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This study analyzes disparities in initial health care responses in Turkey and Syria following the 2023 earthquakes.
Methods
Using Humanitarian Data Exchange, Crude Mortality Rates (CMR) and injury rates in both countries were calculated, and temporal trends of death tolls and injuries in the first month post- catastrophe were compared. World Health Organization (WHO) Flash Appeal estimated funding requirements, and ratios of humanitarian aid personnel in Urban Search and Rescue (USAR) teams per population from ReliefWeb and MAPACTION data were used to gauge disparities.
Results
56 051 096 individuals were exposed, with Turkey having 44 million vs 12 million in Syria. Turkey had higher CMR in affected areas (10.5 vs. 5.0 per 10,000), while Syria had higher CMR in intensely seismic regions (9.3 vs. 7.7 per 1,000). Turkey had higher injury rates (24.6 vs. 9.9 per 10 000). Death and injury rates plateaued in Syria after 3 days, but steadily rose in Turkey. Syria allocated more funding for all priorities per population except health care facilities’ rehabilitation. Turkey had 219 USAR teams compared to Syria’s 6, with significantly more humanitarian aid personnel (23 vs. 2/100,000).
Conclusions
Significant disparities in the initial health care response were observed between Turkey and Syria, highlighting the need for policymakers to enhance response capabilities in conflict-affected events to reduce the impact on affected populations.
Narrative Abstract
The 2023 Turkish-Syrian earthquakes, the most devastating in the region since 1939, heightened challenges in Syria’s health care system amid ongoing conflict, disrupting Gaziantep’s humanitarian aid supply route. The initial health care responses post-earthquakes in Turkey and Syria were analyzed through a descriptive study, where Crude Mortality Rates (CMR) and injury rates during the first week were calculated. The World Health Organization’s funding priorities and the ratio of humanitarian aid personnel in Urban Search and Rescue teams per population were assessed. Turkey had 4-fold higher earthquake exposure and experienced higher CMR and injuries per population, while Syria had higher CMR in intensely seismic regions. Temporal trends showed plateaued death and injury rates in Syria within 3 days, while Turkey’s continued to increase. Syria required more funding across nearly all priorities while Turkey had more humanitarian aid personnel per population. Significant health care response disparities were observed, emphasizing the imperative for policymakers to enhance initial responses in conflict-affected events.
This chapter explores the ways in which young children develop their self-concept in relation to their body image and discusses some of the influencing factors that condition children to perceiving favourable body images over unfavourable body images. The chapter incorporates discussions relating to ‘thinness’, and goes beyond this aspect to consider the effects of perceived anomalies and injuries on a child’s body satisfaction and positive self-concept. In addition, we discuss ways to support children in developing a positive self-concept in relation to body image, and to promote their wellbeing using the revised Belonging, Being and Becoming: The Early Years Learning Framework for Australia (V2.0) (EYLF) (Australian Government Department of Education [AGDE], 2022).
For at least three million years, knapping stone has been practiced by hominin societies large and small, past and present. Thus, understanding knapping, knappers, and knapping cultures is fundamental to anthropological research around the world. Although there is a general sense that stone knapping is inherently dangerous and can lead to injury, little is formally, specifically, or systematically known about the frequency, location, or severity of knapping injuries. Toward this end, we conducted a 31-question survey of modern knappers to better understand knapping risks. Responses from 173 survey participants suggest that knapping injuries are a real and persistent hazard, even though a majority of modern knappers use personal protective equipment. A variety of injuries (lacerations, punctures, aches, etc.) can occur on nearly any part of the body. The severity of injury sustained by some of our participants is shocking, and nearly one-quarter of respondents reported having sought or received professional medical attention for a flintknapping-related injury. Overall, the results of this survey suggest that there would have likely been serious, even fatal, costs to knappers in past societies. Such costs may have encouraged the deployment of any social learning capacities possessed by hominins or delayed the learning or exposure of young infants or children to knapping.
The availability and complexity of escape routes are key aspects in modulating aggression. The effect of increased vertical space on the occurrence and severity of aggression was studied in a large group of chimpanzees (Pan troglodytes). Fifty wooden poles were added to the outdoor enclosure at Chester Zoological Gardens, England, UK. Connected with ropes and nets to form a complex vertical structure, they substantially increased the potential for escape routes during aggression. This study is an investigation into whether the use of the new vertical structure reduced the severity of aggression. Aggressive interactions among 29 chimpanzees (five adult males, 15 adult females, and nine immatures) were recorded whenever observed. We found that the proportion of total aggression involving the use of the vertical structure was much lower than expected based on the time individuals spent on the structure. We also found that no severe aggression was initiated when individuals were on the vertical structure. Most importantly, the proportion of severe aggression was lower when recipients of aggression moved onto the vertical structure than when they stayed on the ground. Furthermore, incidents of serious injuries were reduced after the vertical structure was added. The vertical structure appeared to function as a deterrent of aggression and an important escape route during aggressive interactions, which reduced the severity of aggression. Our results suggest that complex vertical structures are highly beneficial for semi-arboreal species with the potential for severe aggression and should be strongly considered by zoos housing such species.
The relationship between social behaviour and skin injuries (caused by horns) of loose housed horned cows was investigated on 35 dairy farms. While the frequencies of two agonistic behaviour elements (push and chase away) were positively correlated with the occurrence of skin injuries, the frequencies of butting and horning were not. Butting appears to have an ambivalent motivation, in that its occurrence is correlated positively both with agonistic behaviour and with social licking. Horning showed a positive correlation with social licking only. Four groups of husbandry conditions that may be associated with the occurrence of social behaviour and of injuries were distinguished: i) herd management, with variables including problem solving management by the farmer, integration of new cows, and dealing with periparturient and oestrus cows; ii) human-animal relationship, with variables including ability to identify individual cows, frequency of brushing the cows, number of milkers, and frequency of personnel changes; iii) animal characteristics, with the variable of herd size; and iv) stable characteristics, with the variable of space per cow (m2). The relevance of the husbandry variables investigated here had been confirmed in a previous stepwise regression analysis (Menke 1996). The variables for herd management and human-animal relationship conditions correlated in a consistent way with the occurrence of agonistic behaviour and/or of injuries, while most of them also correlated in the opposite direction with the occurrence of social licking. Herd size correlated positively with agonistic behaviour, but negatively with social licking. Space per cow correlated negatively with agonistic behaviour and injuries. In more than 70 per cent of the herds investigated, the levels of agonistic behaviour and of skin injuries were low, implying that horned dairy cows can be kept with less risk than is often assumed. We argue that such risks strongly depend on management factors that can be improved.
In most European countries broilers are currently caught manually: broilers are caught by the leg, inverted and carried by a catcher with 3–4 birds in each hand. This method of catching broiler chickens is a welfare concern as it causes severe stress to the birds. A possible alternative to manual catching may be mechanical catching. The aim of this study was to compare the level of stress and injuries of broilers caught manually or with a harvesting machine (CIEMME Super Apollo L harvester) under commercial conditions. The results indicated that there was no significant difference in plasma corticosterone concentrations and duration of tonic immobility, which suggested that mechanically caught broilers were no more stressed than those caught manually. At the end of the catching process, mechanically caught broilers had even lower plasma corticosterone concentrations and shorter durations of tonic immobility, indicating that at this moment these broilers were less stressed than the manually caught birds. The incidence of wing haemorrhages was also reduced for broilers caught mechanically; however, there was no significant difference in the incidence of haemorrhages in the breast or legs between the two catching methods. As injuries are associated with pain and stress, this parameter is important not only for the welfare of the birds but also for product quality and the subsequent financial return. Therefore, it can be concluded that the use of the mechanical harvesting machine, CIEMME Super Apollo L, appears to be a good alternative to manual catching. Nevertheless, some aspects of mechanical catching require further improvement.
A preliminary investigation was undertaken to evaluate a series of animal-based welfare measures for the assessment of finishing pigs in units that were members of the RSPCA Freedom Food farm assurance scheme. A total of 20 finishing pig units were visited in the summer of 2002 and 14 of these were revisited in late winter 2003. Behavioural observations of the pigs, both undisturbed and disturbed by the observer, were made in 128 pens containing 9,444 pigs and the physical condition of 650 individuals was examined. A range of event behaviours were observed including social interactions. Play behaviour was observed in 66% of pens during ten-minute observation periods. The prevalence of physical conditions varied greatly between units. The most prevalent skin lesion was on the flank (40.8%) however, only 4.5% of pigs had both fresh and healed flank lesions suggestive of persistent fighting.
The objective of this study was to test the hypothesis that the body condition of the mink dam, the frequency of dirty nests, frequency of injuries and diarrhoea change significantly with the day of assessment, post-partum, within the data collection period from parturition to weaning, influencing the scores of WelFur at criteria level, but not at principal level or the overall category of mink (Neovison vison) welfare according to the WelFur-Mink protocol. Data from a representative sample of around 120 dams and litters on four farms were collected three to four times in the period stipulated by the WelFur-Mink protocol. WelFur-scores between 0 (worst) and 100 (best) were calculated, aggregated and compared at criteria and principal level. The score for the criterion, ‘Absence of prolonged hunger’ dropped from 86 to 38 after about five weeks of lactation, affecting the principal score ‘Good feeding’, but not by enough to affect the estimated welfare classification. The score for the three other measures also varied with date of assessment but not enough to affect the classification. However, the observed change in the four measures we focused on indicates that a change in the overall WelFur classification can occur if these or other measures change a little more for the better or worse. Possible solutions to this could be reducing the time window for assessment, development of a valid correction factor or to stratify the visits into an early, middle and late visit on a farm within the three registration periods.
Health information systems (HIS) are crucial for guiding sound public health policies and programs. Information systems are complex entities formed of diverse parts with one common plan and purpose. A critical feature of information systems is that their components have regular interactions and interdependences. The systems should be flexible and adaptable to changes in burden and circumstances. Building health information systems should start by complementing what is currently in place and improving existing systems. It should use new technologies and include training for collectors and users. Most importantly, the data and findings should be rigorously analysed, interpreted, translated, disseminated and used to inform implementation. In this chapter, we provide a brief review of HIS and an example using the Global Burden of Disease as a case study of how different sources of HIS are used to estimate the burden of a disease to guide policies and programs.
The coronavirus disease 2019 (COVID-19) pandemic had detrimental impacts across multiple sectors of the Mexican health care system. The prehospital care system, however, remains largely under-studied. The first objective of this study was to calculate the monthly per capita rates of injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) during the early pandemic period (January 1 through June 30, 2020), while the second objective was to conduct these calculations at the borough-level for the same outcomes and time period. The third objective was to compare monthly per capita rates of injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) during the pre-pandemic (January 1 through June 30, 2019), early pandemic (January 1 through June 30, 2020), and later pandemic periods (January 1 through June 30, 2021).
Methods:
A retrospective analysis was conducted to examine injury-related 9-1-1 calls, traffic accidents, and crime at the state-level (Mexico City) and borough-levels. Monthly per capita rates were calculated using four datasets, including Mexico City’s Public Release 9-1-1 Emergency Calls, National Institute of Statistics and Geography’s (INEGI) Traffic Accidents Micro-Dataset, Mexico City’s Attorney General’s Office Crime Dataset, and Projections of the Population of the Municipalities of Mexico, 2015 to 2030. All statistical analyses were conducted using STATA 17.0.
Results:
During the early pandemic period, injury-related 9-1-1 emergency calls, traffic accidents, and crime experienced similar trends in monthly per capita rates at the state-level and borough-levels. While the monthly per capita rates remained constant from January to March 2020, starting in March, there was a precipitous decrease across all three outcomes, although decline rates varied across boroughs. The monthly per capita rates across the three outcomes were higher during the pre-pandemic period compared to the early pandemic period. As the COVID-19 pandemic progressed, the monthly per capita rates during the later pandemic period increased across the three outcomes compared to the early pandemic period, although they did not reach pre-pandemic levels during the study period.
Conclusion:
The precipitous decline in injury-related 9-1-1 calls, traffic accidents, and crime in Mexico City occurred at the same time as the issuance of the first wave of public health orders in March 2020. The largest decrease across the three outcomes occurred one to two months post-issuance of the orders.
It remains unclear which mass-casualty incident (MCI) triage tool best predicts outcomes for child disaster victims.
Study Objectives:
The primary objective of this study was to compare triage outcomes of Simple Triage and Rapid Treatment (START), modified START, and CareFlight in pediatric patients to an outcomes-based gold standard using the Criteria Outcomes Tool (COT). The secondary outcomes were sensitivity, specificity, under-triage, over-triage, and overall accuracy at each level for each MCI triage algorithm.
Methods:
Singleton trauma patients under 16 years of age with complete prehospital, emergency department (ED), and in-patient data were identified in the 2007-2009 National Trauma Data Bank (NTDB). The COT outcomes and procedures were translated into ICD-9 procedure codes with added timing criteria. Gold standard triage levels were assigned using the COT based on outcomes, including mortality, injury type, admission to the hospital, and surgical procedures. Comparison triage levels were determined based on algorithmic depictions of the three MCI triage tools.
Results:
A total of 31,093 patients with complete data were identified from the NTDB. The COT was applied to these patients, and the breakdown of gold standard triage levels, based on their actual clinical outcomes, was: 17,333 (55.7%) GREEN; 11,587 (37.3%) YELLOW; 1,572 (5.1%) RED; and 601 (1.9%) BLACK. CareFlight had the best sensitivity for predicting COT outcomes for BLACK (83% [95% confidence interval, 80%-86%]) and GREEN patients (79% [95% CI, 79%-80%]) and the best specificity for RED patients (89% [95% CI, 89%-90%]).
Conclusion:
Among three prehospital MCI triage tools, CareFlight had the best performance for correlating with outcomes in the COT. Overall, none of three tools had good test characteristics for predicting pediatric patient needs for surgical procedures or hospital admission.
This study focuses on the dolphins populating the water between Gibraltar and Algeciras in the south Iberian Peninsula, an area subjected to pressure due to high human activity. The area is considered an important feeding and breeding ground for common dolphins (Delphinus delphis). Due to the degree of residence of some specimens, and the large gap in knowledge about the evolution of wounds in D. delphis specimens with lacerations, this work sought to perform the following analyses: identify lacerated individuals; characterize sequences of ‘before – during – after’ with respect to the occurrence of lacerations; and associate the type of injury with its severity. This work will inform future studies by expanding a database on injured individuals and contribute to periodical monitoring of specimens that frequent these geographic areas. Between 2013 and 2017, we were able to track the healing process of five injured individuals of common dolphins from a whale-watching platform thanks to photo identification. The animals exhibited fresh external wounds from different sources. In the majority of individuals, the wound-healing processes lasted 3–21 weeks. The frequency with which sightings are made and knowledge about the local population will help track injured animals, follow their wound evolution, and document their survival rates. The documented injuries inflicted by human interactions described in this paper may include fishing interactions and propeller strikes, probably as a consequence of the high intensity of recreational fishing and whale-watching activities in the area.
Deep learning using convolutional neural networks represents a form of artificial intelligence where computers recognise patterns and make predictions based upon provided datasets. This study aimed to determine if a convolutional neural network could be trained to differentiate the location of the anterior ethmoidal artery as either adhered to the skull base or within a bone ‘mesentery’ on sinus computed tomography scans.
Methods
Coronal sinus computed tomography scans were reviewed by two otolaryngology residents for anterior ethmoidal artery location and used as data for the Google Inception-V3 convolutional neural network base. The classification layer of Inception-V3 was retrained in Python (programming language software) using a transfer learning method to interpret the computed tomography images.
Results
A total of 675 images from 388 patients were used to train the convolutional neural network. A further 197 unique images were used to test the algorithm; this yielded a total accuracy of 82.7 per cent (95 per cent confidence interval = 77.7–87.8), kappa statistic of 0.62 and area under the curve of 0.86.
Conclusion
Convolutional neural networks demonstrate promise in identifying clinically important structures in functional endoscopic sinus surgery, such as anterior ethmoidal artery location on pre-operative sinus computed tomography.
Psychotic experiences (PEs) may be associated with injuries, but studies focusing specifically on low- and middle-income countries (LAMICs) are scarce. Thus, the current study examined the link between injuries and PEs in a large number of LAMICs.
Method
Cross-sectional data were used from 242 952 individuals in 48 LAMICs that were collected during the World Health Survey in 2002–2004 to examine the association between traffic-related and other (non-traffic-related) forms of injury and PEs. Multivariable logistic regression analysis and meta-analysis were used to examine associations while controlling for a variety of covariates including depression.
Results
In fully adjusted analyses, any injury [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.85–2.31], traffic injury (OR 1.84, 95% CI 1.53–2.21) and other injury (OR 2.09, 95% CI 1.84–2.37) were associated with higher odds for PEs. Results from a country-wise analysis showed that any injury was associated with significantly increased odds for PEs in 39 countries with the overall pooled OR estimated by meta-analysis being 2.46 (95% CI 2.22–2.74) with a moderate level of between-country heterogeneity (I2 = 56.3%). Similar results were observed across all country income levels (low, lower-middle and upper-middle).
Conclusions
Different types of injury are associated with PEs in LAMICs. Improving mental health systems and trauma capacity in LAMICs may be important for preventing injury-related negative mental health outcomes.
The aim of this study is to describe the risk factors of injured children’s posttraumatic stress disorder (PTSD) in China and provide the scientific data for PTSD prevention and control in children.
Methods:
Electronic databases, including Medline, Science Direct, Google Scholar, and CNKI (China National Knowledge Infrastructure), were searched for articles published on or before October 30, 2018, searching for the words, “PTSD,” “child”/“children,” “injury”/“injuries,” and “China”/“Chinese.” Forty-seven articles met the inclusion criteria and were meta-analyzed using random-effect models.
Results:
The total sample size in our meta-analysis was 65 298, and there were 13 402 children diagnosed with PTSD. The prevalence of PTSD after suffering from injury was 20.52% (95% CI = 17%–23%). PTSD occurrence was higher in girls than boys (24.61% vs 19.36%, P < 0.001). The PTSD rate for students was 51.82%, 37.12%, and 14.02% in senior, junior high school children, and primary school student, respectively. PTSD prevalence was 58.93% in rural children and higher than the urban children (57.36%). The prevalence of PTSD in ethnic minority children was significantly higher than that of Han Chinese children (35.38% vs 13.50%).
Conclusion:
PTSD in injured children is significantly higher in girls, senior high school children, in rural areas, and in ethnic minority children. PTSD prevention and control should be focused on these 4 subgroups.
Mass gatherings (MGs) are held throughout the world. The aim of this review was to assess and identify the health threats based on the type of the MG, type of diseases, and injuries. Research platforms such as Web of Science, Medline, and Scopus were searched through June 2017. All epidemiologic studies that investigated the health threats during the MGs, such as communicable diseases, injuries, high-risk behaviors, and environmental health problems, were included in this review. Out of 1264 references, 45 articles were included in the review.
Three main types of MGs include religious, festival, and sporting event; and fairs such as trade, book, and agricultural types were also reported in the selected studies. In the religious MGs, infectious diseases were the most common health threat. Road traffic accidents and environmental health problems were additional health threats. At MG sporting events, injuries were the most common health problems. Infectious diseases and alcohol and drug-related disorders were other reported public health concerns. In the festival MGs, alcohol and drug-related problems were commonly reported. This review showed that health threats vary, based on the type of mass gathering. The health organizers of MGs should consider the type of the MG and the health needs and safety of the participants to help them plan their action and provide the needed health care services.
The rate of failing to apply a tourniquet remains high.
Hypothesis:
The study objective was to examine whether early advanced training under conditions that approximate combat conditions and provide stress inoculation improve competency, compared to the current educational program of non-medical personnel.
Methods:
This was a randomized controlled trial. Male recruits of the armored corps were included in the study. During Combat Lifesaver training, recruits apply The Tourniquet 12 times. This educational program was used as the control group. The combat stress inoculation (CSI) group also included 12 tourniquet applications, albeit some of them in combat conditions such as low light and physical exertion. Three parameters defined success, and these parameters were measured by The Simulator: (1) applied pressure ≥ 200mmHg; (2) time to stop bleeding ≤ 60 seconds; and (3) placement up to 7.5cm above the amputation.
Results:
Out of the participants, 138 were assigned to the control group and 167 were assigned to the CSI group. The overall failure rate was 80.33% (81.90% in the control group versus 79.00% in the CSI group; P value = .565; 95% confidence interval, 0.677 to 2.122). Differences in pressure, time to stop bleeding, or placement were not significant (95% confidence intervals, −17.283 to 23.404, −1.792 to 6.105, and 0.932 to 2.387, respectively). Tourniquet placement was incorrect in most of the applications (62.30%).
Conclusions:
This study found high rates of failure in tourniquet application immediately after successful completion of tourniquet training. These rates did not improve with tourniquet training, including CSI. The results may indicate that better tourniquet training methods should be pursued.
Tsur, AM, Binyamin, Y, Koren, L, Ohayon, S, Thompson; P, Glassberg, E. High tourniquet failure rates among non-medical personnel do not improve with tourniquet training, including combat stress inoculation: a randomized controlled trial. Prehosp Disaster Med. 2019;34(3):282–287.
Increased pressure on the poultry industry by animal-rights organisations and environmentally-conscious consumers has led to the rising popularity of cage-free housing system for hens. One of the main dangers of cage-free housing systems is the possibility for laying hens to damage their keels. Keel bone fracture incidence rate ranges up to 85%, and can lead to extensive pain in any bird, and potentially be the cause of the death for a hen in a cage-free environment. It was reported that kneel bone damage observed in flocks housed in non-cage systems was 30 to 95% while in furnished cages it was 15 to 55%. The purpose of this review is to compare the prevalence of the problem found in the three main housing systems (conventional, enriched cage, and cage-free), discuss if such damage could affect the behaviour and production of laying hens, and provide potential solutions for reducing the prevalence of keel bone damage. Keel fractures can negatively affect a hen in its day-to-day life by causing pain and restricting its movements. The prevalence of keel bone damage varies considerably among the studies due to differences in the system design, genetic line, age and method for determining the keel damage, which makes difficult to compare the systems. The genetic selection, adequate nutrition and modifications in the house design have shown to be useful tools in reducing keel bone damage in laying hens.
The aim of this study was to examine the effects of genetic and environment influences and sex on injury involvement using two sets of Finnish twin data. The younger participants were 955 twins born between 1983 and 1987, aged 20 to 24 years. The older participants were 12,428 twins born between 1930 and 1957, aged 33 to 60 years. Within-twin correlations in monozygotic and dizygotic twins suggested that genetic effects play no role in injury involvement among young twins, but do have some effect at older ages. The results indicated that environmental factors have greater importance in injury involvement than genetic factors in the younger twin data set (FT12), whereas in a middle-aged (33–60 years) twin data set, genetic effects explained about quarter of the variance in injury involvement. Sex was a strong contributing factor, with males being generally more prone to injuries than females.
Introduction: The number of refugees accepted to Canada grew from 24,600 in 2014 to 46,700 in 2016. Many of these refugees have young families and the number of child refugees has increased accordingly. Although child refugee health care has been in the forefront of media and medical attention recently, there is limited data on injury patterns in this population. Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) collects data on injuries in children presenting to the emergency department (ED). Our objective is to examine the clinical presentations and outcomes of refugee children with injuries presenting to a tertiary care paediatric ED. Methods: Our paediatric hospital has approximately 70,000 ED visits per year of which 13,000 are due to injuries and/or poisonings. The CHIRPP database was accessed to identify children with injuries presenting to our ED from April 2014 to March 2017 with Interim Federal Health Program (IFHP) registration status. All patient charts were reviewed to extract demographic and clinical care information. Results: There were 74 children with 81 ED visits during the study period of whom 19% were transferred from other facilities. Most of them (72%) were males with a mean age of 8.7 years (standard deviation 4.29). There were significant medical histories in 32% of children. The presentation to our ED (greater than 24 hours post-injury) was seen in 25% of visits. Twenty five percent of injured children were seen in our ED. The distribution of Canadian Triage Acuity Score (CTAS) scores 1, 2, 3, 4, and 5 were 0%, 16%, 37%, 46% and 1% respectively. However, subspecialty consultations were required in 69%, 60% and 27% of CTAS 2, 3 and 4 children respectively. Overall, 46% of all patients required subspecialty consults. The top three categories of injuries include fractures (23%), soft tissue injuries (20%) and lacerations (17%). More than half (56%) required diagnostic imaging. Most (89%) were treated in ED and discharged (average length-of-stay 3 hours 55 minutes) and 11% required admissions. 47% of children lacked primary care physicians. Conclusion: Almost half of refugee children with IFHP status require DI testing, sub-specialty consultations and primary care referrals when presenting to our ED with injuries. Follow up arrangements are needed as many do not have access to primary care providers. This demonstrates a need for securing primary care providers early for this vulnerable population.