As part of EU (Horizon 2020) HERoS program, UK-MED and PCPM compiled main operational difficulties faced by the two EMTs in 25 and seven COVID-19 deployments, respectively. In particular, the paper discusses the changing role of EMTs, as well as challenges faced in meeting high expectations of the respective Ministries of Health (MOH).

Documenting challenges faced by EMTs in COVID-19 response, lessons learned, and best practices.

Review of mission reports; interviews with mission members; input from other EMTs (TBC).

The paper lists best practices of the two EMTs and recommendations to donors and EMT Secretariat, particularly linked to mission duration and collaboration with MOH.

The paper lists best practices of the two EMTs and recommendations to donors and EMT Secretariat, particularly linked to mission duration and collaboration with MOH.

Emergency Medical Services (EMS) is a critical part of Disaster Medicine (DM) and can limit morbidity and mortality with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training available to EMS physicians. The Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War arose during the SARS-CoV-2 (COVID-19) pandemic.

This study assessed the state of disaster preparedness of the Armenian EMS system and effects of the simultaneous pandemic and war on EMS providers.

This was a cross-sectional study by anonymous survey of Yerevan EMS physicians who provided care to war casualties and COVID-19 patients.

Most participants had been a physician for ≤three years (52.1%). Many were in residency (64.6%).

Battlefield medicine experience was limited prior to the war. The majority reported no experience treating mass casualties (52.1%), explosives wounds (52.1%), or performing surgical procedures (52.1%). Greater battlefield medicine experience was found with ≥three years of experience as a physician (z-score -3.26; P value <.01) or EMS physician (z-score -2.76; P value <.01), and being ≥30 years old (z-score -2.11; P value = .03). Most participants felt in danger during the war at least sometimes (89.6%).

EMS physicians in Armenia had limited training and experience in DM prior to the 2020 Nagorno-Karabakh War, but practiced in a setting requiring extensive DM knowledge as evidenced by the simultaneous response to the COVID-19 pandemic and war. There is a strong need for DM training within the Armenian EMS system.

The World Health Organization (WHO) declared climate change a defining issue in the 21st century with more intense heatwaves, higher risks of flooding and damaging storms, and a changing pattern of emerging infectious diseases. In this scenario, the response of Emergency Medical Teams (EMTs) to disasters represents a fundamental resource.

To expand EMT2-ITA-Regione Piemonte operational independence and to minimize its environmental footprint.

A multiphasic and prospective project is planned in order to:

(1) Reduce water consumption: use of a sterilizer designed with a set of high-efficiency heat exchangers enabling a substantial saving in water consumption by the vacuum pump and a significant reduction of total water usage through a recirculation system.

(2) Reduce demand for diesel: photovoltaic (PV) system to integrate the current energy production system based on diesel generators.

(3) Reduce paper consumption: use of sterilization management and traceability system and computerized medical record in order to be paperless.

(4) Improve staff awareness and education on greening practices: educational program for the staff focused on waste segregation/management and energy and water saving both in the hospital and in the Base of Operation (BoO).

EMT2-ITA-Regione Piemonte aims to reduce energy and water consumption by 30% and to become paperless.

Advances in greening initiatives offer to EMT2-ITA-Regione Piemonte the potential to improve its disaster medical response capabilities and to reduce its ecological footprint.

Health staff in South Sudan and Nigeria face extreme risks while providing services: in 2021, at least 18 health care workers were killed in South Sudan and Nigeria, while 32 were kidnapped. Reporting of such incidents takes place via the WHO coordinated SS. However, such event reporting is not designed to capture “lower scale” security incidents, nor does it capture possible solutions. As such, the IRC in coordination with the Health Cluster and national organizations are conducting a survey to complement the existing analysis with insights of frontline health care workers, to support program design, funding requests, and advocacy activities. Research questions include:

• What are the most common incidents of violence against health care workers?

• What has been the impact of these incidents on staff well-being, on the health system/sector, and on access to health care for the wider community?

• What are the priorities in preventing such incidents and reducing their impact?

To identify incidents of violence against health care as experienced by health care staff in 2022.

To identify health workers perspective on causes, impact, and what works in terms of prevention and response.

A self-administered, online survey targeting all health staff working for the humanitarian community in South Sudan and Northeastern Nigeria.

This study is on-going with results expected by early September.

This study is on-going with results expected by early September.

The World Health Organization (WHO) Emergency Medical Teams (EMT) Initiative is an important mechanism for strengthening surge capacities for clinical care during public health emergencies (PHE) in West Africa. To enhance preparedness, response capacity, and resilience, the West African Health Organization (WAHO) helps countries to establish, manage, and strengthen essential EMT capacities with other partners.

We describe the EMT capacity-building experience in West Africa and highlight gaps and lessons learnt.

We conducted a descriptive, cross-sectional assessment using data from regional and national EMT awareness workshops and other activities reports. We also administrated a questionnaire to a convenient sample of EMT stakeholders for identifying challenges and gaps in strengthening EMTs.

A total of 14 EMT awareness workshops have been performed in West Africa resulting in on-going implementation national actions plans. Member States were at different levels of implementation of their EMT’s action plan. Only one National EMT is fully operational. The main challenges in EMT implementation included lack of political will, lack of skilled workforce, lack of guidelines for developing SOPs, and inadequate funding for EMT operations. A total of 606 health workers have been trained including 492 males (80.92%). The trainees were public health specialists (44.90%), clinicians (15.80%), support staff (13.65%), and non-health actors (25,66%).

Our study highlighted critical challenges to guide the EMT implementation in West Africa. Despite the knowledge gained from the trainings, there is a need to take some urgent actions in West Africa for improving national EMT functionality and performance in West Africa.

The WHO EMT Minimum Data Set (EMT-MDS) was designed for data collection in sudden-onset disasters. Using EMT-MDS in the context of primary health care (PHC) generated large quantities of low granularity data that threatened the successful delivery of UK-Med’s clinical programs in Ukraine. Accordingly, UK-Med developed, piloted, and implemented a new coding tool (PHC-CT) tailored to PHC presentations prevalent in humanitarian settings.

To assess the performance of EMT-MDS and PHC-CT in the generation of programmatically-useful diagnostic codes from data collected in mobile PHC clinics in Ukraine during active conflict.

To compare the performance of EMT-MDS and PHC-CT in this setting and to suggest recommendations for data collection tool improvements.

After multiple iterations, the final version of PHC-CT was used to collect clinical data from all UK-Med clinical encounters in Ukraine from March 28, 2022-May 13, 2022. Clinical data using EMT-MDS were collected simultaneously. The prevalence of each diagnostic code was calculated using both EMT-MDS and PHC-CT, expressed as a proportion of the total diagnoses, and compared between the two coding tools.

1,390 clinical encounters took place during the study. Data coded using EMT-MDS generated 1,756 diagnoses (86.8% of total diagnoses) categorized as “Other Diagnosis” while the same data coded using PHC-CT generated 37 diagnoses (1.8% of total diagnoses) categorized as “Other Diagnosis.” Only seven of the available 25 diagnostic codes in EMT-MDS were used, while 48 of the 67 available diagnostic codes in PHC-CT were used.

PHC-CT offers substantial benefits beyond those provided by EMT-MDS when utilized in mobile PHC clinics in humanitarian settings.

Tables and Figures (optional)

Table 1.

Number of Clinical Encounters, Unique Diagnoses, and Frequency of Selected Diagnostic Codes for EMT-MDS and PHC-CT. (Note: % refers to proportion of diagnoses made)

COVID-19 tremendously affected Papua New Guinea in late 2021, which accompanied by a low vaccination rate (<4%), lead to an International EMT Request for Assistance.

Study’s aim is to share how UK-Med, a part of the UK EMT, developed best practices related to risk communication and community engagement integration within a COVID-19 emergency response.

A participatory health promotion program was piloted in Western Highland Province among 71 health care workers. Training of trainers approach was adopted to build the capacity of health workers in advocating for vaccines uptake. Perception survey was used at the baseline and at the end of the program to assess the knowledge, skills, and attitude of the participants towards COVID-19 vaccine acceptance. A descriptive analysis and paired t-test were used.

Health care professionals are not well-equipped with accurate, scientific, and up-to-date information related to COVID-19 vaccines; which leads to increase in concern and fear among them. Health care workers affect community members’ decision to take the COVID-19 vaccine, being viewed as referents within their communities. The paired t-test showed a significant increase in the knowledge, skills, and attitude (P value <.001) of the participants toward COVID-19 vaccines. Participants described being ready to engage community influencers and cascade training to further reach out to community groups.

Integrating RCCE within EMT deployments plays a crucial role in leveraging health care capabilities to influence community members and advocate for COVID-19 vaccines uptake; which will ultimately decrease morbidity and mortality. Further research is required to strengthen the role of health promotion in emergencies.

Papua New Guinea (PNG) is a Pacific nation of over nine million. It is one of the world’s most diverse nations, with over 800 languages and geographic diversity that includes both tropical islands and highland mountains. Located on the Pacific “ring of fire,” PNG is regularly struck by disasters and outbreaks. The COVID-19 pandemic triggered multiple deployments of international EMTs to PNG, which were coordinated through a national EMT Coordination Cell. To strengthen rapid, national response to future emergencies, the PNG Government through its National Department of Health is now developing the “PNG EMT.”

To describe the development of the PNG EMT.

PNG’s national EMT development was inspired by multiple international EMT deployments, including the 2018 Highlands earthquake and multiple COVID-19 deployments. With support from WHO, PNG’s National Department of Health led EMT coordination efforts in those responses, and recognized the need for similar capabilities to be developed for national response.

To develop the PNG EMT, a focal point was appointed, a national technical working group was formed, and SOPs have been drafted with support from WHO and partners. In consultation with PNG and other Pacific EMTs, WHO is procuring a tailored Pacific EMT cache, including items specifically selected for PNG’s diverse geographic and climactic environments. PNG plans to train team members and be ready for self-sufficient national deployments by late 2022.

PNG is strengthening readiness for future emergencies by developing a national EMT capable of rapid response to challenging and austere post-disaster environments.

The COVID-19 pandemic resulted in multiple requests for EMT assistance in the Pacific Region. AUSMAT responded in six countries, sometimes simultaneously. The needs of the pandemic and the pressures on available resources to respond required development of innovative methods. One example is the “POP-O-MOP” tool.

Describe the evolution and utility of “POP-O-MOP” tool in building local capacity in Pacific health care systems facing COVID-19 outbreaks.

The initial aim of the tool was to assist in maximizing the response by providing a concise, one-page teaching tool to assist in training of local nursing staff. As the tool evolved over successive COVID-19 deployments in the Pacific Region, the scope grew to include medical and allied health staff, and the content was refined.

While the “POP-O-MOP” mnemonic provides an aide-memoir for steps of COVID-19 care at the bedside; it also provided a structure for facilitating training and interdisciplinary discussion amongst clinicians.

By utilizing this structured training face-to-face, video, and online formats, the number of staff able to treat COVID-19 patients was increased, drawing on novices and staff from non-critical care backgrounds.

Of significance, it was observed that while the technical skills included improved health response, the confidence gained by local staff in the brief training increased their desire to contribute to the COVID-19 response by overcoming stigma, fear, and the sense of futility.

The POP-O-MOP tool proved to be an effective tool to leverage in-country resources by providing effective just-in-time training for local health care workers.

During health emergencies, significant disruptions occur concurrently within critical components of acute care systems such as workforce, medical supplies, clinical workflows, patient care pathways, and hospital essential support services. The ability to map both existing and surge capacities across the acute care health system is a complex, nuanced, and often lengthy process which is heavily dependent upon localized knowledge applied in specific, individual contexts.

Outline an innovative, “All Hazards” tool developed through a standardized framework approach to rapidly and consistently identify, assess, and prioritize key system-wide health capacity indicators in acute care hospital settings during health emergencies.

Initially designed as a health systems preparedness and planning tool for use in sudden-onset disasters in 2017, the “7S” framework has been successfully applied during recent AUSMAT outbreak emergency responses to assist local Ministries of Health to effectively identify, articulate, rationalize, and prioritize clinical and operational health response priorities.

Multiple operational health leaders found the “7S” framework valuable in efficiently managing both the assessment of and priority allocation of resources in health systems under duress. The tool was simple to understand and explain, time efficient, and comprehensive. Additionally, the tool provided an effective structure for communicating with local health and response leaders.

The “7S” framework has demonstrated excellent utility as a highly effective and scalable, locally adapted “All Hazards” tool for use during health planning, preparedness, and acute care response phases in diverse health emergencies contexts.

Over the last decade, a global increase in the number of armed conflicts has been recorded and Mobile Health Units (MHU) are deployed to provide aid to people with limited access to health care. However, the service modality has received criticism related to irregular service provision and logistical difficulties. Although MHUs may be of value in conflicts and insecure environments, there is a significant knowledge gap regarding their usefulness to address dominating health needs.

To elucidate the use of MHUs in conflict settings in adherence to WHO Classification for Emergency Medical Teams.

A scoping review was conducted following the framework by Arksey and O’Malley. Twenty-six bibliographic databases and websites were searched for white and grey literature published between 2000-2021 reporting on the use of MHUs in conflict settings.

Fourteen publications were included in the final analysis, highlighting seven themes: site of operation and mobility, key characteristics, services, benchmark indicators, staff, community engagement, and safety and security. The mobile approach was reported to increase access to health services. Challenges described primarily concerned access and availability, limited coverage, and logistics. Several studies highlighted the need for more sustainable interventions and a more clearly defined exit strategy.

There is a paucity of publications reporting on the use of MHUs in conflict settings and inconsistencies in the reported data. The literature adhered to previous research and WHO guidelines to some extent. Further research is needed evaluating the interventions and outcomes of MHUs in conflict settings.

Japan DMAT and US DMAT have been collaborating in the past to prepare for expected and unexpected disasters in Japan. Japan is predicting overwhelming disasters on Japanese soil soon, which needs efficient and optimum use of resources in medical assistance, including additional support from overseas, particularly from the US. The Japanese government established a large-scale Earthquake/Tsunami Disaster Emergency Response protocol in 2020. However, this protocol does not include any standard operation procedure (SOP) to receive an international medical team.

Establishing the SOP of receiving medical assistance from US-DMAT based on the WHO International Emergency Team (EMT) initiative.

Collaborated with the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the United States Health and Human Services, tabletop exercises assuming that a large-scale earthquake occurred during hosting the 2025 Osaka Expo was conducted online meeting system.

Provisional SOP was formed by the Japan research team and ASPR representatives. Even though Japan had several disaster medical assistance collaborations with US DMAT and is well-familiarized with the Classification and Minimum Standards for Emergency Medical Teams, many issues need to be prepared to accept US DMAT.

Numerous procedures need to be conducted to receive US DMAT assistance during a large-scale earthquake in Japan. With this SOP, receiving US medical team assistance will be conducted promptly, eventually saving many lives. This SOP can be modified for other international teams’ acceptance in Japan. It could reference other countries seeking to have SOPs for receiving international medical team assistance in the near future.

The Standard Operating Procedure for Coordination of Emergency Medical Teams in ASEAN (EMT SOP) was developed to facilitate the swift deployment of I-EMTs by ASEAN Member States (AMS) to disaster-affected countries in the ASEAN region and to effectively provide appropriate medical services to the affected population. It is one of the various products and activities by the ARCH Project, which was implemented in collaboration between ASEAN and Japan from 2016 through 2021. The EMT SOP was developed in line with the WHO EMT Initiative, and various WHO forms have been incorporated as ASEAN official forms for the management and coordination of I-EMT.

On the other hand, disaster management in ASEAN is conducted by National Disaster Management Organization (NDMO) of each AMS under the coordination of the ASEAN Coordinating Centre for Humanitarian Assistance on disaster management (AHA Centre) in accordance with the Standard Operating Procedure for Regional Standby Arrangements and Coordination of Joint Disaster Relief and Emergency Response Operations (SASOP), the sole official document for ASEAN regional collaboration in disasters, and AMS I-EMTs are required to follow the SASOP for their deployment to the affected AMS.

Discussions were held between the NDMOs and MOHs, and a table-top exercise to test the EMT SOP was conducted involving NDMOs and MOHs with the facilitation of the AHA Centre.

The EMT SOP has been incorporated as an additional chapter of the SASOP.

The institutionalization of the EMT SOP is an important milestone in strengthening the ASEAN regional cooperation mechanism on disaster management.

The NCCTRC is the custodian of the Australian Medical Assistance Team (AUSMAT) capability. AUSMAT achieved World Health Organization (WHO) verification as a Type 2 Emergency Medical Team (EMT) in 2016.

The NCCTRC explored a quality framework to support quality improvement beyond WHO minimum standards. The Australian Council on Healthcare Standards (ACHS) accreditation standards were applied to a unique field capability setting.

Establish a quality improvement framework for AUSMAT deployable capability to ensure delivery of the highest standard of care to populations affected by disasters and health emergencies.

ACHS surveyors conducted a scoping assessment in 2017. The ACHS EQuIP Framework provided flexibility to accommodate the complexity of a deployable health facility, the fixed and virtual workforce, and the application of disaster response/humanitarian principles.

Self-assessment identified gaps, which were remedied by the development of multiple tools, and an on-going program of improvement in formal documentation of process.

NCCTRC achieved ACHS EQuIP accreditation in June 2019. NCCTRC was awarded the ACHS Global Quality Improvement Award in November 2019. Survey in May 2021 demonstrated continued achievement.

The application of a national accreditation framework to an EMT is unique. The NCCTRC applied a quality improvement framework to provide a standard of care that meets national health facility accreditation criteria, setting a new standard of clinical quality in the field.

The effectiveness of care provided by EMTs is directly linked to the ability to ensure a controlled, coordinated, and safe patient flow through the post, especially in case of MCIs or disease outbreak. Currently, there are neither frameworks nor tools to analyze such flow that is often visualized on paper using arrows or simply connected to the care pathway, thus missing the impact of people’s interactions with the facility.

This study aims at exploring the use of a behavioral-design-based approach in simulating patient flow through EMTs.1

It provides a dynamic behavioral simulation model to assess the interactions between patients, staff members, and the related dynamic movements/interactions with the health care facility, each of them having specific features also in relation to the emergency condition faced.2 Data used in this study consist of literature-based information concerning patient characteristics (eg, age), the variation of expected medical conditions and severity in relation to the time and typology of the emergency,3 layouts of existing facilities (eg, UKMed T1), and experimental activities (eg, exercise).

The analysis of the results will allow to simulate different scenarios and improve the design of health care facilities layouts in order to prevent overcrowding situation, avoid disease spreading, estimate the optimal number of staff for each task, and investigate interactions between patients and staff.

Optimizing patient flow encompasses quickly, efficiently, and effectively movement meeting the demand for care by moving patients through care pathways while improving coordination of care, patient safety, and health outcomes.

Natural and man-made catastrophes have caused significant destruction and loss of lives throughout human history. Disasters accompany various events with multiple causes and consequences, often leading to a cascade of health-related events. Ethiopia, amongst the developing countries in the horn of Africa, is vulnerable to natural and man-made disasters. Over the last few years, Ethiopia learned the hardest way to transform its disaster management from a mere apparatus of response and recovery to preparedness and mitigation.

Review the challenges and opportunities for establishing the Ethiopian EMT and its disaster response experience.

This was a mixed-methods, cross-sectional Intra-Action Review of activities of country EMT. It included a review of documents and key informant interviews. All data were analyzed thematically.

In May 2022, the Ethiopian Federal MOH, in collaboration with WHO, adapted the WHO EMT initiative to tackle the identified challenges. Ethiopia’s EMT implementation plan was created, which included ten steps and 50 detailed activities. This initiative aims to have a classified Type I fixed EMT in the coming six months. Based on the objective evaluation of the last four months’ performance toward plan implementation, activities show that 65% of the overall plan has been completed.

Implementing the EMT initiative in Ethiopia has positively impacted the clinical quality of care, enhanced coordination, and improved health outcomes for the population served at times of great need. However, the implementation requires collaboration in support, guidance, and experience sharing from stakeholders and partners, including twinning with other organizations.

Tables and Figures (optional)

Table 1.

Ethiopian EMT Ten Steps Implementation

Rapid Response Mobile Laboratories (RRML) are a crucial component of preparedness and response to health emergencies, both as a stand-alone asset and in conjunction with other rapid response capacities. The development of an RRML classification system in 20191 both defines laboratory structure and provides a foundation for the development of RRML minimum standards under the umbrella of the WHO Global Outbreak Alert and Response Network (GOARN).

These minimum standards define the requirements for RRMLs/GOARN in the field and facilitate their interoperability with other important operational assets of WHO, including Emergency Medical Teams (EMTs), contributing to the overall response and to enhanced collaboration among national and international health partners.

The development of minimum standards brought together over 30 technical experts in various disciplines from European GOARN partner institutions to conduct a systematic applied literature review and consolidate field experiences and lessons learned from infectious disease outbreaks globally, as well as addressing the complete RRML deployment life cycle2 and for each RRML type.

The RRML minimum standards focus on four workstreams: Operational Support & Logistics; Laboratory Information Management System; Biosafety & Biosecurity; and Quality Management Systems.

This standardization will ensure predictable response in the field and is the first step in strengthening RRML interoperability with other capacities and members of the global health emergency workforce, such as EMTs and Rapid Response Teams, as well as national-level counterparts.

The standards contribute to strengthening of National Laboratory capacities, provide the basis for a forthcoming monitoring and evaluation Framework, and WHO RRML recognition process.

While there are accepted triage and treatment guidelines for the entrapped and mangled extremity in civilian and military resource rich environments, there are none for resource-scarce environments.

A PRISMA systematic literature review was performed to elucidate the current triage and treatment of the entrapped and mangled extremity to understand the factors that contribute to the decision to amputate, or not amputate, and to extract data to develop clinical guidelines.

A lead researcher followed the PRISMA systematic literature review search strategy inclusion and exclusion criteria.

A first reviewer was randomly assigned sources. One of the two lead researchers was the second reviewer. Each determined the Level of Evidence (LOE) and Quality of Evidence (QE) from each source.

Five-hundred ninety-seven (597) records were screened. Fifty-eight (58) articles were entered into the final study. There was one study determined to be LOE-1, 29 LOE-2, and 28 LOE-3 with 15 determined to achieve QE-1, 37 QE-2, and six QE-3.

Data extracted included relevant information to develop clinical guidelines to include physiologic parameters, injury patterns or procedures, imaging, rehabilitation, ethics, and the informed consent process.

This systematic literature review showed that there is a lack of studies producing strong evidence to support the triage and treatment of an entrapped or mangled extremity in resource-scarce environments. A Delphi method study is suggested to adapt and modify available evidence extracted to create clinical guidelines in the resource-scarce environment.

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.