Importance of Team Experience and Coordination in Disaster Response: Building Collapse

Objective: The objective of this study was to determine whether coordination of prehospital emergency health services and Disaster and Emergency Management Presidency (DEMP) and being prepared for disasters, such as building collapses, allow quick evaluation and fast intervention. Methods: The information flow, hierarchy, treatment, and rehabilitation processes, and rescue organization and planning during the rescue attempt for 35 people who needed help due to this building collapse were reviewed. Results: Of the 43 people who lived in this 8-story building, 35 were inside the building during the collapse; 40% of them were assessed as injured and 60% as exitus. Almost two-thirds (64.3%) of the injured individuals who were rescued were women. The mean duration until rescue was 330 (57.0-512.0) min. Conclusions: Leading and important factors that can increase the success rate in search and rescue interventions are informing official authorities as first early warning by individuals who can clearly define the situation, early security measures by security forces arriving before the health and search-rescue teams, accurate identification of estimated numbers of injured victims, and identifying and informing appropriate hospitals which victims rescued from the debris will be transferred to there.

Impact of COVID-19 pandemic on use of Pediatric Emergency Health Services in a Tertiary Care Pediatric Hospital in North India

ObjectiveTo compare Pediatric Emergency attendance pre-COVID 19 to that during COVID 19 pandemic and to study changes in patient profiles attending Pediatric Emergency Department during COVID 19 pandemic.MethodsWe conducted a retrospective cross-sectional observational study and collected data from Medical Record Section during the COVID-19 pandemic from January to June 2020 and compared it with data from 2019 in similar months. Data collected was analyzed to find out the impact of COVID – 19 on use of pediatric emergency health services with respect to patient attendance, age and clinical profile before and during COVID-19 in a tertiary care hospital in New Delhi.ResultsWe observed a 43% decline in PED visits which increased to 75% during the period of lock-down (p value = 0.005). There was a significant decrease in children of age group 1-5 years attending PED. Mortality rate during lockdown had gone up by nearly 3times than the average monthly mortality.ConclusionsWhile children might not have been directly affected by the COVID-19 pandemic, but the fear of COVID 19 and measures taken to control the pandemic has affected the health seeking behavior of patients to an extent that indirectly caused more damage than anticipated.

Why Does Patient–Physician Communication Matter? More Active Patients, Decreased Healthcare Use and Costs

Today, the increase in the use of emergency health services is one of the most discussed issues. Solutions are sought to reduce the use of unnecessary resources. One of these solutions can be patient–physician communication. Along with this approach, the relationships between patient–physician communication, use of emergency health services, and length of hospital stay was evaluated in this study. In addition, the effect of communication with the physician on the patient activity level was also examined. A total of 724 patients (F/M 397/327, mean age 33.36 ± 15.22 years) were included in this cross-sectional study. “Pearson Correlation Test” and “Simple Linear Regression Test” were used to analyze the data. High communication between physician and patient were associated with higher levels of patient activation ( r = 0.632; P < .01). Likewise, a negative correlation was found between patient–physician communication and emergency healthcare use ( r = −0.712, P < .01) and length of hospital stay ( r = −0.317, P < .01). We think that the positive development of patient–physician communication may be an important way to reduce the use of emergency health services. The findings obtained regarding the length of hospital stay support this result. In addition, it was concluded that good communication with the physician may be an important factor in patients taking a more active role in healthcare. Further research is suggested to examine whether the observed associations are causal.

Exploring the use of emergency health services for stroke: what is known about when to seek emergency help and how transport decisions impact in-hospital emergency care

Transport practices for seeking emergency stroke care remain largely underresearched and poorly understood, particularly for individuals living in small urban, rural, and remote regions. This multi-method study aims to address this knowledge gap and explores the impact of mode of transport on in-hospital stroke care and the decision-making process of seeking emergency medical attention for patients and their caregivers. Data from the Discharge Abstract Database provide information on stroke-related use of emergency health services across British Columbia. Data from the Canadian Institutes for Health Information Special Project 340 provide information on if calling emergency health services impacts the delivery of care, including the completion of neuroimaging, the administration of acute thrombolysis, and the prescription of antithrombotics upon discharge across a northern health region. Focused, semi-structured interviews provide contextual insight into the decision-making processes for seeking emergency stroke care among patient and caregiver participants in a northern health region. Stroke-related emergency health service use across British Columbia from January 2015 to March 2018 was 67.9% (N=19,849), ranging from 58.8% in Northern Health to 70.2% in Fraser Health. In Northern Health (N=784), there were differences between health service delivery areas for stroke-related emergency health service use ranging from 53.7% in the Northwest to 64.8% in the Northern Interior from January 2015 to March 2018. Similar differences in thrombolytic therapy administration and the prescription of antithrombotics were noted. The odds of emergency health service use were greater for those 65 years of age and older than those younger than 65 and lower for those in the Northwest health service delivery area than those in the Northern Interior health service delivery area. Differences were found for the completion of neuroimaging between males and females. Interviews for patient (n=12) and caregiver (n=7) participants provide complementary contextual insights and yielded three key themes, including the decision-making process following a stroke, experiences of care, and perceived gaps and areas in need of further support. This integrated knowledge translation-informed and practice-driven research addresses health services and policy priorities. Findings are anticipated to help inform the development and refinement of emergency health services in British Columbia by highlighting differences in emergency health services use across geographies and identifying factors that inform patient decisionmaking when seeking emergency medical attention.

Readiness of the nurses employed by Bezmi-alem Vakif University hospital for disasters

Background This study is intended to increase disaster awareness of the nurses so as to increase the survival rate during disasters. Methods The research was done via a total of 430 nurses, consisting of 360 nurses employed by Bezmialem Vakıf University (BVU) Medical Faculty Hospital and 70 nurses employed by the BVU Dragos Hospital from 01.11.2018 to 01.02.2019. Data was collected by using the Introductory Information Form and the Scale for Basic Qualifications for Readiness of the Nurses for Disasters. IBM SPSS Statistics V23 program was used for evaluation of the data. Results For the nurses, it was determined that the average age was 26.06±6.05 and the average working hours was 6.24±5.86. It was found out that 60.6% of the nurses did not have any training in relation to the disasters. It was found that the average point for perception of readiness for the disasters by the nurses was 5.03±2.38 (0-10) while the average point for perception of disaster plan information at hospital was 4.27±2.53 (0-10). It was established that the nurses consider the disaster management course as the course required most for disaster preparation with a rate of 47.9%. It was found that the average point achieved via the Scale for Basic Qualifications for Readiness of Nurses for Disasters was 141.46±32.48, and the lowest average sub-dimension point was 11.49±3.42 as critical thinking abilities while the highest average sub-dimension point was 48.23±12.21 as technical abilities. A positive weakly significant relationship was found between critical thinking abilities and evaluation of readiness for disasters. Conclusions Nurses have technical knowledge and abilities on topics related to their field, but they need to participate in educational activities for increasing the level of knowledge in terms of disasters. Key messages The role of nurses in emergency health services during disasters is great. Thus, disaster awareness of all the nurses worldwide must be increased so that they are ready for the disasters.

The Impact of the COVID-19 Epidemic on Patterns of Attendance at Emergency Departments in Two Large London Hospitals: An Observational Study

Background Hospitals in England have undergone considerable change to address the surge in demand imposed by the COVID-19 epidemic. The impact of this on emergency department (ED) attendances is unknown, especially for non-COVID-19 related emergencies. Methods We calibrated auto-regressive integrated moving average time-series models of ED attendances to Imperial College Healthcare NHS Trust (ICHNT) using historic (2015–2019) data. Forecasted trends were compared to present year ICHNT data for the period between March 12 (when England implemented the first COVID-19 public health measure) and May 31. We compared ICHTN trends with publicly available regional and national data. Lastly, we compared emergency admissions and in-hospital mortality at ICHNT during the present year to a historic 5-year average. Results ED attendances at ICHNT decreased by 35%, in keeping with the trend for ED attendances across all England regions, which fell by approximately 50%. For ICHNT, the decrease in attendances was mainly amongst those aged < 65 years and those arriving by their own means (e.g. personal or public transport). Increasing distance from postcode of residence to hospital was a significant predictor of reduced attendances. Non-COVID related emergency admissions to hospital after March 12 fell by 48%; there was an indication of a non-significant increase in non-COVID-19 crude mortality risk (RR 1.13, 95%CI 0.94–1.37, p = 0.19). Conclusions Our study finds strong evidence that emergency healthcare seeking has drastically changed across the population in England. At ICHNT, we find that a larger proportion arrived by ambulance and that hospitalisation outcomes of non-COVID patients did not differ from previous years. The extent to which these findings relate to ED avoidance behaviours compared to having sought alternative emergency health services outside of hospital remains unknown. National analyses and strategies to streamline emergency services in England going forward are urgently needed.