Within out-of-hospital emergencies, Primary Health Care (PHC) pediatricians will likely be the first to provide health care at the scene of a life-threatening emergency (LTE) in children. Pediatricians should be trained to initially intervene, safely and effectively the LTEs, including the activation of Emergency Medical Systems (EMS), an adequate stabilization of patients and transport to the hospital.

The aims of this study are to know the training received for out-of-hospital LTEs by PHC pediatricians of the Principality of Asturias (Spain) and the perception they have about their own theoretical knowledge and practical skills in a series of emergency procedures used in LTEs; also, to analyze the differences according to the geographical context of their work.

This was a cross-sectional, descriptive, and observational study of a sample of 27 PHC pediatricians from PHC Service of Asturias, Spain, from among the total of 88 pediatricians who make up the staff of pediatricians, conducted from April through May 2019. The survey was designed ad hoc using the Curriculum in Primary Care Pediatrics (CPCP) proposed by the European Confederation of Primary Care Pediatricians (ECPCP; Europe), which indicates the theoretical and practical procedures that must be acquired by the PHC pediatricians. It is composed of 30 procedures or techniques employed in LTEs using a 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to 10 (“Maximum”).

There are significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.

Asturian pediatricians are generally well-prepared to solve LTEs with a few exceptions. The degree of self-perception and acquisition of general theoretical knowledge and general practical skills in LTEs is heterogeneous, with differences according to the scope of work.

Primary triage in a mass-casualty event setting using low-visibility tags may lead to informational confusion and difficulty in judging triage attribution of patients. In this simulation study, informational confusion during primary triage was investigated using a method described in a prior study that applied Shannon’s Information Theory to triage.

Primary triage using a low-visibility tag leads to a risk of informational confusion in prioritizing care, owing to the intermingling of pre- and post-triage patients. It is possible that Shannon’s entropy evaluates the degree of informational confusion quantitatively and improves primary triage.

The Simple Triage and Rapid Treatment (START) triage method was employed. In Setting 1, entropy of a triage area with 32 patients was calculated for the following situations: Case 1 – all 32 patients in the triage area at commencement of triage; Case 2 – 16 randomly imported patients to join 16 post-triage patients; Case 3 – eight patients imported randomly and another eight grouped separately; Case 4 – 16 patients grouped separately; Case 5 – random placement of all 32 post-triage patients; Case 6 – isolation of eight patients of minor priority level; Case 7 – division of all patients into two groups of 16; and Case 8 – separation of all patients into four categories of eight each. In Setting 2, entropies in the triage area with 32 patients were calculated continuously with each increase of four post-triage patients in Systems A and B (System A – triage conducted in random manner; and System B – triage arranged into four categories).

In Setting 1, entropies in Cases 1-8 were 2.00, 3.00, 2.69, 2.00, 2.00, 1.19, 1.00, and 0.00 bits/symbol, respectively. Entropy increased with random triage. In Setting 2, entropies of System A maintained values the same as, or higher than, those before initiation of triage: 2.00 bits/symbol throughout the triage. The graphic waveform showed a concave shape and took 3.00 bits/symbol as maximal value when the probability of each category was 1/8, whereas the values in System B showed a linear decrease from 2.00 to 0.00 bits/symbol.

Informational confusion in a primary triage area measured using Shannon’s entropy revealed that random triage using a low-visibility tag might increase the degree of confusion. Methods for reducing entropy, such as enhancement of triage colors, may contribute to minimizing informational confusion.

AjimiY, SasakiM, UchidaY, KanekoI, NakaharaS, SakamotoT. Primary Triage in a Mass-casualty Event Possesses a Risk of Increasing Informational Confusion: A Simulation Study Using Shannon’s Entropy. Prehosp Disaster Med. 2016;31(5):498–504.

Methods of defining hospital disaster preparedness are poorly defined in the literature, leaving wide discrepancies between a hospital's self-reported preparedness and that assessed by an objective reviewer.

This study compared self-reported surge capacity data from individual hospitals, obtained from a previously reported long-distance tabletop drill (LDTT) prior to the 2010 FIFA World Cup tournament in Cape Town, South Africa, with surge capacity data assessed by an on-site survey inspection team.

In this prospective, observational study, contact persons used in the prior LDTT assessing hospital disaster preparedness in the lead-up to the 2010 FIFA World Cup made surge capacity assessments (licensed bed capacity plus surge capacity beds) for the respiratory intensive care unit (RICU), neonatal intensive care unit (NICU), medical intensive care unit (MICU), and general medical/surgical beds in each hospital. Following the 2010 World Cup, this data was then re-evaluated by an on-site survey team consisting of two of the authors.

The contact persons for the individual hospitals from the LDTT underreported their individual hospital's surge capacity in 86% (95% CI, 46%-99%) of RICU beds; 100% (95% CI, 63%-100%) of MICU beds; 75% (95% CI, 40%-94%) of NICU beds; and 71% (95% CI, 35%-92%) of medical/surgical beds compared with the on-site inspection team.

The contact persons for the LDTT overwhelmingly underreported surge capacity beds compared with the surge capacity determined by the on-site inspection team.

ValeskyW, RoblinP, PatelB, AdelaineJ, ZehtabchiS, ArquillaB. Assessing Hospital Preparedness: Comparison of an On-site Survey with a Self-reported, Internet-based, Long-distance Tabletop Drill. Prehosp Disaster Med. 2013;28(4):1-4.

Mass-gathering events require varying types and amounts of medical resources to deal with patient presentations as well as careful planning for environmental health management. The Holy Shroud Exhibition was hosted in Torino, Italy, between April and May 2010. The venue was a unique mass-gathering event which lasted several weeks. It was held in a limited area in the center of the city and it was attended by a large and heterogeneous population. A dedicated Health Care Service was created for the event.

This study is a retrospective analysis of clinical presentations of patients who were managed by the Medical Services during the event. The main study outcomes included Patient Presentation Rate (PPR), type of injuries and illnesses, and the Transport to Hospital Rate (TTHR).

The PPR and TTHR were both low (0.27 and 0.039 respectively). The majority of patients presented with low severity codes and no sudden cardiac death (SCD) or cardiac arrest occurred. Cardiac and trauma emergencies were most frequent categories of presentation. A number of pediatric patients (19.37%) were treated by the event Medical Service. Approximately two million persons participated in the 40-day event.

The experience for this 40-day event supported having an on-site, organized, dedicated Medical Service that decreased overcrowding of the local Emergency Medical System and hospitals. It is recommended that, for such events, there be recruitment of emergency physicians with experience in mass-gathering events, recruitment of pediatricians, and training for professionals during the planning process.

BortolinM, UllaM, BonoA, FerreriE, TomatisM, SgambetterraS. Holy Shroud Exhibition 2010: Health Services During a 40-Day Mass-Gathering Event. Prehosp Disaster Med. 2013;28(3):1-6.