American Journal of Disaster Medicine 2024-04-03T18:34:55-04:00 Richard A. DeVito, Jr. Open Journal Systems <p><em><strong>American Journal of Disaster Medicine</strong> </em>deals with all aspects of mass casualty medicine and its public health implications.</p><p>With the publication of the <em><strong>American Journal of Disaster Medicine</strong></em>, for the first time, comes real guidance in this important medical specialty, from the foremost experts in mass casualty medicine; including a deadly cocktail of catastrophic events like blast wounds and post explosion injuries, biological weapons contamination and mass physical and psychological trauma that comes in the wake of natural and man-made disasters as well as disease outbreak.</p><p>The journal has one goal: to provide physicians and medical professionals the latest research and essential informational tools they need as they seek to manage the complexities of emergency medical and trauma skills with crisis management in a mass casualty environment.</p><p>Peer reviewed and designed to meet the formidable medical challenges in a post 9/11, post Katrina world, the <strong><em>American Journal of Disaster Medicine</em></strong> addresses all aspects of this important discipline and does so under the watchful eye of a internationally recognized editorial review board led by <strong>Editor-in-Chief Susan M.Briggs, MD, MPH</strong>, Director, International Trauma and Disaster Institute, Massachusetts General Hospital, Boston, MA and Associate Professor of Surgery, Harvard Medical School. Under the guidance of Dr. Briggs, who is also the Supervising Medical Officer, International Medical Surgical Response Teams, National Disaster Medical System, the journal will be interdisciplinary and have a national and international focus in view of the global threats of today's complex disasters.</p><p>Each issue of the <strong><em>American Journal of Disaster Medicine</em></strong> will offer physicians and medical professionals, an academic forum on topics as wide ranging as these:</p><ul><li>Medical preparation for mass gathering events</li><li>Triage in disaster medicine both extra hospital and in hospital</li><li>Toxicological disaster</li><li>Ethics in disaster medicine</li><li>Confined space and medical training</li><li>Military triage translating to civilian disasters</li><li>Medical response to collapsed structures</li><li>Traumatic amputations</li><li>Open brain injuries</li><li>Effectively treating large numbers of injured people</li><li>Evaluating patients for exposure to various chemical, biological and radioactive agents</li><li>indexed in PubMed/Medline</li><li>peer-reviewed</li><li>disaster and emergency medicine</li><li>interdisciplinary</li><li>natural disasters</li><li>disease outbreak</li><li>biological weapons contamination</li><li>psychological trauma</li><li>pandemic flu</li><li>military triage</li></ul><p><em><strong>Subscribe Today!</strong></em></p> A faculty-led resident strike team as a force expander during disaster 2024-04-03T18:34:55-04:00 Angela P. Cornelius Axel Rodrigues-Rosa <p><em>The emergence of the coronavirus disease 2019 (COVID-19) pandemic produced an unprecedented strain on the United States medical system. Prior to the pandemic, there was an estimated 20,000 physician shortage. This has been further stressed by physicians falling ill and the increased acuity of the COVID-19 patients. Federal medical team availability was stretched to its capabilities with the large numbers of deployments.</em></p> <p><em>With such severe staffing shortages, creative ways of force expansion were undertaken. New Orleans, Louisiana, was one of the hardest hit areas early in the pandemic. As the case counts built, a call was put out for help. The Louisiana State University (LSU) system responded with a faculty-led resident strike team out of the LSU Health Shreveport Academic Medical Center. </em></p> <p><em>Residents and faculty alike volunteered, forming a multispecialty, attending-led medical strike team of approximately 10 physicians. Administrative aspects such as institution-specific credentialing, malpractice coverage, resident distribution, attending physician oversight, among other aspects were addressed, managed, and agreed upon between the LSU Health Shreveport and the New Orleans hospital institutions and leadership prior to deployment in April 2020.</em></p> <p><em>In New Orleans, the residents managed patients within the departments of emergency medicine, medical floor, and intensive care unit (ICU). The residents assigned to the medical floor became a new hospitalist service team. The diversity of specialties allowed the team to address patient care in a multidisciplinary manner, leading to comprehensive patient care plans and unhindered team dynamic and workflow. During the first week alone, the team admitted and cared for over 100 patients combined from the medical floor and ICU.</em></p> <p><em>In a disaster situation compounded by staff shortages, a resident strike team is a beneficial solution for force expansion. This article qualitatively reviews the first published incidence of a faculty-led multispecialty resident strike team being used as a force expander in a disaster.</em></p> <p><em>&nbsp;</em></p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine Perceptions regarding second wave of coronavirus disease 2019 (COVID-19) pandemic among Indian adults: A cross-sectional study 2024-04-03T18:34:51-04:00 Priyanka Sharma Anita Khokhar Shubham Mittal <p><em>Background and aims: A massive surge in coronavirus disease 2019 (COVID-19) cases and deaths occurred in India during March–April 2021, and this was considered as second wave of the pandemic in the country. This study was conducted to find out the perceptions about second wave of the COVID-19 pandemic among Indian adults.</em></p> <p><em>Methods: An online-survey-based cross-sectional study was conducted over 3 weeks from April 21, 2021</em></p> <p><em>to May 11, 2021. Information regarding sociodemographic profile, perceptions about COVID-19 during second wave, perceptions and practices related to COVID-19 vaccination, COVID-19 appropriate behavior, and government’s response to the pandemic was collected. Descriptive analysis was performed.</em></p> <p><em>Results: A total of 408 study participants were included. Mean age of the study participants was 29.2 ± 10.4 years. Around 92.6 percent (378) of respondents agreed that COVID-19 in 2021 is different from 2020. Perceived reasons for increased severity and cases were change in virus characteristics; social, religious, and political gatherings; and complacent behavior by people. Three-fourth (311, 76.2 percent) of the study participants agreed that vaccines have a positive role against COVID-19. Majority of the study participants (329, 80.6 percent) concurred that lockdown restrictions help in control of the pandemic. About 60.3 percent (246) of respondents had less trust on government post this pandemic compared to pre-COVID-19 times.</em></p> <p><em>Conclusion: The public perception about reasons for second wave in India acknowledges both human and virus factors and highlights the importance of shared responsibility between citizens and government for controlling the pandemic.</em></p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine Managing CBRN mass casualty incidents at hospitals—Find a simple solution for a complex problem: A pilot study 2024-04-03T18:34:50-04:00 Maximilian Kippnich Nora Schorscher Helmut Sattler Uwe Kippnich Patrick Meybohm Thomas Wurmb <p><em>Objective: Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management.</em></p> <p><em>Methods: The entire decontamination area can be deployed 24</em>/<em>7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants.</em></p> <p><em>Results: The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F).</em></p> <p><em>Conclusion: The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.</em></p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine A distinct immune cytokine profile is associated with morning cortisol and repeated stress 2024-04-03T18:34:46-04:00 Rebecca Ryznar Anthony LaPorta Spencer Cooper Nicholas Maher Christian Clodfelder Jeffrey Edwards Francina Towne K. Dean Gubler <p><em>Objective: The objective of this study was to investigate possible immune cytokine trends throughout a week-long surgical simulation mass-casualty training session in order to determine the effects of stress inoculation on the immune system.</em></p> <p><em>Methods: Thirty-seven military medical students participated in a hyper-realistic surgical simulation training event conducted at Strategic Operations site in San Diego, California. Salivary samples were collected every morning of the stress training exercise for 4 consecutive days. Cortisol, along with a panel of 42 immune cytokines, was measured using multiplex enzyme-linked immunosorbent assays from Eve Technologies. The determined concentrations were averaged and plotted on a scatter plot, and then points were fit to a second-order polynomial trendline of best fit to measure.</em></p> <p><em>Results: The cytokines epidermal growth factor, growth-related oncogene-</em>α<em>, interleukin (IL)-1</em>α<em>, and platelet-derived growth factor-AA followed a noted pattern of cortisol decrease throughout the week. In addition, cytokines IL-27, granulocyte colony stimulating factor, IL-10, and IL-13 demonstrated a late peak, followed by a return to baseline at the conclusion of training. Finally, the cytokine monocyte chemoattractant protein-1 displayed a decline throughout the week followed by an increase on the last day of stress training.</em></p> <p><em>Conclusions: Altogether, these results help to identify important biomarkers that may help to improve long-term stress adaptation and prevent post-traumatic stress disorder following exposure to repeated stress.</em></p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine Advanced Surgical Skills for Exposure in Trauma (ASSET) course improves military surgeon confidence 2024-04-03T18:34:44-04:00 Rebecca A. Saberi Graham B. Parker Noreen Mohsin Gareth P. Gilna Alessia C. Cioci Eva M. Urrechaga Mark D. Buzzelli Carl I. Schulman Kenneth G. Proctor George D. Garcia <p><em>Objective: Active duty military surgeons often have limited trauma surgery experience prior to deployment. Consequently, military-civilian training programs have been developed at high-volume trauma centers to evaluate and maintain proficiencies. Advanced Surgical Skills for Exposure in Trauma (ASSET) was incorporated into the predeployment curriculum at the Army Trauma Training Detachment in 2011. This is the first study to assess whether military surgeons demonstrated improved knowledge and increased confidence after taking ASSET.</em></p> <p><em>Design: Retrospective cohort study.</em></p> <p><em>Setting: Quaternary care hospital.</em></p> <p><em>Patients and participants: Attending military surgeons who completed ASSET between July 2011 and October 2020.</em></p> <p><em>Main outcome measure(s): Pre- and post-course self-reported comfort level with procedures was converted from a five-point Likert scale to a percentage and compared using paired t-tests.</em></p> <p><em>Results: In 188 military surgeons, the median</em></p> <p><em>time in practice was 3 (1-8) years, with specialties in general surgery (52 percent), orthopedic surgery (29 percent), trauma (7 percent), and other disciplines (12 percent). The completed self-evaluation response rate was 80 percent (n = 151). The self-reported comfort level for all body regions improved following course completion (p &lt; 0.001): chest (27 percent), neck (23 percent), upper extremity (22 percent), lower extremity (21 percent), and abdomen</em>/<em>pelvis (19 percent). The overall score on the competency test improved after completion of ASSET, with averages increasing from 62 ± 18 percent pretest to 71 ± 13 percent post-test (p &lt; 0.001).</em></p> <p><em>Conclusions: After taking the ASSET course, military surgeons demonstrated improved knowledge and increased confidence in the operative skills taught in the course. The ASSET course may provide sustainment of knowledge and confidence if used at regular intervals to maintain trauma skills and deployment readiness.</em></p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine Pediatric disaster preparedness curriculum across emergency medicine residencies 2024-04-03T18:34:41-04:00 Lea Ohana-Sarna Cahan Alexander Hart Attila J. Hertelendy Amalia Voskanyan Debra L. Weiner Gregory R. Ciottone <p><em>Objective: To assess pediatric disaster medicine (PDM) instruction in emergency medicine (EM) residency programs and to identify barriers to integrating these skills into EM training.</em></p> <p><em>Methods: National survey study of United States EM Residency Program Directors (PDs) and Assistant PDs during the 2021-2022 academic year.</em></p> <p><em>Results: Of the 186 EM residency programs identified, a total of 24 responses were recorded with a response rate of 12.9 percent. Importance of training was rated 5.79 (standard deviation 2.51) using the Likert scale ranging from 1 to 10. Out of 24 programs, 17 (70.8 percent) do not have any PDM training as part of residency training. Live drill, simulation, and tabletop were identified as most effective methods to deliver PDM training with the Likert scale score of 4.78, 4.6, and 4.47, respectively. Senior trainees’ level of knowledge</em>/ <em>skills with family reunification (Likert 2.09</em>/<em>5; chemical-biologicalradiological-nuclear explosive 2.95</em>/<em>5) and mass casualty preparation of the emergency department (3.3</em>/<em>5) as assessed by the respondents. The main barrier to education included logistics, eg, space and costs (Likert 3.7</em>/<em>5), lack of didactic time (3.7</em>/<em>5), and limited faculty knowledge, skill, or experience (3.3</em>/<em>5).</em></p> <p><em>Conclusion: PDM training is lacking and requires standardization. This study highlights the opportunity for the creation of a model for EM resident education in PDM.</em></p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine Perceived stress, burnout, and resilience among healthcare workers in a multiple disaster-impacted setting during the COVID-19 pandemic 2024-04-03T18:34:40-04:00 Bushra Syed Imtiyaz Mushtaq Ahmad Margoob Fazle Roub Mehwish Imtiaz <p><em>Objective: Current literature on coronavirus disease 2019 (COVID-19) research presents gaps and opportunities to investigate the psychological experiences of healthcare workers (HCWs) serving in mass trauma situations. We aimed to measure perceived stress, burnout, and resilience in Kashmiri HCWs and explore the relationship of burnout with sociodemographic, work-related, and pandemic-related factors.</em></p> <p><em>Design, setting, and participants: This was a cross-sectional descriptive study. Data were collected by circulating a web-based questionnaire among HCWs across primary, secondary, and tertiary healthcare levels in Kashmir, India. The questionnaire consisted of sections on personal, work-related, and pandemic-related variables as well as validated instruments to measure perceived stress, burnout, and resilience.</em></p> <p><em>Results: A total of 514 valid responses were received. More than 80 percent of HCWs had moderate to high perceived stress. The prevalence of personal, work-related, and client-related burnouts was 68, 48.6, and 46 percent, respectively. Resilience was negatively correlated with stress and burnout. Younger (18-28 years), unmarried HCWs, especially junior residents and nurses, had higher burnout levels. Redeployment to deliver COVID-19 duties, unpredictability in work schedule, tested positive for COVID-19, and spending time in isolation</em>/<em>quarantine were also found to be significant risk factors for developing burnout.</em></p> <p><em>Conclusions: Nearly half of the HCWs suffered from burnout, and more than half had moderate to high perceived stress. In addition to pre-existing risk factors of burnout, the pandemic seems to have introduced more occupational risk factors in this disaster-affected area. Lessons learnt from COVID-19 pandemic may help guide need-based intervention strategies designed for specific target population rather than a one size fits all approach.</em></p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine Protection enhancement strategies of potential outbreaks during Hajj 2024-04-03T18:34:36-04:00 Abdulaiziz Mustafa Kheimi Jean B. Bail Steven J. Parrillo <p><em>Objective: This study aimed to assist governments and organizers of mass gathering events in reviewing existing preventive measures for disease outbreaks to inform the adoption of enhanced strategies for risk reduction and impacts on public health. </em></p> <p><em>Design: A cross-sectional, quantitative, descriptive study.</em></p> <p><em>Setting: This study was conducted in a mass gathering of Hajj, an annual religious event in Mecca, Saudi Arabia.</em></p> <p><em>Participants: A convenience sample of 70 personnel working in government ministries of Saudi Arabia (Ministry of Health, Ministry of Hajj, and Ministry of Interior) and the Saudi Red Crescent Authority involved in health management in Hajj, including policy formulation and implementation. </em></p> <p><em>Main outcome measures: Perception and knowledge of health risks and outbreaks associated with Hajj.</em></p> <p><em>Results: The majority of the respondents (60 percent) expressed concern about the potential for infection transmission during Hajj. The respondents also reported having or knowing a colleague, a friend, or a family member with a history of infection during or after Hajj. However, the respondents’ knowledge of the possible modes of infection of various diseases was limited.</em></p> <p><em>Conclusions: Hajj is associated with various risks of outbreaks, and thus, better protection-enhancing measures are required. Training personnel involved in health management, including planners, coordinators, and healthcare providers, can help reduce the risks and prevent potential outbreaks.</em></p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine Volume 19, Number 1 2024-03-22T10:10:54-04:00 American Journal of Disaster Medicine <p>-</p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine Agile response to critical need for clinical trial accessibility during the first COVID-19 pandemic wave 2024-04-03T18:34:34-04:00 Stephanie Smith Frederick Millham <p><em>This article discusses some of the major challenges that the clinical research community faced during the early days of the coronavirus disease 2019 pandemic. A model is offered that may assist other institutions while planning for future pandemics or disasters.</em></p> <p><em>&nbsp;</em></p> <p><em>&nbsp;</em></p> 2024-02-01T00:00:00-05:00 Copyright (c) 2024 American Journal of Disaster Medicine