American Journal of Disaster Medicine

Improve disaster response by planning for and logistically supporting acute exacerbations of chronic diseases

Michael D. Owens — 2024-04-01

Provide a more effective medical response by emphasizing the management of acute exacerbations of chronic diseases in disasters. Disaster victims need treatment for their acute exacerbations of and ongoing chronic medical conditions, medication refills, mental health resources, and have an expectation that medical facilities will provide resources beyond medical care. Medical response is more efficient, cost effective, and effectual when these considerations are supported.

Volume 19, Number 2

American Journal of Disaster Medicine — 2024-04-01

Disaster healthcare disparities solutions: Part 1—Preparation

Angela Pettit Cornelius — 2024-04-01

The purpose of this study was to explore the potential solutions for disaster healthcare disparities. This paper is the first of a three-part series that was written by the Disaster Healthcare Disparities Workgroup of the American College of Emergency Physicians Disaster Preparedness and Response Committee. The committee workgroup conducted a literature review and chose articles most representative and demonstrative of solutions to disaster healthcare disparities found in a past workgroup product exploring disaster healthcare disparities seen in disaster. Many solutions for disaster healthcare disparities during preparation were found. Some of these solutions have been successfully implemented, while others are still theoretical. Solutions for disaster healthcare disparities seen in disaster preparation are achievable, but there is still much work to do. There are a variety of solutions that can be easily advocated for by disaster and nondisaster specialists, leading to better care for our patients.

Disaster healthcare disparities solutions: Part 2—Response

Angela Pettit Cornelius — 2024-04-01

The purpose of this study was to explore the potential solutions for disaster healthcare disparities. This paper is the second of a three-part series that was written by the Disaster Healthcare Disparities Workgroup of the American College of Emergency Physicians Disaster Preparedness and Response Committee. The committee conducted a literature review and chose articles most representative and demonstrative of solutions to disaster healthcare disparities found in a past workgroup product. Many solutions for disaster healthcare disparities during disaster response were found. Some of these solutions have been successfully implemented and some are hypothetical. Solutions for disaster healthcare disparities seen during response are achievable but there is still much work to do. A variety of the proposed solutions can be advocated for by nondisaster specialists leading to better care for all our patients.

Disaster healthcare disparities solutions: Part 3—Recovery and mitigation

Angela Pettit Cornelius — 2024-04-01

The purpose of this study was to explore the potential solutions for disaster healthcare disparities. This paper is the third of a three-part series that was written by the Disaster Healthcare Disparities Workgroup of the American College of Emergency Physicians Disaster Preparedness and Response Committee. The committee conducted a literature review and chose articles most representative and demonstrative of solutions to disaster healthcare disparities found in a past workgroup product. Many solutions for disaster healthcare disparities seen during recovery and mitigation were found. Some of these solutions have been successfully implemented and some remain theoretical. Solutions for disaster healthcare disparities seen during recovery and mitigation are achievable but there is still much work to do. Many of these solutions can be advocated for by nondisaster specialists.

Surgical capacity is disaster preparedness: A scoping review of how surgery and anesthesiology departments responded to COVID-19

Matthew T. Hey — 2024-04-01

Objective: This study evaluated how surgical and anesthesiology departments adapted their resources in response to the coronavirus disease 2019 (COVID-19) pandemic.

Design: This scoping review used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol, with Covidence as a screening tool. An initial search of PubMed, Embase, Web of Science, Global Index Medicus, and Cochrane Systematic Reviews returned 6,131 results in October 2021. After exclusion of duplicates and abstract screening, 415 articles were included. After full-text screening, 108 articles remained.

Results: Most commonly, studies were retrospective in nature (47.22 percent), with data from a single institution (60.19 percent). Nearly all studies occurred in high-income countries (HICs), 78.70 percent, with no articles from low-income countries. The reported responses to the COVID-19 pandemic involving surgical departments were grouped into seven categories, with multiple responses reported in some articles for a total of 192 responses. The most frequently reported responses were changes to surgical department staffing (29.17 percent) and task-shifting or task-sharing of personnel (25.52 percent).

Conclusion: Our review reflects the mechanisms by which hospital surgical systems responded to the initial stress of the COVID-19 pandemic and reinforced the many changes to hospital policy that occurred in the pandemic. Healthcare systems with robust surgical systems were better able to cope with the initial stress of the COVID-19 pandemic. The well-resourced health systems of HICs reported rapid and dynamic changes by providers to assist in and ultimately improve the care of patients during the pandemic. Surgical system strengthening will allow health systems to be more resilient and prepared for the next disaster.

Stop the Bleed® in medical schools: Early advocacy and promising results

Jeremy Fridling — 2024-04-01

Objective: We hypothesized that medical students would be empowered by hemorrhage-control training and would support efforts to include Stop the Bleed^® (STB) in medical education.

Design: This is a multi-institution survey study. Surveys were administered immediately following and 6 months after the course.

Setting: This study took place at the Association of American Medical Colleges-accredited medical schools in the United States.

Participants: Participants were first-year medical students at participating institutions. A total of 442 students completed post-course surveys, and 213 students (48.2 percent) also completed 6-month follow-up surveys.

Intervention: An 1-hour, in-person STB course.

Main outcomes measures: Student empowerment was measured by Likert-scale scoring, 1 (Strongly Disagree) to 5 (Strongly Agree). The usage of hemorrhage- control skills was also measured.

Results: A total of 419 students (95.9 percent) affirmed that the course taught the basics of bleeding control, and 169 (79.3 percent) responded positively at follow-up, with a significant decrease in Likert response (4.65, 3.87, p < 0.001). Four hundred and twenty-three students (97.0 percent) affirmed that they would apply bleeding control skills to a patient, and 192 (90.1 percent) responded positively at follow-up (4.61, 4.19, p < 0.001). Three hundred and sixty-one students (82.8 percent) believed that they were able to save a life, and 109 (51.2 percent) responded positively at follow-up (4.14, 3.56, p < 0.001). Four hundred and twenty-five students (97.0 percent) would recommend the course to another medical student, and 196 (92.0 percent) responded positively at follow-up (4.68, 4.31, p < 0.001). Six students (2.8 percent) used skills on live patients, with success in five of the six instances.

Conclusions: Medical students were empowered by STB and have used hemorrhage-control skills on live victims. Medical students support efforts to include STB in medical education.

Terrorist attacks against healthcare facilities involving hostages

Reed Macy — 2024-04-01

Introduction: The incidence of terrorist attacks against healthcare facilities has been increasing over recent years. In addition to direct attacks on physical structures, many attacks have involved taking hostages. Hospital and healthcare facilities remain historically underprepared for terrorist attacks, representing vulnerable locations. Yet, studies examining the frequency and reach of hostage-taking incidents within healthcare facilities are limited.

Methods: A search of the Global Terrorism Database was performed. A total of 191,465 terrorist attacks were identified. The database search was narrowed down to healthcare-related terrorist attacks (2,322) and then manually analyzed to only include those incidents which involved hospitals and hostage-taking (64).

Results: Sixty-four attacks against hospitals involving hostage-taking were identified. A total of 91 victims were injured in these attacks, and 47 were killed. The attacks affected a total of 23 countries worldwide, conducted largely by unidentified terrorist organizations, with approximately half involving firearms. Discussion: This study shows that terrorist attacks against healthcare facilities that involve hostage-taking have increased in frequency over the past 10 years and have global reach. Systems may still be underprepared for this potentially increasing phenomenon and require preparedness plans with education and simulated practice in place. Healthcare facilities should consider mitigation strategies such as preparedness drills and additional education.

The Jerusalem tribune collapse incident: Challenges in the management of a pediatric mass casualty incident

Naama Pines — 2024-04-01

Objectives: Children comprise up to 30-50 percent of all disaster victims. Pediatric disaster medicine is a poorly established field, and most protocols are designed without adequate emphasis on the special needs of the pediatric population. During the 2021 Shavuot holiday in Israel, the collapse of temporary steel bleachers in a partially constructed synagogue resulted in a mass casualty incident (MCI) with a majority of pediatric casualties. This study analyzed the differences in post-incident casualty management, treatment, and outcomes in three Jerusalem medical centers.

Methods: Multicenter retrospective data were collected from two tertiary level 1 trauma centers and one secondary hospital in Jerusalem. The data included demographics, triage scores, injury mechanisms, medical workups, and the management of the pediatric patients.

Results: A total of 171 children and adolescents aged 9-18 years presented to three centers. In two institutions, the triage was performed by a senior emergency medicine physician, and in the third institution, by a senior trauma physician. Different protocols were applied, resulting in significant differences in triage, identification and documentation, admission strategies, adherence, and analgesic treatment. Most patients presented with orthopedic injuries (115/171, 67 percent). A small number had head, chest, abdominal, and multisystem injuries (11, 5, 2, and 2 percent, respectively).

Conclusion: Pediatric MCI management presents specific challenges. The lack of consistency in triage, registry, and management highlights the need for robust pediatric MCI training programs.

Investigating health and treatment measures during the Arbaeen procession 2022: A qualitative study

Saeed Nazari — 2024-04-01

Aims: The Arbaeen procession is one of the largest religious gatherings in which tens of millions of people participate every year. The presence of many people in this religious gathering highlights the necessity of planning to reduce incidents related to pilgrims in the field of health and to ensure their timely access to health and treatment services. The current research was conducted with the aim of investigating and analyzing the health field in the Arbaeen procession of 2022.

Methodology: This was a qualitative study, in which in-depth and semistructured interviews were conducted. The target population comprised healthcare policymakers, managers, and providers of the Arbaeen procession in 2022. The interview and data collection guide were developed using the World Health Organization’s recommendations. Data collection was continued till data saturation. Directed content analysis was used to analyze the data. Different strategies were applied to increase the validity and reliability of the results of this study.

Finding: Data saturation was reached after 33 interviews. In total, eight main topics were identified, including follow-up of disease and trauma, promotion of public health, education and health system, cooperation and coordination in the field of health, information and communication management, response operations, support and resource management, and security and safety.

Conclusion: Essential health issues in Arbaeen procession were identified in this research, which may be considered as an evidence-based guide for planners, planners, and executive managers of this religious community. The findings of this research may be used in other marches and public gatherings.

Terrorist attacks in Iran: A counter-terrorism medicine analysis

Hossein Armin — 2024-04-01

Introduction: Terrorism is a combined phenomenon, the concept of which is strongly affected by the spatial and temporal situation. Terrorist attacks can affect the demand for and delivery of healthcare services and often put a unique burden on the first responders, hospitals, and health systems. This study provides an epidemiological description of all terrorist-related attacks

in Iran from 1979 to 2020.

Methods: Data were collected using a retrospective search through Global Terrorism Database (GTD). GTD was searched using internal database search functions for all incidents that occurred in Iran from January 1, 1979, to December 31, 2020. The target type, attack type, primary weapon type, perpetrator group, country where the incident occurred, and the number of fatalities and injuries were collected, and the results were analyzed.

Results: In total, 543 terrorist attacks were identified in the study period, which resulted in the fatality of 1,150 people and the injury of 3,792 people. It indicates 2.12 fatalities and 7,009 injuries per incident. Explosives were used in 301 attacks (55.63 percent), followed by incendiary weapons in 177 attacks (32.71 percent). The most significant types of attacks are bombings in 290 attacks (52.3 percent), followed by assassination in 99 attacks (17.9 percent), and armed assaults in 81 attacks (14.6 percent).

Conclusion: Due to a decreasing trend of terrorist incidents in Iran, we can state that national security and stability have improved in Iran. However, the development of security promotion policies and passive defense approaches can help prevent the occurrence of such incidents.

Integrating the six C’s of disaster response: Lessons from the mega terrorist attack on October 7, 2023

Debra Gershov West — 2024-04-01

On October 7, 2023, over 2,500 Hamas terrorists infiltrated Israel from Gaza and killed over 1,400 people and injured 2,800, resulting in the largest terrorist attack in Israel’s history. Several models describe the principles of managing a mass casualty event. One of them is an Australian construct known as the six C’s. While command, control, and coordination are familiar concepts, the six C’s emphasize the importance of communication and community (consequences and community connection). We describe how two emergency departments in Israel—Assuta Ashdod and the Hadassah Medical Center-Ein Kerem—responded to this disaster in the context of the six C’s.