To assess the current state of knowledge and perceptions towards heatwaves of emergency department (ED) health care workers in Singapore and investigate potential strategies and solutions to improve the knowledge and readiness.

A qualitative study conducted in Khoo Teck Puat Hospital in Singapore, using semi-structured, face-to-face interviews with an open-ended interview guide on emergency physicians and registered nurses of various lengths of work experience actively working in the ED. Thematic analysis was employed involving memo-writing, coding, and theme-development with constant comparison.

Six themes— (1) Knowledge and understanding of Extreme Weather Events, (2) Knowledge and risk-assessment of Heatwaves, (3) Impressions of increased vulnerability to heatwaves, (4) Preventive measures for acute heat related illness, (5) Heatwave impact on the emergency department, and (6) Potential strategies and solutions—emerged and were presented in an interactive framework. Overall, it emerged that there is basic foundational knowledge, with more education and training required, especially targeting the knowledge gaps identified. There is also a need to increase awareness of heatwaves and their impact on health, and to develop comprehensive extreme heat response plans.

The findings provide a framework for emergency departments to guide their preparations for inevitable heatwaves and their associated health impacts.

The objective is to determine if a practical face-to-face emergency disaster incident response training program delivered in the clinical setting will improve self-reported confidence and assessed knowledge of emergency department (ED) nurses to respond to disasters.

A single site prospective pre-test and post-test randomized controlled trial was adopted for this study. The intervention was a practical face-to-face training program, while the control group completed the required annual mandatory hospital online training.

There was a large difference in post-test median self-reported confidence between groups. There was also a large difference in the proportion of subjects who reached satisfactory levels of self-reported confidence post-test. Regarding assessed knowledge, there was a moderate difference in post-test median knowledge between groups. There was also a moderate difference in the proportion who reached satisfactory levels of knowledge post-test.

This study has shown that ED nurses who undertake a practical face-to-face disaster preparedness education program in the clinical setting, are better prepared to respond to emergency disaster incidents. Organizations should consider the use of a practical structured face-to-face emergency disaster incident response education program to complement and enhance any online emergency and disaster training.

During mass-casualty incidents (MCIs), prehospital triage is performed to identify which patients most urgently need medical care. Formal MCI triage tools exist, but their performance is variable. The Shock Index (SI; heart rate [HR] divided by systolic blood pressure [SBP]) has previously been shown to be an efficient screening tool for identifying critically ill patients in a variety of in-hospital contexts. The primary objective of this study was to assess the ability of the SI to identify trauma patients requiring urgent life-saving interventions in the prehospital setting.

Clinical data captured in the Alberta Trauma Registry (ATR) were used to determine the SI and the “true” triage category of each patient using previously published reference standard definitions. The ATR is a provincial trauma registry that captures clinical records of eligible patients in Alberta, Canada. The primary outcome was the sensitivity of SI to identify patients classified as “Priority 1 (Immediate),” meaning they received urgent life-saving interventions as defined by published consensus-based criteria. Specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated as secondary outcomes. These outcomes were compared to the performance of existing formal MCI triage tools referencing performance characteristics reported in a previously published study.

Of the 9,448 records that were extracted from the ATR, a total of 8,650 were included in the analysis. The SI threshold maximizing Youden’s index was 0.72. At this threshold, SI had a sensitivity of 0.53 for identifying “Priority 1” patients. At a threshold of 1.00, SI had a sensitivity of 0.19.

The SI has a relatively low sensitivity and did not out-perform existing MCI triage tools at identifying trauma patients who met the definition of “Priority 1” patients.

Blast injuries can occur by a multitude of mechanisms, including improvised explosive devices (IEDs), military munitions, and accidental detonation of chemical or petroleum stores. These injuries disproportionately affect people in low- and middle-income countries (LMICs), where there are often fewer resources to manage complex injuries and mass-casualty events.

The aim of this systematic review is to describe the literature on the acute facility-based management of blast injuries in LMICs to aid hospitals and organizations preparing to respond to conflict- and non-conflict-related blast events.

A search of Ovid MEDLINE, Scopus, Global Index Medicus, Web of Science, CINAHL, and Cochrane databases was used to identify relevant citations from January 1998 through July 2024. This systematic review was conducted in adherence with PRISMA guidelines. Data were extracted and analyzed descriptively. A meta-analysis calculated the pooled proportions of mortality, hospital admission, intensive care unit (ICU) admission, intubation and mechanical ventilation, and emergency surgery.

Reviewers screened 3,731 titles and abstracts and 173 full texts. Seventy-five articles from 22 countries were included for analysis. Only 14.7% of included articles came from low-income countries (LICs). Sixty percent of studies were conducted in tertiary care hospitals. The mean proportion of patients who were admitted was 52.1% (95% CI, 0.376 to 0.664). Among all in-patients, 20.0% (95% CI, 0.124 to 0.288) were admitted to an ICU. Overall, 38.0% (95% CI, 0.256 to 0.513) of in-patients underwent emergency surgery and 13.8% (95% CI, 0.023 to 0.315) were intubated. Pooled in-patient mortality was 9.5% (95% CI, 0.046 to 0.156) and total hospital mortality (including emergency department [ED] mortality) was 7.4% (95% CI, 0.034 to 0.124). There were no significant differences in mortality when stratified by country income level or hospital setting.

Findings from this systematic review can be used to guide preparedness and resource allocation for acute care facilities. Pooled proportions for mortality and other outcomes described in the meta-analysis offer a metric by which future researchers can assess the impact of blast events. Under-representation of LICs and non-tertiary care medical facilities and significant heterogeneity in data reporting among published studies limited the analysis.

Vital signs are an essential component of the prehospital assessment of patients encountered in an emergency response system and during mass-casualty disaster events. Limited data exist to define meaningful vital sign ranges to predict need for advanced care.

The aim of this study was to identify vital sign ranges that were maximally predictive of requiring a life-saving intervention (LSI) among adults cared for by Emergency Medical Services (EMS).

A retrospective study of adult prehospital encounters that resulted in hospital transport by an Advanced Life Support (ALS) provider in the 2022 National EMS Information System (NEMSIS) dataset was performed. The outcome was performance of an LSI, a composite measure incorporating critical airway, medication, and procedural interventions, categorized into eleven groups: tachydysrhythmia, cardiac arrest, airway, seizure/sedation, toxicologic, bradycardia, airway foreign body removal, vasoactive medication, hemorrhage control, needle decompression, and hypoglycemia. Cut point selection was performed in a training partition (75%) to identify ranges for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), oxygen saturation, and Glasgow Coma Scale (GCS) by using an approach intended to prioritize specificity, keeping sensitivity constrained to at least 25%.

Of 18,259,766 included encounters (median age 63 years; 51.8% male), 6.3% had at least one LSI, with the most common being airway interventions (2.2%). Optimal ranges for vital signs included 47-129 beats/minute for HR, 8-30 breaths/minute for RR, 96-180mmHg for SBP, >93% for oxygen saturation, and >13 for GCS. In the test partition, an abnormal vital sign had a sensitivity of 75.1%, specificity of 66.6%, and positive predictive value (PPV) of 12.5%. A multivariable model encompassing all vital signs demonstrated an area under the receiver operator characteristic curve (AUROC) of 0.78 (95% confidence interval [CI], 0.78-0.78). Vital signs were of greater accuracy (AUROC) in identifying encounters needing airway management (0.85), needle decompression (0.84), and tachydysrhythmia (0.84) and were lower for hemorrhage control (0.52), hypoglycemia management (0.68), and foreign body removal (0.69).

Optimal ranges for adult vital signs in the prehospital setting were statistically derived. These may be useful in prehospital protocols and medical alert systems or may be incorporated within prediction models to identify those with critical illness and/or injury for patients with out-of-hospital emergencies.

Mass-gathering events (MGEs) such as sporting competitions and music festivals that take place in stadiums and arenas pose challenges to health care delivery that can differ from other types of MGEs. This scoping review aimed to describe factors that influence patient presentations to in-event health services, ambulance services, and emergency departments (EDs) from stadium and arena MGEs.

This scoping review followed the Preferred Reporting Items of Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) checklist and blended both Arksey and O’Malley methodology and the Joanna Briggs Institute’s (JBI’s) approach. Four databases (CINAHL, Embase, PubMed, and Scopus) were searched using keywords and terms about “mass gatherings,” “stadium” or “arena,” and “in-event health services.” In this review, the population pertains to the spectators who seek in-event health services, the concept was MGEs, and the context was stadiums and/or arenas.

Twenty-two articles were included in the review, most of which focused on sporting events (n = 18; 81.8%) and music concerts (n = 3; 13.6%). The reported patient presentation rate (PPR) ranged between one and 24 per 10,000 spectators; the median PPR was 3.8 per 10,000. The transfer to hospital rate (TTHR) varied from zero to four per 10,000 spectators, and the median TTHR was 0.35 per 10,000. Key factors reported for PPR and TTHR include event, venue, and health support characteristics.

There is a complexity of health care delivery amid MGEs, stressing the need for uniform measurement and continued research to enhance predictive accuracy and advance health care services in these contexts. This review extends the current MGE domains (biomedical, psychosocial, and environmental) to encompass specific stadium/arena event characteristics that may have an impact on PPR and TTHR.

Powered equipment for patient handling was designed to alleviate Emergency Medical Service (EMS) clinician injuries while lifting patients. This project evaluated the organizational rationale for purchasing powered equipment and the outcomes from equipment use.

This project analyzed secondary data obtained via an insurance Safety Intervention Grant (SIG) program in Ohio USA. These data were primarily in reports from EMS organizations. Investigators applied a mixed-methods approach, analyzing quantitative data from 297 grants and qualitative data from a sample of 64 grants. Analysts abstracted data related to: work-related injuries or risk of musculoskeletal-disorders (MSD), employee feedback regarding acceptance or rejection, and impact on quality, productivity, staffing, and cost.

A total of $16.67 million (2018 adjusted USD) was spent from 2005 through 2018 for powered cots, powered loading systems, powered stair chairs, and non-patient handling equipment (eg, chest compression system, powered roller). Organizations purchased equipment to accommodate staff demographics (height, age, sex) and patient characteristics (weight, impairments). Grantees were fire departments (n = 254) and public (n = 19) and private (n = 24) EMS organizations consisting of career (45%), volunteer (20%), and a combination of career and volunteer (35%) staff. Powered equipment reduced reported musculoskeletal injuries, and organizations reported it improved EMS clinicians’ safety. Organization feedback was mostly positive, and no organization indicated outright rejection of the purchased equipment. Analyst-identified design advantages for powered cots included increased patient weight capacity and hydraulic features, but the greater weight of the powered cot was a disadvantage. The locking mechanism to hold the cot during transportation was reported as an advantage, but it was a disadvantage for older cots without a compatibility conversion kit. Around one-half of organizations described a positive impact on quality of care and patient safety resulting from the new equipment.

Overall, organizations reported improved EMS clinicians’ safety but noted that not all safety concerns were addressed by the new equipment.

Patients with thoracic trauma require rapid decision making and early intervention, especially during natural disasters when the influx of patients complicates hospitalization decisions. Identifying the characteristics of these patients can improve triage protocols, optimize resource allocation, and enhance outcomes in future disaster scenarios.

The aim of this study was to determine the characteristics of hospitalized patients after the February 2023 earthquakes in Türkiye and to contribute to Disaster Medicine.

This retrospective, cross-sectional study was conducted in a university hospital’s emergency department (ED) located in the earthquake area. All patients over 18 years old with earthquake-related thoracic trauma were included. Demographic information, mechanisms of injury, associated injuries, laboratory results, and treatments were recorded. Patients were divided into two groups: discharged and hospitalized.

The study included 179 patients, with a median age of 45 years. Overall, 80.4% were trapped under debris, and 43.8% were rescued on the first day. Hospitalization rates were higher in patients trapped under debris and those rescued after the first day. Blunt thoracic trauma was observed in 95.5% of patients. One hundred and three patients (57.5%) underwent Extended Focused Assessment with Sonography in Trauma (E-FAST) in the ED, 152 patients (84.9%) underwent x-ray, and 129 patients (72.1%) underwent computed tomography (CT). Imaging studies revealed rib fractures in 49.7% and lung parenchymal injuries in 48.6% of patients. Patients with lung parenchymal injury had higher hospitalizations rates. Hospitalized patients had higher levels of white blood cells (WBCs), potassium, blood urea nitrogen (BUN), creatinine, creatinine kinase (CK), creatine kinase-myocardial band (CKMB), and troponin I.

This study highlights the prevalence of blunt thoracic trauma and the importance of imaging in the assessment of thoracic injuries following earthquakes. While few patients needed surgery, many required hospitalizations and had abnormal laboratory results, emphasizing the need for careful monitoring for complications like muscle damage and infection.

The aim of this study was to describe the demographic characteristics, injury characteristics, and outcomes of individuals sustaining injuries during a hailstorm in Istanbul, Turkey.

In this study, the medical records of 76 patients who presented to the emergency department (ED) of a tertiary hospital after incurring injuries due to hailstorms were retrospectively reviewed. Analyses were performed to identify hailstorm-associated injury profiles, injury mechanisms, patient demographics, and ED resource use.

Of the 76 patients, 42 (55.3%) were male and 34 (44.7%) were female, with the ages of the patients ranging from five to 79 years. Of the patients, 93.4% presented to the ED within the first eight hours after a hailstorm. The most common injury mechanisms were the direct impact of hailstones on the body surface (36.8%) and slips and falls during escape (35.6%). The most frequently injured anatomical areas were skin (60.5%), head (44.7%), and extremities (16.7%). Significant injuries occurred in only 11.8% of the patients, of whom three were treated surgically and one died. The most common injuries were soft tissue and minor head injuries.

Severe hailstorms often strike suddenly and can be difficult to predict. In response, EDs must handle a large number of injured patients in the aftermath of a hailstorm. It is important to remember that hailstorms, like other natural disasters, can cause serious injuries.

There is evidence of increasing rates of hospital presentations for suicidal crisis, and emergency departments (EDs) are described as an intervention point for suicide prevention. Males account for three in every four suicides in Ireland and are up to twice as likely as females to eventually die by suicide following a hospital presentation for suicidal crisis. This study therefore aimed to profile the characteristics of ED presentations for suicidal ideation and self-harm acts among males in Ireland, using clinical data collected by self-harm nurses within a dedicated national service for crisis presentations to EDs.

Using ED data from 2018–2021, variability in the sociodemographic characteristics of male presentations was examined, followed by age-based diversity in the characteristics of presentations and interventions delivered. Finally, likelihood of onward referral to subsequent care was examined according to presentation characteristics.

Across 45,729 presentations, males more commonly presented with suicidal ideation than females (56% v. 44%) and less often with self-harm (42% v. 58%). Drug- and alcohol-related overdose was the most common method of self-harm observed. A majority of males presenting to ED reported no existing linkage with mental health services.

Emergency clinicians have an opportunity to ensure subsequent linkage to mental health services for males post-crisis, with the aim of prevention of suicides.

We describe activity, outcomes, and benefits after streaming low urgency attenders to General practice services at Door of Accident and Emergency departments (GDAE).

Many attendances to A&Es are for non-urgent health problems that could be better met by primary care rather than urgent care clinicians. It is valuable to monitor service activity, outcomes, service user demographics, and potential benefits when primary care is co-located with A&E departments.

As a service evaluation, we describe and analyse GDAE users, reasons for presentation, wait times, outcomes, and co-located A&E wait times at two hospitals in eastern England. Distributions of outcomes, wait times, reasons for attendance, deprivation, and age groups were compared for GDAE and usual A&E attenders at each site using Pearson chi-square tests and accelerated time failure modelling. Performance in a four-hour key performance indicator was descriptively compared for co-located and similar emergency departments.

Each GDAE saw about 1025 patients per month. Wait times for usual accident and emergency (A&E) care are relatively short at only one site. Reattendances were common (about 11% of unique patients), 75% of GDAE attenders were seen within 1 hour of arrival, 7% of patients initially allocated to GDAE were referred back to A&E for further investigations, and 59% of GDAE patients were treated and discharged with no further treatment or referral required. Pain, injury, infection, or feeling generally unwell each comprised > 10% of primary reasons for attendance. At James Paget University Hospital, 4.3%, and at Queen Elizabeth Hospital, 16.1% of GDAE attendances led to referral to specialist health services. GDAE attenders were younger and more socially deprived than attenders to co-located A&Es. Patients were seen quickly at both GDAE sites, but there were differences in counts of specialist referrals and wait times. Process evaluation could illuminate reasons for differences between study sites.

Rates of self-harm among children and young people (CYP) have been on the rise, presenting major public health concerns in Australia and worldwide. However, there is a scarcity of evidence relating to self-harm among CYP from culturally and linguistically diverse (CALD) backgrounds.

To analyse the relationship between self-harm-related mental health presentations of CYP to emergency departments and CALD status in South Western Sydney (SWS), Australia.

We analysed electronic medical records of mental health-related emergency department presentations by CYP aged between 10 and up to 18 years in six public hospitals in the SWS region from January 2016 to March 2022. A multilevel logistic regression model was used on these data to assess the association between self-harm-related presentations and CALD status while adjusting for covariates and individual-level clustering.

Self-harm accounted for 2457 (31.5%) of the 7789 mental health-related emergency department presentations by CYP; CYP from a CALD background accounted for only 8% (n = 198) of the self-harm-related presentations. CYP from the lowest two most socioeconomic disadvantaged areas made 63% (n = 1544) of the total self-harm-related presentations. Findings of the regression models showed that CYP from a CALD background (compared with those from non-CALD backgrounds) had 19% lower odds of self-harm (adjusted odds ratio 0.81, 95% CI 0.66–0.99).

Findings of this study provide insights into the self-harm-related mental health presentations and other critical clinical features related to CYP from CALD backgrounds that could better inform health service planning and policy to manage self-harm presentations and mental health problems among CYP.

Humanitarian mine action (HMA) stakeholders have an organized presence with well-resourced medical capability in many conflict and post-conflict settings. Humanitarian mine action has the potential to positively augment local trauma care capacity for civilian casualties of explosive ordnance (EO) and explosive weapons (EWs). Yet at present, few strategies exist for coordinated engagement between HMA and the health sector to support emergency care system strengthening to improve outcomes among EO/EW casualties.

A scoping literature review was conducted to identify records that described trauma care interventions pertinent to civilian casualties of EO/EW in resource-constrained settings using structured searches of indexed databases and grey literature. A 2017 World Health Organization (WHO) review on trauma systems components in low- and middle-income countries (LMICs) was updated with additional eligible reports describing trauma care interventions in LMICs or among civilian casualties of EO/EWs after 2001.

A total of 14,195 non-duplicative records were retrieved, of which 48 reports met eligibility criteria. Seventy-four reports from the 2017 WHO review and 16 reports identified from reference lists yielded 138 reports describing interventions in 47 countries. Intervention efficacy was assessed using heterogenous measures ranging from trainee satisfaction to patient outcomes; only 39 reported mortality differences. Interventions that could feasibly be supported by HMA stakeholders were synthesized into a bundle of opportunities for HMA engagement designated links in a Civilian Casualty Care Chain (C-CCC).

This review identified trauma care interventions with the potential to reduce mortality and disability among civilian EO/EW casualties that could be feasibly supported by HMA stakeholders. In partnership with local and multi-lateral health authorities, HMA can leverage their medical capabilities and expertise to strengthen emergency care capacity to improve trauma outcomes in settings affected by EO/EWs.

This study evaluates the Emergency Medical Service system and overall emergency preparedness by analyzing ambulance-transported patients during the February 6, 2023 earthquakes, focusing on those without earthquake-related injuries (medical emergencies and traumas not caused by earthquakes).

A retrospective, observational case series was conducted, involving patients aged 18 and above transported by ambulance between February 6 and March 6, 2023. Patient demographic characteristics, vital signs, diagnoses, treatments, and outcomes were recorded. Predisposing factors for ambulance transportation including post-earthquake health facility issues, housing problems, hygiene, heating, and smoke exposure were meticulously analyzed.

The study included 1872 patients, with a 55.4% hospitalization rate and a 13.7% mortality rate. Cardiovascular emergencies were the primary reason for admission (28.9%). Patients from the hospital in the study’s location form Group 1, whereas those from other earthquake-affected provinces constitute Group 2. Significant predisposing factors for ambulance transportation included post-earthquake health facilities (P < 0.001), housing problems (P < 0.001), hygiene (P < 0.001), heating (P = 0.001), and smoke exposure (P < 0.001). In Group 2, pneumonia (P = 0.001), soft tissue infection (P = 0.002), sepsis (P = 0.004), carbon monoxide poisoning (P < 0.001), and diabetic emergencies (P = 0.013) were statistically significantly more frequent.

Analyzing post-earthquake ambulance-transported patients is vital to comprehend the demand for emergency health care and address post-disaster health care challenges.

Over 2.7 million people have an opioid use disorder (OUD). Opioid-related deaths have steadily increased over the last decade. Although emergency department (ED)-based medication for OUD (MOUD) has been successful in initiating treatment for patients, there still is a need for improved access. This study describes the development of a prehospital MOUD program.

An interdisciplinary team expanded a MOUD program into the prehospital setting through the local city fire department Quick Response Team (QRT) to identify patients appropriate for MOUD treatment. The QRT consisted of a paramedic, social worker, and police officer. This team visited eligible patients (i.e., history of an opioid overdose and received prehospital care the previous week). The implementation team developed a prehospital MOUD protocol and a two-hour training course for QRT personnel. Implementation also required a signed contract between local hospitals and the fire department. A drug license was necessary for the QRT vehicle to carry buprenorphine/naloxone, and a process to restock the vehicle was created. Pamphlets were created to provide to patients. A clinical algorithm was created for substance use disorder (SUD) care coordinators to provide a transition of care for patients. Metrics to evaluate the program included the number of patients seen, the number enrolled in an MOUD program, and the number of naloxone kits dispensed. Data were entered into iPads designated for the QRT and uploaded into the Research Electronic Data Capture (REDCap) program.

Over the six-month pilot, the QRT made 348 visits. Of these, the QRT successfully contacted 83 individuals, and no individuals elected to be evaluated for new MOUD treatment. Nine fatal opioid overdoses occurred during the study period. A total of 55 naloxone kits were distributed, and all patients received MOUD information pamphlets.

A prehospital MOUD program can be established to expand access to early treatment and continuity of care for patients with OUD. The program was well-received by the local city fire department and QRT. There is a plan to expand the prehospital MOUD program to other local fire departments with QRTs.