Emergency Protocols Research Articles

Coping with a protracted crisis: a case study of IT-Integrator in Ukraine

Learning outcomes This case study offers the following learning opportunities for students: to identify and assess how a management team can establish effective working relationships to build a cohesive team during times of severe crisis and to prepare business for the restoration period; and to find alternative ways aimed at restoring the company’s operations and suggest ways of adapting to the new, normal situation. Case overview/synopsis This case study examines the strategic decisions of IT-Integrator, a Ukrainian IT company, during the Russian invasion of Ukraine in 2022. It highlights the leadership of vice president Nadiia Omelchenko in navigating the crisis, focusing on initial chaos, the development of a business continuity plan and efforts to restore operations and ensure employee safety. Despite warnings, the outbreak of war on February 24, 2022, was unexpected, with no established emergency protocols. Companies independently decided on measures for safety and business continuity, especially those critical to infrastructure and banking. In 2021, IT-Integrator faced reluctance within its executive team regarding resource allocation for wartime scenarios. Omelchenko’s push for a comprehensive business continuity plan proved crucial. Despite the plan’s effectiveness, unpreparedness for the crisis’s scale hindered recovery efforts. During the early days of the invasion, Omelchenko managed the dual challenge of safeguarding the business and its employees amid uncertainty and workforce reduction. Each decision had significant implications, requiring a balance between immediate survival and future stability. The case of IT-Integrator underscores the importance of proactive crisis management, strategic planning and resilient leadership. Omelchenko’s experience offers valuable lessons for businesses facing similar crises, emphasizing preparedness, adaptability and a focus on both immediate and long-term recovery. Complexity academic level This case study is suitable for MBA and executive development programs. Supplementary materials Teaching notes are available for educators only. Subject code CSS 6: human resource management.

Generating Synthetic Healthcare Dialogues in Emergency Medicine Using Large Language Models.

Natural Language Processing (NLP) has shown promise in fields like radiology for converting unstructured into structured data, but acquiring suitable datasets poses several challenges, including privacy concerns. Specifically, we aim to utilize Large Language Models (LLMs) to extract medical information from dialogues between ambulance staff and patients to populate emergency protocol forms. However, we currently lack dialogues with known content that can serve as a gold standard for an evaluation. We designed a pipeline using the quantized LLM "Zephyr-7b-beta" for initial dialogue generation, followed by refinement and translation using OpenAI's GPT-4 Turbo. The MIMIC-IV database provided relevant medical data. The evaluation involved accuracy assessment via Retrieval-Augmented Generation (RAG) and sentiment analysis using multilingual models. Initial results showed a high accuracy of 94% with "Zephyr-7b-beta," slightly decreasing to 87% after refinement with GPT-4 Turbo. Sentiment analysis indicated a qualitative shift towards more positive sentiment post-refinement. These findings highlight the potential and challenges of using LLMs for generating synthetic medical dialogues, informing future NLP system development in healthcare.

Validity of lung ultrasound with bedside lung ultrasonography in emergency protocol in diagnosing pneumonia

Background: Pneumonia is an acute inflammation of the lung parenchyma caused by microorganisms. In 2020, pneumonia was included in the top 10 diseases requiring hospitalization in Indonesia with a mortality rate of 23% for patients treated in the intensive care unit. The diagnosis of pneumonia is based on anamnesis, physical examination, and supporting examinations. However, in practice, diagnostic procedures in patients with immobilization or patients with unstable hemodynamics are difficult to perform. Lung ultrasound (LUS) with bedside lung ultrasonography in emergency (BLUE) protocol is a simple and portable supporting examination that is known to be able to diagnose pneumonia more easily, accurately, and quickly. Therefore, a study related to the validity of LUS in diagnosing pneumonia needs to be conducted. Methods: This study is a diagnostic test. The study was conducted over a period of 6 months (August 2023 to February 2024) at Prof. Dr. I.G.N.G. Ngoerah hospital. In this study, the validity was assessed consisting of sensitivity, specificity, and accuracy of LUS in diagnosing pneumonia. Data were analyzed using STATA MP 17. Results: The total subjects in this study were 70 people. The sensitivity of LUS in diagnosing pneumonia was 86.8% (CI95%=74.7-94.5%) and the specificity was 70.6% (CI95%=44-89.7%), with an accuracy of 82.8%. The positive test predictive value was 90.2% (CI95%=78.6-96.7%) and the negative test predictive value was 63.2% (CI95%=38.4-83.7%). Thus, in subjects with LUS suggestive of pneumonia, pneumonia management can be done immediately. However, in subjects with LUS results not showing pneumonia, further supporting examinations are needed to confirm the diagnosis of pneumonia. Sensitivity, specificity, and accuracy varies based on age, body mass index, immunocompromised status, and degree of pneumonia Conclusions: LUS with BLUE protocol is a valid supporting examination in diagnosing pneumonia (rule in disease).

Emotional resilience and sense of danger among doctors in hospitals during periods of heightened tensions and warfare in Israel

BackgroundThe “Iron Swords” War beginning in October 2023 led to unprecedented levels of shock and trauma across Israel, significantly impacting the Israeli population and medical personnel. This study aimed to evaluate and compare the perceived personal resilience and sense of danger among physicians in hospitals located in different conflict zone proximities in Israel during this period.MethodsA quantitative, cross-sectional study was conducted from March to August 2024, during an active phase of the war, using a structured anonymous questionnaire. Participants were 161 physicians from three hospitals: one in southern Israel near the Gaza Strip, another in northern Israel near the borders with Lebanon, Syria, and Jordan, and a third in central Israel near Tel Aviv. The survey measured personal resilience using the Connor-Davidson Resilience Scale (CD-RISC-10) and sense of danger using the Solomon & Prager scale. Statistical analyses included Kruskal-Wallis H test, multiple linear regression, two-way analysis of variance (ANOVA), and Sobel test for mediation effects.ResultsThe final sample included 161 physicians (54 southern, 56 central, 51 northern). The mean resilience score was 31.14 ± 5.77, and the mean sense of danger score was 8.36 ± 4.15 (scales 0–40 and 0–20, respectively). Physicians in the southern hospital reported significantly higher sense of danger scores (p = 0.005). A trend towards lower resilience scores was noted among southern hospital physicians (p = 0.068) (p = 0.068). Two-way ANOVA revealed significant main effects of hospital location and gender on resilience (p = 0.046 and p = 0.003, respectively) and sense of danger (p = 0.005 and p = 0.062, respectively). Multiple regression analysis identified hospital location (β = -0.178, p = 0.023) and gender (β = 0.229, p = 0.004) as significant predictors of resilience. Mediation analysis indicated that personal resilience partially mediated the relationship between hospital location and sense of danger (indirect effect = 0.2896, p < 0.001).ConclusionsPhysicians working near conflict zones report higher levels of perceived danger, though their resilience is comparable to peers in less threatened regions. Enhancing personal resilience is crucial to mitigate the heightened sense of danger. This could include regular resilience training, psychological support, and specific programs for single and childless physicians to improve safety perceptions. Additionally, fostering a supportive community with clear communication and robust emergency protocols is essential for enhancing staff resilience and safety in hospitals.

UNDERSTANDING THE LEVEL OF KNOWLEDGE AMONG NURSES ABOUT FIRE SAFETY IN TERTIARY CARE HOSPITAL LAHORE

Fire safety in healthcare facilities is an important but frequently disregarded part of hospital administration and patient care. Despite substantial study on different aspects of healthcare delivery, there is still a significant gap in understanding and measuring fire safety knowledge and practices among healthcare personnel, particularly in Pakistan's tertiary care facilities. Objective: The purpose of this study was to assess the degree of fire safety knowledge among medical personnel at a tertiary care hospital in Lahore, Pakistan, to identify any shortcomings that may affect their capacity to respond effectively in the event of a fire. Methods: A cross sectional quantitative descriptive study was conducted at Public Tertiary care hospital in Lahore involving 202 nurses. A customized questionnaire was administered to assess the participant’s fire safety knowledge, selected through successive sampling. Data analysis was performed using SPSS version 22.0, categorizing knowledge level as poor, average and good. Results: 85% of survey participants were aware of fire response procedures. However, only 15% knew the fire department contact numbers, and 25% were unaware that foam or water extinguishers are ineffective against grease fires. Additionally, a significant proportion of participants struggled to correctly identify different types of fire extinguishers (65%) and fire categories (50%). The finding underscore the importance of comprehensive fire safety training to address significant knowledge gaps. Conclusions: Healthcare institutions should develop comprehensive fire safety training programs that extend beyond basic emergency protocols. Regular fire drills and simulations should be held to check staff members' understanding and reinforce fire safety procedures. Administrators should examine and update fire safety protocols on a regular basis to reflect new technology, legislation, and lessons learnt from previous events.

B-015 Analytical Verification of MR-proADM Biomarker in Human EDTA Plasma on Immunoassay Analyzer LIAISON® XL of Diasorin

Abstract Background Adrenomedullin (ADM) is a potent vasodilator peptide of 52-aminoacid belonging to the calcitonin family of peptides. Midregional pro-ADM (MR-ProADM) is a precursor for ADM that circulates is in a 1:1 ratio with it, and proportionally represents its levels and activity. Increased ADM circulating concentrations have been described for several disease states, including dysfunction of the cardiovascular system and sepsis. However, reliable ADM quantification has been hampered by the short half-life, the existence of a binding protein, and its physical properties. Hence, quantificacion of MR-proADM represents a more suitable option. The biomarker MR-proADM has been shown to be an accurate prognostic marker for outcome prediction in patients with lower respiratory infections, sepsis, urinary tract infections, and kidney disease. The objective of this study was the verification of the metrological characteristics and the verification of the linearity of quantitative measurement range, as declared by the manufacturer, of the LIAISON® Brahms MR-proADMTM on Liaison® XL (DiaSorin). Methods The verification was performed with two levels of quality controls (QC) from the manufacturer (x̄L=1,19 nmol/L and x̄H=5,48 nmol/L), and residual EDTA plasma samples from patients with an active sepsis code. The evaluation included the assessment of: • Detection capability (including limit of quantification (LoQ) and limit of detection (LoD), measuring three samples at the manufacturer's stated concentration (0.21 nmol/L and 0.09 nmol/L, respectively) in duplicate within 4 runs). • Precision (CV, %) and accuracy (bias, %) within, measuring 10 replicates of each QC level; and between run, measuring 5 replicates for each QC level within 5 runs. • Linearity of the quantitative range of measurement (six intermediate samples prepared by mixing a high concentration sample- XH=9.64 nmol/L- and a low concentration sample, XL=0.59 nmol/L; measured in triplicate). All studies were performed in accordance with the recommendations of the Clinical Laboratory Standards Institute guidelines. Statistical analysis was performed using Microsoft Excel®, 2016. Results All results with diluted samples presented a signal (RLU) higher than that detected in samples without analyte, so the LoD was verified. The precision at the LoQ concentration was 26.7% (acceptance criteria was set as &amp;lt;20%). CV for within-run precision were 4.3% and 2.0% and for between-run precision 6.8% and 7.9% for low (L1) and high (L2) control level, respectively. The average bias was 3.60% for L1 and 4.23% for L2, meeting acceptance criteria (&amp;lt;8%). Linearity was confirmed between 0.59 and 9.64 nmol/L (R2 = 0.995). The biases between the expected and the obtained value were ≤7% through the quantitative range of measurement, except for the lowest concentration sample (close to the quantitation limit). Conclusions Our study showed good compliance with the metrological characteristics declared by the manufacturer for LoD, precision, bias and linearity range. Although the LoQ was not verified, it is outside the clinical decision value in septic patients (&amp;lt; 2.25 nmol/L) and it is not deemed a limitation for clinical practice. Additionally, the Liaison XL® platform permits us to configure an emergency protocol circuit (24/7) with a TAT of 35 min.

Acute respiratory compromise in the NICU

Acute respiratory compromise (ARC) is a significant and frequent emergency in the Neonatal Intensive Care Unit (NICU), characterized by absent, agonal, or inadequate respiration that necessitates an immediate response. The primary etiologies of ARC in neonates can be categorized into upper and lower airway issues, disordered control of breathing, and lung tissue disease. ARC events are particularly dangerous as they compromise oxygen delivery and carbon dioxide removal, potentially leading to cardiopulmonary arrest. Approximately 1 % of NICU admissions experience cardiopulmonary arrest, and ARC is the primary cause of most events. This article provides a comprehensive review of the etiologies of ARC, including anatomical abnormalities, syndromic disorders, airway obstruction, and pulmonary diseases such as bronchopulmonary dysplasia and pneumonia. Management strategies include the use of continuous positive airway pressure, positive pressure ventilation, and advanced interventions like extracorporeal membrane oxygenation (ECMO) in cases of severe respiratory distress. Additionally, quality improvement initiatives aimed at reducing incidents such as unplanned extubations (UE) are discussed, along with emergency responses to ARC, which often require multidisciplinary collaboration and advanced airway management. The article emphasizes the importance of preparedness, training, and structured emergency protocols to ARC in the NICU to optimize patient care.

Standardized emergency protocols to improve the management of patients with suspected or confirmed inherited metabolic disorders (IMDs): An initiative of the French IMDs Healthcare Network for Rare Diseases

ObjectivesPatients with inherited metabolic disorders (IMDs) may require emergency hospital care to prevent life-threatening situations such as metabolic decompensation. To date, over one thousand different rare IMDs have been identified, which means that healthcare professionals (HCPs) initiating emergency treatment may not be familiar with these conditions. The objective of this initiative was to provide HCPs with practical guidance for the acute management of children and adults with IMDs who need emergency care, regardless of the underlying reason. MethodsWe outline how a multidisciplinary working group from the French IMDs Healthcare Network for Rare Diseases, known as G2M, has created concise and standardized protocols _each consisting of a single double-sided A4 sheet _ focused on a specific disease, a group of diseases, or a particular symptom. Prior to validation, these protocols were reviewed by all French reference and competence centres for IMDs, as well as by medical experts from other specialities when necessary, physicians from emergency and intensive care units, and representatives from patient associations. Results and conclusionIn total, 51 emergency protocols containing essential information have been developed and provided to affected patients. All the emergency protocols are freely available in both French and English at https://www.filiere-g2m.fr/urgences. These standardized protocols aim to enhance the emergency care of patients without delay, while also assisting HCPs by increasing their confidence and efficiency, minimizing the risk of dosage errors when administering specialized treatments, saving time, and reducing the number of phone calls to metabolic medicine specialists on night duty. The protocols are scheduled for annual review to facilitate further improvements based on feedback from HCPs and patients, as well as to accommodate any changes in management practices as they evolve.

Academy of Breastfeeding Medicine Position Statement: Breastfeeding in Emergencies.

Background: During emergencies, including natural disasters and armed conflict, breastfeeding is critically important. Breastfeeding provides reliable nutrition and protection against infectious diseases, without the need for clean water, feeding implements, electricity, or external supplies. Key Information: Protection, promotion, and support of breastfeeding should be an integral part of all emergency preparedness plans. Breastfeeding specialists should be part of plan development. Emergency protocols should include breastfeeding specialists among emergency relief personnel, provide culturally sensitive environments for breastfeeding, and prioritize caregivers of infants in food/water distribution. Emergency relief personnel should be aware that dehydration and missed feedings can impact milk production, but stress alone does not. Emergency support should focus on keeping mothers and infants together and providing private and/or protected spaces for mothers to breastfeed or express milk. Emergency support should also focus on rapidly identifying mothers with breastfeeding difficulties and breastfeeding mothers and infants who are separated, so their needs can be prioritized. Breastfeeding support should be available to all women experiencing difficulties, including those needing reassurance. Nonbreastfed infants should be identified as a priority group requiring support. Relactation, wet-nursing, and donor milk should be considered for nonbreastfed infants. No donations of commercial milk formula (CMF), feeding bottles or teats, or breast pumps should be accepted in emergencies. The distribution of CMF must be highly controlled, provided only when infants cannot be breastfed and accompanied by a comprehensive package of support. Recommendations: Protecting, promoting, and supporting breastfeeding should be included in all emergency preparedness planning and in training of personnel.

Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture: A case report

BACKGROUND Superior mesenteric artery (SMA) injuries rarely occur during blunt abdominal injuries, with an incidence of &lt; 1%. The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation, which progress rapidly and are easily misdiagnosed. Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases. This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture. CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture. On admission, he showed extremely unstable vital signs and was unconscious with a laceration on his head, heart rate of 143 beats/min, shallow and fast breathing (frequency &gt; 35 beats/min), and blood pressure as low as 20/10 mmHg (1 mmHg = 0.133 kPa). Computed tomography revealed abdominal and pelvic hematocele effusion, suggesting active bleeding. The patient was suspected of partial rupture of the distal SMA branch. The patient underwent emergency mesenteric artery ligation, scalp suture, and liver laceration closure. In view of conditions with acute onset, rapid progression, and high bleeding volume, key points of nursing were conducted, including activating emergency protocol, opening of the green channel, and arranging relevant examinations with various medical staff for quick diagnosis. The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time. Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability. Strict measures were taken to avoid intraoperative hypothermia and infection. CONCLUSION After 3.5 h of emergency rescue and medical care, bleeding was successfully controlled, and the patient’s condition was stabilized. Subsequently, the patient was transferred to the intensive care unit for continuous monitoring and treatment. On the sixth day, the patient was weaned off the ventilator, extubated, and relocated to a specialized ward. Through diligent medical intervention and attentive nursing, the patient made a full recovery and was discharged on day 22. The follow-up visit confirmed the patient’s successful recovery.

Selective Adsorption of Sr(II) from Aqueous Solution by Na3FePO4CO3: Experimental and DFT Studies.

The efficient segregation of radioactive nuclides from low-level radioactive liquid waste (LLRW) is paramount for nuclear emergency protocols and waste minimization. Here, we synthesized Na3FePO4CO3 (NFPC) via a one-pot hydrothermal method and applied it for the first time to the selective separation of Sr2+ from simulated LLRW. Static adsorption experimental results indicated that the distribution coefficient Kd remained above 5000 mL·g-1, even when the concentration of interfering ions was more than 40 times that of Sr2+. Furthermore, the removal efficiency of Sr2+ showed no significant change within the pH range of 4 to 9. The adsorption of Sr2+ fitted the pseudo-second-order kinetic model and the Langmuir isotherm model, with an equilibrium time of 36 min and a maximum adsorption capacity of 99.6 mg·g-1. Notably, the adsorption capacity was observed to increment marginally with an elevation in temperature. Characterization analyses and density functional theory (DFT) calculations elucidated the adsorption mechanism, demonstrating that Sr2+ initially engaged in an ion exchange reaction with Na+. Subsequently, Sr2+ coordinated with four oxygen atoms on the NFPC (100) facet, establishing a robust Sr-O bond via orbital hybridization.

Evacuation of a Paediatric Hospital Ward in Italy: Lessons Learnt From an Announced Evacuation Drill

The process of evacuating a hospital ward is a complex task that involves several challenges related to emergency protocols, such as the need for assisted evacuation, the staff/patient ratio, and the functional limitations of patients. The purpose of this work is to present a possible sequence of events that can take place during an evacuation drill in a paediatric hospital ward. This is deemed to provide guidance in performing such type of drills and investigate assisted evacuation timelines. The drill was conducted inside a paediatric ward in Italy, at that time closed for maintenance, with the help of figurants emulating paediatric patients. The medical personnel were the ones normally working inside the facility. The activity was video recorded and summarised in a written report. This allowed the analysis of the drill and the reconstruction of typical set of events and timelines that take place in such type of evacuation drill scenarios.

Code Stroke Alert: Focus on Emergency Department Time Targets and Impact on Door-to-Needle Time across Day and Night Shifts.

To minimize stroke-related deaths and maximize the likelihood of cerebral reperfusion, medical professionals developed the "code stroke" emergency protocol, which allows for the prompt evaluation of patients with acute ischemic stroke symptoms in pre-hospital care and the emergency department (ED). This research will outline our experience in implementing the stroke code protocol for acute ischemic stroke patients and its impact on door-to-needle time (DTN) in the ED. Our study included patients with a "code stroke alert" upon arrival at the emergency department. The final sample of this study consisted of 258 patients eligible for intravenous (IV) thrombolysis with an onset-to-door time < 4.5 h. ED admissions were categorized into two distinct groups: "day shift" (from 8 a.m. to 8 p.m.) (n = 178) and "night shift" (from 8 p.m. to 8 a.m.) (n = 80) groups. An analysis of ED time targets showed an increased median during the day shift for onset-to-ED door time of 310 min (IQR, 190-340 min), for door-to-physician (emergency medicine doctor) time of 5 min (IQR, 3-9 min), for door-to-physician (emergency medicine doctor) time of 5 min (IQR, 3-9 min), and for door-to-physician (neurologist) time of 7 min (IQR, 5-10 min), also during the day shift. During the night shift, an increased median was found for door-to-CT time of 21 min (IQR, 16.75-23 min), for door-to-CT results of 40 min (IQR, 38-43 min), and for door-to-needle time of 57.5 min (IQR, 46.25-60 min). Astonishingly, only 17.83% (n = 46) of these patients received intravenous thrombolysis, and the proportion of patients with thrombolysis was significantly higher during the night shift (p = 0.044). A logistic regression analysis considering the door-to-needle time (minutes) as the dependent variable demonstrated that onset-to-ED time (p < 0.001) and door-to-physician (emergency medicine physicians) time (p = 0.021) are predictors for performing thrombolysis in our study. This study identified higher door-to-CT and door-to-emergency medicine physician times associated with an increased DTN, highlighting further opportunities to improve acute stroke care in the emergency department. Further, door-to-CT and door-to-CT results showed statistically significant increases during the night shift.

Computational insights into survival durations and prehospital interventions in accidental cold-water immersion: A comprehensive analysis of fresh and saltwater temperatures

This study examines the complex relationship between scenarios of cold-water immersion, survival durations, and prehospital interventions. It utilizes computational modeling methods to shed light on how different water temperatures affect individuals facing accidental cold-water immersion incidents. The analysis reveals significant variations in survival times based on water temperature. For example, subjects immersed in water at temperatures of 5 °C, 2 °C, and 0 °C had average survival times of 136, 113, and 100 min, respectively, under stable conditions. In flowing water at the same temperatures, survival times decreased to 119, 92, and 81 min, indicating the impact of water movement on cooling rates and survival durations. Likewise, individuals immersed in saltwater at temperatures of 5 °C, 2 °C, 0 °C, and −2 °C showed average survival times of 111, 88, 80, and 66 min, respectively, in static conditions. In flowing saltwater at the same temperatures, survival times decreased to 98, 74, 68, and 57 min, highlighting the influence of water flow on cooling rates and survival durations. A comparison between immersion in pure water and saltwater at 2 °C revealed survival times of 113 and 88 min under stable conditions and 92 and 74 min under dynamic conditions, emphasizing the role of water composition in survival outcomes. The study also challenges the notion that the demise of the Titanic's passengers and crew resulted from hypothermia, asserting instead that severe thermal shock was the primary cause. These numerical findings underscore the importance of considering water temperature, flow dynamics, and prompt medical responses in cold-water emergencies to enhance survival prospects. The study identifies water within the range of 41–43 °C as the most effective active external rewarming fluid for critical hypothermal conditions. By quantifying the impact of these variables on survival times, the study provides data-driven recommendations to improve emergency protocols and outcomes for individuals facing cold-water immersion incidents.

Effectiveness of Lung Ultrasound for Diagnosis of Acute Respiratory Distress Syndrome in Mechanically Ventilated Patients

Background: Acute respiratory distress syndrome (ARDS) requires rapid diagnosis for early intervention and improved outcomes. Lung ultrasound may be a reasonable alternative to chest X-ray for the identification of ARDS but the effectiveness of lung ultrasound in ARDS diagnosis is still uncertain. The objective of the study is to explore the efficacy of lung ultrasound (LUS) for diagnosis of ARDS in mechanically ventilated patients. Methods: A cross sectional study was conducted among 75 patients in Critical Care Centre, Combined Military Hospital, Dhaka from September 2021 to January 2022. The study was approved by the ethical committee in the hospital. In this study, the Bedside Lung Ultrasound in Emergency (BLUE) protocol for the immediate diagnosis of acute respiratory failure was followed. Purposive sampling technique was used. Data were analyzed by using Statistical Package For Social Sciences (SPSS) version 25.0. Results: A total of 75 patients were assessed. Among them male were 42(56%) and female 33(44%). The median age of patients was 48 years (Interquartile range 30-60). Primary diagnoses were pneumonia (22.67%), pulmonary oedema (20%), sepsis (20%) and trauma (17.33%). A total of 34(45.33%) patients fulfilled ‘CXR-based Berlin Definition’ and a total of 36(48%) patients were diagnosed as ARDS by ‘LUS-based Berlin Definition’. Considering the ‘CXR-based Berlin Definition’ as reference standard, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of lung ultrasound were 85.29%, 82.92%, 80.55%, 87.18% and 84% respectively. Conclusion: Lung ultrasound can be an effective tool for the diagnosis &amp; management of ARDS in the intensive care unit. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 51-57

캠핑활동의 지각된 위험과 참여동기가 태도와 행동의도에 미치는 영향

Purpose - The camping market in China has demonstrated consistent growth in recent years, with a continued expansion observed. Particularly, following the COVID-19 pandemic, heightened concern for safety during leisure activities has become prevalent among individuals. This study aimed to ascertain the motivational factors driving Chinese individuals to engage in camping activities, and assess the influence of perceived risk on camper attitudes and behavioral intentions. Design/Methodology/Approach - Data analysis encompassed a sample of 258 sets collected from campers that visited three campsites situated in Qinhuangdao, China. Findings - The findings revealed that all perceived risk factors associated with camping activities significantly impacted individual attitudes. Furthermore, among the motivating factors for participation, aspects such as affinity for nature and escapism from daily routines were identified as influential in attitudes toward camping activities. The study confirmed a substantial relationship between the attitude toward camping activities and behavioral intentions. Research Implications - The outcomes underscore the necessity for camping operators to furnish campers with strategies to manage risks and educational initiatives encompassing safe camping practices and emergency protocols. Consequently, this study offers insights into the future trajectory of the camping industry, emphasizing the imperative of amalgamating safety measures with a rich natural experience.

Frequency and features of medical emergencies at a teaching dental hospital in Saudi Arabia: a 14-year retrospective observational study

BackgroundThis study aimed to determine the nature, frequency, and characteristics of medical emergencies occurring at the King Abdulaziz University Dental Hospital.Materials and methodsThe incident reports of medical emergencies recorded at the King Abdulaziz University Dental Hospital from January 2008 to December 2022 were retrospectively reviewed. The annual/overall incidence of medical emergency events was calculated per 100,000 patients. The following characteristics of the patients/events were evaluated: age, gender, operator, procedure, location, timing of treatment, administration of local anesthesia, past medical history, symptoms, diagnosis, outcome, and disposition. Multivariable logistic regression models were used to investigate the associations of these characteristics with two outcomes: syncope and transfer to the emergency room (ER).ResultsThe incidence of emergency events was 17.4 per 100,000 patients. Syncope and hypoglycemia were the most common emergencies. Most incidents recovered, with only 13% requiring transfer to the ER. Undergoing no procedure and American Society of Anesthesiologists (ASA) class 2,3 were associated with syncope. Undergoing a general dental procedure, ASA class 2,3, and a diagnosis other than hypoglycemia and syncope were associated with transfer to the ER.ConclusionsThe incidence of medical emergencies was low. Dental practitioners need to remain aware of the contributing factors, such as past medical history and anxiety, but medical emergencies can occur in healthy individuals as well. Preparation of the dental office, training of the personnel, and proper recording of the events are essential components of a well-established medical emergency protocol in dental institutions.

Digital communication tools in family therapy: A review of opportunities and challenges for English-Speaking practitioners

Digital communication tools have revolutionized the field of family therapy, offering both opportunities and challenges for English-speaking practitioners. With the proliferation of technology, therapists have access to a wide array of platforms and applications that can enhance therapeutic interventions. However, integrating these tools into practice requires careful consideration of ethical, legal, and clinical implications. Digital communication tools offer numerous advantages for family therapy practitioners. Teletherapy platforms enable therapists to reach clients in remote locations or those with mobility constraints, expanding access to care. Video conferencing allows for face-to-face interactions, facilitating rapport building and nonverbal communication cues essential for effective therapy. Additionally, digital tools such as secure messaging apps or virtual whiteboards enhance communication between sessions, fostering continuity of care and homework completion. Online support groups and forums provide clients with opportunities for peer support and community engagement, supplementing traditional therapy approaches. Despite their benefits, digital communication tools pose significant challenges for English-speaking practitioners. Ensuring confidentiality and data security is paramount, requiring adherence to stringent privacy regulations such as HIPAA (Health Insurance Portability and Accountability Act). Therapists must navigate issues of informed consent, boundary maintenance, and emergency protocols in the digital realm. Moreover, technological barriers, such as internet connectivity issues or lack of digital literacy among clients, can hinder the effectiveness of therapy sessions. Cultural considerations also play a role, as language barriers or cultural differences in technology use may impact therapeutic engagement. Digital communication tools offer English-speaking family therapy practitioners unprecedented opportunities to enhance therapeutic interventions. However, these tools come with inherent challenges that must be addressed to ensure ethical and effective practice. By carefully navigating the opportunities and challenges presented by digital communication tools, therapists can harness the power of technology to improve client outcomes and advance the field of family therapy.

Emergency Preparedness for Guests with Mobility Impairments and Frequency of Visits in Five-Star Hotels in Nairobi City County, Kenya

The purpose of this study was therefore to establish the influence of emergency preparedness on the frequency of visits to five-star hotels in Nairobi City County, Kenya. The specific goals of this research were: to record the types of hazards encountered by five-star hotels in Nairobi City County; to identify the areas of those hotels where emergencies occur; to learn about the barriers to emergency response services for guests with mobility impairments in those hotels; and to identify the factors in emergency response systems that significantly influence visit by guests with mobility impairments. The study was informed by two theories; the theory of time constraints on leisure activities and the theory of social oppression. Ten five-star hotels in Nairobi County served as the sample for this census-style investigation. The sample size was determined by a systematic sampling procedure. The data was gathered through the use of semi-structured questionnaires that were administered by the researcher. Data was coded and analyzed in SPSS using both descriptive and inferential statistical methods. Relationships between the independent variable and the dependent variables were determined using multiple regressions. Tables, charts, and bars were used to show the study's findings. The findings showed that the majority of the five-star hotels had not frequently encountered several types of emergencies. The study found that employee training for emergency preparedness was positively and significantly related to the frequency of visits by guests with mobility impairments to five-star hotels in Nairobi City County, Kenya at (β=0.595, p˂.001). The study concludes that while most sections of these five-star hotels, like kitchens and swimming pools, are perceived as safe zones with minimal emergencies, the parking area emerges as a potential concern. The hotels' commitment to staff training in emergency preparedness is evident, especially in hazard identification and spill response. The study thus recommends that the management of five-star hotels in Nairobi City County should conduct thorough risk assessments, considering both high and low-frequency hazards. Emergency protocols should also be in place not only for situations like terrorist threats but also for seemingly less immediate threats like floods and utility failures. Keywords: Emergency preparedness, Risk assessment, Five-Star Hotels, Mobility impairments, Nairobi City County

The “we” factor in improvisational statecraft: frontline repair of the state in Indonesia’s crisis response amidst resource constraints

Street-level bureaucrats, confined by meager discretion, often find themselves reconciling the challenging terrain of inflexible policies with messy frontline realities. With a phenomenological lens, we examine how Indonesia’s frontline healthcare workers exercise discretion and improvise informal practices to adapt policies and deliver care despite scarce resources during the COVID-19 crisis. As formal emergency protocols lie encumbered under conditions of austerity, a grassroots motivation for communal action occurs from exchanges between peers mired in resource quandaries, encapsulating an improvisational “we” cohering frontline allies. Manifesting through focused responses drawing on unwritten collegial knowledge, these collaborative efforts embody the relational essence and defining contours of frontline policy repair, as opposed to isolated discretion. Probing further into these repair processes surfaces how shared struggles have the power to ignite collective capacity, empowering bureaucrats to govern complexity in concert, construct agency despite constraints, and promote equity in times of scarcity. Our findings champion tending to institutional receptivity and solidarity-anchored creative frontline initiatives, endorsing agile, adaptive processes finely tuned to situational realities that contests paradigms fixated solely on compliance.