Topic Editors

Prof. Dr. Amir Khorram-Manesh
Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
Dr. Krzysztof Goniewicz
Department of Aviation Security, Military University of Aviation, 08521 Deblin, Poland

Multiagency Approach to Disaster Management, Focusing on Triage, Treatment and Transport

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closed (10 February 2022)
Manuscript submission deadline
10 August 2022
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Topic Information

Dear Colleagues,

Several steps need to be considered in the management of disasters and emergencies.

Establishing command and control with the ability of communication enables sufficient collaboration and engagement of other agencies and offers a magnificent possibility for both situational assessment of the incident and the balance between available personnel and material resources and the needs for successful management of the incident. Although these steps are necessary for overall management of the incident, the medical part remains critical to the operational level of an incident. Triage, treatment, and transport of patients are vital steps in the management of the victims and influence the overall outcome of an incident. It is therefore critical to have established a guideline of how victims are triaged, treated, and transported to specialized medical facilities. These comprise vital parameters in a multiagency approach to disasters and major incidents, where several organizations with diverse backgrounds, knowledge, limitations, and abilities need to work together.

The most critical function of triage is to sort out patients in a fair, swift, medically safe, and compatible way to facilitate patients transfer from the incident site to a medical facility. However, although there are several prehospital triage models, there is no evidence for one being superior to others. Therefore, as long as the participating agencies practice a uniform type of triage, there will be no danger to patients’ medical safety. However, this is not always the case, and even within one region, various types of prehospital triage might be employed, which indicates a need for uniform triage strategies.

Treatment quality and duration at both prehospital and emergency department settings are critical for the survival of the victims. Prehospital treatment should not be time-consuming to facilitate a quick transport of the patient to the hospitals. Various guidelines provide a good foundation for professionals to act at this level; however, with the involvement of communities and immediate responders, there is a need for the review of the current guidelines to discuss the extent of immediate responders’ participation in the primary management of injured and victims.

Transport and logistics of victims remain another core area that needs to be discussed. In most countries, the number of medically equiped vehicles is insufficient either due to the limited number of unoccupied vehicles or the lack of staff and ambulances. Ground ambulances may also encounter various difficulties due to traffic congestion. Air ambulances and helicopters represent other alternatives, but many countries lack the necessary financial means or favorable geography for the use of these modalities.

The aim of this issue is to bring researchers and practitioners together to discuss and describe issues and solutions regarding evidence-based management of disasters and major incidents victims with particular focus on triage, treatment, and transport. Special considerations should be given to CBRNE events and their influence on the assessment and management of the victims.

Prof. Dr. Amir Khorram-Manesh
Dr. Krzysztof Goniewicz
Topic Editors

Keywords

  • triage
  • treatment
  • transport
  • prehospital
  • disasters
  • major incidents

Participating Journals

Journal Name Impact Factor CiteScore Launched Year First Decision (median) APC
International Journal of Environmental Research and Public Health
ijerph
3.390 3.4 2004 21.4 Days 2500 CHF Submit
Sustainability
sustainability
3.251 3.9 2009 17.6 Days 2000 CHF Submit
Healthcare
healthcare
2.645 - 2013 21.4 Days 1800 CHF Submit
Safety
safety
- 2.2 2015 42.1 Days 1600 CHF Submit

Published Papers (11 papers)

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Article
The Associations between Evacuation Status and Lifestyle-Related Diseases in Fukushima after the Great East Japan Earthquake: The Fukushima Health Management Survey
Int. J. Environ. Res. Public Health 2022, 19(9), 5661; https://doi.org/10.3390/ijerph19095661 - 06 May 2022
Abstract
Background: This study aimed to investigate the association between evacuation status and lifestyle-related disease risks among Fukushima residents following the Great East Japan earthquake. Methods: Fukushima health management survey respondents were classified into non-evacuees, returnees, evacuees in lifted areas, and evacuees in banned [...] Read more.
Background: This study aimed to investigate the association between evacuation status and lifestyle-related disease risks among Fukushima residents following the Great East Japan earthquake. Methods: Fukushima health management survey respondents were classified into non-evacuees, returnees, evacuees in lifted areas, and evacuees in banned areas. During a seven-year follow-up, 22,234 men and 31,158 women were included. Those with a history of diabetes, hypertension, or dyslipidemia at baseline were excluded. The odds ratios of risk factors (ORs) and 95% confidence intervals (CIs) for diabetes, hypertension, and dyslipidemia were calculated using a logistic regression model. Spatial autocorrelation of the prevalence of these diseases in the Fukushima area in 2017, was calculated to detect the disease prevalence status. Results: The risks of diabetes, hypertension, and dyslipidemia were higher in evacuees in banned areas than in non-evacuees; the multivariable ORs were 1.32 (95% CI: 1.19–1.46), 1.15 (1.06–1.25), and 1.20 (1.11–1.30) for diabetes, hypertension, and dyslipidemia, respectively. Returnees and evacuees in lifted areas had no increased risk of diseases. The area analyzed had a non-uniform spatial distribution of diabetes, hypertension, and hyperlipidemia, with clusters around Fukushima and Koriyama. Conclusion: Our findings imply the need for continuous support for evacuees in banned areas. Full article
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Review
Health, Economic and Social Development Challenges of the COVID-19 Pandemic: Strategies for Multiple and Interconnected Issues
Healthcare 2022, 10(5), 770; https://doi.org/10.3390/healthcare10050770 - 21 Apr 2022
Abstract
The COVID-19-pandemic-related economic and social crises are leading to huge challenges for all spheres of human life across the globe. Various challenges highlighted by this pandemic include, but are not limited to, the need for global health cooperation and security, better crisis management, [...] Read more.
The COVID-19-pandemic-related economic and social crises are leading to huge challenges for all spheres of human life across the globe. Various challenges highlighted by this pandemic include, but are not limited to, the need for global health cooperation and security, better crisis management, coordinated funding in public health emergencies, and access to measures related to prevention, treatment and control. This systematic review explores health, economic and social development issues in a COVID-19 pandemic context and aftermath. Accordingly, a methodology that focuses on identifying relevant literature with a focus on meta-analysis is used. A protocol with inclusion and exclusion criteria was developed, with articles from 15 December 2019 to 15 March 2022 included in the study. This was followed by a review and data analysis. The research results reveal that non-pharmaceutical measures like social distancing, lockdown and quarantine have created long-term impacts on issues such as changes in production and consumption patterns, market crashes resulting in the closure of business operations, and the slowing down of the economy. COVID-19 has exposed huge health inequalities across most countries due to social stratification and unequal distribution of wealth and/or resources. People from lower socio-economic backgrounds lack access to essential healthcare services during this critical time for both COVID-19 and other non-COVID ailments. The review shows that there is minimal literature available with evidence and empirical backup; similarly, data/studies from all countries/regions are not available. We propose that there is a need to conduct empirical research employing a trans-disciplinary approach to develop the most effective and efficient strategies to combat the pandemic and its aftermath. There is a need to explore the social and ecological determinants of this contagious infection and develop strategies for the prevention and control of COVID-19 or similar infections in future. Full article
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Article
A Critical Analysis of the COVID-19 Hospitalization Network in Countries with Limited Resources
Int. J. Environ. Res. Public Health 2022, 19(7), 3872; https://doi.org/10.3390/ijerph19073872 - 24 Mar 2022
Abstract
To effectively combat the COVID-19 pandemic, countries with limited resources could only allocate intensive and non-intensive care units to a low number of regions. In this work, we evaluated the actual displacement of infected patients in search of care, aiming to understand how [...] Read more.
To effectively combat the COVID-19 pandemic, countries with limited resources could only allocate intensive and non-intensive care units to a low number of regions. In this work, we evaluated the actual displacement of infected patients in search of care, aiming to understand how the networks of planned and actual hospitalizations take place. To assess the flow of hospitalizations outside the place of residence, we used the concepts of complex networks. Our findings indicate that the current distribution of health facilities in Bahia, Brazil, is not sufficient to effectively reduce the distances traveled by patients with COVID-19 who require hospitalization. We believe that unnecessary trips to distant hospitals can put both the sick and the healthy involved in the transport process at risk, further delaying the stabilization of the COVID-19 pandemic in each region of the state of Bahia. From the results found, we concluded that, to mitigate this situation, the implementation of health units in countries with limited resources should be based on scientific methods, and international collaborations should be established. Full article
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Article
The Effect of Competency-Based Triage Education Application on Emergency Nurses’ Triage Competency and Performance
Healthcare 2022, 10(4), 596; https://doi.org/10.3390/healthcare10040596 - 22 Mar 2022
Abstract
The Korean Triage and Acuity Scale (KTAS) is used to determine emergency patient priority. The purpose of this study was to develop the Competency-Based Triage Education Application (CTEA) using KTAS and evaluate its effectiveness on emergency nurses’ triage competency and performance. The developed [...] Read more.
The Korean Triage and Acuity Scale (KTAS) is used to determine emergency patient priority. The purpose of this study was to develop the Competency-Based Triage Education Application (CTEA) using KTAS and evaluate its effectiveness on emergency nurses’ triage competency and performance. The developed CTEA mobile application comprised 4 lectures, 12 text-based cases, and 8 video-based triage scenarios. A quasi-experimental pre-post design with a comparison group (CG) was used to evaluate the effectiveness of the CTEA. Thirty-one participants were assigned to an intervention group (IG) and used the application for at least 100 min over one week. Thirty-five participants were assigned to a CG and underwent book-based learning, which covered the same content as the CTEA. Triage competency (t = 2.55, p = 0.013) and performance (t = 2.11, p = 0.039) were significantly improved in the IG. The IG’s undertriage error was significantly reduced compared to that of the CG (t = 2.08, p = 0.041). These results indicated that the CTEA was effective in improving the emergency nurses’ triage competency and performance. This application will be useful as a program for providing repeated and continuous triage education. Full article
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Article
Addressing Uncertainty by Designing an Intelligent Fuzzy System to Help Decision Support Systems for Winter Road Maintenance
Safety 2022, 8(1), 14; https://doi.org/10.3390/safety8010014 - 17 Feb 2022
Cited by 1
Abstract
One of the main challenges in developing efficient and effective winter road maintenance is to design an accurate prediction model for the road surface friction coefficient. A reliable and accurate prediction model of road surface friction coefficient can help decision support systems to [...] Read more.
One of the main challenges in developing efficient and effective winter road maintenance is to design an accurate prediction model for the road surface friction coefficient. A reliable and accurate prediction model of road surface friction coefficient can help decision support systems to significantly increase traffic safety, while saving time and cost. High dynamicity in weather and road surface conditions can lead to the presence of uncertainties in historical data extracted by sensors. To overcome this issue, this study uses an adaptive neuro-fuzzy inference system that can appropriately address uncertainty using fuzzy logic neural networks. To investigate the ability of the proposed model to predict the road surface friction coefficient, real data were measured at equal time intervals using optical sensors and road-mounted sensors. Then, the most critical features were selected based on the Pearson correlation coefficient, and the dataset was split into two independent training and test datasets. Next, the input variables were fuzzified by generating a fuzzy inference system using the fuzzy c-means clustering method. After training the model, a testing set was used to validate the trained model. The model was evaluated by means of graphical and numerical metrics. The results show that the constructed adaptive neuro-fuzzy model has an excellent ability to learn and accurately predict the road surface friction coefficient. Full article
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Article
The Service Capability of Primary Health Institutions under the Hierarchical Medical System
Healthcare 2022, 10(2), 335; https://doi.org/10.3390/healthcare10020335 - 10 Feb 2022
Abstract
Background: Primary health institutions (PHIs) are the foundation of the whole health system and the basic link to achieve the goal of all people enjoying primary health care. However, the service capability of primary health institutions is not under the hierarchical medical system. [...] Read more.
Background: Primary health institutions (PHIs) are the foundation of the whole health system and the basic link to achieve the goal of all people enjoying primary health care. However, the service capability of primary health institutions is not under the hierarchical medical system. Method: Data were collected from the China Health Statistics Yearbook between 2014 and 2020. PHIs included community health centres, community health stations, and township hospitals in our study. The service capability of primary health institutions was analysed from the perspective of structure, process, and results. Structure capability was evaluated using the number of beds, number of personnel, number of health technicians, and proportion of the number of personnel in PHIs accounting for the total number of health personnel. Process capability was evaluated using the number of general practitioners. The number of outpatients and inpatients, medical income, the proportion of drug income, and the average number of patients and beds served by physicians in PHIs per day were employed to evaluate the resulting capability. Results: From 2014 to 2020, the number of community health service centres/stations increased, while the number of township health centres decreased. In the aspect of structure capability, the total number of personnel and health technicians in community health centres/stations and township hospitals both increased during 2014 and 2020. However, the increasing rate in PHIs was a little bit less than that of general medical institutions. The proportion of male health technicians in community health centres and township hospitals both decreased, while the proportion of female technicians in both increased. From 2014 to 2020, the number of beds in PHIs also increased from 138.12 × 104 to 164.94 × 104. However, the proportion of beds in PHIs accounting for the total number of beds in medical institutions decreased. For the resulting capability, from 2014 to 2019, the proportion of diagnosis and treatment times in PHIs decreased from 57.41% to 51.96%, although it increased in 2020. The proportion of inpatients in PHIs decreased from 20.03% to 16.11%. From 2014 to 2020, the utilisation rate of hospital beds in PHIs decreased (from 55.6% to 34% for community health centres and 60.5% to 53.6% for township hospitals). The average daily bed days of doctors in township hospitals was higher than that of doctors in community health service centres. However, the average medical cost of outpatients and the per capita medical cost of inpatients in community health service centres were higher than in township hospitals. Conclusion: In recent years, although the service capability showed an increasing trend in PHIs, the growth rate was lower than the general health institutions. The utilisation rates of PHIs, including beds and physicians, were decreased. Among PHIs, the utilisation in township hospitals was higher than in community health centres with a relatively low price. Under the hierarchical medical system and normalisation period of the COVID-19 epidemic, it is important to improve the service capability to achieve its goal of increasing PHI utilisation and decreasing secondary and tertiary hospital utilisation. Full article
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Article
Effect of the Strategic Thinking, Problem Solving Skills, and Grit on the Disaster Triage Ability of Emergency Room Nurses
Int. J. Environ. Res. Public Health 2022, 19(2), 987; https://doi.org/10.3390/ijerph19020987 - 16 Jan 2022
Abstract
In this descriptive study, we aimed to identify factors related to emergency room nurses’ disaster triage ability. A total of 166 nurses who worked for emergency departments of general hospitals completed a structured questionnaire consisting of the Disaster Triage Ability Scale (DTAS), the [...] Read more.
In this descriptive study, we aimed to identify factors related to emergency room nurses’ disaster triage ability. A total of 166 nurses who worked for emergency departments of general hospitals completed a structured questionnaire consisting of the Disaster Triage Ability Scale (DTAS), the Strategic Thinking Scale (STS), the Problem-Solving Inventory (PSI), and the Original Grit Scale (Grit-O). The data were analyzed using SPSS/WIN 25.0 by means of descriptive statistics, t-test, one-way ANOVA, the Scheffé post hoc test, Pearson’s correlation coefficients, and stepwise multiple regression. Participants’ DTAS averaged 14.03 ± 4.28 (Range 0–20) and showed a statistically significant difference according to their experience of triage education (t = 2.26, p = 0.022) as a disaster triage-related attribute. There were significant correlations among DTAS and confidence in the PSI (r = 0.30, p < 0.001), the approach-avoidance style in the PSI (r = −0.28, p < 0.001), and futurism in the STS (r = 0.19, p = 0.019). The strongest predictor was confidence in the PSI; in addition, 14.1% of the DTAS was explained by confidence in the PSI, approach-avoidance in the PSI, and futurism in the STS. Emergency room nurses who received triage education showed a higher level of the DTAS and their DTAS could be explained by problem-solving skills and strategic thinking. Therefore, it is necessary to develop and implement triage education programs integrated with stress management to improve the approach-avoidance style to ensure better problem-solving skills and to utilize various training methods to enhance confidence to improve problem-solving skills and futurism as part of strategic thinking. Full article
Article
Civilian-Military Collaboration before and during COVID-19 Pandemic—A Systematic Review and a Pilot Survey among Practitioners
Sustainability 2022, 14(2), 624; https://doi.org/10.3390/su14020624 - 06 Jan 2022
Cited by 3
Abstract
Due to the similarity in skills and assets, Civilian-Military collaboration has emerged as one of the most reliable partnerships during the disaster and public health emergency management to address all necessary elements of surge capacity, i.e., staff, stuff, structure (space), and systems. This [...] Read more.
Due to the similarity in skills and assets, Civilian-Military collaboration has emerged as one of the most reliable partnerships during the disaster and public health emergency management to address all necessary elements of surge capacity, i.e., staff, stuff, structure (space), and systems. This study aimed to evaluate this collaboration before and during the coronavirus 2019 pandemic. The outcomes of the systematic review revealed several published reports on successful civilian-military collaboration and proposed a need for further improvement. One hundred sixty-six individuals from 19 countries responded to nine questions, included in an online survey with the possibility to leave comments if necessary. The questionnaire referred to elements such as command and control, safety, communication, assessment, triage, treatment, and transport, as the crucial components of emergency management. The comprehensive examination of the survey results together with registered comments revealed a possible improvement in collaboration particularly on the strategic levels, i.e., meetings at the command-and-control level, safety, communication, and networking issues. While logistic collaboration seemed to be unchanged, the practical parts of the collaboration, i.e., clinical and non-clinical operational partnership (Triage and Treatment), mutual education, training, and operational understanding of each organization remained unchanged. In conclusion, although the current pandemic may have facilitated a more intense collaboration between civilian and military healthcare organizations, it lacks practical partnership and operative engagement, representing two crucial elements necessary for harmony and compatibility of both systems. Such collaboration may require a political will and perhaps a mutual civilian-military authority. Full article
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Review
Decontamination Methods of N95 Respirators Contaminated with SARS-CoV-2
Sustainability 2021, 13(22), 12474; https://doi.org/10.3390/su132212474 - 11 Nov 2021
Cited by 1
Abstract
In the preparation and response to the COVID-19 pandemic, a sufficient supply of personal protective equipment (PPE), particularly the face mask, is essential. Shortage of PPE due to growing demand leaves health workers at significant risk as they fight this pandemic on the [...] Read more.
In the preparation and response to the COVID-19 pandemic, a sufficient supply of personal protective equipment (PPE), particularly the face mask, is essential. Shortage of PPE due to growing demand leaves health workers at significant risk as they fight this pandemic on the frontline. As a mitigation measure to overcome potential mask shortages, these masks could be decontaminated and prepared for reuse. This review explored past scientific research on various methods of decontamination of the N95-type respirators and their efficiency against the SARS-CoV-2 virus. Ultraviolet germicidal irradiation (UVGI) and hydrogen peroxide vapor (HPV) show great potential as an effective decontamination system. In addition, UVGI and HPV exhibit excellent effectiveness against the SARS-CoV-2 virus on the N95 respirator surfaces. Full article
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Article
Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies
Healthcare 2021, 9(11), 1462; https://doi.org/10.3390/healthcare9111462 - 28 Oct 2021
Abstract
(1) Background: Chest pain center accreditation has been associated with improved timelines of primary percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI). However, evidence from low- and middle-income regions was insufficient, and whether the sensitivity to improvements differs between walk-in and [...] Read more.
(1) Background: Chest pain center accreditation has been associated with improved timelines of primary percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI). However, evidence from low- and middle-income regions was insufficient, and whether the sensitivity to improvements differs between walk-in and emergency medical service (EMS)-transported patients remained unclear. In this study, we aimed to examine the association of chest pain center accreditation status with door-to-balloon (D2B) time and the potential modification effect of arrival mode. (2) Methods: The associations were examined using generalized linear mixed models, and the effect modification of arrival mode was examined by incorporating an interaction term in the models. (3) Results: In 4186 STEMI patients, during and after accreditation were respectively associated with 65% (95% CI: 54%, 73%) and 71% (95% CI: 61%, 79%) reduced risk of D2B time being more than 90 min (using before accreditation as the reference). Decreases of 27.88 (95% CI: 19.57, 36.22) minutes and 26.55 (95% CI: 17.45, 35.70) minutes in D2B were also observed for the during and after accreditation groups, respectively. The impact of accreditation on timeline improvement was greater for EMS-transported patients than for walk-in patients. (4) Conclusions: EMS-transported patients were more sensitive to the shortened in-hospital delay associated with the initiative, which could exacerbate the existing disparity among patients with different arrival modes. Full article
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Article
Development and Validation of an Instrument to Measure Work-Related Stress among Rescue Workers in Traumatic Mass-Casualty Disasters
Int. J. Environ. Res. Public Health 2021, 18(16), 8340; https://doi.org/10.3390/ijerph18168340 - 06 Aug 2021
Abstract
Rescue workers are a population at high-risk for mental problems as they are exposed to work-related stress from confrontation with traumatic events when responding to a disaster. A reliable measure is needed to assess rescue workers’ work-related stress from their surveillance of a [...] Read more.
Rescue workers are a population at high-risk for mental problems as they are exposed to work-related stress from confrontation with traumatic events when responding to a disaster. A reliable measure is needed to assess rescue workers’ work-related stress from their surveillance of a disaster scene to help prevent severe PTSD and depressive symptoms. The purpose of this study was to develop and validate the Work-Related Stress Scale (WRSS) designed to measure stress in rescue workers after responding to traumatic mass-casualty events. An exploratory sequential mixed methods procedure was employed. The qualitative phase of the item generation component involved in-depth interviews of 7 experienced rescue workers from multiple specialties who had taken part in 1 or 2 mass-casualty events: the 2018 Hualien earthquake or the 2016 Tainan earthquake. In the quantitative phase, a modified Delphi approach was used to achieve consensus ratings by the same 7 raters on the items and to assess content validity. Construct validity was determined by confirmatory factor analysis using a broader sample of 293 rescue workers who had taken part in 1 of 2 mass-casualty events: the 2018 Hualien earthquake or the 2021 Hualien train derailment. The final WRSS consists of 16 items total and 4 subscales: Physical Demands, Psychological Response, Environmental Interruption, and Leadership, with aggregated alphas of 0.74–0.88. The WRSS was found to have psychometric integrity as a measure of stress in rescue workers after responding to a disaster. Full article
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