Local EMS Research Articles

The Asymmetrical Distribution of a Dominant Motional Electric Field within the Martian Magnetosheath

Attributed to the lack of an Earth-like global intrinsic dipole magnetic field on Mars, the induced electromagnetic field environment plays a crucial role in the evolution of its atmosphere. The dominant motional electric field (EM) induced by the bulk motion of the magnetic field within the Martian magnetosheath serves to accelerate ions toward escape velocity, thereby forming a plume escape channel. However, the distribution morphology of EM itself has received limited attention in previous research. In this study, by taking advantage of the multi-fluid Hall-MHD model cooperating with the Martian crustal field model, we focus on elucidating the physical mechanisms underlying the asymmetrical distribution of EM and examining the influence of the crustal field on this asymmetry. The results obtained from the simulation conducted in the absence of the crustal field indicate that the EM is more intense within the −ZMSE magnetosheath, where EM is directed toward Mars, primarily due to its corresponding higher velocity and a stronger magnetic field at lower solar zenith angles. The Martian crustal field has the ability to enhance the local EM around the inner boundary of the magnetosheath by amplifying both the magnetic field and its associated velocity. Accordingly, these findings provide valuable insights into the asymmetric nature of EM within the Martian magnetosheath under typical quiet-time solar wind conditions.

Pilot study to teach residents about EMS scope of practice through reverse role simulations

Objective: To improve emergency physician trainee understanding of Emergency Medical Services´ (EMS) scope of practice, and physician confidence in performing EMS skills by conducting a simulation role reversal workshop. Methods: EMS clinicians and physicians created and facilitated a role-reversal workshop for seven pediatric emergency medicine (PEM) fellows designed to emphasize scope of practice of EMS clinicians using basic life support (BLS) and advanced life support (ALS) skills. Fellows roleplayed using BLS or ALS skills in three different case scenarios. Medication preparation and delivery were assessed. Pre, post, and retention surveys (provided at 1 month post-intervention) were performed to assess scope of practice knowledge, and the EMS skill set confidence of the fellows. Results: Fellows reported the curriculum had an impact on their understanding of EMS scope of practice. Confidence in differentiating ALS and BLS scope of practice improved as did the subjective understanding of local EMS protocols. The confidence in preparing and administering multiple types of medications (i.e., intramuscular epinephrine administration, nebulized medication preparation) significantly improved as well (p<0.016 with Bonferroni adjustment). Conclusion: Given improved confidence scoring in understanding EMS scope of practice and medication administration, role reversal methodology may offer intangible affective and psychomotor benefits for emergency medicine trainees by generating a sense of a “lived-experience” when role-playing EMS skill sets. The workshop may serve as a model to use in teaching pre-hospital scope of practice and generating interprofessional understanding for physician trainees.

A SABEDORIA LOCAL EM SISTEMAS AGROFLORESTAIS: O ESTUDO DE CASO NA VILA WANGA, SUBDISTRITO DE MOTOLING LESTE, REGÊNCIA DE MINAHASA DO SUL, INDONÉSIA

Purpose: The purpose of this study is to ascertain how the Wanga Village community manages land using agroforestry technologies. Based on the observations, different component kinds are found in the sites of the respondents. Agrisilviculture, agrosilvofishery, agrosilvopasture and agroforestry patterns employed by the residents of Wanga village. Method: The approach is a survey that combines field observations and interviewing methods. Purposive sampling was used to select respondents, and the indigenous inhabitants of Wanga Village who oversee agroforestry land met the selection criterion. Interviews with respondents using questionnaires. Following the research results, a descriptive analysis was conducted on the data. Results and conclusion: The Wanga Village community still uses an agroforestry technique to manage their land with the help of local knowledge. The agroforestry system in Wanga Village is still used to manage land utilizing the traditional knowledge of "mapalus" or "maendo," "toki bulu," and moon observation. Research implications: The way the residents of Wanga Village observe the "New Moon" phase which comes once a month when the moon is in the west, appears at sunset and the moon adopts the appearance of a crescent. The young quartile moon phase follows the "new moon" phase, which lasts for three days during which people are believed to not plant anything. After the young quartile phase, people wait six days for the big moon phase, during which they believe they cannot plant any fruit plants because they will not bear fruit. Originality/value: "Toki Bulu" is a community activity on agrosilvofishery land in providing fish food. Based on the results of interviews, the community's unique way of feeding fish is by "Toki Bulu" (tapping the feathers) first to call the fish. "Mapalus" is a social activity originating from Minahasa culture and is usually called mutual cooperation. "Mapalus" for the Tountemboan people is called "Maendo" which means taking the day or taking advantage of the day to work together with other people. The Wanga Village community still carries out this activity, especially in land preparation.

Mass Casualty Incident Preparedness for Airport Emergencies: Report From an Aeroplane Crash Simulation at Guglielmo Marconi Airport, Bologna (Italy).

Airport emergencies are rare but potentially catastrophic; therefore, system preparedness is crucial. Airport emergency plans include the organization of emergency drills on a regular basis, including full-scale exercises, to train and test the entire rescue organization. This report describes a full-scale simulation at Bologna International Airport, Italy, in October 2022, involving local EMS resources. A full-scale aeroplane crash was simulated on the airport ground, activating the Airport emergency plan, and requiring the intervention of supplementary resources (ambulances, medical cars, and other emergency vehicles). Twenty-seven simulated patients were evaluated by EMS: START triage assessment was correct for 81.48% of patients; 11.11% were over-triaged and 7.41% were under-triaged. All patients were transported to the hospitals of the area. The simulation ended 2 hours and 28 minutes after the initial alarm. The response time proved a good response. Triage accuracy was correct in more than 80% of simulated patients. The availability of a trauma centre within 6 kilometres allowed the transportation of a quota of patients directly from the event, without affecting transportation times. Areas for improvement were identified in the communication within the different agencies and in moving ambulances within the airport runway without airport personnel guidance.

721 The Rising Use of Fire as a Weapon

Abstract Introduction Disaster planning and preparedness for a Burn Mass Causality Incident (BMCI) must consider both worst-case scenarios as well as most likely events that could strain a burn center (BC) resources. This study evaluates the growing threat of utilizing fire as a weapon for terrorist attacks and criminal acts in the United States. Methods Statistics regarding the use of fire as a weapon over a 2-year period were reviewed and summarized along with a review of significant events over 30 years. In addition, data regarding the type of weapon used in these attacks, intended target, and motives were collected and compared. Results According to the Cyber Security and Infrastructure Security Agency (CSISA), incidents related to arson or fire as a weapon in the US increased by 56.9% in cities with populations over 1 million people between 2019 and 2020 and 11.3% in towns with populations under 10,000. In addition, improvised Incendiary Device (IID) incidents increased by 210% at government facilities, 113% at commercial facilities, and 114% at critical infrastructure facilities during the same time frame. Conclusions The US continues to face complex and evolving threats from extremists, criminals, and terrorists. Methods have included attacks utilizing arson, IIDs, deliberate forest fires, and more. Assailants have used fire as a weapon to target public gatherings, individuals, and government property and as a component of complex coordinated attacks. These attacks have resulted in both large numbers of fatalities and burn injuries. The materials required to create a weapon utilizing fire are cheap, readily available, and require no formal training. Applicability of Research to Practice Criminal or terrorism-related incidents involving the use of fire as a weapon can result in mass causality events with large numbers of burn patients. These incidents can potentially overwhelm both first responders and local BC quickly. Therefore, BCs must have an updated disaster plan that has been evaluated and communicated with local fire and EMS, neighboring hospitals, and regional BCs.

A Novel EM-Type Algorithm to Estimate Semi-Parametric Mixtures of Partially Linear Models

Semi- and non-parametric mixture of normal regression models are a flexible class of mixture of regression models. These models assume that the component mixing proportions, regression functions and/or variances are non-parametric functions of the covariates. Among this class of models, the semi-parametric mixture of partially linear models (SPMPLMs) combine the desirable interpretability of a parametric model and the flexibility of a non-parametric model. However, local-likelihood estimation of the non-parametric term poses a computational challenge. Traditional EM optimisation of the local-likelihood functions is not appropriate due to the label-switching problem. Separately applying the EM algorithm on each local-likelihood function will likely result in non-smooth function estimates. This is because the local responsibilities calculated at the E-step of each local EM are not guaranteed to be aligned. To prevent this, the EM algorithm must be modified so that the same (global) responsibilities are used at each local M-step. In this paper, we propose a one-step backfitting EM-type algorithm to estimate the SPMPLMs and effectively address the label-switching problem. The proposed algorithm estimates the non-parametric term using each set of local responsibilities in turn and then incorporates a smoothing step to obtain the smoothest estimate. In addition, to reduce the computational burden imposed by the use of the partial-residuals estimator of the parametric term, we propose a plug-in estimator. The performance and practical usefulness of the proposed methods was tested using a simulated dataset and two real datasets, respectively. Our finite sample analysis revealed that the proposed methods are effective at solving the label-switching problem and producing reasonable and interpretable results in a reasonable amount of time.

Patients utilizing emergency medical services – Does facility type matter?

BackgroundEmergency departments (EDs) play a critical role in the US healthcare system. As freestanding EDs (FSEDs) are integrated into the acute care landscape, local EMS providers are transporting to these facilities, which may be closer in proximity and provide faster turnaround times. We hypothesized that patients transported via EMS to a freestanding ED required fewer tests and are admitted less frequently than those transported to a HBED. Our objective was to compare testing frequency and admission rates between patients transported via EMS to a FSED vs. HBED. MethodsThis was a retrospective cohort study of all patients who presented within a large integrated hospital system via EMS to one of 10 HBEDs or one of 6 FSEDs between April 1, 2020 – May 1, 2021. Categorical variables are presented as frequencies and percentages and comparisons between groups were obtained using chi squared tests. Continuous variables are presented as mean and standard deviation and p-values comparing groups were obtained using t-tests. Multiple logistic regression was used to assess the effect of ED type on admission status, labs ordered, and testing performed. ResultsA total of 123,120 encounters were included in our study. Mean age at the FSEDs was 59.9 vs. 61.3 at the HBEDs. At the FSEDs 55.6% (n = 4675) were female vs. 53.0% (n = 60,809) at the HBEDs. At the FSEDs 82.0% (n = 6805) were White vs. 60.7% (n = 68,430) at the HBEDs. We found 50.0% (n = 3974) had Medicare at the FSEDs vs 50.9% (n = 55,372) at the FSEDs. At the FSEDs, 69.5% (n = 5846) had bloodwork vs. 82.4% (n = 94,512) at the HBEDs; 68.3% (n = 5745) had an x-ray at the FSEDs vs. 70.7% (n = 81,089) at the HBEDs; 40.1% (n = 3370) had a CT scan at the FSEDs vs. 44.9% (n = 51,503) at the HBEDs; and 40.6% (n = 3412) were admitted at the FSEDs vs. 56.1% (n = 64,355) at the HBEDs. After controlling for Charlson Comorbidity Index, acuity, age, gender, sex, insurance and race, patients in FSEDs were 35% less likely to be admitted as compared to HBEDs. ConclusionPatients brought in via EMS to a FSED were less likely to have blood work, x-ray, or CT scan, and were less likely to be admitted to the hospital than those transported to a HBED.

Bridging the gap? Local production of medicines on the national essential medicine lists of Kenya, Tanzania and Uganda

BackgroundEssential medicines (EMs) are those that satisfy the basic healthcare needs of the population. However, access to EMs remains a global health challenge. The World Health Organization (WHO) and the East African Community (EAC) manufacturing plan 2017–2027 support local production of EMs as a strategy to improve access to medicines. The aim of this study was to determine for each therapeutic class on the national essential medicine lists (NEMLs) of Kenya, Tanzania and Uganda, the number of EMs produced in each country.MethodsIn 2018, we analysed NEMLs and national drug registers (NDRs) in each country to identify local manufacturers and local products by EM status. For each local manufacturer we determined the number of EM products and individual EMs, and analysed EMs in each therapeutic class by registration status and whether produced locally.ResultsThere were nine companies manufacturing locally in Kenya, four in Tanzania and six in Uganda. Most local medicine products were non-EM products. Of the 946 locally produced products in Kenya, 310 were EM products; of the 97 locally produced products in Tanzania, 39 were EM products; and of the 181 locally produced products in Uganda, 100 were EM products. Many local EM products were duplicate. Only a small proportion of EMs on each NEML were produced locally: 21% (92/430) in Kenya, 5% (24/510) in Tanzania, and 10% (55/526) in Uganda. Kenya, Tanzania and Uganda had no local EM products in 13/32, 17/28 and 15/32 therapeutic classes, respectively. The proportion of EMs that were registered varied across the countries from 327 (76%) in Kenya, 269 (53%) in Tanzania, and 319 (60%) in Uganda.ConclusionsThis study highlights the importance of auditing NDRs and NEMLs for local production to inform regional and national local manufacturing strategies. EMs should be prioritized for local production and drug registration to ensure that production is aligned with local health needs.

Implementation of a Leave-behind Naloxone Program in San Francisco: A One-year Experience

In response to the ongoing opioid overdose crisis, US officials urged the expansion of access to naloxone for opioid overdose reversal. Since then, emergency medical services' (EMS) dispensing of naloxone kits has become an emerging harm reduction strategy. We created a naloxone training and low-barrier distribution program in San Francisco: Project FRIEND (First Responder Increased Education and Naloxone Distribution). The team assembled an advisory committee of stakeholders and subject-matter experts, worked with local and state EMS agencies to augment existing protocols, created training curricula, and developed a naloxone-distribution data collection system. Naloxone kits were labeled for registration and data tracking. Emergency medical technicians and paramedics were asked to distribute naloxone kits to any individuals (patient or bystander) they deemed at risk of experiencing or witnessing an opioid overdose, and to voluntarily register those kits. Training modalities included a video module (distributed to over 700 EMS personnel) and voluntary, in-person training sessions, attended by 224 EMS personnel. From September 25, 2019-September 24, 2020, 1,200 naloxone kits were distributed to EMS companies. Of these, 232 kits (19%) were registered by EMS personnel. Among registered kits, 146 (63%) were distributed during encounters for suspected overdose, and 103 (44%) were distributed to patients themselves. Most patients were male (n = 153, 66%) and of White race (n = 124, 53%); median age was 37.5 years (interquartile range 31-47). We describe a successful implementation and highlight the feasibility of a low-threshold, leave-behind naloxone program. Collaboration with multiple entities was a key component of the program's success.

166 Barriers and Facilitators to Emergency Medicine Residency Program Development in Latin America and the Caribbean

Although EM is rapidly expanding in Latin America and the Caribbean, there has been no formal evaluation of the implementation of recently established EM training programs to guide the process in other countries. We aimed to describe the barriers and facilitators of developing an EM residency training program in Latin American and Caribbean countries to identify and disseminate the relevant “lessons learned.” Methods: Semi-structured, virtual, individual qualitative interviews with key stakeholders involved in the development of EM residency programs in Latin America and the Caribbean. Interviews were in English or Spanish, recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) guided the interview and analysis using 5 constructs applied systematically to the varying program implementations: inner setting, outer setting, individuals involved, implementation process, and intervention characteristics. Fourteen interviews were completed with physicians from Nicaragua, Guatemala, Chile, Mexico, Argentina, Haiti, Peru, and Brazil. Inner setting: Major barriers included lack of EM-trained physicians in the teaching faculty, resistance from other specialties, and lack of general support which caused feelings of isolation for the initial EM residents. Facilitators included the formation of national EM associations, cultivation of local EM-trained faculty as residents graduated, adapting curriculum to local needs, and formal feedback processes for program improvement. Outer setting: Barriers included lack of autonomy of the medical schools from the government and limited public and health system awareness of the role of EM. The COVID-19 pandemic was a facilitator as it brought recognition and legitimacy to EM due to the relevant skill sets of Emergency physicians. Financial help and additional educational opportunities from foreign organizations were helpful in some cases. Individuals involved: Key individuals served as champions who advocated for the implementation of the EM specialty and served as the catalyst for the program implementation in their countries. Some non-Emergency physicians were considered a barrier because of discouraging or luring residents away from EM. Implementation process: Barriers included lack of resources (functional equipment, textbooks), lack of program accreditation, and difficulty engaging applicants due to limited exposure of specialty. Facilitators included recognition and program approval from the Ministry of Health and “grandfathering” to establish first local EM faculty. Intervention characteristics: Barriers included the language of the available EM literature and lack of relevant language skills of the volunteer foreign EM faculty. Lack of funding to provide sufficient salary or any salary at all for the initial EM residents was another hurdle. Facilitators included funding from the government or external entities, and a curriculum document outlining EM-specific objectives enabled consistent, targeted training. Countries and organizations planning to initiate new EM training programs in Latin American and the Caribbean may benefit from the shared experience, including common barriers and facilitators to program establishment described by key stakeholders of recently developed programs in the region. Dissemination of these findings will avoid institutions “re-inventing the wheel”.

19 Utilization of Advanced Providers in the Field for Medical Custody Clearance

19 Utilization of Advanced Providers in the Field for Medical Custody Clearance

The role of medical and non-medical volunteers in managing severe pre-hospital COVID-19 cases via mobile applications and local EMS network during the scarcity of hospital beds in Thailand

The role of medical and non-medical volunteers in managing severe pre-hospital COVID-19 cases via mobile applications and local EMS network during the scarcity of hospital beds in Thailand

“Where People Come to Press Close to the Other Side”: Religion, Politics, and the American Border

“Where People Come to Press Close to the Other Side”: Religion, Politics, and the American Border Elizabeth Shakman Hurd In January 2020, I visited the US-Mexico border as a part of a group trip to northern Sonora with Border Community Alliance, a nonprofit advocacy group based in Tubac, Arizona.1 We crossed into Mexico at Nogales, a city bisected by the border and often called “Ambos Nogales” (“Both Nogales”) for that reason. While at the border I was struck by a sense of inevitability and banality; the relaxed posture of a US border official on his bike at Morley Gate (Figure 1) speaks to this feeling. Contributing to this laid-back atmosphere was the fact that my traveling companion, a fellow US citizen, and I were able to cross back and forth at will between the US and Mexico, as if passing through a metro station. At the end of our trip to Sonora, after crossing over to the US to check into our hotel, we decided to go back to Mexico for happy hour at La Roca, a bar nestled into a picturesque cliff face just steps from the border. A century ago, Mexican Nogales was a boomtown and haven for US Americans seeking to escape Prohibition. It [End Page 108] is said that at least one binational bar let US patrons drink as long as they stood on the Mexican side of the room. The border was largely irrelevant for those on both sides until the 1950s. Click for larger view View full resolution Figure 1. Photo taken by the author. Today that is not the case. At the Morley Gate crossing, while searching for the nineteenth-century border markers on the Mexican side of the wall, we noticed two people who, presumably, lacked permission to enter the United States. They were gazing through the border fence onto International Boulevard at the southern end of Nogales, Arizona (Figure 2). We wondered what they were doing. Waiting for someone? Just watching? Journalist and poet Amelia Urry observed that, “Nogales is a place where people come to press close to the other side.”2 The border was very much present for them. There were other signs of its presence. Within sight of the unimposing Morley Gate crossing sits Nogales Tactical. It sets a different tone. A block from the border, [End Page 109] Click for larger view View full resolution Figure 2. Photo taken by the author. [End Page 110] Nogales Tactical sells tactical gear and accessories for actual and aspiring border enforcers. The sign and window display leave little doubt as to what is for sale (combat gear) and who the intended customers are (white American men). Their website reads: “Nogales Tactical is proud to serve the men and women of public safety and homeland security. Nogales Tactical specializes in tactical accessories, uniforms, and boots for Customs and Border Patrol, Local Police Departments, EMS, Firefighters, Military and Security. Custom fitting, alterations, tailoring and embroidery are available. Make sure to visit our store or call us for all your tactical needs.”3 My friend hesitated when I suggested we go inside to have a look, but we went. The store was huge. The sense of a no-holds-barred, heavily militarized defense of the border, of the United States, and of whiteness, was palpable, unpleasant, and, at times, frightening. We didn’t stay long. Most US Americans think the border should be secured and defended. The border, according to this consensus, is somewhat inevitable. Good fences make good neighbors. Big walls make better neighbors. It is not only Trump and his supporters who support a fortified border. US annual budgets for immigration and border enforcement have grown almost eighty-fold since 1978, totaling about 23 billion dollars in Fiscal Year 2021.4 As of 2016, the US was spending more on border and immigration enforcement than on all other federal law-enforcement agencies combined.5 The border is not only a line in the sand or a wall but also a web of heavily militarized and often racialized, US-overseen enforcement regimes that blanket the world.6 This was palpable at Nogales Tactical and in the CBP advertisements posted...

Optical multipolar torque in structured electromagnetic fields: On helicity gradient torque, quadrupolar torque, and spin of the field gradient

Structured light mechanically interacts with matter via optical forces and torques. Optical torque is traditionally calculated via the flux of total angular momentum (AM) into a volume enclosing an object. In the work published in [Phys. Rev. A 92, 043843 (2015)], a powerful method was suggested to calculate the optical torque separately from the flux of the spin and the orbital parts of optical AM, rather than the total, providing useful physical insight. However, the method predicted a new type of dipolar torque dependent on the gradient of the helicity density of the optical beam, inconsistent with prior torque calculations. In this work, we first intend to clarify this discrepancy and clear up the confusion. We rederive, from first principles and with detailed derivations, both the traditional dipolar torque using total AM flux, and the spin and orbital torque components based on the corresponding AM contributions, ensuring that their sum agrees with the total torque. We also test our derived analytical expressions against numerical integration, with the exact agreement. We find that ``helicity gradient'' torque terms indeed exist in the spin and orbital components separately, but we present corrected prefactors, such that upon adding them, they cancel out, and the helicity gradient term vanishes from the total dipolar torque, reconciling literature results. In the second part of the work, we derive the analytical expression of the quadrupolar torque, showing that it is proportional to the spin of the EM field gradient, rather than the local EM field spin, as sometimes wrongly assumed in the literature. We provide examples of counter-intuitive situations where the spin of the EM field gradient behaves very differently from the local EM spin. Naively using the local EM field spin leads to wrong predictions of the torque on large particles with strong contributions of quadrupole and higher-order multipoles, especially in a structured incident field.

108 Development and Implementation of a Burn Nurse Educator

IntroductionPrior to the introduction of the Burn Nurse Educator (BNE), at a growing and newly established burn center, the education of the Burn Trauma ICU staff was completed by the Burn Director and Burn Supervisor. In this burn center, large amounts of education became difficult to create and distribute by the current Burn Director and Burn Supervisor due to the demand of their respective job roles. The role of the BNE was to create initial and ongoing education for the Burn Trauma ICU Staff, Ortho-Trauma staff, ED staff, local EMS agencies, and the community.MethodsThe Burn Nurse Educator reviewed previous education that was provided to the staff, compared it to the Burn Nurse Competencies established by the American Burn Association, and was able to formulate a new education plan. The Burn Nurse Educator created several burn-based courses. These classes included: Floating into Burn Care, Burn Boot Camp, and Burns in the Pediatric Population. There was also the introduction of mock codes focused on the pediatric burn population. In addition to the formulation of these educational opportunities, the Burn Nurse Educator worked directly with the Quality Improvement Committee to find gaps in care. These gaps were then turned into project improvement plans and additional education was provided to the bedside staff. The Burn Nurse Educator formed relationships with local EMS agencies and was able to provide burn lectures and continuing education.ResultsEach class offered had a pre and post test administered, all with improved scores. A sample size of 30 nurses who enrolled in Burns in the Pediatric Population had a score increase from 46% to 94%. A sample size of 14 nurses had a score increase of 55% to 80% after enrolling in Floating into Burn Care. A sample size of 30 nurses who enrolled in Burn Boot Camp had a score increase of 71% to 95%. More importantly, the staff expressed a higher level of confidence when caring for a burn patient after these classes. The outreach with local EMS agencies also increased our EMS admits to the hospital, improved knowledge for caring for burn victims, and created a relationship with our local cities EMS.ConclusionsIt is anticipated that as the program continues to expand, the role of the Burn Nurse Educator will continue to grow and encompass new responsibilities. To ensure each nurse remains competent in their skill set, additional knowledge testing will be completed one year after a nurse has completed a class.

Logistics: More than a List


 
 According to Canada’s Incident Command System (ICS), logistics represent the provision of “resources and other services to support incident management” (ICS Canada, 2019). Sometimes referred to as the “getters”, people working in a Logistics Section are faced with the challenge of finding diverse products and services to support efforts on the front lines, within the command centre, and at reception and registration centres. While a comprehensive hazard assessment can be helpful to identify typical resources, in a disaster situation, we never really know what we need until we need it – and then we need it right away.
 According to Young (2014), “the logistics and resource management functions of Emergency Management (refer to as EM logistics) have been largely reactive, with little to no pre-event planning for potential demand”. In other words, capacity building is absent. Where logistics planning has been made a priority, it generally appears in the form of updated contact information and vendor lists painstakingly collated annually. This results in a labour-intensive, redundant, and highly ineffective process and outcome. In the constantly changing and dynamic environment of emergency management, maintaining current information is a significant challenge for even the most advanced organizations.
 Many organizations conduct emergency management planning and preparations from the corner of their desk as they lack the capacity and resources to dedicate full time attention. Directors of Emergency Management (DEMs) regularly build relationships within their sector and engage “contractors through personal relationships and other channels” (KPMG, 2021. P.130). However, major disaster situations remove the DEM from significant logistics functions, leaving other members of the local EM team to fulfil the Logistics responsibilities. Incomplete paper or digital lists with missing information add time and complexity that can result in missed opportunities to mitigate damage to people and property – especially when the logistics functions are being undertaken by people infrequently engaged in crisis situations.
 This article substantiates the need for logistics as a central consideration in building and maintaining networks for connection and collaboration, identifies the value of maintaining comprehensive resource lists as a logistics function, and highlights the significance of building and maintaining local data as part of a solid strategy in preparation for the next disaster situation.
 

The feasibility of medical unmanned aerial systems in suburban areas.

Out-of-Hospital Cardiac Arrests (OHCA) are one of the biggest challenges facing medical systems world-wide. Each year, more than 420,000 Americans experience cardiac arrests with a survival rate of approximately 10%.1 A large challenge to treating OHCA continues to be rapid access to AEDs which can increase survival rates up to 40%.1 While pivotal to an OHCA patient's survival, AEDs are not always readily available. Advances in unmanned aerial systems (UAS) - commonly referred to as drones - can provide a solution since UAS have the ability to rapidly carry an AED payload to an emergency site. This study examined the potential use of UAS delivered AEDs in suburban areas by using the Charlottesville-Albemarle area as an example. This study was carried out by using Geographical Information Systems mapping. Specifications of the Eagle drone model by Flirtey were used to develop a beneficial drone placement plan. Models were created with drones at first responder stations. Coverage area of the drones at first responder stations was compared to coverage area of drone units placed at "ideal" locations in the Charlottesville-Albemarle County area. Population statistics were gathered from the GIS program Social Explorer, using data from the U.S. Census Bureau. The "ideal" location placement plan was then evaluated for an estimate of total population covered by the system. Finally, ideal drone placements were evaluated and compared to response time and distances versus a local EMS ground unit. With the derived ideal placements, 70.08% of the area would have drone coverage that could deliver an AED in less than five minutes and 97.97% of the area would have coverage in less than 10min. At minimum, 94.72% of the population would be covered by the ideal placements of drones within the area. Drone response time was significantly faster than ground EMS response by a factor of 5× (P value < .05). Drones were able to get to the incident scene of a theoretical OHCA faster without and with vertical response challenges. The results show that UAS delivery of AEDs is not only possible in the Charlottesville-Albemarle County area, but an effective way to decrease response time to improve chances of survival for a person experiencing an OHCA in similar suburban areas.

Design and optimal energy management of community microgrids with flexible renewable energy sources

Energy communities is a new, but already successful prosumer model of the local energy systems' construction. It is based on distributed energy sources and the electricity consumers’ flexibility who are the members of the community. In search of the most effective ways to interact within themselves and with the external energy system, local energy communities become platforms for exciting experiments in the field of new energy practices including local markets for flexibility, building cooperative microgrids, achieving energy autonomy, and many others. This work aims to present a unified approach to building and optimally managing the community microgrids with an internal market, given the social, environmental, and economic benefits of a particular location of such a community. A new modeling framework is introduced, based on bilevel programming and reinforcement learning, for structuring and solving the internal local market of a community microgrids, composed of entities that may exchange energy and services among themselves. The overall framework is formulated in the form of a bilevel model, where the lower level problem clears the market, while the upper level problem plays the role of the community microgrid operator (Community EMS). We strengthen the traditional bilevel problem statement by the local energy management system (Local EMS) introduction based on Monte-Carlo tree search algorithm. Our approach makes it possible to enable interaction of the local control systems for microgrids with the community microgrid operator as part bilevel programming problem solution. Numerical results obtained on the real test case of the microgrid community for the settlements located in the Transbaikal National Park (Russia), which include various renewable energy sources (wind, solar power, biomass gasifiers) and storage devices, show reduction of the LCOE index from 20% to 40% and improving the quality of electricity supply to the analyzed settlements.

Onset of Plasmoid Reconnection during Magnetorotational Instability

Abstract The evolution of current sheets in accretion flows undergoing magnetorotational instability (MRI) is examined through two- and three-dimensional numerical modeling of the resistive MHD equations in global cylindrical geometry. With an initial uniform magnetic field aligned in the vertical (z) direction, MRI produces radially extended toroidal (azimuthal) current sheets. In both 2D and 3D when axisymmetric modes dominate, these current sheets attract each other and merge in the poloidal (rz) plane, driving magnetic reconnection when the Lundquist number S &gt; 3 × 102, making it a possible source of plasmoids (closed magnetic loops) in accretion disks. At high Lundquist numbers in the 2D regime, starting at S = 5 × 103, self-consistent MRI-generated current sheets become thin and subject to plasmoid instability, and therefore spontaneous magnetic reconnection. When nonaxisymmetric 3D modes dominate, turbulence makes the azimuthal current sheets more unstable and stretch vertically. Toroidally extended vertical current sheets in the inner region, as well as larger 3D magnetic islands in the outer regions of the disks are also formed. These findings have strong ramifications for astrophysical disks as potential sources of plasmoids that could cause local heating, particle acceleration, and high energy EM radiation.

“House Calls” by Mobile Integrated Health Paramedics for Patients with Heart Failure: A Feasibility Study

Background: Early readmissions following hospital discharge for heart failure (HF) remain a major concern. Among the various strategies designed to reduce readmissions, home evaluations have been observed to have a favorable impact. We assessed the feasibility of integrating community paramedics into the outpatient management of HF patients. Methods: Selected paramedics completed an educational HF curriculum. These Mobile Integrated Health Paramedics (MIHP) performed scheduled home visits 2- and 15-days post-discharge for patients with Stage C HF (Phase I) and patients with Stage D HF (Phase II). Facilitated by a Call Center, a process was created for performing urgent MIHP house calls within 60 minutes of a medical provider’s request. A HF specialist, with an on-call emergency department command physician, could order an intravenous diuretic during home visits. During each phase of the study the incidence of 30-day HF readmissions, 30-day all-cause readmissions, emergency room evaluations, unplanned office encounters, as well as any adverse events were prospectively documented. Results: Collaborative relationships between our hospital network and local EMS organizations were created. There were 82 MIHP home visits. Eight patients received urgent home evaluations within 60-minutes post-request, one requiring transport to an ED. The incidence of all-cause 30-day readmissions in 20 Stage C and 20 Stage D patients was 15% and 40%, respectively. There were no adverse events attributable to the MIHP house calls. Conclusions: It is feasible to integrate MIHPs into the outpatient management of HF. Signals of effectiveness for reducing early readmissions were observed. Obstacles to creating an effective paramedic “House Calls” program were identified. A randomized trial is required to assess the value of this care process and its impact on early readmissions in patients with Stage C and Stage D HF.