Plans for allocation of scarce life-sustaining resources during the coronavirus disease 2019 (COVID-19) pandemic often include triage teams, but operational details are lacking, including what patient information is needed to make triage decisions.

A Delphi study among Washington state disaster preparedness experts was performed to develop a list of patient information items needed for triage team decision-making during the COVID-19 pandemic. Experts proposed and rated their agreement with candidate information items during asynchronous Delphi rounds. Consensus was defined as ≥80% agreement. Qualitative analysis was used to describe considerations arising in this deliberation. A timed simulation was performed to evaluate feasibility of data collection from the electronic health record.

Over 3 asynchronous Delphi rounds, 50 experts reached consensus on 24 patient information items, including patients’ age, severe or end-stage comorbidities, the reason for and timing of admission, measures of acute respiratory failure, and clinical trajectory. Experts weighed complex considerations around how information items could support effective prognostication, consistency, accuracy, minimizing bias, and operationalizability of the triage process. Data collection took a median of 227 seconds (interquartile range = 205, 298) per patient.

Experts achieved consensus on patient information items that were necessary and appropriate for informing triage teams during the COVID-19 pandemic.

This survey examined and compared the disaster perception and preparedness of 2421 residents with and without chronic disease in Shenzhen, China.

The participants were recruited and were asked to complete a survey in 2018.

Three types of disasters considered most likely to happen in Shenzhen were: typhoons (73.5% vs 74.9%), major transport accidents (61.5% vs 64.7%), and major fires (60.8% vs 63.0%). Only 5.9% and 5% of them, respectively, considered infectious diseases pandemics to be likely. There were significant differences between those with and without chronic disease in disaster preparedness, only a small percentage could be considered to have prepared for disaster (20.7% vs 14.5%). Logistic regression analyses showed that those aged 65 or older (odds ratio [OR] = 2.76), who had attained a Master’s degree or higher (OR = 2.0), and with chronic disease (OR = 1.38) were more prepared for disasters.

Although participants with chronic disease were better prepared than those without, overall, Shenzhen residents were inadequately prepared for disasters and in need of public education.

The aim of this study was to determine how the early stages of the coronavirus disease 2019 (COVID-19) pandemic affected the use of the pediatric emergency department (PED).

Cross-sectional study of PED visits during January through April, 2016-2020. Data included: total PED visits, emergency severity index (ESI), disposition, chief complaint, age (months), time from first provider to disposition (PTD), and PED length of stay (PED-LOS). P-value <0.01 was statistically significant.

In total, 67,499 visits were reported. There was a significant decrease in PED visits of 24-71% from March to April 2020. Chief complaints for fever and cough were highest in March 2020; while April 2020 had a shorter mean PED-LOS (from 158 to 123 min), an increase of admissions (from 8% to 14%), a decrease in ESI 4 (10%), and an increase in ESI 3 (8%) (P < 0.001). There was no difference in mean monthly PTD time.

Patient flow in the PED was negatively affected by a decrease in PED visits and increase in admission rate that may be related to higher acuity. By understanding the interaction between hospital processes on PEDs and patient factors during a pandemic, we are able to anticipate and better allocate future resources.

This study aimed to assess the protective measures among health-care workers (HCWs) in a war-torn area during coronavirus disease 2019 (COVID-19) pandemic.

An online cross-sectional questionnaire was administrated to HCWs in Syria between April 1 and May 21, 2020. The questions aimed to assess the HCWs’ application of safety, hygiene, and necessary protection considerations while attending to suspected or proven COVID-19 cases. Unpaired t-test and 1-way analysis of variance (ANOVA) were used for statistical analysis.

Of the 290 participants included in the statistical analysis, 250 were medical doctors. Low scores of protective practices were noticed among the participants, as only 12% of doctors had a score above 6/15 points, and only 37.5% of nurses had a score of more than 4/12 points. Medical doctors who were not on the frontlines scored significantly higher than those who were on the frontlines (4.69 vs 3.80 points, respectively; P < 0.001).

More courses and training sessions should be implemented to improve the practice of protective measures among HCWs (frontliners in particular) in areas with fragile health systems, such as Syria, during the COVID-19 pandemic, especially those on the frontlines. Moreover, specific COVID-19 protection measures guidelines to low-income countries are needed.

This hospital-based study aimed to evaluate the nutritional status and dietary habits, the amount of nutrients provided to the patients in the hospital and to detect the predictors of severity among COVID-19 patients in Jordan.

A hospital-based study (N = 367; mean age 42.3 y; SD 15.4; 66.0% men) was conducted between March 17 and July 25, 2020, in Prince Hamza Hospital. Data about socio-demographic, anthropometric, dietary habits, and macro- and micronutrients intake were collected from the patients’ medical files, and some missing data were collected by phone directly from the patients.

The results of the linear regression showed that only age was significantly and positively (ß = 0.454; P = 0.001) associated with severity of the disease among the study patients. Approximately 57% of the COVID-19 patients consumed 3 meals daily, while 31-34% consumed 1 to 2 snacks daily. The majority (64%) of the patients drank more than 5 cups of water daily. Around 24% of the patients complained of eating problems, such as taste and/or smell loss, low appetite, and swallowing difficulty. The intakes of the vitamins B1, B2, B3, B6, and C, as well as calcium, magnesium, phosphorus, selenium, and sodium, were within the recommended dietary allowances (RDA).

The servings of the 5 food groups as well as most of the macro- and micronutrient requirements were within the recommended intakes and RDA.

Traumatic brain injuries (TBIs) are 1 of the most common reasons for young adult death and disability. This study sought to provide novel data for TBIs in Southern Punjab, as well as to identify any areas of service improvement to reduce the acute and long-term burden of this condition.

A survey in English was created, which was then circulated to members of the emergency and neurosurgical department for a 3-wk period.

A total of 450 patients (379 male [84.2%] and 71 female [15.2%]) were included as TBI admissions or attendances with a mean age of 28.9 y. Of the total, 420 people (93.2%) had experienced a TBI following a road traffic incident (RTI), with 78.7% (n = 354) of TBIs involving motorbike users who were not wearing helmets. A total of 226 (50.1%) patients arrived by car to the hospital, and 201 (44.7%) arrived by means of provincial government-funded emergency ambulance services.

TBIs in Southern Punjab mostly affect younger males involved in RTIs while riding motorbikes. Recommendations to reduce the acute and long-term burden of TBIs in this region include formal training of all hospital and prehospital staff in the management of acute trauma cases according to international guidelines and operating provincial government emergency ambulance services in a wider geographic area.

Health-care personnel (HCPs) are predisposed to infection during direct or indirect patient care as well as due to the community spread of the disease.

We observed the clinical presentation and course of severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) infection in HCPs working in a dedicated coronavirus disease 2019 (COVID-19) care hospital during the first and the second wave.

A total of 100 and 223 HCPs were enrolled for the first wave and the second wave, respectively. Cough, shortness of breath, sore throat, runny nose, and headache was seen in 40 (40%) and 152 (68%) (P < 0.01), 15 (15%) and 64 (29%) (P = 0.006), 40 (40%) and 119 (53.3%) (P = 0.03), 9 (9%) and 66 (30%) (P < 0.01), 20 (20%) and 125 (56%) (P < 0.01), respectively. Persistent symptoms at the time of joining back to work were seen in 31 (31%) HCPs and 152 (68%) HCPs, respectively (P ≤ 0.01). Reinfection was reported in 10 HCPs.

Most of the HCPs had mild to moderate infections. Symptoms persist after joining back to work. Upgradation of home-based care and teleconsultation facilities for active disease and redressal of residual symptoms will be helpful.

Recent disasters have demonstrated gaps in employers’ preparedness to protect employees and promote their well-being in the face of disruptive events. Our objective was to develop a useful strategy for advancing comprehensive employer preparedness and to assess employer preparedness in a sample of employers.

A Total Worker Health Employer Preparedness Model was developed to include seven domains: planning, human resources policies, hazard reduction, training, staffing, communications, and resources for resilience. A Survey and scoring Index based upon the Model were administered to human resources professionals in the northeast United States.

Seventy-six responded, representing diverse employment sectors. The mean Index score was 8.8 (out of 23), which is a moderate level of preparedness. Nine scored over 15, indicating greater preparedness. Thirteen scored 0. Employers were most prepared for severe weather events and least prepared for acts of violence. There were no significant differences by sector, size, or reach, although the health-care sector reported higher scores.

This unique attempt to assess TWH Employer Preparedness can serve as the basis of important further study that strengthens the empirical basis of the construct. Additionally, the Model, Survey, and Index can assist employers in advancing their preparedness for all hazards.

The objective of this study is to evaluate the status of the Syrian refugees (SR) in Turkey in terms of using the National Health System (NHS) between 2011 and 2017.

The study is a descriptive and cross-sectional epidemiological research ORACLE SQL Developer program was used for data analysis, and frequency analyzes regarding the person, place, and time characteristics of the health services that SR received between 2011 and 2017 were presented.

The SRs benefited from NHS hospital services approximately 35 million times (34,973,029). Approximately 40% of the SRs that benefited from the NHS are under the age of 18. The proportion of those under 5 y old is 15.8%; 55.8% of the SRs that benefited from the NHS are women. The utilization status of the SRs from the NHS by region is as follows: 33.4% Mediterranean Region, 29.2% Southeastern Anatolia Region, and 19.0% Marmara Region. The types of health institutions that the SRs used are as follows: 44.0% state hospitals, 15.0% family medicine centers, and 13.3% training and research hospitals. A total of 16,009,524 cases were intervened as part of EMS.

Syrian refugees in Turkey comprehensively benefited from primary, secondary, and tertiary health services free of charge between 2011 and 2017 in Turkey. It is seen that they have access to private and high-cost health services, such as air ambulance, cancer treatment, and dental treatment.

The aim of this study was to examine birth outcomes in areas affected by Hurricane Michael.

Vital statistics data of 2017–2019 were obtained from the state of Florida. Births occurring in the year before and after the date of Hurricane Michael (October 7, 2018) were used. Florida counties were divided into 3 categories reflecting extent of impact from Hurricane Michael. Birth outcomes including incidence of preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) were also compared before and after Hurricane Michael. Spontaneous and indicated PTBs were distinguished based on previously published algorithms. Multiple regression was used to control for potential confounders.

Both LBW (aRR 1.19, 95% CI: 1.07, 1.32) and SGA (aRR 1.11, 95% CI: 1.01, 1.21) were higher in the year after Michael than the year before in the most-affected area; a similar effect was not seen in other areas. A stronger effect was seen for exposure in the first trimester or in the 2 months after Michael than in the second or third trimester.

Consistent with many previous studies, this study of Hurricane Michael found an effect on fetal growth.

An earthquake followed by tsunami and liquefaction on September 28, 2018, in Central Sulawesi caused health system disruptions. This study aimed to know health system disruption at the primary health center (PHC) level due to the disaster in 3 districts (Palu, Sigi, Donggala) of Central Sulawesi.

This was a qualitative study conducted in March 2019 involving 36 PHCs. Data were collected through interview of PHC officers using a structured questionnaire. Variables included disruption of management, budget, human resources, drug supply, Early Warning Alert and Response System (EWARS) of epidemic prone disease (EPD), human resource migration, health facility damage, and health facility access. Descriptive analysis was conducted to define disruption for a 1-y projection.

Health system disruptions in Palu affected management, budget, human resources, EWARS, health facility damage, and health access; occurred within 1-2 mo; and were projected to become better after 6 mo. Problems in Sigi were management, human resources, drug supply, EPD, and EWARS for 1 mo after disaster and were projected to be better after 2 mo. The problems in Donggala were health services access, management, human resources for 1 mo after the disaster and were projected to be normal after 2 mo.

Health system disruptions occurred in Central Sulawesi Province at the PHC level within 1-2 mo and were projected to become better after 3 mo in most PHCs.

Respiratory illnesses, including coronavirus disease 2019 (COVID-19), have resulted in millions of deaths globally. Guidance on mask-wearing in community settings has been inconsistent. This review examined the effectiveness of mask-wearing on respiratory virus transmission in community settings.

A search was conducted for English language reports of randomized controlled trials of mask-wearing in the community and effect on laboratory-confirmed respiratory infections or influenza-like illness. Investigators abstracted study characteristics and assessed bias. Meta-analysis was conducted to calculate pooled risk estimates.

Eleven studies were included. In 7 studies that evaluated influenza-like illness symptoms as an outcome (3029 participants), this study found mask-wearing associated with a decreased risk of influenza-like illness (overall risk ratio [RR], 0.83; 95% confidence interval [CI], 0.71 to 0.96). Studies examining laboratory-confirmed respiratory infections as an outcome (10,531 participants) showed no statistically significant association between mask-wearing and infections (RR, 1.04; 95% CI, 0.60-1.80). However, masking combined with enhanced hand hygiene was associated with a decreased risk for both influenza-like illness symptoms (RR, 0.88; 95% CI, 0.51-1.51) and laboratory-confirmed respiratory infection (RR, 0.79; 95% CI, 0.52-1.18).

Masking in community settings decreases transmission of influenza-like illness. Mask-wearing combined with enhanced hand hygiene reduces transmission of influenza-like illness and laboratory-confirmed respiratory infection.

This study examines the factors associated with the willingness to get the coronavirus vaccine among individuals aged 18 and above.

This cross-sectional study was conducted in Turkey. The participants aged 18 and older were recruited between December, 2020 and January, 2021 through conventional social media sites. Snowball sampling was used. An anonymous questionnaire consisted of demographics, vaccination experiences, and perceived risk of coronavirus disease.

1202 women and 651 men were included in the data analysis. Findings showed that demographics, vaccination experience, and perceived risk of getting COVID-19 were explained. 37% of the variance in people’s willingness to get the COVID-19 vaccination was according to hierarchical logistic regression. Furthermore, increasing age, being male, acquiring positive information about COVID-19 vaccines, having a lower level of vaccine hesitancy, the high level of worry about COVID-19, and low level of perceptions of the possibility of becoming infected by the COVID-19 were the main predictors of COVID-19 vaccine willingness.

Factors affecting adults’ willingness to be inoculated with COVID-19 vaccines were related to demographics, vaccination experiences, and perceived risk of getting COVID-19. We recommend that public health authorities and practitioners should consider these multiple factors regarding vaccine confidence to achieve herd immunity.

Due to factors that still remain under debate, both social and virological, the coronavirus disease 2019 (COVID-19) pandemic has continued to flare up in India, particularly in northern and western areas. This has led to an incidence of approximately 350,000 cases per day and a daily death toll of around 4000 in the weeks between May 1 and 14, 2021. The current pandemic is testing the adaptability of the oxygen distribution and consumption.

Following India’s request for support, the European Union (EU) Civil Protection Mechanism coordinated the response agreed by EU Member States providing shipments of oxygen and equipment. In this scenario, our Emergency Medical Team (EMT)-2, based in Italy, organized a cargo and a 12-member team of technicians and medical professionals with the main objective of installing a novel source of oxygen.

The installation of a Pressure Swing Adsorption (PSA) oxygen plant provided the Indo-Tibetan Border Police (ITBP) hospital in Greater Noida, India, with a sustainable solution to combat oxygen shortage in less than 48 h.

The supply of oxygen could not be deemed a successful intervention without a proper plan to guarantee the rational use of the source so additional training was carried out. Our EMT were among the first responders in mitigating this public health crisis.

The object of this study was to examine the accuracy in prehospital shock index (SI) for predicting intensive care unit (ICU) requirement and 30-d mortality among from coronavirus disease 2019 (COVID-19) patients transported to the hospital by ambulance.

All consecutive patients who were the age ≥18 y, transported to the emergency department (ED) by ambulance with a suspected or confirmed COVID-19 in the prehospital frame were included in the study. Four different cutoff points were compared (0.7, 0.8, 0.9, and 1.0) to examine the predictive performance of both the mortality and ICU requirement of the SI. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate each cut-off value discriminatory for predicting 30-d mortality and ICU admission.

The total of 364 patients was included in this study. The median age in the study population was 69 y (range, 55-80 y), of which 196 were men and 168 were women. AUC values for 30-d mortality outcome were calculated as 0.672, 0.674, 0.755, and 0.626, respectively, for threshold values of 0.7, 0.8, 0.9 and 1.0. ICU admission was more likely for the patients with prehospital SI > 0.9. Similarly, the mortality rate was higher in patients with prehospital SI > 0.9.

Early triage of COVID-19 patients will ensure efficient use of health-care resources. The SI could be a helpful, fast, and powerful tool for predicting mortality status and ICU requirements of adult COVID-19 patients. It was concluded that the most useful threshold value for the shock index in predicting the prognosis of COVID-19 patients is 0.9.