The latest medical research on Disaster Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about disaster medicine gathered by our medical AI research bot.

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ASSESSMENT OF VULNERABILITY TO THE COVID-19 PANDEMIC IN THE CENTRAL AFRICAN SUB-REGION.

Disaster Prevention & Management

This study aimed at examining the vulnerability of Central Africa to the Covid-19 pandemic.

Demographic, health and socio-economic indicators were used to describe the vulnerability.

According to demographic indicators, populations appear younger than in Europe, Asia and North America, where evidence showed a higher lethality of Covid-19 and a higher frequency of hospitalization among the elderly. This highlights the protective effect of the age structure of the Central African populations. There is a significant vulnerability of their populations resulting from high morbidity and a considerable deficit in health care. Poverty indicators are not in their favour for a sustainable implementation of effective pandemic control measures. Very low literacy rates in some countries, misinformation and belief in conspiracy theory could affect the community involvement in the response. Several countries are weakened by other humanitarian crises, including; conflicts and other epidemics. The early easing in lockdown restrictions in certain countries could worsen the situation.

This Sub-region, where the largest proportion of the population lives in poverty, poor sanitary conditions, conflicts and humanitarian crises, the questions of standards of prevention could appear to them as luxurious idea relegated to the background. Central African Countries need financial and logistic support for a sustainable effective response. These observations could be easily extrapolated to other Sub-Saharan sub-regions.

Development and Evaluation of Innovative and Practical Table-top Exercises Based on a Real Mass-Casualty Incident.

Disaster Medicine and Public Health

The aim of this work was to develop a table-top exercise (TTX) program for mass-casualty incident (MCI) response based on a real incident to evaluate the program.

The TTX program was developed based on the 8 TTX design steps. Convenience sampling was adopted to recruit recently graduated physicians in China. After the TTX training, the participants completed a self-designed questionnaire, as well as the Simulation Design Scale (SDS) and Educational Practices in Simulation Scale (EPSS).

In total, 148 valid questionnaires were collected. The difficulty score of the TTX program was 3.69 ± 0.8. The participants evaluated the program highly, with a score of 4.72 ± 0.54 out of 5. Both the SDS and the EPSS had average scores higher than 4.5. Guided reflection/feedback (M = 4.68, SD = 0.41) and fidelity (M =4.66, SD = 0.57) were the 2 highest-rated SDS subscales. For the EPSS, diverse ways of learning and collaboration were the 2 highest-rated subscales. Multivariate stepwise regression analysis showed that the participants' evaluations of the TTX training course were related to the EPSS score, the difficulty rating, the evaluation of the instructional props, and the degree of participant involvement (F = 24.385, P < 0.001).

A TTX program for MCIs was developed based on the 2014 Shanghai New Year Crush. The TTX kit is practical and sophisticated, and it provides an effective strategy for MCI training.

Characteristics and Trend of Drug-Resistant Tuberculosis at a Major Specialized Hospital in Chongqing, China: 2016 Versus 2019.

Disaster Medicine and Public Health

The epidemic of drug-resistant tuberculosis (DR-TB) has become a major concern in global TB control. This study aimed to investigate the patterns and trend of DR-TB epidemic between different time periods in Chongqing.

A total of 985 and 835 culture positive TB patients with drug susceptibility testing (DST) results admitted to the hospital in 2016 and 2019, respectively, were included. Chi-square testing was used to compare the prevalence and trends of DR-TB in 2016 and 2019.

The proportion of previously treated TB cases with culture positivity was 45.7% in 2019, significantly higher than that in 2016 (39.1%, P = 0.004). The overall rate of drug resistance in 2019 was 43.1%, higher than that in 2016 (40.2%). The rates of multi-drug resistant TB (MDR-TB) and pre-extensively drug resistant TB (pre-XDR-TB) increased significantly from 2016 to 2019 among all TB cases (MDR: 25% vs 33.4%, P < 0.001 and pre-XDR: 7.1% vs 12.8%, P < 0.001, respectively) and previously treated TB cases (MDR: 46.5% vs 56%, P = 0.008 and pre-XDR: 13.2% vs 21.5%, P = 0.003, respectively).

Our findings indicated that the prevalence of DR-TB remains high in Chongqing. The trend of resistance to anti-TB drugs beccame worse between 2016 and 2019. Moreover, acquired MDR may play a major role in MDR-TB epidemic in Chongqing. Therefore, rapid diagnosis and effective treatment of TB patients will be important to reduce the burden of DR-TB in Chongqing.

Challenges and Barriers of Humanitarian Hygiene Items Management in Recent Disasters in Iran.

Disaster Medicine and Public Health

The provision and continuation of the basic needs of affected communities, including water, food, and shelter remain the most important priorities in responding to disasters. In this regard, this study sought to investigate the management challenges of humanitarian hygiene items in recent disasters in Iran.

This qualitative study was conducted through a semi-structured interview. Nineteen participants with different experiences, roles, and responsibilities in the recent disaster of Iran and experiences of various events in the national and international arenas were included in the study. A thematic analysis was used, and an initial conceptual framework was defined based on the study aim. The relationship between the components was compared and interpreted in this framework and the main and subthemes were extracted accordingly.

Six main themes and 21 subthemes were extracted based on the results. The main challenges in recent disasters were the lack of protocols and standard guidelines, inappropriate selection of items in each hygiene kit, the lack of standard distribution of hygiene kits, and the lack of attention to the affected population's culture.

Overall, it is necessary to define a system for preparation, supply, storage, and timely distribution of hygiene. Finally, it is suggested that an organization should be appointed for this purpose.

The Policy Gap and Inefficiency in Public Volunteers' Response to Assist the Hospitals After Natural Disasters in Iran: A Grounded Theory Methodology.

Disaster Prevention & Management

This study aims to explore a public volunteer's hospital response model in natural disasters in Iran.

This study employed grounded theory using the Strauss and Corbin 2008 method and data analysis was carried out in three steps, namely open, axial, and selective coding. The present qualitative study was done using semi-structured interviews with 36 participants who were on two levels and with different experiences in responding to emergencies and disasters as "public volunteers" and "experts". National and local experts were comprised of professors in the field of disaster management, hospital managers, Red Crescent experts, staff and managers of Iran Ministry of Health and Medical Education.

The main concept of the paradigm model was "policy gap and inefficiency" in the management of public volunteers, which was rooted in political factions, ethnicity, regulations, and elites. The policy gap and inefficiency led to chaos and "crises over crises." Overcoming the policy gap will result in hospital disaster resilience. Meanwhile, the model covered the causal, contextual, and intervening conditions, strategies, and consequences in relation to the public volunteers' hospital response phase.

The current public volunteers' hospital in Iran suffered from the lack of a coherent, comprehensive, and forward-looking plan for their response. The most important beneficiaries of this paradigm model will be for health policy-makers, to clarify the main culprits of creating policy gap and inefficiency in Iran and other countries with a similar context. It can guide the decision-makings in upstream documents on the public volunteers. Further research should carried out to improve the understanding of the supportive legal framework, building the culture of volunteering, and enhancing volunteers' retention rate.

Limited utility of self-made oxygen generators assembled from everyday commodities during the COVID-19 pandemic.

Disaster Prevention & Management

The current COVID-19 pandemic has aggravated pre-existing oxygen supply gaps all over the world. In fact, oxygen shortages occurred in affluent are...

Decision-Making During a Disaster-Scenario Tabletop Exercise by Prelicensure Student Nurses - A Replication Study.

Disaster Prevention & Management

"Determine which clients to recommend for discharge in a disaster situation" is a Registered Nurse Activity Statement on the National Council Licensing Exam test plan. The activity statement raised the nursing education research question: could senior student nurses transfer their learning to a novel circumstance, with a high degree of risk, making decisions using patient assessments and determining resource needs? A study with a descriptive quantitative approach was designed with 2 aims. The first was to describe students' transfer of learning for basic disaster and medical-surgical knowledge and make recommendations for patient dispositions. The second aim was to describe students' attitudes about their transfer of learning during the tabletop exercise.

A researcher-designed disaster-scenario tabletop exercise and 3 instruments with subject-matter-expert feedback captured participants' decisions. Eligible senior student nurses volunteered to participate in the replicated study that was extended to 2 universities. Participant decisions and attitude responses were statistically analyzed.

Descriptive and difficulty index statistics described students' transfer of learning for basic disaster and medical-surgical topics, patient disposition recommendations, and attitudes. The cut-score for optimal transfer of learning was difficulty index (DI) ≤ .49.

Students had positive attitudes and transferred learning to most decisions. Decision DIs ≤ .49 were remediated.

Injuries from explosions: more differences than similarities between various types.

Disaster Medicine and Public Health

To compare injury patterns of different types of explosions.

A retrospective study of 4,508 patients hospitalized due to explosions recorded in the Israeli National Trauma Registry between January 1997 and December 2018. The events were divided into four groups: terror-related, war-related, civilian intentional and civilian unintentional explosions. The groups were compared in terms of injuries sustained, utilization of hospital resources and clinical outcomes.

Civilian intentional and terror-related explosions were found to be similar in most aspects except for factors directly influencing mortality and a larger volume of severely injured body regions among terror-victims. Comparisons between other groups produced some parallels, albeit less consistent. Civilian intentional and civilian unintentional explosions were different from each other in most aspects. The latter group also differed from others by its high volume of life-threatening burns and a higher proportion of children casualties.

While consistent similarities between explosion casualties exist, especially between victims of intentional civilian and terror-related explosions, the general rule is that clinical experience with on type of explosions cannot be directly transferred to other types.

Identifying and Explaining the Components Affecting for Design Preparedness Exercises of the Health System in Emergencies and Disasters: A Quality Content Analysis.

Disaster Medicine and Public Health

Running exercise courses in different sectors of the health system is one of the important steps to prepare and deploy disaster risk management programs. The present study aimed to identify and explain the components affecting the design of preparedness exercises of the health system in disasters.

This study was a qualitative content analysis. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 25 health professionals in disasters who had experience in designing, implementing, and evaluating an exercise. The data were analyzed using the content analysis method.

The data analysis resulted in the production of 50 initial codes, 12 subcategories, 4 main categories of "Coordination, Command, and Guidance of Exercise," "Hardware and Software Requirements of Exercise," "Organizational Exercise Resources," and "Communication and Exercise Public Information" with the original theme of "Exercise Design."

This study provides a clear picture and rich, constructive information on the concept of designing health system preparedness exercises in disasters. The findings of this study can greatly increase the attention of senior managers in all areas of health, especially managers of prehospitals and hospitals who are in the front line of the response to disasters to design standard and scientific preparedness exercises.

Dialysis Care for US Military Veterans in Puerto Rico during the 2017 Atlantic Hurricane Season.

Disaster Medicine and Public Health

Patients with end stage kidney disease (ESKD) are at higher risk for increased mortality and morbidity due to disaster-related disruptions to care. We examine effects of Hurricanes Irma and Maria on access to dialysis care for US Department of Veterans Affairs (VA) ESKD patients in Puerto Rico.

A retrospective, longitudinal cohort study was conducted among VA patients with at least 1 dialysis-related encounter between September 6, 2016, and September 5, 2018. The annual number of dialysis encounters, visits to an emergency department (ED), and the number of deaths pre- and post-hurricanes were compared. A random effects logistic regression model for correlated binary outcomes was fitted for predictors of mortality. Chi-square tests were for differences between pre- and post-hurricane visits.

The number of ED visits increased in post-hurricane period (1172 [5.7%] to 1195 [6.6%]; P < 0.001). ESKD-related ED visits increased from 200 (0.9%) to 227 (1.3%) (P < 0.05). Increase in mortality was associated with age (OR = 1.66; CI: 1.23-2.17), heart failure (OR = 2.07; CI: 1.26-3.40), chronic pulmonary disease (OR = 3.26; CI: 1.28-8.28), and sepsis (OR = 3.16; CI: 1.89-5.29).

There was an increase in dialysis services at the San Juan VA Medical Center post-Irma/Maria, and access to dialysis care at the non-VA clinics was limited. The role of VA dialysis centers in providing care during disasters warrants further investigation.

Comparison of Standard Training to Virtual Reality Training in Nuclear Radiation Emergency Medical Rescue Education.

Disaster Medicine and Public Health

Due to the particularity of nuclear radiation emergencies, professional technical training is necessary. However, nuclear radiation emergency medical rescue nurses are not well prepared to respond in time. This study aims to explore the effect of virtual reality (VR) in training nurses for nuclear radiation emergency medical rescue.

Thirty nurses who received traditional nuclear radiation rescue training from May 2020 to October 2020 were selected as the control group, and another 30 nurses who received VR nuclear radiation emergency medical rescue training from November 2020 to April 2021 were selected as the experimental group. The examination results, learning enthusiasm, training effect evaluation, and training satisfaction were compared between the 2 groups.

The experimental group had significantly higher examination score, learning enthusiasm, training effect evaluation, and training satisfaction than the control group (P < 0.05).

The application of VR in the training of nuclear radiation emergency medical rescue can improve the training performance, learning enthusiasm, training effect, and training satisfaction of trainees. Considering the advantages of VR, it could be widely used in the training of nuclear radiation emergency medical rescue in the future.

Use of Point-of-Care Ultrasound by Non-Physicians to Assess Respiratory Distress in the Out-of-Hospital Environment: A Scoping Review.

Prehosp Disaster Med

The use of ultrasound in the out-of-hospital environment is increasingly feasible. The potential uses for point-of-care ultrasound (POCUS) by paramedics are many, but have historically been limited to traumatic indications. This study utilized a scoping review methodology to map the evidence for the use of POCUS by paramedics to assess respiratory distress and to gain a broader understanding of the topic.

Databases Ovid MEDLINE, EMBASE, CINAHL Plus, and PUBMED were searched from January 1, 1990 through April 14, 2021. Google Scholar was searched, and reference lists of relevant papers were examined to identify additional studies. Articles were included if they reported on out-of-hospital POCUS performed by non-physicians for non-traumatic respiratory distress.

A total of 591 unique articles were identified, of which seven articles met the inclusion criteria. The articles reported various different scan protocols and, with one exception, suffered from low enrolments and low participation. Most articles reported that non-physician-performed ultrasound was feasible. Articles reported moderate to high levels of agreement between paramedics and expert reviewers for scan interpretation in most studies.

Paramedics and emergency medical technicians (EMTs) have demonstrated the feasibility of lung ultrasound in the out-of-hospital environment. Further research should investigate the utility of standardized education and scanning protocols in paramedic-performed lung ultrasound for the differentiation of respiratory distress and the implications for patient outcomes.