Mass gatherings may have far-reaching effects on medical care because of the potential high load on the health care system. In preparation of large events (mass gatherings), such as music festivals or marathons, an extended risk assessment forms the basis for issuing advice on health and safety and possible necessary precautionary measures. In the Netherlands, the 25 regional Public Health Directors are responsible for public health and safety. This includes responsibility for advice on large-scale events, based on which the local authorities (e.g. the mayor) decide on the approval. Health care professionals are looking for better tools with regard to the arising dilemmas around responsibilities and risks. Also, as new forms of events are created, uniform (safety) regulations are lacking. GGD GHOR Netherlands (Dutch Society of the regional Public Health Services [GGD] and Major Incident Medical Planning and Coordination Offices [GHOR]) has updated the existing national guideline in collaboration with the Academic Network for Applied Public Health and Emergency Management (Anaphem). The focus was on improving the guideline by including all current expertise and experience in the field.

Various expert sessions were held in 2017 and 2018 to collect all relevant knowledge, evidence, and experience that is currently accessible to develop an improved uniform approach for risk assessment and process steps.

A new dynamic national guideline, including factsheets in various topics being effective by 2019. As a result, a list of topics is formulated for further research.

The new guideline includes the current knowledge and raised awareness among the experts of some important gaps in current evidence on several topics.

Climate change is intricately related to human health and impacts acute and chronic diseases leading to increased demands on the health care system.

The University of Colorado Graduate Medical Education (GME) Fellowship in Climate Change and Health Science Policy (CCHSP) aims to train and equip a new generation of clinicians knowledgeable in climate science, proficient in climate health education, and facile with advocacy skills in order to become leaders in health policy.

The CCHSP fellowship is funded by the Living Closer Foundation and hosted through the University of Colorado Department of Emergency Medicine. It is a one to two-year program tailored to the fellow’s specific goals with the opportunity to earn an MPH or MA. Clinical work is supported through the UCHealth network. Site placement occurs at partnering organizations, including the National Institutes of Health, the Centers for Disease Control and Prevention, and fieldwork throughout the world (via Colorado School of Public Health, Harvard FXB Center for Health and Human Rights).

The first fellow was recruited in 2017 and has participated in and completed multiple projects: technical contributor to the US Government’s Fourth National Climate Assessment; advocating for women’s health policy in India; authorship of climate change and health resource documents for the World Bank; climate change leadership within SAEM; advocacy work with local and state governments; multiple research publications.

As climate change continues to impact human health with widespread consequences, we need effective and articulate leaders to affect policy. Although this Fellowship originated in Emergency Medicine, its competencies and structure are replicable for other clinical specialties. Climate change will be one of the core global health challenges for generations. A strong foundation of clinicians who understand its causes and the strategies for adaptation and mitigations are necessary to optimize health outcomes amidst this growing threat.

Acute infection in post-disaster settings is associated with increased morbidity and mortality. Sepsis management in low resource settings is controversial with recent research suggesting that aggressive fluid resuscitation may cause greater harm than benefit. However, the vast majority of international sepsis guidelines still suggest large initial fluid boluses as part of sepsis algorithms.

To create an adult and pediatric sepsis algorithm to be applied in low resource clinical settings. This is part of a larger project to create clinical algorithms to provide standardization of emergency case management for low-resource clinical environments.

A literature search was performed through PubMed identifying and reviewing fluid resuscitation in adult and pediatric sepsis patients in high and low resource clinical environments. The pathways were created based on interpretation of the available evidence-based literature. Focus groups were conducted in Zambia in March 2018 for feedback from local practitioners regarding feasibility of pathways. The pathways were then modified, reviewed by experts peer-review and revised.

Final pediatric and adult sepsis clinical algorithms were created and posted to the free web-based application AgileMD™. They will be available via app access, an online platform, or printable pathways for use in the clinical environment.

The study is currently undergoing IRB approval with a plan for implementation of multiple clinical algorithms at a referral hospital site in Zambia in January 2019. Site direction at Ndola Hospital will be conducted under the leadership of an Emergency Medicine trained physician, who will assist in implementation of algorithms and collection of data. Initial data review will be conducted in May 2019. There will be incremental site visits by organizing researchers throughout the implementation and data collection period. Statistical analysis will examine sepsis associated processes and outcome indicators pre and post-intervention to further delineate sepsis management in low resource clinical environments.

This research builds on a previously developed triage: Mass Gathering Triage Scale (MaGaTT) by Cannon, et al (2017). This tool was targeted towards non-health care professional first responders within mass-gathering events (MGEs). However, this tool had not been evaluated.

To further develop the previously designed MaGaTT using vignettes of clinical cases to: 1) determine variation in decision-making, and 2) inform further tool development prior to real-world testing.

Volunteer members of St. John Ambulance Australia were surveyed using 18 vignettes of de-identified real patient record forms from MGEs covered by St. John Ambulance Australia (NSW) in 2013-2014. Participants were given the MaGaTT and written instructions on its use. Participants triaged 18 patients, recording their decisions on the online survey. Responses against the vignettes were analyzed using Fleiss Kappa [p-bar] measure. A score of 0.61 – 0.8 represented substantial agreement and a score of between 0.41 and 0.6 represented moderate agreement between participants.

There were 110 completed responses. The majority of participants were male (n =66, 60%), having completed a Bachelor’s Degree (n =38, 34.5%), and holding the clinical skill level of “first responder” (n=42, 38.2%). The overall agreement [p-bar] for the 18 items was moderate at 0.55. When examined by triage category, the “Resuscitation” category had substantial agreement (0.69), when compared with moderate agreement for “Urgent” (0.52) and “Minor” (0.52) categories.

This research demonstrates that the MaGaTT can be used with moderate agreement, and substantial agreement within the resuscitation category. This is similar to triage tools internationally, where high levels of agreement relate to triage categories for patients requiring resuscitation when compared to patients requiring lower levels of clinical care. Slight changes have been made to the original MaGaTT as a result of this research.

Public sector challenges have initiated new forms of collaboration between emergency response organizations, occupations from other societal sectors, and civil citizens, not the least in socio-economically vulnerable areas. As collaborations emerge, there is a need to explore the tasks, needs, and challenges of the new resources when providing medical emergency response.

To explore two cases of 1) security guards and 2) organized civil volunteers collaborating with the ambulance services and municipal rescue services, and identifying relevant tasks, needs and challenges. The presentation will focus on their dispatch on medical alerts. A brief comparison of the two groups will also be performed.

A case study approach was applied involving interviews and workshops with security guards, civil volunteers, ambulance services, and rescue services personnel.

The civil volunteers are dispatched on medical alerts concerning heart failures and accidents requiring first aid, including stopping major bleedings. The scope of tasks of security guards is broader since they are also dispatched on suicide and assault alerts. Needs in both cases include, e.g., proper training, joint exercises, equipment in terms of defibrillators, torquedos, and first aid kits, and proper ICT/GPS positioning support for dispatching. Challenges are mainly organizational and legal where security guards are somewhat protected by their own employer (e.g., through agreements, trauma support, and safety measures such as receiving a hepatitis vaccine) while civil volunteers do not have sufficient protection in any of these respects.

Both groups are useful resources in future medical emergency response since they are often close to the incident site and can provide first response while waiting for the professional resources, thereby saving lives and reducing consequences of trauma. However, they need to be better integrated into the professional emergency response system.

Recent mass shooting events remind us of the importance of hospitals’ preparedness to manage a large number of patients in a short period of time. While prehospital systems triage for field interventions and priority of transport, they were not designed to triage for the scarce resources of a hospital. Therefore, upon arrival to hospital, clinicians must then quickly determine how to best assess and provide life-saving interventions based on their limited resources.

In collaboration with the Greater New York Hospital Association (GNYHA), the Center for Disaster Medicine at New York Medical College piloted an interactive and intensive eight-hour course at four New York State hospitals that covered critical areas such as: current literature on Mass Casualty Events and Triage, review of hospital emergency management, hospital-based triage principles, a MCI exercise in the emergency department, a surge capacity tabletop exercise, and use of ultrasound. While targeted towards physicians to foster team-based care and learning, nurses, physician assistants, and hospital administrators also participated in the pilot course.

Sixty persons from four hospitals participated in the pilot phase. Preliminary findings post-training reveal the following: 58% of participants expressed greater confidence in distinguishing between emergency department triage and triage during disasters; 59% of participants expressed greater confidence in performing initial triage of victims; 49% of participants expressed greater confidence in describing the use of ultrasound-guided triage; and 95% of participants reported an enhancement in their ability to perform their clinical role.

Preliminary findings reiterate the ongoing need for hospitals to provide training to their staff in the unique aspects of hospital triage and surge management using tools specifically designed in order to be prepared for the rapid influx of a large number of patients. A multipronged training model is a positive approach to help hospitals prepare for large-scale disasters.

On February 6, 2018, a magnitude 6.2 earthquake struck Hualien, the eastern part of Taiwan. The quake resulted in 17 deaths and more than 300 people injured. Four buildings completely collapsed and hundreds of houses were damaged.

The aim of this research was to use the patient data to analyze the reasons for visits, the trauma sites, and the severity.

We obtained the patient information from the Taiwan Eastern Medical Emergency Operation Center. Medical records were reviewed to analyze the primary diagnosis, the trauma mechanisms, and the sites of injury. Injury severity score (ISS) was used to assess trauma severity.

Two hundred and eighty patients were included in the study, with 90.3% being traumatic patients. Among them, 18.2% was geriatric trauma, 4.7% was pediatric trauma, and 0.4% was obstetric trauma. The most common injury site was lower extremities (33.2%), followed by head (31.4%) and upper extremities (27.1%). The mean injury severity score (ISS) was 1.9. The geriatric population had an average ISS of 2.4, and the pediatric group had a mean ISS of 1.2.

In our study, the majority of the patients had minor trauma. Lower extremities may be more vulnerable during the evacuation of an earthquake, and thus, became the most common injury site. The elderly patients had a higher ISS, which may be explained by their immobility and fragility of the body. In the future, it is critical to educate citizens about self-protection during earthquakes, focusing on protecting the head and the extremities. Healthcare providers and emergency medical technicians need to be well-trained to handle geriatric trauma since it poses unique challenges and is associated with increased mortality.

The prehospital disaster and emergency medical services community stands on the front-line in the response to events such as novel influenza, multi-drug resistant tuberculosis, and other high consequence diseases such as the Ebola Virus Disease.

To address provider and community safety, we developed an online educational program utilizing a Multi-Pathogen Approach to infectious disease personal protective equipment (PPE) deployment by prehospital providers. Such vigilance starts with syndromic recognition and quickly transcends to include operational issues, clinical interventions, and public health integration.

The University of Maryland, Baltimore County (Maryland, USA), Department of Emergency Health Services partnered with the Maryland State Department of Health (USA), to develop an online educational curriculum. The curriculum was developed through an expert panel consensus group including prehospital providers and is hybrid in design and includes awareness level training and procedural guidance.

Currently deployed online, this educational content demonstrating the use of the Multi-Pathogen Approach is accessible open-access via YouTube worldwide on computers, tablets, and smartphones. This curriculum is also accessible for continuing medical education to over 50,000 prehospital, hospital, and clinic personnel throughout Maryland and the National Capital Region of the United States. The curriculum consists of twelve modules of didactic and live videotaped demonstrations.

The development of the Multi-Pathogen Approach for the deployment of PPE and the use of online education modules has given prehospital providers an easily accessible open-access tool for high consequence disease management. The development of educational efforts such as these can help ensure better patient care and prehospital EMS system readiness.

Prehospital emergency care is a vital and integral component of health systems, particularly in resource-constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities, and trauma caused by road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the prehospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA).

A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions, respectively. Data were descriptively analyzed, and a principal component analysis was employed to identify the most influential weaknesses and capacities affecting the prehospital emergency care for the victims of RTI in the GKMA.

From 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 20164. key weaknesses and 5 key capacities were identified to affect the prehospital emergency care for RTI victims in the GKMA. Although some strengths exist, (e.g., ambulance facilitation, EMS structuring, and coordination), the key weaknesses affecting the pre-hospital care for victims were noted to relate to the absence of predefined EMS systems, particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment, insufficient skills/training of the first responders, inadequate EMS resources, and avoidable delays to respond and transport RTI victims to medical facilities.

Though some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.

The earthquake-resistant standard of the buildings of Japan is maintained by several levels. After the Great Hanshin-Awaji Earthquake(1995) the Ministry of Land, Infrastructure, Transport, and Tourism in Japan classified the earthquake-resistant performance for the base facilities into 3 levels. The hospital manager often selects the middle level of earthquake-resistance. However, 10 hospitals were closed down for the destruction of facilities by the Kumamoto earthquake. Who may evaluate the safety of a hospital after a great earthquake? The purpose of this study is to consider the methods to evaluate the safety of hospital buildings just after a great earthquake.

The damage to hospitals and the measures based on Japanese Law are arranged. Then it is considered who can declare the safety of hospital buildings after a great earthquake.

Hospital buildings collapsed in the Hanshin-Awaji Great Earthquake and many hospitals lost a function by a tsunami in the Great East Japan Earthquake. In addition, the glass and the ceilings of the hospital were damaged in the Kumamoto Earthquake. The damage occurred although these many hospitals had an earthquake-resistant standard established in the Building Standard Act of Japan. It is necessary for the experts to judge the safety of the hospital building just after a great earthquake.

The safety of hospital buildings is the responsibility of the hospital manager. However, there isn’t an expert of building structure employed as staff at a hospital. Thus, the hospital personnel must allow the expert of the building structure to advise a manager. In the future, it is important that the evaluation methods that can judge the damage of a hospital are developed, and the practical training for the hospital personnel are repeated.

On March 11, 2011, the Great East Japan Earthquake struck the northeastern coast of Japan with the magnitude nine. Ishinomaki medical zone was affected most severely with 328 evacuation shelters and approximately 50,000 evacuees. The Ishinomaki Zone Joint Relief Team gathered information directly from all evacuation shelters using assessment sheets. Based on this assessment data, various measures were carried out for environmental improvement of the shelters. To prepare for the next major disaster, a software program called Rapid Assessment System of Evacuation Center Condition - Gonryo and Miyagi (RASECC-GM) was developed, which computerizes the whole process, including entering, tabulating, and managing of shelter assessment data.

To verify the feasibility, usability, and accuracy of RASECC-GM, a verification test was performed using mock shelter data on October 23-26, 2018, to coincide with Logistics Training Course of Medical Logistics for Disasters held by Iwate Medical University.

On October 22, 2018 at four simulated disaster relief and health care branches, participants at each branch were asked to enter two mock shelter data items, submit a closed shelter request, and register a new shelter using RASECC-GM, respectively. The next day participants were asked to enter two mock shelter data items per branch while offline and upload the data to the server when next online. The uploaded data was checked for accuracy and whether it could be viewed on the management screen. After the test, a questionnaire survey was given to participants to verify the feasibility and usability of RASECC-GM.

It was confirmed that RASECC-GM functioned almost correctly. All participants answered that input operation was easy to understand, and 90.9% of participants could input without a mistake and did not feel stress when inputting data.

RASECC-GM appeared to be useful to shelter assessment, but further improvements are needed for practical use.

Attendees at music festivals rely upon on-site medical services for their emergency and medical care needs. Patients previously cared for can re-present for services at different times over the course of an event.

To identify the proportion of visits that are repeat presentations at music festivals and discuss themes in the medical care needs of these potentially resource-intensive patients.

This study included a review of prospectively enrolled patients presenting for health services over five years at a number of music festivals in Belgium and Canada. Patient data were extracted from existing databases of visits as well as visit documentation, and linked by name and date of birth to identify repeat visits. Data were de-identified and visit times, triage acuity, chief complaints, treatments, and discharge instructions were extracted.

Re-presentations constituted approximately 5% of all on-site medical visits. The majority were for minor care (e.g., wounds, dressings, foot care). Repeat visits for major issues included chronic disease (e.g., asthma, seizures, diabetes) and serial intoxications; these were high risk for transport to hospital. Festival duration was positively correlated with the number of patients with multiple visits. Three or more visits or visits in different years were rare occurrences.

At music festivals, a small but significant proportion of attendees utilize medical services repeatedly. Most are low acuity issues that could potentially be avoided with counseling or supplies at the initial visit. However, higher acuity re-registrations, both within and between event years, are a higher risk for transport and could benefit from early identification. Having a plan to identify and potentially remove the sicker, higher risk patients from the event could be important for safety and liability.

Komfo Anokye Teaching Hospital Emergency Department (KATH ED) is a tertiary referral center in Ghana. Anecdotally, patients seeking care at KATH ED do not actively participate in research initiatives.

To find out why patients presenting to KATH ED do not enroll in research studies that are conducted in the department.

The study was a cross-sectional survey of patients presenting to the ED for one month in June 2017. A semi-structured questionnaire was presented to patients presenting to KATH ED from 8:00-20:00 each day. Patients who were interviewed were all patients presenting to the ED for care, including those who had refused to enroll in the ongoing ACESO study. Patients had to be conscious, alert, and with conditions that did not require immediate management.

35% of the interviewees (91/260) had been approached to enroll in research studies at some point in the past. 13.5% had refused to enroll in a research study. 45.7% of those who refused to enroll admitted that they were afraid to enroll in a study; 28.6% had inadequate information and 22.9% perceived enrolling in a study would delay their treatment. The Akan language (73%) was most commonly used by research assistants then English (26%), and finally Hausa (1%) to interact with patients. There was a significant association between educational background and explaining a study to a patient before they enrolled. Males were more willing to enroll in an ongoing study compared to females. All age groups correlated significantly with being approached to enroll in a research study and similarly all age groups also correlated with refusing to enroll in a research study

Patients are paramount to hospital research. Efforts must be made to ensure that patients concerns and needs are addressed to ensure increasing participation.

Major injury incidents in confined settings such as tunnels and underground mineral- and metalliferous mines are rare, but when they do happen, the consequences may be severe with potential for many injured. The incident site is underground and it is difficult for the rescue and emergency medical service to get an overview and reach the injured. Therefore, it is important for the emergency medical service, rescue service, and the company responsible for the underground environment to have a good collaboration.

To develop best practices of conducting rescue response from a disaster medicine perspective in tunnels and underground mines through increased education.

Within an EU-program, the university collaborates with stakeholders such as rescue service, emergency medical service, and two mining companies. Within this project, an explorative case study with participatory research is conducted. This is managed with the help of representatives of the stakeholders, workshops, and through planning for and conducting observations of table-top and full-scale exercises.

At the first workshop the stakeholders built a timeline presenting their activities from a major incident occurring in an underground mine until the last injured was transported to the hospital. Thereafter, several workshops were conducted to find improvements that could be made regarding collaboration between the organizations. Table-top and full-scale exercises have also revealed further challenges. Within the project, prototypes are being developed and will be presented during the conference.

This project involves stakeholders in the research process, and they, therefore, have a direct impact on the development of best practices of rescue in major underground incidents.

Current methods to evaluate the delivery of urgent prehospital care often rely on inadequate surrogate measures or unreliable self-reported data. A workplace-based strategy may be feasible to assess the delivery of prehospital care by ambulances in selected populations.

To perform a nationwide assessment of the psychomotor performance of public ambulance workers in Ukraine, we created a plan of workplace-based observation. We conducted a post-hoc analysis of this strategy to assess feasibility, strengths, and limitations for future use in assessing prehospital ambulance performance.

With support from the Ministry of Health, we sent teams of trained observers to 30 ambulance substations across Ukraine. Using data collection tools on mobile devices, these observers accompanied Advanced Life Support ambulances on urgent calls for periods of 72 hours. We evaluated this program for collecting patient encounter data against the investment of time, personnel, and financial resources.

Over a two-month period, we directly observed 524 patient encounters by public ambulances responding to urgent calls at 30 ambulance substations across Ukraine. We employed 6 observers and 2 administrators over this time period. Collecting our observations required 2,160 person-hours at the ambulance substations. The total distance traveled to these sites was 11,375 kilometers. Project costs amounted to 37,000 USD, equating to 71 USD per observed patient encounter.

Workplace-based assessments are a cost-effective strategy to collect data on the delivery of prehospital care in select populations. This data can be useful for identifying the current state of EMS care delivered and evaluating compliance with established treatment protocols. Successful implementation depends on effective planning and coordination with a commitment of time, personnel, and financial resources. Issues of patient privacy, legal permission, and observer training must be considered.

Medicine is one of the most important areas of higher education. It is important that undergraduate students are well educated and have theoretical knowledge, but also have good clinical skills after graduating from medical training.

To understand whether the training objectives of the emergency medical internship was completed or not and to find the relationship between young doctors’ self-confidence and what they can do via using Rosenberg self-esteem scale (RSES). In addition, an objective was to consider which learning methods are more useful based on the feedback.

This survey study was performed in 2018 at Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey with the students who completed an emergency department rotation in the 2017-2018 education term. The questionnaire was composed by the researchers. It consisted of three parts which were included demographic information and education methods in emergency medicine of internships, questions about knowledge goals and learning goals for basic medicine applications, and RSES to assess young doctors’ self-confidence.

96 young doctors with the mean age of 25.22 ± 1.216 years(minimum 23 and maximum 30 years) were in the study5. 3 (55.2%) of which were female. All young doctors were evaluated with RSES4. (4.2%) of which were low self-confidence and 32 (33.3%) of which were high self-confidence. The best useful learning methods were clinical application of interaction with patients (n=828. 5%) and invasive procedures performed on patients (n=727. 5%).

The more you practice, the more you learn. Practice-based education is an important factor in a young doctor’s life. Besides, the higher self-confidence you have, the more you can. Young doctors with high self-esteem see themselves as qualified to perform applications even in complicated situations. However, more studies are needed to find out whether they could really perform or not.