Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has killed nearly 800,000 Americans since early 2020. The disease has disproportionately affected older Americans, men, persons of color, and those living in congregate living facilities. Sacramento County (California USA) has used a novel Mobile Integrated Health Unit (MIH) to test hundreds of patients who dwell in congregate living facilities, including skilled nursing facilities (SNF), residential care facilities (ie, assisted living facilities [ALF] and board and care facilities [BCF]), and inpatient psychiatric facilities (PSY), for SARS-CoV-2.

The MIH was authorized and rapidly created at the beginning of the COVID-19 pandemic as a joint venture between the Sacramento County Department of Public Health (SCDPH) and several fire-based Emergency Medical Services (EMS) agencies within the county to perform SARS-CoV-2 testing and surveillance in a prehospital setting at a number of congregate living facilities. All adult patients (≥18 years) who were tested for SARS-CoV-2 infection by the MIH from March 31, 2020 through April 30, 2020 and lived in congregate living facilities were included in this retrospective descriptive cohort. Demographic and laboratory data were collected to describe the cohort of patients tested by the MIH.

During the study period, the MIH tested a total of 323 patients from 15 facilities in Sacramento County. The median age of patients tested was 66 years and the majority were female (72%). Overall, 72 patients (22%) tested positive for SARS-CoV-2 in congregate living settings, a higher rate of positivity than was measured across the county during the same time period.

The MIH was a novel method of epidemic surveillance that succeeded in delivering effective and efficient testing to patients who reside in congregate living facilities and was able to accurately identify pockets of infection within otherwise low prevalence areas. Cooperative prehospital models are an effective model to deliver out-of-hospital testing and disease surveillance that may serve as a blueprint for community-based care delivery for a number of disease states and future epidemics or pandemics.

Tropical cyclones are a recurrent, lethal hazard. Climate change, demographic, and development trends contribute to increasing hazards and vulnerability. This mapping review of articles on tropical cyclone mortality assesses geographic publication patterns, research gaps, and priorities for investigation to inform evidence-based risk reduction.

A mapping review of published scientific articles on tropical cyclone-related mortality indexed in PubMed and EMBASE (English) and SINOMED and CNKI (Chinese), focusing on research approach, location, and storm information, was conducted. Results were compared with data on historical tropical cyclone disasters.

A total of 150 articles were included, 116 in English and 34 in Chinese. Nine cyclones accounted for 61% of specific event analyses. The United States (US) reported 0.76% of fatalities but was studied in 51% of articles, 96% in English and four percent in Chinese. Asian nations reported 90.4% of fatalities but were studied in 39% of articles, 50% in English and 50% in Chinese. Within the US, New York, New Jersey, and Pennsylvania experienced 4.59% of US tropical cyclones but were studied in 24% of US articles. Of the 12 articles where data were collected beyond six months from impact, 11 focused on storms in the US. Climate change was mentioned in eight percent of article abstracts.

Regions that have historically experienced high mortality from tropical cyclones have not been studied as extensively as some regions with lower mortality impacts. Long-term mortality and the implications of climate change have not been extensively studied nor discussed in most settings. Research in highly impacted settings should be prioritized.

Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments. Whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSE).

What is appropriate SMR in RSE?

The first round of this Modified Delphi (mD) study was a structured focus group. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the 20 mD statements presented to the experts.

Experts rated their agreement with each statement on a scale from one to seven. Consensus amongst experts was defined as SD≤1.0. Statements that were in agreement reaching consensus were included in the final report. Those not reaching consensus advanced to the next mD round.

For these subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement.

Twenty-two experts completed the first mD round, 19 completed the second mD round, and 16 completed the third mD round. Eleven statements reached consensus (Table 1). Nine statements did not reach consensus (Table 2).

Experts reached consensus offering 11 statements to be incorporated into the creation of SMR clinical guidelines in RSE.

Tables and Figures (optional)

Table 1.

Table 2.

Education and training programs are critical to achieve personnel capacity building and professionalization in the rapidly growing humanitarian health sector. Thus, this study aimed to describe the status of humanitarian health education and training programs world-wide.

A web-based analysis was conducted to identify the available humanitarian health programs. The following characteristics of the training programs were described: geographical location, target audience, prerequisite, qualification, curriculum, content, length, modality of delivery, teaching and assessment methods, and tuition fee.

The search identified a total number of 142 training programs, most of them available in few countries of the global North. Only seven percent of the identified programs qualified for a master’s degree in humanitarian health. Public health was the most identified content (47.2%). Approximately one-half of the training programs (50.7%) were delivered face-to-face. Theoretical knowledge was the most common method used for teaching and assessment. The duration of the training and tuition fees were different for different programs and qualifications, while target audience, prerequisite, and curriculum design were often vaguely described or missing.

The study shows a global inequality in access to humanitarian health training programs due to financial and geographical constraints. The study also reveals gaps in program contents, as well as teaching and assessment methods, all issues that could be addressed by developing cost-effective e-learning and online simulation programs. Lastly, the data from this study provide a learning tool that can be used by humanitarian health educators and training centers to further define and standardize the requirements and competencies of humanitarian health professionals.

Evaluation of the Emergency Unit resilience during COVID-19 outbreak is important. In this study, we discuss steps to develop a valid and reliable national Iranian toolkit to assess the EU resilience.

To develop a toolkit to evaluate the EU resilience during COVID-19 pandemic.

Comprehensive literature reviews, experts panel discussion, focus group discussion, semi-structured interviews, and two-round Delphi surveys were used to develop a questionnaire. Then the items reviewed for their readability, feasibility, clarity of wording, layout, and style. A web-based form was designed to evaluate their face and content validity by a separate panel of experts. The final draft was tested on 30 voluntary EU managers two times (14 days apart). The gathered data were analyzed by SPSS software.

Descriptive statistics used to examine the floor and ceiling effects. The short answer comments were analyzed using meaning condensation developed by Svend Brinkmann & Steinar Kvale. Spearman correlation coefficients was used to examine test-retest reliability for agreement with the level of significance set at P<.05.

Cronbach alpha was used to evaluate the internal consistency reliability and Cohen’s kappa scores was used to measure reliability.

Finally, a 47-item questionnaire was developed and sent to the MOH to be used for evaluating EUs resilience.

A valid and reliable national toolkit is essential to evaluate EU resilience to deliver a high-quality emergency care and all the emergency managers should be familiar with the process of developing a valid and reliable toolkit.

In March 2021, a series of explosions shook a military base in Bata, Equatorial Guinea. As a response to government officials’ request, the Israel Defense Forces Medical Corps (IDF-MC) deployed an emergency aid team that faced two major challenges: (1) understanding the scenario, the injury patterns, and the needs of the local medical system; and (2) minimizing the coronavirus disease 2019 (COVID-19) outbreak threats. This report describes the team design, the activities performed before and during the deployment, analyzes the pathology encountered, and shares lessons learned from the mission.

Data were collected from the delegation protocols and IDF medical records. All activities of the Israeli delegation were coordinated with the local government.

The local authorities reported that a total of 107 people were killed and more than 700 people were wounded. The team was the first international team to arrive at the scene and assisted the local medical teams to treat 231 patients in the three local hospitals and 213 patients in field clinics in the villages surrounding Bata. The COVID-19 pandemic influenced the operation of this mission, and caution measures were activated.

Unplanned explosions at munitions sites (UEMS) are a growing problem causing the medical teams to face unique challenges. By understanding the expected challenges, the team was reinforced with a plastic surgeon, portable ultrasound devices, a large amount and a variety of antibiotics, whole blood units, and freeze-dried plasma. Rehabilitation experts were needed in some cases in the week following the injury. An important key for the success of this kind of medical aid delegation is the collaboration with the local medical teams, which enhances patient care.

Following natural disasters, rural general practitioners (GPs) are expected to undertake several roles, including identifying those experiencing psychological distress and providing evidence-informed mental health care. This paper reports on a collaborative mental health program developed to support a rural GP practice (population <1,500) and a disaster response service.

The program provided specialized disaster mental health care via the placement of a clinician in the GP facility. In collaboration with the GP practice, the program offered opportunistic screening using the Primary Care Posttraumatic Stress Disorder (PTSD) Scale (PC-PTSD) for probable PTSD as the primary measure and the Kessler 6 (K6) as a secondary measure. Those scoring higher than two on the PC-PTSD scale were referred to the mental health clinician (MHC) for further assessment and treatment.

Sixty screening assessments were completed. Fourteen patients (male = 3; female = 11) scored higher than two on the PC-PTSD. The referred group PC-PTSD mean score was 3.14 and K6 mean score of 19. Those not referred had a PC-PTSD mean score = 0.72 and K6 mean score = 7.30. The treatment and non-treatment groups differed significantly (PC-PTSD: P <.00001 and K6: P <.00001). A prior history of trauma exposure was notable in the intervention group. Eight reported a history of domestic violence, seven histories of sexual abuse, five childhood sexual abuse, and eight intimate partner violence (IPV).

A post-disaster integrated GP and mental health program in a rural community can assist in identifying individuals experiencing post-disaster psychological distress using opportunistic psychological screening. The findings indicate that collaborative mental health programs may effectively support rural communities post-disaster.

Hesitancy towards the coronavirus disease 2019 (COVID-19) vaccine has been a topic of considerable concern in recent months. Studies have reported hesitancy within the general population and specific facets of the health care system. Little evidence has been published about vaccine hesitancy among Emergency Medical Services (EMS) providers despite them having played a frontline role throughout the pandemic.

A 27-question survey examining vaccination decisions and potential influencing factors among EMS providers was created and disseminated. Responses from providers who declined a COVID-19 vaccine were compared with responses from providers who did not decline a COVID-19 vaccine.

Across 166 respondents, 16% reported declining a COVID-19 vaccine. Providers who self-identified as men, providers who reported conservative or conservative-leaning beliefs, and providers surrounded by environments where the vaccine was discussed negatively or not encouraged are significantly more likely to decline a vaccine (P <.01). Providers who have declined a vaccine reported significantly greater levels of concern about its safety, effectiveness, and development (P <.01).

This study answers key questions about why some EMS providers might be declining COVID-19 vaccinations. Initiatives to improve vaccination among EMS providers should focus on the areas highlighted, and further studies should continue to examine vaccine hesitancy among EMS providers as well as in other populations.

Japan recently experienced two major heavy rain disasters: the West Japan heavy rain disaster in July 2018 and the Kumamoto heavy rain disaster in July 2020. Between the occurrences of these two disasters, Japan began experiencing the wave of the coronavirus disease 2019 (COVID-19) pandemic, providing a unique opportunity to compare the incidence of acute respiratory infection (ARI) between the two disaster responses under distinct conditions.

The data were collected by using the standard disaster medical reporting system used in Japan, so-called the Japan-Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED), which reports number and types of patients treated by Emergency Medical Teams (EMTs). Data for ARI were extracted from daily aggregated data on the J-SPEED form and the frequency of ARI in two disasters was compared.

Acute respiratory infection in the West Japan heavy rain that occurred in the absence of COVID-19 and in the Kumamoto heavy rain that occurred in the presence of COVID-19 were responsible for 5.4% and 1.2% of the total consultation, respectively (P <.001).

Between the occurrence of these two disasters, Japan implemented COVID-19 preventive measures on a personal and organizational level, such as wearing masks, disinfecting hands, maintaining social distance, improving room ventilation, and screening people who entered evacuation centers by using hygiene management checklists. By following the basic prevention measures stated above, ARI can be significantly reduced during a disaster.

During COVID-19 pandemic, the EMS of the city of Madrid decided to make available its human and material resources to the Government. Despite its vast experience in disaster care and management, this mission was challenging. EMT1 SAMUR-PC was deployed, fully trained and self-sufficient inside and outside the city.

To review EMT1 activities during coronavirus disease, checking its adaptation to unusual circumstances.

Description of settings where our teams (physicians, nurses, emergency care assistants, and logisticians) were deployed.

As elderly people were highly affected, EMT1 offered assessment and advise at nursing homes in Madrid and other cities. Personalized visits were planned and performed addressing personnel and material needs and processed to authorities in daily meetings.

Logisticians advised about how to control clean and dirty zones, isolating positive cases. Meanwhile, doctors and nurses wearing PPE provided health care and referred severe patients. Quality of care in elderly was measured, improvement areas were notified directly to heads.

We were deployed to some hospitals in the country, reinforcing medical and nursing staff at wards, observation areas, and intensive care units. It was also necessary to transfer critical patients between hospitals.

Decontamination lines were set up by CBN experts. Rapid response teams were ready to provide care to colleagues.

During COVID-19 pandemic, Spanish EMT1 was able to adapt its normal way of working at different settings, supporting and re-establishing essential health services. It required flexibility, taking advantage of existing structures, and focusing on vulnerable populations. Its role was important for saving lives, preserving health, and alleviating suffering.

The 2019-2020 “Black Summer” bushfires in Australia focused the attention of the nation on the critical role that volunteer firefighters play in the response to such a disaster, spurring a national conversation about how to best support those on the frontline. The objective of this research was to explore the impact of the Black Summer bushfires on volunteer firefighter well-being and to investigate how to deliver effective well-being support.

An explorative qualitative design underpinned by a phenomenological approach was applied. Participant recruitment followed a multi-modal sampling strategy and data were collected through semi-structured, in-depth interviews.

Qualitative data were collected from 58 participants aged from 23 to 61-years-of-age (average age of 46 years). All self-reported as volunteer firefighters who had responded to the Black Summer bushfires in Australia. Just over 80% of participants were male and the majority lived in the Australian states of New South Wales (65%) and Victoria (32%). All participants reported impact on their well-being, resulting from cumulative trauma exposure, responding to fires in local communities, intense work demands, minimal intervals between deployments, and disruption to primary employment. In regard to supporting well-being, four key themes emerged from data analysis: (1) Well-being support needs to be both proactive and reactive and empower local leaders to “reach in” while encouraging responders to “reach out;” (2) Employee Assistance Programs (EAPs) should not be the only well-being support option available; (3) The sharing of lived experience is important; and (4) Support programs need to address self-stigmatization.

Participants in this research identified that effective well-being support needs to be both proactive and reactive and holistic in approach.