Amidst the COVID-19 pandemic, the EU-MODEX exercise had to rethink its logistics in order to promote safer environments for its participants.1

To describe the Blended EU-MODEX exercise as a method to minimize the risk of COVID-19 contagion and the role of CRIMEDIM during such innovative approach.

The first post-COVID-19 EU-MODEX exercise was performed in October 2021. To avoid travels, three EMTs from Austria, Romania, and Estonia virtually deployed in a fictious country hit by a typhoon, operated independently in their own country. The Excon worked remotely from Germany. The interoperability among the EMTs was simulated using an online tool. When a patient, simulated by a local role player, needed a transfer from the EMT1 in Romania or Austria, all clinical information were shared online and a new role player was prepared with that information to continue the simulation in Estonia. CRIMEDIM personnel located at each EMT were tasked to ensure the consistency and the quality of all the clinical cases, matching the clinical information of the incoming patient with the new role player, especially regarding the treatment received and the makeup instruction.

During the exercise, 425 clinical cases were played by the three EMTs. The exercise lasted for 60 hours and provided unique challenges due to its blended nature. No COVID-19 outbreaks were registered following the exercise.

The experience of the Blended EU-MODEX exercise showed the potentiality of the virtual simulation environment as an effective alternative to avoid secondary contagion as well as reduce costs.

In Canada, access to health care is considered a universal right, however, many Indigenous communities exist in austere settings and the major health care provided is through a nursing station. As a result, they are vulnerable to developing acute staff shortages during COVID-19 outbreaks.

Trial the effectiveness of a Nomadic Medical Assistance Team (NoMAT) to mitigate sudden staff shortages caused by a COVID-19 outbreak in a remote Indigenous community served only by a nursing station.

Indigenous Services Canada funded a pilot and NoMAT was deployed from March 13 through April 2, 2022 to a small Indigenous community in remote Northern Ontario, Canada.

The team consisted of up to seven personnel: MD, Nurse, Nurse Practitioner, Physician Assistant, Paramedic, Data Support, and Logistics. Individuals served from one-to-two weeks of a three-week deployment. If there was a shortage, the MD could be virtual. Local health resources were used and the team resided at the local school.

The NoMAT rapidly: (1) worked with the local team to co-develop outbreak management; (2) identified high-risk patients for treatment; (3) supported non-COVID-19 patient care; and (4) reduced a backlog of care.

The NoMAT strategy is highly effective and efficient in mitigating the impact of both COVID-19 surges and reducing backlogs of care. The next step is developing a proposal for full-time teams.

Simulation is an “educational method that can be applied to the training of processes, technical, and non-technical skills.” Literature underlines how simulating with the maximum realism possible improves the quality of training.

To describe the methodology used by CRIMEDIM to create a high-quality database of clinical cases to improve the realism of the EU MODEX exercises.

In 2021, CRIMEDIM created a new database of clinical cases with disaster and non-disaster-related injuries and diseases to be used for the EU MODEX exercises. Each clinical case has four temporal stages: prehospital, T0, T1, and T2, and each of them has two possible variations: Type A (improvement) and Type B (deterioration). Timing and treatments received (or not received) determine the evolution between one step and the following one. Each clinical case consists of past medical history, disaster-related history, drugs, and allergies. There are also various exams (eg, blood tests [blood count, ABG, biochemical test, coagulation], imaging [ultrasound, XR, CT], and EKG) and other clinical information. The database allows printing casualty cards, each containing instructions for role players and make-up artists.

At this moment, the database consists of 1,174 clinical cases, with the possibility to create new cases according to different disaster scenarios, training needs, and learning objectives.

According to participants’ feedback, the introduction of such an innovative and comprehensive database seemed to have improved the quality and the realism of the Medical EU MODEX.

Moral distress is a well-described phenomenon in medical providers. It has been linked to mental health deterioration, decreased job satisfaction, and early retirement. No study has been done on the level of moral distress associated with treating patients in simultaneous disasters.

1. 1. To learn what is known about the experience of moral distress in frontline health care providers during the COVID-19 pandemic and the concurrent conflict in Armenia during 2020.

2. 2. To determine how WHO EMTs can support their frontline staff experiencing moral distress.

A survey was designed to test the moral distress felt by Armenian EMS providers who had cared for both COVID-19 and war casualty patients. This was adapted from the Moral Distress Scale Revised (MDS-R).

Of the questions asked, respondents most often responded that they were disturbed by: “Continuing to participate in care for a hopelessly ill or injured person who is being sustained on a ventilator when no one will make a decision to withdraw support” (Mean 2.68/Median 3/Mode 4); and “Initiated extensive life-saving actions when I think they only prolong death” (2.47/3/3), which caused the next most distress to subjects.

It is expected that some health care workers in Armenia are likely facing on-going consequences of the moral distress they faced during this unprecedented period of global pandemic and war. Clinics and teams who are more likely to encounter potentially morally distressing events, such as disaster medicine workers, need to address their moral distress mitigation plan by identifying strategies across the continuum of disaster management.