flight to a civilian Role 4 treatment facility for definitive care. He was found to have a 99% occlusion of the left anterior descending (LAD) coronary artery, as well as a 75% occlusion of the posterior coronary artery and a chronic 100% occlusion of the circumflex artery. The LAD and posterior arteries were stented, and the patient made a favorable recovery. This case highlights the importance of preparedness for medical emergencies and care of medically critical patients in remote and austere locations.

Are Online Simulations for Radiation Emergency Medical Preparedness Less Effective in Teaching Than Face-to-Face Simulations?

The study clarified differences in understanding and satisfaction between face-to-face and online training on radiation emergency medical preparedness (REMP) training. The training was held at Hirosaki University between 2018 and 2022, with 46 face-to-face participants and 25 online participants. Face-to-face training was significantly more understandable than online for the use of the Geiger counter (P < 0.05), but the educational effect of virtual reality (VR) was not significantly different from the actual practice. For the team exercise of taking care of the victims, online resulted in a significantly higher understanding (P < 0.05). Interactive exercises can be done online with equipment sent to learners, and VR is also as effective. The use of videos was more effective for first-timers to learn the practical process from a bird's-eye view, especially for team-based medical procedures.

Prehospital Preparedness for Major Incidents in Sweden: A National Survey with Focus on Mass-Casualty Incidents.

Major incidents (MIs) put great demands on the medical response to effectively organize and redistribute resources and personnel, in prehospital care as well as hospital care, and coordinating functions. Studies indicate that regular training and well-established contingency plans are vital for the medical response to MIs. Previous assessments have concluded that Swedish disaster preparedness requires improved organization and coordination. There is currently no method to easily follow-up the preparedness work of the prehospital medical response organizations for MIs in Sweden. The aim of the study was to assess qualifications and training requirements for central individual roles, to examine frequency and focus of training and simulation, as well as to examine current regional routines for MIs in Sweden. The aim was also to identify, to evaluate, and to investigate areas for improvement in prehospital health care preparedness for MIs in Sweden. Descriptive comparative study of Sweden's prehospital organization, planning, education, and training for MIs through a web-based survey sent to all 21 regions in Sweden. The survey included 64 questions and was based on national legislation and guidelines for preparedness and previous investigations of real MIs. A total of 37 answers to the survey were collected representing 17/21 regions (80.9%) from which Regional Management Individuals (RMIs) were selected from 15 regions and used as representative primary responses. The initial routines regarding alarm and establishment of management functions were mainly in-line with national guidelines. Staffing and qualification requirements for certain leadership roles differed substantially between regions. The requirements for the health care staff's knowledge of the contingency plan were generally low and routines for follow-up were often lacking. The frequency of exercises in certain areas were deficient. The results of the study showed several potential areas for improvement within the prehospital emergency medical preparedness for MIs in Sweden. Methodology and adherence of national guidelines for medical response preparedness differ between regions in Sweden, which motivates recurring assessments. It is possible to use a well-prepared questionnaire study to follow-up and to examine parts of the regional prehospital preparedness work and organization for MIs.

Comparing medical emergency preparedness in U.S. public and academic libraries

This study sought to determine what medical emergency resources and training are provided in U.S. public and academic libraries, how public versus academic preparedness compares, and what reasons may contribute to decisions against adoption. Survey responses from 65 libraries were analyzed regarding availability of, plans to acquire, or reasons for not acquiring five interventions—automatic electronic defibrillators (AEDs), naloxone, epinephrine, cardiopulmonary resuscitation (CPR) training, and mental health crisis training. Findings showed that these interventions were not necessarily common—41.5% of respondents offered zero of the five interventions, while the most common, AED, was available in 52.3% of libraries. AEDs and epinephrine were somewhat more common in academic libraries, but naloxone, CPR training, and mental health crisis training were more common in public libraries. Primary reasons for not adopting medical interventions included alternative emergency response options, cost, concerns regarding legal liability, and the sense that this is outside the scope of a library’s duties. Implications and considerations for library planning are discussed.

The importance of improvement of radiation emergency medical preparedness and response system in Mongolia.

The objective was to identify and share the key challenges facing Mongolia regarding the ability to introduce and establish an effective system for radiation emergency medicine (REM). National arrangements for preparedness and response to radiological emergencies include legal documents andcommitments of regulatory bodies and governmental agencies were briefly mentioned. The key challenges include the establishment of an adequate system for radiation emergency medicine and related infrastructure; development of human resources including requirements for education, qualifications and regular trainings; supporting physical infrastructure, such as dosimetry and measurement devices including a cytogenetic biodosimetry laboratory. In addressing these challenges, the importance of establishment of an adequate system for radiation emergency medicine was highlighted. Utilization of support networks at international level such as IAEA and WHO/REMPAN which can assist Mongolia by provision of expert missions. It is considered as a crucial factor for successful implementation of the Mongolian project to develop its capacity in REM.

Awareness of medical emergencies and preparedness of undergraduate clinical dental students in a tertiary institution in Nigeria

Background : Medical emergency can be described as an unwanted, unexpected reaction or complication which usually requires immediate attention or intervention. Aim: This study aims to assess awareness and preparedness for medical emergencies amongst undergraduate clinical dental students at the University of Benin, Nigeria.Materials and Methods : A descriptive cross-sectional study involving all clinical dental students in the School of Dentistry, University of Benin. The questionnaire was divided into three main sections: Socio-demographic characteristics of the respondents; Selfassessed medical emergency preparedness among the respondents; Self-evaluation of knowledge of specific medical procedures about medical emergencies.Results : The age of the respondents ranged from 19 to 31 years, with a mean age of 24.49 ± 3.1 years. A higher proportion of the respondents were male (47; 72.3%). Seventy-two percent of students adequately assessed the patient’s medical history, but only 40.0% regularly used medical Pro-forma to obtain the patients' health history. About 41.5% of the students had poor knowledge about medical emergencies, while 43.1% had adequate knowledge. Only 15.4% of the students had good knowledge.Conclusion : The study showed that only 15.4% of the students had good knowledge of handling medical emergencies, although 69.2% of the dental students specified good emergency preparedness. The findings point to a deficiency in the dental students’ curriculum regarding medical emergencies, which makes them inadequately prepared to handle them. This emphasizes the need for a review of clinical dental students’ curricula to introduce the management of medical emergencies.

Assessment of the Effectiveness of Medical Emergency Preparedness among Oil and Gas Platforms in the Niger Delta

The need for effective Medical Emergency Preparedness (MEP) systems in an offshore facility is of great importance due to the high Health Safety and Environment (HSE) risks to Personnel on Board in the terrain. Despite the great strides recorded in Nigeria’s offshore oil and gas sector, little is known about the availability of a nationally constituted evaluation tool for offshore MEP systems in the oil and gas industry in Niger Delta. Hence, the call for a systematic national MEP framework based on the provisions of global best practices. This paper is aimed at assessing the effectiveness of the MEP framework of three selected offshore (jack up) oil and gas platforms in the Niger Delta. Data were obtained using a standard checklist and self-structured questionnaire and a purposive sampling technique adopted from a population of selected three jack up rigs operating in Niger Delta. The analysis was conducted using analysis of variance at 95% confidence interval. The effectiveness levels expressed as a function of numerical scores were used to carry out statistical comparative study to check for consistency in operability and quality. Results from the Welch robust test of equality of means showed to be significant (p &lt; 0.05) for all 3 rigs. However, the pairwise post-analysis at 95% confidence interval showed that the mean difference between Rig1 and Rig2 were not significant (p-value = 0.352). But the other pairs (Rig1 versus Rig3 and Rig2 versus Rig3) showed considerable differences in their mean scores with p-values of 0.001 and 0.001, respectively. It is concluded that the rig’s functionality plays a role on the MEP system’s effectiveness of jack up platforms in the Niger Delta. Therefore, the study advocates for a robust and holistic substantial national assessment tool for oil and gas regulatory authorities for evaluating and monitoring MEP systems of various offshore companies.

Radiation Emergency Medical Preparedness in Japan: A Survey of Nuclear Emergency Core Hospitals

Based on experiences following the Great East Japan Earthquake and nuclear power plant accident in 2011, Nuclear Emergency Core Hospitals (NECHs) were designated as centers for radiation disaster management in Japan. This study aimed to investigate their current status and identify areas for improvement. This cross-sectional study was conducted in October 2018. Demographic data were collected by a questionnaire with free text responses about attitudes toward NECHs. Considerations regarding risk communications during a radiation disaster were analyzed using qualitative text mining analysis. A total of 36 hospitals participated in this study. Only 31% of NECHs anticipated a radiation disaster. The importance of business continuity plans and risk communications was shown. Text analysis identified 7 important categories for health care workers during a radiation disaster, including media response, communications to hospital staff, risk communications, radiation effects on children, planning for a radiation disaster in the region, rumors, and the role in the region. The radiation disaster medical system and NECHs in Japan were surveyed. The importance of risk communications, planning for a radiation disaster in each region, and the role in the region are identified as issues that need to be addressed.

Medical Emergency Management in the Dental Office (MEMDO): A Pilot Study Assessing a Simulation-Based Training Curriculum for Dentists.

In the event of a medical emergency in the dental office, the dentist must be able to identify a patient in distress, assess the situation, and institute proper management. This study assessed the impact of a simulation-based medical emergency preparedness curriculum on a resident's ability to manage medical emergencies. This interventional and pre-post educational pilot study included 8 participants who completed a standard curriculum and 8 who completed a modified curriculum (N = 16). The intervention consisted of a comprehensive medical emergency preparedness curriculum that replaced lecture sessions in a standard curriculum. Participants completed performance assessments using scenario-based objective structured clinical examinations (OSCEs) that were recorded and evaluated by calibrated faculty reviewers using a customized scoring grid. The intervention group performed significantly better than the control group on their summative OSCEs, averaging 90.9 versus 61.2 points out of 128 (p = .0009). All participants from the intervention group passed their summative OSCE with scores >60%, while none from the control group received passing scores. Completion of a simulation-based medical emergency preparedness curriculum significantly improved resident performance during simulated medical emergencies.

Assessing readiness to manage medical emergencies among dental students at four dental schools.

Dentists treat a wide range of patients, including patients with compromised health conditions. While rendering treatment, various medical emergencies can and do occur. To help increase the knowledge required to manage such emergencies, dental students must be trained while in dental school. This study aims to assess the level of medical emergency preparedness and knowledge among dental students at four dental schools. The participating dental schools were IUSD, Case Western Reserve University School of Dentistry, Marquette University School of Dentistry, and the University of Alabama School of Dentistry. Groups were designed to include 20 dental students from Years 1 to 4. Students were asked to fill out a survey and were then tested on 10 clinical medical emergency scenarios. A total of 331 dental students participated in the study. The scores based on 10 case scenarios presented with a range of 4.35-8.02. There was no statistically significant difference in the level of preparedness when dental schools were compared. However, Year 1 and Year 2 dental students had significantly lower total scores than those of Years 3 and 4. The students in Years 1 and 2 demonstrated less confidence in their current knowledge to manage medical emergencies. Satisfaction with the training received ranged from 38% to 84%. The results from this study indicate that students' preparedness to manage medical emergencies at these four dental schools is statistically similar. Additional yearly training could enhance students' preparedness in the management of medical emergencies in the dental setting.

Assessment of an Emergency Medicine System for Radiation Accidents in Korea: A State Survey of the Workers Involved the Medical Response to Radiation Accidents.

Radiation emergency medicine systems are operated around the world to provide special care for the injured that require immediate medical attention in accidents. The objective of this survey was to evaluate people’s perception of those who design the emergency medical plan for radiation accidents and those who supervise it in Korea. A questionnaire survey was conducted on the people involved in a regulatory system for medical response in a radiation emergency. Of 150 survey recipients, 133 (88.7%) completed the survey, including 92 workers and 41 inspectors. The respondents expressed the view that the national emergency medical plan is prepared above the average level using a Likert-style scale of 1 to 5 (mean = 3.55, SD = 0.74). Interestingly, using the Mann–Whitney U test, it could be shown that inspectors evaluated the emergency medical system for radiation accidents more strictly in all of the questions than the licensee workers, especially on radiation medical emergency preparedness (p = 0.004) and the governmental regulatory policy for radiation safety (p = 0.007). For a more efficient system of radiation emergency medicine, licensee workers prioritized the workforce, whereas inspectors favored laws and regulations for safety. The survey results show different perspectives between inspectors and licensee workers, which stem from the actual properties of each occupational role in the regulatory system for radiation medical emergency. These data could be utilized for communication and interaction with relevant people to improve the medical response preparedness against radiation accidents.

A Pilot Study of Preparedness for Medical Emergencies in Urban Private Dental Practices in Malaysia

A Pilot Study of Preparedness for Medical Emergencies in Urban Private Dental Practices in Malaysia

Reproductive and contraceptive healthcare for vulnerable people in the Netherlands: Pregnant not now!

Abstract Issue/problem Unplanned and unwanted pregnancies are an important issue in public health. Especially when parents already are in complex or vulnerable situations, for example being homeless, having an addiction, serious psychiatric- or financial problems or intellectual disabilities. Although most of these parents are in contact with several professionals, family planning and contraceptives are rarely discussed. Description of the problem In 2014 a pilot programme was developed to support vulnerable adults on family planning and adequate use of contraception. In a qualitative explorative case study the pilot was evaluated. Results The pilot showed a significant increase in postponed pregnancies by using appropriate contraceptives. Over eighty percent of this population started contraception on a voluntary basis. The study showed 5 determinants influencing contraception use: responsibility, knowledge, finance, emotion and social environment. If needed, the programme played a role on all different determinants. The method of working was the key element in the success: addressing family planning and contraceptive use through an outreach practise orientated presence approach and empowerment. Another important factor for success was the collaboration between public health and medical doctors. Lessons The successful pilot became regular care for vulnerable (potential) parents in Tilburg. The pilot was replicated in two other cities, Rotterdam and Nijmegen, with similar results. In 2018-2021 the programme will be implemented nationwide with financial support of the Ministry of Health, Welfare and Sports, coordinated by GGD GHOR Nederland (the Association of GGDs (Regional Public Health Services) and GHOR-(Regional Medical Emergency Preparedness and Planning) offices in the Netherlands). Key messages ‘Pregnant not now!’ successfully supports vulnerable people with family planning and contraceptives, helping them to gain control over their future and preventing unplanned and unwanted pregnancies. The programme is unique and preventive, its innovative character is applicable in other communities in the Netherlands and possibly across Europe.

Implementing automated external defibrillators into community sports clubs/facilities: a cross-sectional survey of community club member preparedness for medical emergencies

ObjectiveThere is a growing focus on ensuring the availability of automated external defibrillators (AED) in sport settings to assist in preventing sudden cardiac death. For the AED to be most...