Sengkang General Hospital (SKH) is a part of the national network of hospitals to respond to civil emergencies including hazardous material (Hazmat) incidents in Singapore. The HDS course aims to train our staff on basic knowledge of the effects of hazardous material exposure and the operations of the HDS.

HDS course was planned in three phases:

Phase one aimed to train all DEM personnel so as to have a critical mass of personnel equipped to operate the HDS upon immediate notice. Phase two involves hospital staff from non-emergency departments. Material and simulations for phase two was simplified to focus on the skills and prompt decontamination. Phase three aims to test out capabilities of HDS and review processes through department simulations and hospital.

155 staff have completed HDS training since 2019, amongst them, 23 as instructors. 67.7% found the demonstrations, skills and practices exceeded expectations. 69% were able to apply skills taught during simulation and overall, 71.2% were able to understand topics covered in the modules.

SKH was at the forefront of battling Covid-19 and resources were tight. We have resumed trainings to complete Phase two. We aim to train more than 35% of manpower in non-emergency departments to achieve higher recall.

Training for national emergencies is challenging. HDS is located right outside the emergency department and has advantages of allowing smooth traffic to decontaminate patients and prompt treatment. However, training can get disrupted with incoming ambulances, patient influx and lack of resources.

SKH aims to be well prepared in handling pandemics and still maintain its capabilities in assisting in national emergencies. There are plans for hospital simulation exercises for all relevant stakeholders and internal and external reviews are required to improve decontamination systems and processes. It is important to continue training hospital personnel to support HDS during crises.

A multiple patient incident involving a commercial airliner is a challenge for any community EMS system. When the community is on a remote island in the North Pacific Ocean, where there is no hospital and only a small clinic staffed by just one physician and several nurses and technicians, the challenge is much greater. The incident described herein necessitated providing emergency care at the airport, and at the same time, activating a response capability from hundreds of miles away to transport the patients to definitive care. The situation was compounded further by the fact that most of those injured spoke little or no English. This paper reviews the events that occurred and the lessons learned..

To identify the events that occurred when a commercial airliner, with more than 250 passengers and crew aboard, experienced an in-flight “upset” that resulted in many being injured. What was learned may help other areas be better prepared for such events.

A commercial airliner incident that occurred in April, 1993 resulted in the need for emergency medical care at the remote island location of Shemya, Alaska initially, and fixed-wing transport of the injured to definitive care in Anchorage, Alaska, USA, which is about 1,300 miles (2,130 km) from Shemya.

A case review methodology was used that included interviews with key persons involved in the response to this incident to learn first-hand what occurred; by review of the National Transportation Safety Board (NTSB) reports, and by having agencies involved in the event review draft report materials to ensure accuracy.

This study showed how a remote site with a small cadre of medically trained personnel could organize and effectively provide initial emergency care for >200 persons, an have them transported more than a thousand miles to definitive care.

Valuable lessons were learned from this incident that may help other areas be better prepared, particularly in remote areas, for large multiple patient events.

Diabetes mellitus, although a chronic disease, also can cause acute, sudden symptoms requiring emergency intervention. In these cases, Emergency Medical Dispatchers (EMDs) must identify true diabetic complaints in order to determine the correct care. In 911 systems utilizing the Medical Priority Dispatch System (MPDS), International Academies of Emergency Dispatch-certified EMDs determine a patient's chief complaint by matching the caller's response to an initial pre-scripted question to one of 37 possible chief complaints protocols. The ability of EMDs to identify true diabetic-triggered events reported through 911 has not been studied.

The primary objective of this study was to determine the percentage of EMD-recorded patient cases (using the Diabetic Problems protocol in the MPDS) that were confirmed by either attending paramedics or the hospital as experiencing a diabetic-triggered event.

This was a retrospective study involving six hospitals, one fire department, and one ambulance service in Salt Lake City, Utah USA. Dispatch data for one year recorded under the Diabetic Problems protocol, along with the associated paramedic and hospital outcome data, were reviewed/analyzed. The outcome measures were: the percentage of cases that had diabetic history, percentage of EMD-identified diabetic problems cases that were confirmed by Emergency Medical Services (EMS) and/or hospital records as true diabetic-triggered events, and percentage of EMD-identified diabetic patients who also had other medical conditions. A diabetic-triggered event was defined as one in which the patient's emergency was directly caused by diabetes or its medical management. Descriptive statistics were used for categorical measures and parametric statistical methods assessed the differences between study groups, for continuous measures.

Three-hundred ninety-three patient cases were assigned to the Diabetic Problems Chief Complaint protocol. Of the 367 (93.4%) patients who had a documented history of diabetes, 279 (76%) were determined to have had a diabetic-triggered event. However, only 12 (3.6%) initially assigned to this protocol did not have a confirmed history of diabetes.

Using the MPDS to select the Diabetic Problems Chief Complaint protocol, the EMDs correctly identified a true diabetic-triggered event the majority of the time. However, many patients had other medical conditions, which complicated the initial classification of true diabetic-triggered events. Future studies should examine the associations between the five specific Diabetic Problems Chief Complaint protocol determinant codes (triage priority levels) and severity measures, eg, blood sugar level and Glasgow Coma Score.

ClawsonJ , ScottG , LloydW , PattersonB , BarronT , GardettI , OlolaC . Outcome Accuracy of the Emergency Medical Dispatcher's Initial Selection of a Diabetic Problems Protocol. Prehosp Disaster Med. 2013:28(6):1-6.

As more chronically ill people are living in the community and disasters are occurring frequently, the elderly and the medically frail vulnerable populations are experiencing significantly more disaster-related morbidity and mortality than the rest of the population. A failure to adequately address these vulnerabilities has been shown to have negative effects on the response to the disaster and the community as a whole.

The purpose of this research was to understand how older and/or medically frail adults have experienced disaster and how this experience impacts what they do now to prepare for disaster. A second purpose was the generation of theory regarding the process through which community members prepare for disasters.

This study employed a qualitative descriptive methodology, Situational Analysis, to explore the social processes of disaster preparedness in older and/or medically frail adults.

The core category was “Experience is the Best Teacher.” Based on the findings, it was theorized that these community members are generally considered unprepared for disaster. Their lack of preparedness is due in large part to a lack of education on how best to prepare. Once educated, motivation for self-responsibility of household emergency preparedness can be expected. Community interventions like distributing disaster supply kits and offering evacuation assistance help overcome their situational impediments to preparedness and provide the best chance for these community members to survive disasters without becoming ill or injured or experiencing a decline in their baseline functional status. If these community members are incidentally prepared, it is largely due to their past experience with disaster or their professional experience.

The results from this study could inform emergency plans and policy efforts to better meet the needs of elderly and medically frail community members during disaster.

Prehospital emergency services are a vital public service, and consumer access to the system is an important factor in their use. The Dominican Republic recently experienced “the epidemiological transition” leading to increased morbidity and mortality secondary to traumatic and cardiac conditions—thus, increasing the need for prompt and adequate delivery of emergency medical care.

A survey was administered to 90 subjects from diverse backgrounds, all living in Santo Domingo. Survey items included questions on emergency medical services (EMS) systems knowledge (i.e., access numbers), confidence in the system, first-aid education and prior experience with the EMS system. Chi-square was used to measure statistical significance for categorical variables and Student's t-test for continuous variables (JMP 2.0 software was used for statistical processing).

A total of 90 subjects were surveyed. The average age of respondents was 36 ± 12 years SD. More than one-fifth (22.2%) of respondents did not know the established universal emergency number (9-1-1), and 37.8% responded that they would access a different telephone number in case of a medical emergency.

Important deficiencies and access-to-care concerns were interpreted from the results. An adequate understanding of the current state of prehospital care could lead to creation of policies by system administrators to further improve the delivery of emergency medical care. This study will assist system administrators in future design and policy issues.

To examine the effects of age, race, gender, and insurance status on utilization and times-to-transport (TTT) for interhospital air medical transfers from rural hospitals to tertiary care centers.

A retrospective review of interhospital transport records. The TTT was examined as a function of age, gender, race, and insurance status using the Student's t-test for unpaired samples. The Exact Binomial Test (alpha error at 0.05) was used to compare the observed versus expected transport rates for non-whites.

A total of 268 patient transfers from hospitals within a two-county region in central Pennsylvania to tertiary care centers was analyzed. All records with sufficient demographic, TTT, or insurance data were included. Absence of data was the only exclusion.

The TTT (mean ± SD) was longer (2666 ± 3940 minutes (min.) versus 619 ± 909 min., respectively) for adult than pediatric patients (p <O1), and (2588 ± 4041 min. versus 640 ± 1301 min., respectively) for insured versus uninsured patients (p <.O1). The observed proportion of non-whites transported was less than expected (.41% versus 2.1 %) based on the proportion of non-whites in the region (p <.O5).

The TTT was longer for adults than for children and for the insured than the uninsured. Non-whites were transported less frequently than predicted.

The problems of pre-hospital care and training in the developing world are very similar – resource limitations and training deficiencies. Humanitarian conditions in the Sudan have been among the worst in the world including both man-made and natural disasters. Effectively responding to emergencies is of paramount importance.

The information was collected by a group of Sudanese physicians working in the emergency department at a large urban public hospital in Khartoum, Sudan and in the U.S. for the purpose of establishing structured training programs for pre-hospital responders.

There are currently 37 registered state operated mini-van ambulances serving ∼8 million people in the capital city of Khartoum. There is 1 central dispatching command center operated by the state Ministry of Health (MOH) that serves 29 hospitals. Services are available by calling a central “999” emergency response number. There are no private ambulances in Khartoum; however, most patients are transported by private or public transportation. Ambulance transport teams consist of ∼2 ambulance emergency assistants with limited medical training. Ambulance transport costs are covered either by insurance for the insured; however, the majority of patients are self paid. Emergencies are also managed by the Department of Civil Defense, which is a branch of the Sudanese MOH that responds to natural and man-made disasters. There are 2 layers of this team; 420 physician with masters degrees in DM and emergency rescue workers. These emergency rescue workers do not have formalized training. Other important findings are: lack of training centers for first emergency responders, no standardized practice guide lines among pre-hospital care personnel.

Emergency response in the Sudan is a relatively new practice but has shown a promising trend for the continued development of a highly advanced and functional pre-hospital/emergency response system. More structured training through collaborative efforts and substantial resources are needed.

The aim of this review was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians.

PubMed, Embase, CINAHL, and SCOPUS were searched from January 1, 2006 through March 15, 2022 for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven (11) observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing (survey-weight adjusted odds ratio [OR] 4.20; 95% confidence interval [CI], 1.02 to 17.27) and less frequent hand hygiene after glove use (survey-weight adjusted OR 10.51; 95% CI, 2.54 to 43.45) were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity (unadjusted risk ratio [RR] 4.2; 95% CI, 1.03 to 17.22). Workers were more likely to be vaccinated against influenza if their employer offered the vaccine (unadjusted OR 3.3; 95% CI, 1.3 to 8.3). Active, targeted education modules for H1N1 influenza were effective at increasing vaccination rates and the success of on-site vaccine clinics.

Evidence from the United States exists on the effectiveness of IPC practices in EMS clinicians, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. More research is needed on the effectiveness of PPE and vaccine acceptance.