Emergency Management Research Articles

Road Accident Emergency Reporting Management System using Neural Network

Given the high number of road accidents that result in deaths every day, victims may lose their lives if emergency medical personnel or concerned parties fail to arrive promptly to intervene in an accident or if they do so, because they are unaware of the location of a nearby hospital or medical facility, they may not be able to provide the much-needed help. To avert this scenario, this research work seeks to deploy a Deep Learning Road Accident Emergencies Management model, which by examining of video and sensors’ data, identifies and reports traffic incidents in real time. A Neural Network (NN) is used by the model to recognize accident scenarios based on anomalous motion patterns inside video frames, including sudden halts and crashes. Put into practice in python, the program incorporates deep learning libraries such as OpenCV and TensorFlow for strong data processing and analysis in real time. To train and evaluate the model, an 80/20 data split, which results in reduced latency and high accuracy in accident detection. The Key performance metrics include a testing accuracy of 96%, an F1-score of 87.5%, and a response time of less than two seconds on average. The study advances the domains of artificial intelligence, transportation safety, and emergency management by offering a practical, real-time solution for automated accident reporting. This quick detection capability allows for timely emergency alerts, which are sent to responders via a web-based interface, giving them precise location details. The model's promise as a life-saving tool in smart city infrastructures is highlighted by its capacity to deliver precise and prompt replies. The Road Accident Emergency Reporting Model has important ramifications for increasing road safety, decreasing emergency response times, and boosting public safety in general due to its strong design and low latency.

Towards future of work in immersive environments and its impact on the Quality of Working Life: a scoping review

Abstract In recent years, immersive environments and the technologies employed within them, such as Augmented Reality (AR), Virtual Reality (VR), and Mixed Reality (MR), have become increasingly significant, particularly in the domains of education, work, and entertainment. Moreover, the concept of persistent, immersive virtual worlds – commonly referred to as Metaverses – has gained attention due to advancements and opportunities in VR and AR. These immersive environments are transforming how we work, especially in communication, coordination, and collaboration. Hence, an important question that arises is how these environments influence Quality of Working Life (QWL). This study provides an overview of the effects of immersive environments on QWL. We conducted a scoping review following the framework by Arksey and O’Malley in accordance with the PRISMA guidelines. The findings identify three major QWL topics influenced by immersive environments: (i) Mental Health, highlighting stress reduction and well-being enhancement; (ii) Safety & Prevention, emphasizing accident prevention and risk mitigation; and (iii) Workplace Design, focusing on improved ergonomics. We derive practical implications for QWL and provide theoretical implications to scoping reviews. While our study considered the short-term effects of such technologies as limitations, future studies should address the long-term effects of immersive environments on QWL.

Use of virtual reality to remotely train healthcare professionals in paediatric emergency tracheostomy skills: protocol for a multi-centre, non-inferiority educational interventional study with historical controls

BackgroundThe insertion of a tracheostomy is an established technique used to wean patients off ventilatory support, manage secretions in complex conditions, and as a potentially life-saving procedure to bypass upper airway obstruction. Life-threatening complications during aftercare are not uncommon and may be influenced by a lack of education of carers or healthcare providers of children and young people living with a tracheostomy. Education programmes designed and supported by the National Tracheostomy Safety Project are effective, but resources are not available to educate the workforce at scale. With the overarching aim of widening access to paediatric tracheostomy skills training, we present the protocol for the development and evaluation of a novel virtual reality (VR) training tool designed to simulate the emergency management of paediatric tracheostomy complications.Methods and discussionA multi-centre, non-inferiority educational interventional study with historical controls will be used to evaluate the novel VR training package. A group of 69 healthcare staff and students will have one week to use the educational intervention as often as necessary to learn paediatric emergency tracheostomy skills. The primary outcome measure is skill performance in simulation in a pre- and post-intervention structure within subjects. Participant performance will also be assessed using non-inferiority metrics against historical traditional educational control data. Secondary outcomes include knowledge gain, knowledge retention, usability, side effects, and participant satisfaction. To minimise the risk of cybersickness, teleportation was the preferred locomotion method for the user navigation within the VR environment.Trial registrationFull registration of this study was completed at ClinicalTrials.gov. The registration number is NCT06350708 and was accepted on the 4th April 2024.

Unlocking the Potential of Cecostomies: A Valuable Lifesaving Procedure in Emergency Surgery for Colonic Obstructions

Background: Colonic obstructions present a serious medical emergency that requires prompt surgical intervention to prevent life-threatening complications. Cecostomy, a procedure involving the creation of an opening in the cecum to decompress the colon, serves as one surgical approach for managing these obstructions. The aim of this review is to evaluate the effectiveness and benefits of cecostomies in emergency surgical settings, with a focus on recent clinical studies and case reports. Cecostomy is highlighted as a bridge procedure in cases such as obstructive carcinomas, providing data on success rates, relative survival, and clinical effectiveness. The importance of the patient’s condition and surgeon expertise in selecting cecostomy as a procedure is emphasized. Further comparative research is suggested to optimize the selection criteria, providing a strong, clinically oriented conclusion. Methods: A comprehensive literature review was conducted to identify studies and case reports focusing on the application of cecostomies in cases of acute colonic obstruction. Articles were selected based on their relevance to emergency surgery, the effectiveness of cecostomies, and patient outcomes in various clinical scenarios, including obstructive carcinomas and colonic pseudo-obstructions. Results: The analysis reveals that cecostomies provide rapid decompression and effective relief from colonic obstruction, particularly when immediate intervention is needed to prevent bowel perforation or ischemia. In several cases, cecostomies act as a bridge to more definitive surgical treatments, such as resection and anastomosis, and are associated with reduced morbidity and mortality. The selection of cecostomy as a preferred procedure depends on the patient’s condition, location of the obstruction, and surgeon expertise. Conclusions: Cecostomies play a crucial role in the emergency management of colonic obstructions, offering a viable and sometimes lifesaving alternative for rapid decompression. Understanding the indications and appropriate use of cecostomies can enhance patient outcomes and provide surgeons with effective strategies for managing acute colonic obstructions. Further research is warranted to refine selection criteria and to compare outcomes between cecostomies and other decompressive techniques in emergency settings.

Navigating Emergency Management of Cancer Patients: A Retrospective Study on First-Time, End-Stage, and Other Established Diagnoses in a High Turnover Emergency County Hospital

Background and Objectives: The incidence and prevalence of cancers are increasing worldwide, with special emphasis placed on prevention, early detection, and the development of new therapeutic strategies that strongly impact patient outcomes. Limited data are available about emergency care’s role in treating patients with cancer. This study aims to determine the burden of end-stage and first-time diagnosis of cancer on emergency care in a high-turnover emergency care center. Materials and Methods: A retrospective observational study was conducted to identify patients requesting emergent aid for cancer-related symptoms in the Emergency Department of “St. Spiridon” Hospital from Iasi (Romania) between 1 October 2022 and 30 September 2023. The proportion and demographic characteristics of end-stage patients and those who received a first-time diagnosis during the emergency visit were evaluated. Risk analysis was performed to understand these patients’ care needs (such as medical care, surgical care, specialty consults, intensive care, ward admission, and other hospital transfers) and immediate care outcomes (such as in-hospital mortality and home discharge). Results: 2318 patients with cancer requested emergent care (patient presentation rate of 3.08%), of which 444 (19.15%) were diagnosed for the first time, and 616 (26.57%) were at the end-stage. First-time diagnosed patients had a significantly different distribution of cancer types (p < 0.001), were more likely to need any form of medical care, to require a specialty consultation, or to be admitted to a ward (OR 2.65, 95% CI: 2.12–3.32; p < 0.001; OR 3.28, 95% CI: 2.48–4.35, p < 0.001; OR 2.09, 95% CI: 1.70–2.59; p < 0.001, respectively) but were less severe, while end-stage patients were more likely to address repeatedly to the emergency room (OR 1.86, 95% CI: 1.32–2.59; p = 0.001) and had higher odds of needing intensive care, assisted ventilation and death (OR-4.63, 95% CI: 1.10–19.45, p = 0.04; OR 2.59, 95% CI: 1.57–4.28; p < 0.001, and OR 4.06, 95% CI: 1.73–9.54; p = 0.001, respectively). Conclusions: The emergency department often carries the weight of diagnosing patients with cancer and treating patients with end-stage disease. These data highlight the importance of prehospital care, particularly for cancer screening and palliative care, and the importance of fostering multidisciplinary collaboration in the emergency room with oncologists, geriatricians, and palliative care specialists to improve patient outcomes.

Resonance+: Operationalizing Protective Action Decision Model for Finding Information Useful for Public Information Officers

Microblogging platforms have been increasingly used by the public in crisis situations, enabling more participatory crisis communication between the official response channels and the affected community. However, the sheer volume of crisis-related messages on social media can make it challenging for officials to find pertinent information and understand the public’s perception of evolving risks. To address this issue, crisis informatics researchers have proposed a variety of technological solutions, but there has been limited examination of the cognitive and perceptual processes and subsequent responses of the affected population. Yet, this information is critical for the crisis response officials to gauge public’s understanding of the event, their perception of event-related risk, and perception of incident response and recovery efforts, in turn enabling the officials to craft crisis communication messaging more effectively. Taking cues from the Protective Action Decision Model, we conceptualize a metric —resonance+ — that prioritizes the cognitive and perceptual processes of the affected population, quantifying shifts in collective attention and information exposure for each tweet. Based on resonance+, we develop a principled, scalable pipeline that recommends content relating to people’s cognitive and perceptual processes. Our results suggest that resonance+ is generalizable across different types of natural hazards. We have also demonstrated its applicability for near-real time scenarios. According to the feedback from the target users, the local public information officers (PIOs) in emergency management, the messages recommended by our pipeline are useful in their tasks of understanding public perception and finding hopeful narratives, potentially leading to more effective crisis communications.

Exploring Emergency Decision-Making: A Bibliometric Review of Existing Literature

In recent years, we have witnessed an increase in emergency and catastrophic events. It is now crucial for professionals involved in emergency management to stay updated on issues and statistics related to decision-making in emergency situations. Emergency Decision-Making (EDM) has emerged as a strategic field of study, guiding the training and education of those responsible for managing and responding to emergencies, making it a critical area for national security. This original work advances the study of EDM by offering key insights into research trends over the years, the geographical distribution of scientific output, the methodologies employed, yearly statistics, and the spread of key terms and the most-explored topics. The main findings of this study on EDM literature from 1977 to 2023 highlight the dominant role of China and the USA in scientific productivity in the field. Moreover, a significant absolute increase in scientific productivity has been observed from 2020 to the present.

Characterization and Modelling of Potential Seaborne Disasters, in the ANA Region

Shipping activities continue to experience growth across a multitude of industrial sectors within the Arctic, hence there are risks in terms of severity and likelihood of accidents. The Arctic region is inherently dangerous to transportation and human existence due to its extreme climate and environmental conditions, and hence the complexities associated with emergency situations within the maritime domain are amplified when operating within the Arctic and North-Atlantic (ANA). The definition and characterisation of potential seaborne disasters and catastrophic incidents in the ANA region are significant enablers in providing a set of critical and sustainable tools for Search and Rescue (SAR), Oil Spill Response (OSR), and emergency management practitioners. Therefore, in this paper we aim to identify and characterise high-priority potential seaborne disasters and catastrophic incidents in the ANA region such as cruise ship accidents, oil leaks, radiological leaks, and fishing boat groundings. These were compiled as an outcome of a set of workshops carried out as part of the ARCSAR, EU Horizon 2020 funded project , and from analysis of the literature. We also provide root cause analysis techniques, tools for strategic decision-making, and means of mitigation. We demonstrate how such tools can be used by applying some of them to a selective case study and drawing lessons learned from the application of root cause analysis, which can help emergency response organisations with preparedness work and hence more efficient response. In doing so, we provide a set of tools that can be used for strategic and operational learning. Such approaches can help standardise the definition and characterisation of potential seaborne disasters and catastrophic incidents in the ANA region in both prospective and retrospective analysis.

Implications of the fair processes for financing UHC report for development assistance: reflections and an application of the decision-making principles to PEPFAR.

The framework presented in the World Bank report Open and Inclusive: Fair processes for Financing Universal Health Coverage effectively connects proposed decision-making principles with practical examples that country governments can use to pursue greater fairness. In this commentary, we consider the suggestion that international development partners might use the report's criteria to examine their own processes. We consider what the report's primary Fair Process principles - equality, impartiality and consistency - imply for development partners. Specifically, we address two questions in turn: (i) how relevant the Fair Processes report is to development assistance for health; (ii) if it is deemed relevant, what practical implications does the report have for how aid works? We address the second question by briefly applying the framework to a particular global health initiative, namely the United States President's Emergency Plan for AIDS Relief (PEPFAR). Our analysis suggests that development partners' additional sets of accountabilities, particularly linked to funding sources, may pose more fundamental challenges to impartiality than to equality and consistency in decision-making processes. A question inviting further examination, then, is how development partners can redesign their processes to optimise impartiality given institutional constraints that bind them independently of the populations they purport to serve.

Application and advantage analysis of triangular gastric suspension technique in laparoscopic distal pancreatectomy.

Laparoscopic distal pancreatectomy is a safe and effective surgical method for treating benign and malignant tumors of the pancreatic body and tail. However, laparoscopic surgery requires good intraoperative exposure, and since the pancreas is obstructed by the stomach and duodenum, making surgical operations and the management of intraoperative emergencies challenging. Therefore, gastric traction is crucial in laparoscopic distal pancreatectomy. Common gastric suspension techniques include single and double gastric suspension. Here, we propose a new, simple, and effective gastric suspension method called the triangular gastric suspension. We retrospectively analyzed the clinical data of 62 patients who underwent laparoscopic distal pancreatectomy at the Hepatobiliary and Pancreatic Surgery Department, The Affiliated LiHuiLi Hospital of Ningbo University from February 2017 to March 2024. The patients were divided into two groups based on whether triangular gastric suspension with silk sutures was used during surgery: the suspension group (28 cases) and the control group (34 cases). We analyzed various perioperative indicators between the two groups both before and after propensity score matching (PSM). With or without PSM, there were no statistically significant differences between the two groups in terms of age, gender, body mass index, American Society of Anesthesiologists classification, surgical approach, tumor pathological type and tumor length. Meanwhile, there were no statistically significant differences between the two groups in terms of pancreatic stump anastomosis, intraoperative transfusion, intraoperative R0 rate, postoperative pancreatic fistula grade, postoperative severe hemorrhage, reoperation, and delayed gastric emptying rate. However, the differences in operative time, intraoperative blood loss, and total hospital stay were statistically significant, with the suspension group showing better outcomes. The triangular gastric suspension method provides significant advantages in reducing intraoperative blood loss and shortening operative time during laparoscopic distal pancreatectomy. It is a new, simple, and effective suspension method.

Case Report of Status Epilepticus in a Patient with Acute HAE

Introduction: Hereditary angioedema (HAE) is a genetic disorder associated with recurrent episodes of angioedema in the absence of urticaria and pruritus. Hereditary angioedema is inherited in an autosomal dominant pattern and results in a quantitative deficiency (HAE type I) or dysfunction (HAE type II) of the C1-esterase inhibitor (C1-INH) protein. A very rare third type of HAE which is associated with normal quantitative and functional levels of C1-INH (HAE-nl-C1-INH) has been described. Case Report: A 54-year-old female with past medical history significant for HAE-nl-C1-INH presented to the emergency department (ED) for an acute attack of HAE and seizures. The patient arrived postictal after experiencing a total of three witnessed seizures, each lasting approximately 30 seconds. After the initial seizure was witnessed in the ED, the patient received 4200 Units of recombinant C1-INH intravenously. The patient’s mental status did not return to baseline, and she experienced two additional seizures. She was given a dose of the kallikrein inhibitor, ecallantide, as well as standard dosing of lorazepam and levetiracetam. The patient returned to her baseline and had no subsequent seizures while in the ED. Inpatient work-up included continuous video electroencephalography monitoring and magnetic resonance imaging of the brain, both of which were normal. The remainder of the inpatient course wasuncomplicated, and the patient was discharged home neurologically intact. Conclusion: We present a case of status epilepticus in a patient with HAE-nl-C1-INH. The focus of emergent medical management of status epilepticus includes airway protection, respiratory support, and administration of abortive and prophylactic antiepileptic drugs. The emergency medicine physician should also consider and treat possible underlying etiologies. The treatment of an acute attack of HAE should focus on replacing C1-INH and preventing the formation and limiting the action of bradykinin.

Exploration of Teaching Practice and Reform of Emergency Management: Taking the Course of “Emergency Rescue and Disposal of Accidents” as an Example

In recent years, various types of accidents have occurred frequently, and the situation of emergency management has been grave. Major universities have launched emergency management-related majors, and the teaching quality needs to be enhanced. This paper conducts an exploration of the teaching practice and teaching reform of emergency management by taking the course “Accident Emergency Rescue and Disposal” as an example. Focusing on the training of professional talents in emergency rescue, this paper analyzes the problems existing in the teaching process of this core professional course based on teaching practice and puts forward corresponding suggestions for teaching reform.

Barriers to Evacuating: A Study on Administrative Burdens to Special Needs Shelters

Emergencies, such as extreme weather events, require residents to evacuate for their safety. Past research suggests that administrative burdens—compliance, learning, and psychological costs—can impact the likelihood of evacuations to shelters. These burdens disproportionately impact socially vulnerable populations and create social equity issues. Florida operates special needs shelters to provide safe environments and basic assistance to individuals needing higher levels of care and supervision and ensure that special medical needs are met during an evacuation. Using data from 23 county after-action reports from Hurricane Irma, this article examines administrative burdens faced by individuals evacuating to special needs shelters. Although residents faced all three types of administrative burdens, psychological costs were most common, especially among counties with high social vulnerability. Based on the results, recommendations are provided for public administrators and emergency managers to reduce these administrative burdens when evacuating to special needs shelters during future emergencies.

Response to critics of Open and Inclusive: Fair Processes for Financing Universal Health Coverage.

In response to our critics, we clarify and defend key ideas in the report Open and Inclusive: Fair Processes for Financing Universal Health Coverage. First, we argue that procedural fairness has greater value than Dan Hausman allows. Second, we argue that the Report aligns with John Kinuthia's view that a knowledgeable public and a capable civil society, alongside good facilitation, are important for effective public deliberation. Moreover, we agree with Kinuthia that the Report's framework for procedural fairness applies not merely within the health sector, but also to the wider budget process. Third, we argue that while Dheepa Rajan and Benjamin Rouffy-Ly are right that robust processes for equal participation are often central to a fair process, sometimes improvements in other aspects of procedural fairness, such as transparency, can take priority over strengthening participation. Fourth, while we welcome Sara Bennett and Maria Merritt's fascinating use of the Report's principles of procedural fairness to assess the US President's Emergency Plan for AIDS Relief, we argue that their application of the Report's principle of equality to development partners' decision-making requires further justification.

Urban flood risk assessment and evacuation planning: a bi-level optimization model for sustainable high-density coastal areas

ABSTRACT Flooding caused by extreme climate change is becoming increasingly severe, especially in high-density coastal areas worldwide. Although many studies have conducted risk assessments of urban floods, most have not formed a comprehensive evacuation plan considering population distribution and flood disaster risk. To further enhance urban flood planning and emergency management for coastal areas, this study uses Victoria Harbor in Hong Kong, a typical flood-prone region, as a research area. The study first conducts a flood exposure risk assessment and classifies different regions according to flood risk levels. Then, by combining evacuation ability with the changing flood disaster and road evacuation flows, a novel bi-level optimization model is proposed to allocate zones for the citizens day and night. With the upper level using a genetic algorithm to minimize the total system evacuation time and the lower level applying a user equilibrium model for evacuee allocation, this model forms an evacuation that considers the distribution of population hotspots and the impact of flood risks on the road network. The findings of the study show that functional urban areas with high pedestrian flow, tourist spots, commercial centres, and schools are exposed to higher flood risk. Besides, the evacuation simulation of the bi-level optimization model proposed in this study matches the zoning results of actual urban activities and can effectively achieve the goal of evacuating 480,000 people within 12–18 minutes. This study innovatively proposes an effective evacuation plan that can reference the government’s emergency evacuation planning work.

Tone deaf and a tin ear: political leaders and listening in disasters

ABSTRACT Research alludes to the inability of some politicians to listen to people affected by disasters, sometimes with disastrous consequences for those caught up in disasters and for politicians. This article suggests a new approach to engagement by politicians with disaster affected communities – that of listening. It draws on interviews with senior emergency managers in Australia, the United Kingdom, North America, Iceland and Norway, to explore their views about the need for politicians to listen in disasters. Examples are provided of instances in which the perceived inability of politicians to listen disaster survivors drew significant public attention. This article suggests a variety of ways in which politicians might effectively listen to those effected by disasters. The findings of this article have ramifications for politicians, their advisors and disaster affected communities.

Identification and Prioritization of Criteria Affecting the Location of Safe Assembly Points Using the Best-Worst Method

Introduction: Identifying secure gathering spots during emergencies is a crucial step in emergency management across multiple industries, particularly in oil, gas, and petrochemical fields. This study was designed to identify and rank the factors affecting the placement of safe assembly points for implementation in the country’s process industries. Materials and Methods: This descriptive-exploratory study was conducted at the National Petrochemical Company. During the initial phase, criteria affecting the selection of safe assembly points were determined by examining scientific literature, standards, guidelines, along with national and international directives. A Delphi study involving 15 experts in emergency management experts was subsequently conducted to finalize the criteria list . During the second phase, these criteria were prioritized and ranked through a multi-criteria decision-making method utilizing and the Best-Worst Method. Results: The Delphi study was completed after two rounds, revealing 10 internal and 7 external criteria, amounting to 17 criteria that affect the determination of safe assembly points during emergencies in processing industries. Within the internal criteria, accessibility was the highest rated (weight: 0.1948), vulnerability to incidents was second (weight: 0.1543), and travel time was third (weight: 0.1109). Among the external criteria, the distance from nearby hazardous centres was the highest (weight: 0.2181), the type of potential scenarios was second (weight: 0.2081), and nearby emergency facilities placed third (weight: 0.1462). Conclusion: In process industries, the placement of safe assembly points during emergencies must take into account factors like the distance from surrounding hazardous areas, the type of possible incidents, ease of access, vulnerability to incidents, nearby emergency services, and wind patterns to guarantee optimal personnel protection.

Treatment quality with and without an electronic cognitive aid for emergencies in anaesthesia (eGENA) : The DANGER pilot study part 2 in randomized controlled in-situ emergency simulations

The electronic cognitive aid for emergencies in anesthesia (eGENA) is an app that offers digital support in anesthesiological emergency situations as a cognitive aid tool via checklists for memory and making decisions. The eGENA was published by the German Society of Anesthesiology and has been implemented in the emergency management of the anesthesiological team of the clinic in Potsdam, Germany. The primary endpoint was to observe the influence of eGENA on the anesthesiological emergency management on the subjective feeling of assurance as well as on quality of treatment and, therefore, patient safety. All employees in the anesthesia department (nursing staff and physicians) took part in the initial implementation of eGENA. The implementation phase covered crew resource management (CRM) principles and eGENA use as well as 10case studies that were discussed with help from eGENA. Afterwards in arandomized controlled simulation study, realistic case studies were processed and evaluated. In this, 18cases were handled by 9groups with 4persons in each group. Treatment during these simulations was assessed using apredetermined 20-point evaluation form and 10resuscitation-related and 10case-related points were awarded. Significance tests were carried out using the Wilcoxon-test (significance levelp < 0.05) and two evaluations were completed by the attendees at the beginning and the end of the eGENA implementation process. Scenarios1 and2 showed comparable overall scores (14.9vs. 16.3points out of 20, not significant). Higher case-associated scores (7.6 vs.5.6out of 10, p = 0.03) and higher total scores were achieved with the help of eGENA (16.9 vs. 14.3 out of 20, p = 0.02). Resuscitation-associated scores did not differ significantly (9.3vs.8.8 of 10, p = 0.1). During eGENA use for cases the execution of the algorithm-based resuscitation measures was not delayed or accelerated. With eGENA, however, differential diagnoses were discussed significantly more frequently and expanded treatment and diagnostic measures were implemented. During simulation cases eGENA was mainly used by physicians. The initially very positive responses of the evaluations toned down over time. Planned eGENA use for self-study was less frequent (p = 0.006) and there was less approval of the quality of treatment by eGENA than in the first survey (p = 0.002). The cooperation between doctors and nurses in emergency treatment showed an improvement (p < 0.001). The questions about self-assessed safety in emergency treatment on ascale from 0to 10showed higher values in all categories at the second survey (except only circulatory emergencies and 'other' emergencies). The respondents were more likely to be involved in emergency treatment at the second time of the survey (p = 0.03) after a median of 20months. The sense of security and emergency involvement increased significantly over the observation period. The initial need to use eGENA in everyday life has diminished over time; however, these results cannot be causally associated with eGENA. The use of eGENA does not improve resuscitation efforts but does not delay them either. With the use of eGENA better case-associated results are achieved and advanced diagnostics and treatment are implemented more frequently in complex emergency situations. This increases the quality of treatment. Further studies should be carried out with alarger number of cases to confirm the shown effects.

COVID Lessons Learned: From Response to Recovery.

The COVID-19 pandemic had a profound impact on all school staff. As a consequence of their role as frontline responders, school nurses experienced significant trauma and moral injury. The Washington State School Nurse Corps debriefed the pandemic response to plan for future disasters. In the process, they discovered that much of the literature reflects the school nurse's role in the early phase of disaster response. There is little attention given to recovery processes and few current sources could be found on the role of nursing in debriefing. School nurses could benefit from and play an important role in supporting recovery, particularly debriefing, for their school communities.

Timely delivery of care in neurological emergencies: can standardized management protocols help?

To review the evidence that supports the implementation of goal-directed care bundle protocols to improve outcomes from neurocritical conditions, and of the possible advantage of specific over generalized protocols. Articles from January 1, 2023 to July 31, 2024 were searched to evaluate the effectiveness of standardized management in neurological emergencies. The use of care bundles and standardized protocols with time- and target-related metrics has shown benefit in patients with acute stroke and traumatic brain injury. A goal-directed care protocol to guide standard management implemented by a multidisciplinary team can improve outcomes from neurological emergencies. However, implementation challenges need to be addressed before wide adoption of protocolized care for maximum benefit to populations.