The Kahramanmaraş earthquakes struck the north-eastern part of Türkiye and Syria on February 6, 2023. It is well known that timely coordination and provision of emergency medical care in the field is particularly important to save lives after earthquakes. This study aimed to identify the challenges faced by medical responders on the ground.

This exploratory-descriptive qualitative study was conducted in Hatay, the province most affected by the earthquakes. Data were collected through in-depth semi-structured interviews and field observations, and then analyzed using thematic analysis approach.

The study was carried out with 15 first responders from the medical profession. The study revealed 9 themes of challenges faced by medical responders: providing safety and security, human resources management, meeting personal needs, recording data, communication, patient transport, burial procedures, psychological acumen, and logistical problems. Some problems were resolved after 72 h and some continued until day 7.

Inadequate organization of volunteer health workers, communication breakdowns, and logistical problems are some of the main challenges. To address these issues, satellite phones and radio systems can be promoted, as well as disaster-resilient logistical planning and better coordination of volunteers.

Several studies highlighted how COVID-19-related isolation and quarantine deeply weighed on the mental health of both the general and psychiatric population. There has been limited investigation about self-harm and impulsivity during the COVID-19 pandemic.

The aim of this study is to evaluate how COVID-19-related lockdown affected self-harm rates in an Italian hospital.

Data on 59 patients were retrospectively collected from the Emercency deparment of the Policlinico Tor Vergata, Rome, from March 11 to May 4, 2020 (Italian mass quarantine) and the same periods of 2019 and 2021. Demographics, psychiatric history, substance use/abuse, types of self-harm and admission in psychiatric acute unit (PAU) rates were recorded.

No statistical difference was reported in self-harm rates [9.8%(26/266) in 2019 vs 13.2%(10/76) in 2020 vs 10.7%(23/215) in 2021;p>0.05]. In 2020 subjects were younger (31.9±12.1 vs 39.2±14.4,p=0.22;vs 38.1±14.4;p=0.15) and had higher incidence of psychiatric history [90%(9/10) vs 73.1%(19/26), p=0.42;vs 65.2% (15/23),p=0.29],than 2019 and 2021 respectively. Substance use/abuse rates were significantly lower in 2020 compared to 2019 and 2021 [10%(1/10) vs 53.8%(14/26),p=0.04;vs 60.9% (14/23), p=0.02]. In 2020, subjects committing self-harms were more frequently admitted to PAU compared to 2019 and 2021 [60%(6/10)vs19.2%(5/26),p=0.04; vs 17.4% (4/23), p=0.04).

Consistent with the literature, lockdown-related measures negatively impacted on younger people, with higher rates of self-harm between March and May 2020. This, together with a higher rate of admissions to PAU, should warn the mental health system to target with specific programs to support adolescents and youngers.

No significant relationships.

Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness.

PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences.

Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences.

Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.

Suicidal phenomena help seeking depends on a broad array of factors, which include climatic variables. Our aim was to analyse the effect of precipitation with help seeking in patients suffering from suicidal behaviour

Our aim was to analyse the effect of precipitation with help seeking in patients suffering from suicidal behaviour

Daily urgency visits from suicidal phenomena (including suicide attempt and ideation) were extracted from electronic medical records of Hospital Universitario La Paz from 1st January 2019 to 31st December 2019. Precipitation data (measured as accumulated litres per square meter) was obtained from a local climate station. Spearman correlation was estimated

The Spearman correlation coefficient was 0.04(p = 0.48)

Precipitation did not influence help seeking for patients affected by suicidal phenomena

No significant relationships.

Psychiatric emergency care visits have been associated to several climate variables. However, the influence of precipitation has been understudied

To study the association between precipitation and number of emergency care psychiatric visits.

Daily urgency visits were extracted from electronic medical records of Hospital Universitario La Paz from 1st January 2019 to 31th December 2019. Precipitation data (measured as accumulated litres per square meter) was obtained from a local climate station. Spearman correlation was estimated.

The Spearman correlation coefficient was -0.02(p = 0.80).

Precipitation was not associated to number of emergency visits.

No significant relationships.

Psychiatric emergency visits have with associated with seasonal pattern that reflect psychosocial factors. Its knowledge could proving valuable insight about help seeking behaviour of patiens suffering with mental illness.

Our aim was to analyse weekly and monthly seasonality

Daily urgency visits were extracted from electronic medical records of Hospital Universitario La Paz from 1st January 2019 to 31st December 2019. A poisson multivariate model was performed with day of the week and month as covariates. Predictive margins were estimated

Psychiatric emergency visits were less frequent in Saturday and Sunday (5.5 visits per day) than weekdays (7.5 visits per day). Not differences were observed among months.

A weekly season pattern was observed with less psychiatric emergency visits during weekends.

No significant relationships.

Psychiatric emergency visits have been associated to several climate variables. However, the influence of relative humidity has been not well stablished.

The analyse the influence of relative humidity on emergency care visits.

Daily urgency visits were extracted from electronic medical records of Hospital Universitario La Paz from 1st January 2019 to 31st December 2019. Relative humidity data (%) was obtained from a local climate station. A negative binomial multivariate regression model was performed with relative humidity, weekday and month as covariates.

Relative humidity was not associated with number of psychiatric emergency department visits (IRR 1.00; 95%CI 0.99-1.00)

Relative humidity did not influence emergency help seeking for patients suffering from suicidal phenomena

No significant relationships.

Prehospital care is a key component of an emergency care system. Prehospital providers initiate patient care in the field and transition it to the emergency department. Emergency Medicine (EM) specialist training programs are growing rapidly in low- and middle-income countries (LMICs), and future emergency physicians will oversee emergency care systems. Despite this, no standardized prehospital care curriculum exists for physicians in these settings. This report describes the development of a prehospital rotation for an EM residency program in Central Haiti.

Using a conceptual framework, existing prehospital curricula from high-income countries (HICs) were reviewed and adapted to the Haitian context. Didactics covering prehospital care from LMICs were also reviewed and adapted. Regional stakeholders were identified and engaged in the curriculum development.

A one-week long, 40-hour curriculum was developed which included didactic, clinical, evaluation, and assessment components. All senior residents completed the rotation in the first year. Feedback was positive from residents, field sites, and students.

A standardized prehospital rotation for EM residents in Haiti was successfully implemented and well-received. This model of adaptation and local engagement can be applied to other residency programs in low-income countries to increase physician engagement in prehospital care.

As the novel coronavirus disease 2019 changed patient presentation, this study aimed to prospectively identify these changes in a single ENT centre.

A seven-week prospective case series was conducted of urgently referred patients from primary care and accident and emergency department.

There was a total of 133 referrals. Referral rates fell by 93 per cent over seven weeks, from a mean of 5.4 to 0.4 per day. Reductions were seen in referrals from both primary care (89 per cent) and the accident and emergency department (93 per cent). Presentations of otitis externa and epistaxis fell by 83 per cent, and presentations of glandular fever, tonsillitis and peritonsillar abscess fell by 67 per cent.

Coronavirus disease 2019 has greatly reduced the number of referrals into secondary care ENT. The cause for this reduction is likely to be due to patients’ increased perceived risk of the virus presence in a medical setting. The impact of this reduction is yet to be ascertained, but will likely result in a substantial increase in emergency pressures once the lockdown is lifted and the general public's perception of the coronavirus disease 2019 risk reduces.

The World Health Organization (WHO; Geneva, Switzerland) recommends lay first responder (LFR) programs as a first step toward establishing formal Emergency Medical Services (EMS) in low- and middle-income countries (LMICs) to address injury. There is a scarcity of research investigating LFR program development in predominantly rural settings of LMICs.

A pilot LFR program was launched and assessed over 12 months to investigate the feasibility of leveraging pre-existing transportation providers to scale up prehospital emergency care in rural, low-resource settings of LMICs.

An LFR program was established in rural Chad to evaluate curriculum efficacy, using a validated 15-question pre-/post-test to measure participant knowledge improvement. Pre-/post-test score distributions were compared using a Wilcoxon Signed-Rank test. For test evaluation, each pre-test question was mapped to its corresponding post-test analog and compared using McNemar’s Chi-Squared Test to examine knowledge acquisition on a by-question basis. Longitudinal prehospital care was evaluated with incident reports, while program cost was tracked using a one-way sensitivity analysis. Qualitative follow-up surveys and semi-interviews were conducted at 12 months, with initial participants and randomly sampled motorcycle taxi drivers, and used a constructivist grounded theory approach to understand the factors motivating continued voluntary participation to inform future program continuity. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide design, analysis, and reporting the qualitative results.

A total of 108 motorcycle taxi participants demonstrated significant knowledge improvement (P <.001) across three of four curricular categories: scene safety, airway and breathing, and bleeding control. Lay first responders treated 71 patients over six months, encountering five deaths, and provided patient transport in 82% of encounters. Lay first responders reported an average confidence score of 8.53/10 (n = 38). In qualitative follow-up surveys and semi-structured interviews, the ability to care for the injured, new knowledge/skills, and the resultant gain in social status and customer acquisition motivated continued involvement as LFRs. Ninety-six percent of untrained, randomly sampled motorcycle taxi drivers reported they would be willing to pay to participate in future training courses.

Lay first responder programs appear feasible and cost-effective in rural LMIC settings. Participants demonstrate significant knowledge acquisition, and after 12 months of providing emergency care, report sustained voluntary participation due to social and financial benefits, suggesting sustainability and scalability of LFR programs in low-resource settings.

Bystanders can improve the outcome in emergencies by activating the “chain of survival.” Gaza’s (Palestine) population has little, if any, access to training in Basic Life Support (BLS) and cardiopulmonary resuscitation (CPR). The goal was to recruit local medical students to be life-saving first aid instructors, and have them train 3,000 laypeople in BLS and CPR.

One hundred and seventeen medical students from Al Azhar University-Gaza (Gaza City, Palestine) were trained as BLS and CPR instructors. Twelve training hours were delivered in practical BLS and CPR skills, plus four in communication and didactical skills, to enable training of laypeople. Students answered a questionnaire exploring demographics, prior training experience, expectations, and motivation to join the training. Teaching material were developed after the European Resuscitation Council (ERC; Niel, Belgium) guidelines and similar training at The Arctic University of Norway (Tromsø, Norway).

A total of 117 medical students (52.1% female; 47.9% male), from third through sixth year, completed training, and all were in their early twenties. Ninety-five (81.2%) agreed to answer the questionnaire. Of those, five students lost family members during Israeli military operations. Eighty-two (70.1%) never had hands-on first aid training. Seventy-six (80.0%) hoped the training would improve their community’s response to emergencies. With 58 training sessions completed, 1,312 laypeople (596 males; 716 females) were trained: 5.52 lay trainees per student instructor. The majority (n = 1,012; 77.1%) were school students aged 13–20 years.

It is feasible to recruit local medical students for practical BLS and CPR trainings targeting laypeople in communities under stress. The training impact on local resilience and patients’ outcomes need further studies.

Natural disasters have a significant impact on the health sector. On April 25, 2015, Nepal was struck by a 7.8 magnitude earthquake. The aim of the study was to compare patient volumes and clinical conditions presenting to the emergency department pre- and post-earthquake.

A retrospective study was done at Patan Hospital Emergency Department in Kathmandu, Nepal. Volume, demographics, and patient diagnoses were collected for 4 months post-disaster and compared with cases seen the same months the year before the disaster to control for seasonal variations.

After the 2015 Nepal earthquake, 12,180 patients were seen in the emergency department. This was a significant decrease in patient volume compared with the 14,971 patients seen during the same months in 2014 (P=0.04). Of those, 5496 patients (4093 pre-disaster and 1433 post-disaster) had a chief complaint or diagnosis recorded for analysis. An increase in cardiovascular and respiratory cases was seen as well as an increase in psychiatric cases (mostly alcohol related) and cases of anemia. There was a decrease in the number of obstetrics/gynecology, infectious disease, and poisoning cases post-earthquake.

Understanding emergency department utilization after the earthquake has the potential to give further insight into improving disaster preparedness plans for post-disaster health needs. (Disaster Med Public Health Preparedness. 2019;13:211–216).