Emergency Response Team Research Articles

Evaluation of the Domino Effect Caused by Pool Fires in a Tank Farm

Major hazard installations (MHIs), such as oil refineries, petrochemical plants, and terminals, use large-capacity storage tanks for storing crude oil and by-products. Pool fire is one of the most common types of storage tank fire incidents. This technical article aims to investigate the domino effect resulting from a pool fire in a tank farm consisting of eight large floating-roof storage tanks, with a focus on four specific tanks. A crude oil storage tank was selected as the primary tank (source tank). Point source and plume solid models were used to estimate the thermal radiation. It has been noted that the thermal radiation from the source tank to the adjacent tank in the same dike exceeds the threshold heat radiation level and might result in a domino effect; however, the thermal radiation from the source tank alone does not reach the threshold level for the tanks in the other dike. Additionally, it was found that the thermal radiation from both the primary and secondary tanks just reaches the threshold level for the farther-away tank in the other dike. The domino effect occurs provided that the firefighting system is not activated and the emergency response team does not intervene within ten minutes.

A Pilot Randomized Controlled Study to Determine the Effect of Real-Time Videos With Smart Glass on the Performance of the Cardiopulmonary Resuscitation.

The aim of this study was to determine the effect of real-time videos with smart glasses on the performance of cardiopulmonary resuscitation performed by nursing students. In this randomized controlled pilot study, the students were randomly assigned to the smart glass group (n = 12) or control group (n = 8). Each student's cardiopulmonary resuscitation performance was evaluated by determining sequential steps in the American Heart Association algorithm they applied and the accuracy and time of each step. A higher number of participants correctly checked response breathing, requested a defibrillator, activated the emergency response team, and provided appropriate chest compressions and breaths in the smart glass group than the control group. There were significant differences between groups. Furthermore, more participants significantly corrected chest compression rate and depth and hand location, used a defibrillator, and sustained cardiopulmonary resuscitation until the emergency response team arrived in the smart glass group than in the control group. Additionally, a significantly shorter time was observed in the smart glass group than in the control group in all variables except time to activate the emergency response team (P < .05). Remote expert assistance with smart glass technology during cardiopulmonary resuscitation is promising. Smart glass led to a significantly better ABC (airway, breathing, circulation) approach, chest compression depth and rate, and hand position. Furthermore, remote expert assistance with smart glass has the potential to improve overall resuscitation performance because it enabled students to initiate resuscitation, use a defibrillator, and defibrillate patients earlier. Nurses may benefit from smart glass technology in real life to provide effective cardiopulmonary resuscitation.

The role of discretion and street‐level deliberative practices in the COVID‐19 crisis response: Lessons from the Philippines

AbstractThis study investigates the role of frontline workers, such as the Barangay Health Emergency Response Teams (BHERTs) in the Philippines, as street‐level bureaucrats (SLBs) in implementing COVID‐19 community quarantine policies. Drawing from SLB theory and deliberative policy analysis (DPA), I explore how SLBs adapted to rapidly changing conditions by exercising discretion in interpreting and adapting the implementation of nationally formulated pandemic management policies to meet local realities. I argue that SLBs functioned as deliberative practitioners, mediating between national policies and local realities while engaging in deliberative practices with their clients. Using the experience of BHERTs in Palompon, Leyte in the Philippines as an illustrative case, I identified the policy mandates (policy‐as‐written) of the BHERTs; the challenges and constraints they faced in implementing community quarantine policies; and the discretion they exercised in implementing community quarantine policies (policy‐as‐practiced). The findings reveal that, to meet their policy mandates and address the challenges they faced, they engaged in deliberative practices and collaborated with citizens in implementing context‐specific and creative strategies. Insights from this study highlight the adaptive and deliberative potential of SLBs in crisis situations and the value of a DPA in understanding SLB theory and research. By examining SLBs’ experiences during the pandemic, this study contributes to the SLB literature and offers practical lessons to policy practitioners in facilitating deliberation and developing context‐specific solutions in times of crisis.Points for practitioners The COVID‐19 pandemic and the subsequent government response in the Philippines have increased the challenges faced by street‐level bureaucrats (SLBs), including resource scarcity, organisational and political pressure, public resistance, and the risk of exposure to the virus. SLBs have shown their capacity to apply discretion and collaborate with their clients to resolve their own and the client's challenges and limitations through negotiation, mediation, conflict management, and active listening. This cooperative approach empowers them to resolve common issues and together formulate effective strategies that are beneficial to all parties involved. Relationships outside of SLBs’ duties as state agents (i.e. socio‐cultural relationships) can be a viable pathway for SLBs to implement alternative policy strategies to meet their policy mandates and address the challenges they face as they implement their mandates. Competing value systems, knowledge claims, and emotional narratives, compounded by a governance crisis, define the complex and informal nature of the policy process in the context of a crisis like the pandemic. Although SLBs demonstrate their capacity to creatively solve the challenges they encounter through deliberative practices, this should not serve as a justification for the government's lack of action in prioritising, safeguarding, and preserving their welfare.

Predictors of emergency medical transport refusal following opioid overdose in Washington, DC.

Patient initiated transport refusal during Emergency Medical Service (EMS) opioid overdose encounters has become an endemic problem. This study aimed to quantify circumstantial and environmental factors which predict refusal of further care. In this cross-sectional analysis, a case definition for opioid overdose was applied retrospectively to EMS encounters. Selected cases had sociodemographic and situational/incident variables extracted using patient information and free text searches of case narratives. 50 unique binary variables were used to build a logistic model. Prehospital EMS overdose encounters in Washington, DC, USA, from July 2017 to July 2023. Of EMS encounters in the study timeframe, 14 587 cases were selected as opioid overdoses. Predicted probability for covariates was the outcome variable. Model performance was assessed using Stratified K-Fold Cross-Validation and scored with positive predictive value, sensitivity and F1. Prediction accuracy and McFadden's pseudo-R squared are also determined. The model achieved a predictive accuracy of 78% with a high positive predictive value (0.83) and moderate sensitivity (0.68). Bystander type influenced the refusal outcome, with decreased refusal probability associated with family (nondescript) (-28%) and parents (-16%), while presence of a girlfriend increased it (+28%). Negative situational factors like noted physical trauma (-62%), poor weather (-14%) and lack of housing (-14%) decreased refusal probability. Characteristics of the emergency response team, like a prior crew member encounter (+20%) or crew experience <1year (-36%), had a variable association with transport. Refusal of emergency transport for opioid overdose cases in Washington, DC, USA, has expanded by 43.8% since 2017. Several social, environmental and systematic factors can predict this refusal. Logistic regression models can be used to quantify broad categories of behavior in surveillance medical research.

Air Rescue Missions for Suicide: A Retrospective Analysis of a 12-Year Period From a German Rescue Helicopter Base

ObjectiveTypical reasons for calling the rescue helicopter are medical emergencies, such as heart disease, trauma, and neurologic emergencies. However, there are also a small number of patients with attempted or completed suicide. The aim of this article was a general analysis and evaluation of the specific circumstances of emergencies related to suicide or attempted suicide in the prehospital environment involving the rescue helicopter (helicopter emergency medical services) Christoph 38 of the DRF Stiftung Luftrettung gAG based in Dresden, Germany. MethodsThe data of all emergency interventions performed by the helicopter emergency medical services in Dresden, Germany, between January 1, 2008, and December 31, 2020, were analyzed by examining the DIVI rescue protocols and electronic data (MEDAT and HEMSDER (Convexis, Germany)) with regard to suicide-related variables. The time, methods and information about the reason, sociodemographic data, and results of medical treatment were recorded and retrospectively analyzed. ResultsThere were a total of 17,754 emergencies during the study period. Of these, 277 cases (1.56%) were due to suicide. The average time for the emergency services to arrive at the scene of the emergency was 11.14 minutes. There were 52 patients with a completed suicide, 183 with a suicide attempt, and 42 patients with a suicide threat. Eleven were pronounced dead before or at the time of arrival of the emergency doctor. Of the 241 patients who were still alive when the emergency physician arrived, 101 were endotracheally intubated and mechanically ventilated, and 25 patients received cardiopulmonary resuscitation. In 19.57% of the patients, health problems were noted as the primary reason for attempted/completed suicide. In a further 12.68%, partnership problems or the loss of a partner were cited. The most common method used was an overdose (49.39%) followed by leaping from a great height (20%) and hanging (15.51%). Stab wounds and gunshot wounds were observed in 24% of the cases. The overall mortality rate was 18.77%. The method used, sex, and a suicide note were identified as possible influencing factors for the fatal outcome of a suicide. ConclusionThe number of suicide victims is low compared with the total number of 17,754 deployments. However, the mortality rate for these missions is quite high at 18%. Although some factors and circumstances could be identified in this study, many backgrounds and explanations are still missing. Therefore, this study shows a general need for more research in regard to better prevention as well as improved education and training of emergency response teams.

Development of Model and Graphical User Interface for Leak Localization in Crude Oil Pipeline

Pipelines provide the most efficient and cost-effective means for fluid transport but the challenge posed by leaks has substantially increased the risks and hazards in pipeline fluid transportation. The development of efficient leak detection system pays off in quicker leak detection and localization, leading to quicker responses and remediation works by the pipeline emergency response team. This would ultimately bring about less severity of the pipeline leak in terms of financial losses, human and environmental consequences. Steady state modeling of crude oil pipeline flow with attempt to determine and localize leak has been achieved in this study. Mathematical models have been developed to detect and localize leaks in crude oil pipeline during leak occurrence. Leak detection was modeled using the conservation of mass equation while leak localization was modeled by modifying the Darcy-Weisbach pipeline liquid flow equations and utilizing the Swamee-Jain friction factor correlation. Equations for flowrate and pressure drop along the pipeline were developed for two cases: a case where there is no leak in the pipeline and a case where there is leak in the pipeline. Leak localization equation was determined by equating the fluid flow equation when there is no leak and when there is leak. The model was structured and simulated in Matlab software with the model tested for four field cases. The results from the simulation revealed swift leak detection, accurate localization of the leak, and determination of the pressure at the point of leak. Experimentally determined results from actual field measurements of leak incidences were used to validate the results. The result determined from the model developed proved accurate with only an average error of 0.216 miles.

Heart Rate Variability Monitoring in Special Emergency Response Team Anaerobic-Based Tasks and Training

The Law enforcement profession is known to impart high stress. Members of Special Weapons and Tactics (SWAT) teams are allocated particularly demanding law enforcement operations and may therefore attain high fitness levels but may accumulate excessive stress. Heart rate variability (HRV), an assessment of time differences between heartbeats, likely indicates holistic load in field settings. To date, though, little research measuring HRV has been conducted involving SWAT units. The purpose of this study was to explore HRV measurements following (1) annual firearms qualification and (2) potential stress exposure with respect to completion time on an anaerobically taxing obstacle course. Officers with greater obstacle course performance were hypothesized to also exhibit greater HRV. HRV was also expected to stratify personnel more effectively than heart rate. Prospective 3-lead ECGs were obtained from a cohort of male SWAT operators (n = 15) with 5.2 ± 4.3 years of experience at three time points throughout one training day. HRV was assessed by time, frequency, and non-linear domains. Differences between baseline and post-training values were significant as assessed by the Wilcoxon signed-ranks test for heart rate, SDRR, LF, HF, and SD2. An enter-method linear regression model predicted post-training HF HRV by obstacle course time; r2 = 0.617, F (1,6) = 9.652, p = 0.021. Anaerobic performance may be highly valuable in SWAT units. HRV analysis may also be beneficial in measuring the psychophysiological impact of SWAT activities.

Effects of field activities by age of 119 emergency response team on the blood pressure, pulse, respiration, and quality of cardiopulmonary resuscitation

This study analyzed the physical changes according to age and the quality of cardiopulmonary resuscitation through experiments by 119 EMT in transporting equipment at the first aid site and performing post-cardiopulmonary resuscitation. In all ages, cardiopulmonary resuscitation was performed without physical load and CPR was performed after moving the equipment, first, the pulse was significantly increased, and the average pulse was measured higher than in other higher age groups under the age of 30. Second, respiratory changes were significantly increased, and average breathing was measured higher than in other higher age groups when CPR was performed after wearing personal protective equipment and moving the equipment. Third, as for changes in blood pressure, all blood pressure rose, and the average blood pressure in the 40s and older was measured higher than that of the younger age. Fourth, in the quality change of cardiopulmonary resuscitation, the pressure rate was found to have a statistically significant difference in those under 30, 30 to 34, and 35 to 39 years of age, and it was measured that the speed was maintained without change in those over 40. Finally, there was a statistically significant difference in pressure depth between those under 30 and those under 35-39 years old, and the average depth was measured deeper than other higher age groups, so it is necessary to develop differentiated education and training methods at those under 30 years of relatively little experience.

Influential criteria in domino accident analysis: An evaluation using the logarithm methodology of additive weights

Domino incidents in process industries entail cascading failures, demanding thorough analysis to uncover root causes and enhance safety measures. Standard criteria are crucial for systematically evaluating incident investigation techniques, ensuring informed decision-making and consistency. Multi-Criteria Decision Making (MCDM) methods offer a structured approach to technique selection. This study addresses the need for systematic evaluation and prioritization of criteria influencing domino accident analysis technique selection. Through a comprehensive literature review, 16 main criteria and 42 sub-criteria were identified and weighted using the Logarithm Methodology of Additive Weights (LMAW) method, incorporating expert opinions. Results indicate the significance of criteria like applicability, accuracy, and comprehensiveness. Conversely, criteria such as relevance, cost-effectiveness, and emergency response team consideration had lower weights but remained significant. Findings regarding sub-criteria highlight the importance of consistent application of investigation methods and understanding sequential incident progression. This study advances domino accident investigation practices, promoting safety in process industries.

A collaborative cybersecurity framework for higher education

Purpose The purpose of this paper is to present the educational computer emergency response team (EduCERT) framework, an integrated response mechanism to bolster national cybersecurity through collaborative efforts in the higher education sector. The EduCERT framework addresses this gap by enhancing cyber security and mitigating cybercrime through collaborative incident management, knowledge sharing and university awareness campaigns. Design/methodology/approach The authors propose an EduCERT framework following the design science methodology. The framework is developed based on literature and input from focus group experts. Moreover, it is grounded in the principles of the technology-organization-environment framework, organizational learning and diffusion of innovations theory. Findings The EduCERT has eight components: infrastructure, governance, knowledge development, awareness, incident management, evaluation and continuous improvement. The framework reinforces national cybersecurity through cooperation between universities and the National Computer Emergency Response Team. The framework has been implemented in Jordan to generate a cybersecurity foundation for higher education. Evaluating the EduCERT framework’s influence on national cybersecurity highlights the importance of adopting comprehensive cyber-security policies and controls. The framework application shows its relevance, effectiveness, adaptability and alignment with best practices. Research limitations/implications Despite the impact of applying the framework in the Jordanian context, it is essential to acknowledge that the proposed EduCERT framework’s practical implementation may encounter challenges specific to diverse international educational environment sectors. However, framework customization for global applicability could address varied educational institutions in other countries. Practical implications Furthermore, the proposed EduCERT framework is designed with universal applicability that extends beyond the specific country’s context. The principles and components presented in the framework can serve as valuable design advice for establishing collaborative and resilient cybersecurity frameworks in educational settings worldwide. Therefore, the research enhances the proposed framework’s practical utility and positions it as an invaluable contribution to the broader discourse on global cybersecurity in academia. Originality/value This paper enhances national cybersecurity in the higher education sector, addressing the need for a more integrated response mechanism. The EduCERT framework demonstrates its effectiveness, adaptability and alignment with best practices, offering valuable guidance for global educational institutions.

How practical is tactical? Political sociology, militarization, and police tactical teams in Canada

Emergency Response Teams (ERT), commonly referred to as Special Weapons And Tactics (SWAT) teams, are the specialized police unit responsible for mitigating violent and dangerous conflict beyond the capacity of general duty to handle effectively. Debates surrounding the application and effectiveness of ERTs in policing highlight a need to keep ERT members safe due to adequacy and occupational health and safety standards while concurrently managing the expectations of community groups. These groups include those calling for defunding or de-militarization. Explored in the current article, is a thematic analysis of popularized media to unpack the arguments that police, government officials and community activist groups make to help shift opinions on police militarization. However, we frame these media account within Bourdieusian concepts of symbolic power, habitus or field struggle to provide insight into, arguably conflicting, interpretations of police militarization.

Bringing the operating room to the field: lessons learned from on-scene field amputations.

Complicated field extrication may require the assistance of a surgical team to perform an on-scene limb amputation. Although a rare event, when needed, an organized and efficient response is critical to successful outcomes. The Los Angeles County Hospital Emergency Response Team (HERT) program and the organization of the team is described, and a multidisciplinary quality improvement process reviewed and analyzed two cases and identified areas for performance improvement. Experience shapes policy and procedures within the HERT program. The timeliness of HERT activation has a major influence on the success of extrication, and regular drills of the multidisciplinary team consisting of trauma surgeons, emergency physicians, nurses, paramedics, and fire department allow for rapid, effective activation. Post-event quality improvement process reviews the timeline of events, provider activation, communication across field and hospital providers, in-hospital events, and medical decision making throughout. Critical analysis of every step helps prepare for any subsequent encounter. A well-organized and rehearsed protocol to streamline activation and transportation of a well-trained, designated team, in addition to pre-packaged surgical supplies and an effective communication tree are essential elements of a HERT program.

Improving Medical Emergency Team Response Time for Urgent Care Patients in Primary Health Care Centers, Riyadh, Saudi Arabia

Background: Emergency healthcare systems are of increasing concern in international healthcare developments and the global fight against the burdens of disease. Concerns about focusing on ambulance response time as a single indicator are addressed by showing a case-sensitive approach for developing emergency health care systems that in return can identify ambulance response as the main indicator for a particular system. Problem description: Data collected by monitoring the time of receiving the call at the ambulance division until transport time.Methods: The fishbone diagram is used as a tool for understanding the process variation, investigate and eliminating unusual occurrences by the following methodology: M.M.M.Main outcomes: Responding time in emergency cases not exceeding 5 minutes; To improve responding time; To improve types of communication; To improve compliance with the logbook of the emergency referred cases. The intervention plan was Continuous Training for the staff and Clear Guidelines for emergency calls. Review and assess the actual implementation of the project. Data will be collected by an Emergency Medical specialist. A copy of the data should be sent to CQI for a continuous monitoring process. Check the data for process improvement (incident report analysis). Document the results of the change. Modify the change, if necessary and possible. The Emergency Medical Technicians quality coordinator will check the Data. Continue improvement by close monitoring of the compliance.Results: the mean response time dropped from 15 minutes in January 2023 to less than 5 minutes in December 2023.Conclusion: this initiative positively impacts the emergency team's response time and improves patient satisfaction. Response time reduction was evident, and the quality of the health care service was improved. Reduction of response time also improved emergency preparedness

Transport of Patients With High-Consequence Infectious Diseases: Development of European Capacity in Norway.

Infection of Western aid workers with Ebola virus disease during the 2014-2016 West African outbreak demonstrated the need for medical evacuation to high-level isolation units in Europe and the United States. In Norway, an ad hoc preparedness team was established for aeromedical evacuation in case of need. In October 2014, this team transported an infected aid worker from the military section of Oslo Airport to Oslo University Hospital. To maintain and strengthen the capacity for domestic ambulance transport on the ground and in the air, the Norwegian Medical Emergency Response Team for High Consequence Infectious Diseases (in Norway known as "Nasjonalt medisinsk utrykningsteam for høyrisikosmitte"), or NORTH, was established as a permanent service in 2017. Recognizing the expertise of this domestic team, Norway was subsequently entrusted with the task of enhancing the European aeromedical transport capacity for high-consequence infectious diseases and establishing the Norwegian rescEU Jet Air Ambulance for Transport of Highly Infectious Patients, or NOJAHIP, in 2022. In this case study, we present experiences and lessons learned from these 2 services and discuss how they can be further developed.

Associations Between Oversedation and Agitation in Postanesthesia Recovery Room and Subsequent Severe Behavioral Emergencies.

Hospital-based behavioral emergency response teams (BERT) respond to acute behavioral disturbances among hospitalized patients. We aimed to examine associations between altered mental status in postanesthesia care unit (PACU) and behavioral disturbances on surgical wards requiring BERT activation. Electronic medical records of patients who underwent general anesthesia and were admitted to the PACU between May 2018-December 2020 were reviewed for episodes of BERT activations on surgical wards. Characteristics of BERT patients were compared with the rest of surgical population during the same period to examine risk factors for BERT. Of 56,275 adult surgical patients, 133 patients had 178 BERT activations (incidence 2.4, 95% confidence interval [CI] 2.0-2.8 per 1000 admissions), with 21 being for physical assault. The risk for BERT activation was increased with each decade over age of 50 as well as younger age (30 versus 50 y), male sex (odds ratio [OR] = 2.48, 95% CI 1.69, 3.62), longer procedures (OR = 1.08 per 30 minutes, 95% CI 1.05, 1.11), and alterations in mental status in PACU, with both moderate/deep sedation (OR = 1.63, 95% CI 1.04, 2.57) and agitation/combative state (OR = 8.47, 95% CI 5.13, 14.01), P < 0.001 for all comparisons. Early postoperative agitation and oversedation are associated with BERT activation on surgical wards. Altered mental status in PACU should be conveyed to accepting hospital units so healthcare staff can be vigilant for the potential development of behavioral disturbances.

Development of earthquake early warning algorithm magnitude scale for the 2023 Kahramanmaraş earthquake region

On 6 February 2023, Türkiye suffered two major earthquakes with magnitudes of Mw = 7.7 and Mw = 7.6 at 04:17 and 13:24 local time in Pazarcık and Elbistan districts of Kahramanmaraş, which were called as the disaster of the century. On 20 February 2023 at 20:04 local time, another major earthquake with Mw = 6.4 occurred in Yayladağı, Hatay. This disaster caused great loss of life and heavy destruction. The burden of the earthquake on the Turkish economy is extremely heavy. The purpose of earthquake early warning systems (EEWS) is to protect people and property, save time for precautions to be taken and prepare emergency response teams. An effective EEWS has a major role in reducing life, structural and economic losses. This study is an implementation of the original California optimized EPIC, an early warning algorithm, in the region of the 2023 Kahramanmaraş earthquakes. A total of 212 earthquakes in the region are replayed to derive magnitude scaling equations based on peak displacement amplitude (Pd) and predominant period (Tpmax). The performance of the modified equations is tested for three large earthquakes. By comparing the magnitudes estimated by Pd and Tpmax, it is observed that Pd gives more suitable results. The 2023 Kahramanmaras earthquakes real-time tests suggested a warning time of 32 s for the first earthquake in Antakya (Hatay), where the heaviest destruction and loss of life was observed. In the other earthquakes, the warning times were interpreted as quite useful to minimize the loss of life. The geography of the 2023 Kahramanmaraş earthquakes is a seismically active region and will be subject to earthquakes in the future. As a result of this study, a region-specific scaling of the magnitude, which is the most important parameter if an early warning system is established in the region, is presented. It is also a good example of how an effective earthquake early warning system can reduce potential hazards.

Hospital Preparedness Analysis in Disaster Management : Literature Review

Under Act No. 44 of 2009, hospitals have a responsibility to actively engage in disaster situations, provide services to victims as they can, and have an accident prevention and disaster management system. This research aims to find out how prepared some hospitals are in disaster management based on some library studies. The preparation of this article uses a method of systematic literature review using 10 articles from 2019 to 2024 from search databases, namely Google Scholar, Garuda, Sage Journals, and ScienceDirect. Although hospitals have policies and standard operational procedures to cope with disasters, the findings suggest that their implementation by health personnel is not optimal. Although disaster response teams, K3RS teams, and abuse teams have been formed, education and training efforts are still not at their maximum. Hospitals are important in disaster management, but many still need improvements such as special guidelines, infrastructure, and intensive training. Preparedness includes planning, organization, movement, control, and recovery. Ready hospitals have emergency response teams, training programs, and early warning systems.

Crisis Management Strategy for Emergency Response Team for Indonesian Diaspora in Middle East and North Africa (MENA)

The Middle East and North Africa (MENA) region has unique characteristics compared to other regions in the world, such as Asia, the US, and Europe, including fewer natural disasters but more conflicts that lead to wars, which can significantly impact the Indonesian diaspora communities residing in the area. Indonesian citizens need to prepare to anticipate crises that require good strategies and collaboration involving the diaspora and the Indonesian government. This research aims to explore the importance of crisis management strategies for the Emergency Response Team (ERT) of the Indonesian diaspora in MENA. This study utilizes a qualitative approach involving in-depth interviews with experts, competent individuals, or members of the Indonesian diaspora ERT in the MENA region. Both primary and secondary data will be collected and analyzed using the Soft Systems Management (SSM) analysis method. Analysis using brainstorming and PESTLE will also be conducted to assist decision-making, as well as Incident Management Systems. The research will also identify challenges faced by the Indonesian Diaspora Emergency Response Team, the Embassy of the Republic of Indonesia, and the Indonesian Community Association in facing crises in the MENA region and analyze effective crisis management strategies that can be used to enhance readiness and response to emergency situations. This includes analysis and case studies on the evacuation of Indonesian citizens due to crises in Yemen, Libya, and Tunisia. The results of this study are expected to develop an understanding of crisis management for the Indonesian diaspora in MENA and provide practical recommendations to strengthen their ERT capacity in dealing with emergency situations, both in MENA and other regions. This study emphasizes the importance of proactive, network-based, and stakeholder engagement strategies and provides useful insights for policy-making and emergency response planning for the Indonesian diaspora community.

Blood far forward: A cross-sectional analysis of prehospital transfusion practices in the Canadian Armed Forces

BackgroundCanadian Armed Forces (CAF) operate in environments that challenge patient care, especially trauma. Military personnel often find themselves in remote settings without conventional healthcare facilities. Treating traumatic injuries, particularly hemorrhagic shock, often necessitates prehospital blood transfusion. This study aims to present an overview of the current CAF prehospital transfusion practices. Furthermore, the study compared current and developing protocols against expert-recommended guidelines. MethodsA cross-sectional survey design was employed to describe and compare CAF prehospital blood transfusion practices and protocols against expert recommendations. Topics included protocols, equipment, and procedures. An online survey targeted medical leadership and providers within CAF, with data collected from August 15 to December 15, 2023. Results were summarized descriptively. This study received approval from the Unity Health Toronto Research Ethics Board (REB 23–087). ResultsUnits and teams with prehospital blood transfusion capabilities were contacted, achieving a 100 % response rate. Within CAF, Canadian Special Operations Forces Command (CANSOFCOM), Mobile Surgical Resuscitation Team (MSRT), and Canadian Medical Emergency Response Team (CMERT) possess these capabilities, established between 2013 and 2018. These programs are crucial for military operations. CAF has access to standard blood components, cold Leuko-Reduced Whole Blood (LrWB), and factor concentrates from Canadian Blood Services (CBS), available for both domestic and international missions given adequate planning and favorable conditions. Key findings indicate high adherence to recommended practices, some variability in the transfusion process, and potential benefits of standardizing prehospital transfusion practices. ConclusionsThis study provided insights into CAF's implementation of prehospital transfusion practices, highlighting high adherence to national expert recommendations and the importance of structured protocols in military prehospital trauma management. Implications of key findingsCAF's approach and adoption of prehospital transfusion protocols lay a strong foundation for managing trauma patients in remote settings and for expanding prehospital transfusion capabilities across CFHS deployed assets. Further research is needed to advance military trauma care by adapting prehospital blood transfusion to dynamic tactical landscapes and evolving technologies.

A workplace violence prevention program targeting high-risk patients in emergency departments.

Patient violence in emergency departments (EDs) may be prevented with proactive mitigation measures targeting potentially violent patients. We aimed to evaluate the effects of two interventions guided by a validated risk-assessment tool. A prospective interventional study was conducted among patients ≥10 years who visited two EDs in Michigan, USA, from October 2022 to August 2023. During triage, the ED nurses completed the Aggressive Behavior Risk Assessment Tool for EDs (ABRAT-ED) to identify high-risk patients. Following the baseline observational period, interventions were implemented stepwise for the high-risk patients: phase 1 period with signage posting and phase 2 period with a proactive Behavioral Emergency Response Team (BERT) huddle added to the signage posting. Before ED disposition, any violent events and their severities were documented. The data were retrieved retrospectively after the study was completed. Of 77,424 evaluable patients, 546 had ≥1 violent event. The violent event rates were 0.93%, 0.68%, and 0.62% for baseline, phase 1, and phase 2, respectively. The relative risk of violent events for phase 1 compared to the baseline was 0.73 (95% confidence interval [CI]: 0.59‒0.90; p=0.003). The relative risk for phase 2 compared to phase 1 was 0.92 (95% CI: 0.76‒1.12; p=0.418). The use of signage posting as a persistent visual cue for high-risk patients identified by ABRAT-ED appears to be effective in reducing the overall violent event rates. However, adding proactive BERT huddle to signage posting showed no significant reduction in the violent event rates compared to signage posting alone.