American Journal of Disaster Medicine

Evaluation of just-in-time trauma training for international surgical military preparedness at a US Civilian Level I Trauma Center: A proof of concept

Jane J. Keating — 2024-09-01

Background: Increasing global conflicts continue to heighten the need for increased focus on preparedness for military physicians and surgeons. Simulation has recently been adopted by civilian surgical trainees to offset the problem of increased work hour restrictions and shift the current focus toward minimally invasive techniques. We hypothesized that just-in-time trauma training, incorporating both focused clinical and simulated experience at our civilian Level I Trauma Center, would increase the competence and confidence of international military physicians in trauma care.

Methods: We performed a feasibility study of five Ukrainian physicians (four surgeons and one anesthesiologist) undergoing an intensive 2-week trauma course taught by 25 American clinicians. The training consisted of several previously validated courses including Advanced Trauma Life Support (ATLS^®), Advanced Surgical Skills for Exposure in Trauma (ASSET^®), Advanced Trauma Operative Management (ATOM^®), and Basic Endovascular Skills for Trauma (BEST^®), among several additional simulated and clinical experiences. Pre- and post-course surveys were analyzed using paired t-tests to assess improvement in trauma care.

Results: All five physicians had significant improvement in confidence following the completion of the course, including the management of injuries to the neck, chest, abdomen, and extremities. Additionally, each clinician significantly improved in their confidence to perform common ATLS procedures and resuscitative endovascular balloon occlusion of the aorta skills. Overall, the mean confidence over all survey responses improved significantly following the completion of the course, 2.28 (precourse confidence range 1.25-3.35) to 3.66 (post-course confidence range 2.95-4.22), p-value = 0.002. All five Ukrainian physicians successfully passed the corresponding post-tests and were certified as having completed ATLS, ATOM, ASSET, and BEST.

Conclusions: A military and civilian partnership in trauma preparedness is feasible to improve surgeon confidence in trauma care.

Impact of Hurricane Maria on the mortality of patients admitted to the MICU at the VA Caribbean Healthcare System in Puerto Rico

Alba Rivera-Diaz — 2024-09-01

Objective: This study aims to assess the impact of Hurricane Maria on mortality rates and patient conditions in the Medical Intensive Care Unit (MICU) at the Veterans Affairs Caribbean Healthcare Hospital in San Juan, Puerto Rico (PR). The focus is on the 2 months before and after the hurricane’s landfall.

Design: This is a retrospective, transversal study.

Setting: The intensive care unit at the Veteran Affairs Caribbean Healthcare System in San Juan, PR.

Participants: A total of 202 patients, sampled using a time-defined method, aged 21-90 years, were admitted to the MICU between July 16, 2017, and November 16, 2017.

Main outcome measure(s): The primary measure is the mortality rate of MICU patients during the specified period. Secondary measures include the severity of patient conditions and changes in the causes of death, particularly cardiovascular deaths.

Results: The overall mortality rate in the MICU did not significantly change following Hurricane Maria. However, there was an increase in cardiovascular-related deaths. In addition, patient conditions showed higher severity post-hurricane, as indicated by Apache II scores, along with prolonged hospital stays and altered admission patterns for specific conditions.

Conclusions: While Hurricane Maria did not significantly alter overall mortality rates in the MICU, the increase in cardiovascular deaths and more severe post-hurricane patient conditions underscore the need for enhanced disaster preparedness and response strategies in critical care settings.

Preparation to provide healthcare in disasters in public hospitals in the district of Lima, Peru

Roxana Obando Zegarra — 2024-09-01

Objective: To assess the safety and degree of preparation of public hospitals in the district of Lima to provide healthcare in the event of disaster by studying their structural and nonstructural safety and their compliance with the established standards for the organization of the hospital’s Emergency Operations Centers (EOCs).

Design: A cross-sectional observational study of 20 out of the 38 public hospitals in the district of Lima was conducted. The hospitals were selected based on the criteria of being state-run, having complete information on open access safety indicators, and belonging to Categories II and III according to the Peruvian Ministry of Health classification, equivalent to the usual secondary and tertiary levels of specialization hospitals. A multivariate regression analysis was performed to study the determining elements of vulnerability.

Results: Only with the existence of a formally established EOC emergency committee and up-to-date and available telephone directory does the average compliance reach 65 percent among all government hospitals. Only in four of the criteria did the hospitals achieve 50 percent good compliance, indicating that they have a plan, have trained the responsible personnel, and have the necessary resources to implement them. Fifty percent of hospitals in the district of Lima do not have a plan for psychosocial care for patients, family members, and health personnel in the event of a disaster; and that only 55 percent have a plan, trained personnel, and resources available for attention in the case of a disaster. In the multivariant analysis of the vulnerability determinants, the statistically significant (p < 0.05) elements were the year in which the emergency plan was drawn up and the year in which the hospital was built.

Conclusions: Public hospitals in Lima have varying levels of hospital security and vulnerability. Several of them do not have adequate capacity and security to provide medical care to patients and protect health personnel in the event of a disaster. Security is compromised by several factors, with the main significant (p < 0.05) determinants of vulnerability being the year the hospitals were built and the time since the hospitals’ emergency plan was drawn up. Emergency plans will need to be updated, and the dimensions that are most deficient in them corrected.

The successful implementation of Stop the Bleed® in Guatemala

Juan P. Cóbar — 2024-09-01

Objective: This project aimed to successfully implement the Stop the Bleed^® (STB) program in Guatemala by targeting key providers in various communities across the country.

Setting: The course was conducted in rural community centers, fire stations, tertiary care centers, and medical school facilities.

Participants: We included agricultural occupational health workers, firefighters, medical providers, and medical students throughout the course.

Results: We successfully trained 247 people in Guatemala in STB and certified 13 instructors and four associate instructors. Through pre- and post-course surveying, we determined that the course improved the participants’ comfort level in managing bleeding emergencies.

Conclusions: Creating partnerships with key providers at different community levels leads to the successful implementation of public health initiatives. Further research should be geared at determining the course’s dissemination by new instructors.

Health systems’ resilience during the COVID-19 pandemic: A South African polio surveillance case study

Juliet Charity Yauka Nyasulu — 2024-09-01

Background: More needs to be known on how the South African health system contained the coronavirus disease 2019 (COVID-19) pandemic and maintained the core business of health service delivery. We describe the practices that have shown to affect the health systems’ resilience in ensuring maintenance of polio surveillance and immunization systems in South Africa (SA) during the COVID-19 pandemic.

Methodology: This is a descriptive, reflective desk review study using the South African polio surveillance systems and immunization coverage as a case study. We applied a health systems’ resilience framework to highlight how the South African health system contained the pandemic and maintained its core business. Routine immunization and polio surveillance data were obtained and analyzed.

Results: The effect of SA’s immunization campaigns, which contributed positively to maintaining the polio immunization coverage during the COVID-19 pandemic, is highlighted, with varied performances among provinces. We established delayed integration of pandemic services and missing public health emergency response structures, which led to redeployment of service providers compromising on the health systems’ core business.

Conclusion: Immunization campaigns are key in maintaining coverage, with individualized approaches in supporting the provinces. The existing health systems’ structures of countries are a critical determinant of response to pandemics regardless of the available resources. Therefore, to ensure that the health systems maintain a balance between containing pandemics like COVID-19 and maintaining its core business, we recommend the establishment of a public health structure from the national to the community level to respond to public health emergencies and the early integration of pandemic services into the day-to-day health systems’ business.

Human well-being and animal welfare: Is there an ethical link to be implemented from the COVID-19 pandemic into the practice of emergency management?

Asante Msimang — 2024-09-01

Through the definition of risk management and its interpretation in multidimensional protection of humans and animals in emergencies and during disasters, in this article, the authors focus on the ethical links between human well-being and animal welfare in emergency and disaster risk management. Coronavirus disease 2019 and its impact on animal welfare are used to consistently demonstrate the link between human well-being and animal welfare. Examples of international legal and ethical norms are provided to demonstrate the need for protecting humans and animals in emergencies and disasters, such as the proposed Universal Declaration of Animal Welfare. The proposed link is ultimately an expression of duty of care required for emergency and disaster risk managers.

Disparities in disaster healthcare: A review through a pandemic lens

Angela Pettit Cornelius — 2024-09-01

Objective: To provide an overview of the literature on the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare disparities in various groups, in relation to social determinants of health (SDOH) and longstanding social disparities.

Design: The Disaster Preparedness and Response Committee of the American College of Emergency Physicians (ACEP) addressed the impact of health disparities in disaster planning and response. A workgroup composed of seven physicians with academic and deployment disaster medicine experience was formed. A literature review focusing on healthcare disparities during the COVID-19 pandemic was conducted. Search strategies included medical sources such as PubMed, Medline, and Google Scholar and nonmedical publications focused on COVID-19. The group combined the literature found and identified general themes. A framework using recognized SDOH was applied to organize the material and allow for ease of reporting. We also noted the unmet burden and challenges that underserved communities struggled with prior to the pandemic onset. The workgroups’ report was presented to the ACEP Board of Directors.

Results: COVID-19 significantly impacted groups burdened with poor SDOH to a much greater degree than the general population. Many healthcare disparities that existed prior to COVID-19 were worsened during the pandemic. Little information exists about how these inequities are being addressed.

Conclusions: COVID-19 magnified and more fully exposed healthcare disparities. These disparities, although common, can be partially mitigated. Efforts are needed to better understand healthcare disparities brought about by the COVID-19 pandemic and to find solutions to address future pandemics across all four phases of a disaster.

Flood inundation and isolation differentially impact access to dialysis care

Jennifer A. Horney — 2024-09-01

Objective: To assess the impacts of flooding on access to dialysis care and compare current and future risk from flood inundation and isolation.

Design: A cross-sectional study. Maps were generated in ArcGIS using the 100-year flood plain, transportation networks, and dialysis center locations, showing spatial flood risks for dialysis center locations in the State of Delaware.

Main outcome measure: Number of roads, intersections, and dialysis centers closed due to flood inundation or isolation and population expected to be impacted.

Results: Six dialysis facilities would be flooded in a flooding event, and three additional facilities would be isolated. The spatial distribution of dialysis care access is inequitable across the state and among socially vulnerable groups.

Conclusions: Mapping the impact of flooding on access to dialysis center care in Delaware is important for identifying geographic areas and socially vulnerable populations at high risk for dialysis service disruptions in flooding events.

Volume 19, Number 3

American Journal of Disaster Medicine — 2024-09-01