Disaster medicine and the emergency medicine resident

Footprint of Emergency Medicine Physicians in Disaster Medicine Publications: A Bibliometric Analysis

INTRODUCTION

Investigating the developments in the ever-growing field of disaster medicine and revealing the scientific trends will make an important contribution to researchers in related fields. This study aims to identify the contributions of emergency medicine physicians (EMPs) and trends in disaster medicine publications.

METHODS

The expressions "disaster medicine" or "disaster*" and "medicine*" were searched in the Web of Science (WoS) database. Research and review papers produced by EMPs from 2001 through 2021 were included in the study. Basic descriptive information was assessed such as the number of publications, authors, citations, most active authors, institutions, countries, and journals. In addition, conceptual, intellectual, and social structures were analyzed.

RESULTS

The study included a total of 346 papers written by 1,500 authors. The mean citation rate per publication was 13.2. Prehospital and Disaster Medicine, Disaster Medicine and Public Health Preparedness, and Academic Emergency Medicine were the journals with the highest number of publications and the highest number of citations. The most common keywords used by the authors were "disaster medicine," "emergency medicine," and "disaster/disasters." According to the distribution of the corresponding authors by country, the United States (n = 175), Japan (n = 23), Italy (n = 20), Australia (n = 17), and Canada (n = 17) had the highest number of publications. The institutions that produced the most publications were John Hopkins University (n = 37), Brigham and Women's Hospital (n = 27), George Washington University (n = 25), University Piemonte Orientale (n = 24), and Brown University (n = 22).

CONCLUSION

Increasingly, EMPs have contributed to disaster medicine publications over the years. This study can be used as a guide for EMPs and other researchers who want to contribute to the disaster medicine literature.

Disaster day: a simulation-based competition for educating emergency medicine residents and medical students on disaster medicine

BACKGROUND

Disaster medicine is a growing field within the specialty of emergency medicine, but educational training typically focuses on hospital drills or other educational strategies, such as didactics, simulation, or tabletop exercises. With the success of gamification in other medical education applications, we sought to investigate if a novel gamified curricular innovation would lead to improved test performance and confidence in the ability to manage a real mass casualty incident (MCI).

METHODS

This was a prospective observational study of medical students and emergency medicine residents who participated in a 4-h simulation-based competition consisting of 4 unique stations. Each station had learning objectives associated with the content taught. Learners completed a pre-event survey, followed by participation in the competitive gamification event, and subsequently completed a post-event survey. Differences between pre- and post-event responses were matched and analyzed using paired and unpaired t tests for medical knowledge assessments, the Mann-Whitney U test for perceptions of confidence in the ability to manage an MCI event, and descriptive statistics provided on perceptions of the effectiveness of this educational strategy.

RESULTS

We analyzed data from 49 learners with matched (and unmatched) pre- and post-event survey responses. There was a statistically significant increase in medical knowledge assessment scores in both unmatched group means and available matched data (47 to 69%, p < 0.01, and 50 to 69%, p < 0.05). Self-reported confidence in the ability to handle an MCI scenario also significantly increased (p < 0.01). Finally, 100% of respondents indicated they "agreed" or "strongly agreed" that the event was an effective education tool for disaster preparedness and training.

CONCLUSIONS

In this study, we found that learners perceived a novel gamification event as an effective educational tool, which led to improved learner knowledge and self-reported confidence in the ability to manage a real MCI.

Examining the disaster medicine curriculum in Canadian Emergency Medicine enhanced skills programs

OBJECTIVES

Disaster medicine teaching is an important, and understudied, component of EM residency training programs. Little is known about disaster medicine training in Canadian EM programs, particularly within the 1-year EM enhanced skills programs. The purpose of this study is to (1) understand which disaster medicine topics are currently taught in EM enhanced skills programs and (2) establish a list of the highest priority disaster medicine teaching topics for those programs.

METHODS

We distributed an eight-question survey to all 31 EM enhanced skills site directors across Canada by email. Questions on the survey asked which of 39 disaster medicine subtopics were (1) currently taught and (2) should be taught to EM enhanced skills residents.

RESULTS

Of 31 invited participants, 16 completed the study (52% response rate). The most taught topic was introduction to disaster medicine/nomenclature (13/16 programs), while 11/16 programs currently teach decontamination indications and issues, personal protective equipment, prehospital disaster management, and trauma mass casualty incidents. Topics reported high or essential priority for teaching included introduction to disaster medicine/nomenclature (12/16 programs), decontamination indications and issues, personal protective equipment, and prehospital disaster management (11/16 programs).

CONCLUSIONS

This study identified disaster medicine topics currently taught at Canadian EM enhanced skills programs, along with recommending a list of priority teaching topics. These findings can inform future disaster medicine content in EM training program curricula.

Knowledge retention and usefulness of simulation exercises for disaster medicine - what do specialty trainees know and think?

Introduction

Disaster medicine education is an important but often neglected part of Emergency Medicine (EM) specialty trainees' curriculum. It is especially neglected in limited resource environments (1), which, owing to poor infrastructure generally, are more likely to be affected by disasters than better resourced environments. Disaster medicine cannot be taught solely in a classroom and various methods are required to teach practical concepts. This study aims to look at Emergency specialty trainees' perception of high-fidelity simulation and their needs with regards to Disaster Medicine Education.

Methods

This was a prospective cross-sectional cohort study involving 27 EM specialty trainees from the University of the Witwatersrand, who, participated in a high-fidelity simulation and were given a questionnaire before and after the exercise. The questionnaire consisted of theory questions relating to disaster medicine as well as Emergency Specialty trainee's perception and needs towards disaster medicine education.

Results

High fidelity simulation does not increase theoretical knowledge of Disaster Medicine but it does increase perceived confidence. EM specialty trainees seek yearly training, beginning in their first year and choose high fidelity simulation as their preferred method of training.

Conclusion

High fidelity simulation is crucial to increasing the confidence of EM specialty trainees during their training. More research is needed to develop core competencies and methods of evaluating training.

Natural Disasters Related Traumatic Injuries/Fatalities in the United States and Their Impact on Emergency Preparedness Operations

INTRODUCTION

From 2015 to 2019, the United States experienced a 17% increase in weather-related disasters.

OBJECTIVES

We aimed to study the patterns of natural disaster-related traumatic injuries and fatalities across the United States from 2014 to 2019 and to provide recommendations that can serve to mitigate the impact these natural disasters have on trauma patient morbidity and mortality.

METHODS

A retrospective analysis of the National Safety Council (2014-2019) of natural disaster-related injuries and fatalities was conducted. Descriptive statistics and independent-samples t tests were performed, with significance defined as p < .05.

RESULTS

Floods produced significantly more mean fatalities per year than tornadoes (118 vs. 33; 95% CI [32.0, 139.0]), wildfires (118 vs. 43, 95% CI [24.8, 155.6]), hurricanes (118 vs. 13, 95% CI [51.5, 159.2]), and tropical storms (118 vs. 15, 95% CI [48.8, 158.2]). Tornadoes produced significantly more mean injuries per year than floods (528 vs. 43, 95% CI [255.9, 715.8]), wildfires (528 vs. 69, 95% CI [227.1, 691.2]), hurricanes (528 vs. 26, 95% CI [270.1, 734.2]), and tropical storms (528 vs. 4, 95% CI [295.9, 753.5]). Southern states experienced greater disaster-related morbidity and mortality over the 6-year study period than other regions with 2,752 injuries and 771 fatalities.

CONCLUSIONS

The incidence of traumatic injuries and fatalities related to certain natural disasters in the United States has significantly increased from 2014 to 2019. Hospital leaders, public health, emergency preparedness personnel, and policy makers must collaborate to implement protocols and guidelines that ensure adequate training, supplies, and personnel to maintain trauma surge capacity, improve emergency preparedness response, and reduce associated morbidity and mortality.

Response by Twin Italian Hub Hospitals in a Double Seismic Event: A Retrospective Observational Investigation

INTRODUCTION

The objectives of this study were to compare prevalence rates of different pathologies, ambulance system and emergency department management times, and patient survival and hazard ratios for codes 2 and 3 in two hub hospitals in Modena in the 36-month period across the stages of two major earthquakes in short sequence in Northern Italy in 2012.

METHODS

Clinical records pertaining to the emergency care of patients were analyzed and only those assigned status codes 2 and 3 by ambulance professionals were included (if the assessment was confirmed by emergency department triage). The statistical analysis of data was divided by three time periods studied: before, during/between, and after the earthquakes.

RESULTS

Among the 2,278 retained records, there were no statistically significant differences in the prevalence of the main pathologies presented at the two hubs in the studied period. A Cox regression model was used to analyze the survival of patients in the different stages of the emergency; there were no statistically significant differences in the hazard ratios of death before, during, and after the earthquake. The study found a significant increase in emergency department treatment times.

DISCUSSION

Redundancies in the Modena medical system were found to have compensated for damaged hospital facilities. In particular, they helped emergency systems reorganize themselves faster in order to bring medical assistance to people during and around seismic events with as a minimal amount of disruption as possible.

CONCLUSION

The Modena medical system was redundant and ensured that disrupted emergency systems were reorganized and put back online while damaged hospital facilities were compensated for/reproduced elsewhere.

Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US

Study Objective

This study aimed to review available disaster training options for health care providers, and to provide specific recommendations for developing and delivering a disaster-response-training program for non-disaster-trained emergency physicians, residents, and trainees prior to acute deployment.

Methods

A comprehensive review of the peer-reviewed and grey literature of the existing training options for health care providers was conducted to provide specific recommendations.

Results

A comprehensive search of the Pubmed, Embase, Web of Science, Scopus, and Cochrane databases was performed to identify publications related to courses for disaster preparedness and response training for health care professionals. This search revealed 7,681 unique titles, of which 53 articles were included in the full review. A total of 384 courses were found through the grey literature search, and many of these were available online for no charge and could be completed in less than six hours. The majority of courses focused on management and disaster planning; few focused on clinical care and acute response.

Conclusion

There is need for a course that is targeted toward emergency physicians and trainees without formal disaster training. This course should be available online and should utilize a mix of educational modalities, including lectures, scenarios, and virtual simulations. An ideal course should focus on disaster preparedness, and the clinical and non-clinical aspects of response, with a focus on an all-hazards approach, including both terrorism-related and environmental disasters.

HansotiB, KelloggDS, AberleSJ, BroccoliMC, FedenJ, FrenchA, LittleCM, MooreB, SabatoJJr., SheetsT, WeinbergR, ElmesP, KangC. Preparing emergency physicians for acute disaster response: a review of current training opportunities in the US. Prehosp Disaster Med. 2016;31(6):643–647.

Reporting for duty during mass casualty events: a survey of factors influencing emergency medicine physicians

BACKGROUND

Academic medical centers play a major role in disaster response, and residents frequently serve as key resources in these situations. Studies examining health care professionals' willingness to report for duty in mass casualty situations have varying response rates, and studies of emergency medicine (EM) residents' willingness to report for duty in disaster events and factors that affect these responses are lacking.

OBJECTIVE

We sought to determine EM resident and faculty willingness to report for duty during 4 disaster scenarios (natural, explosive, nuclear, and communicable), to identify factors that affect willingness to work, and to assess opinions regarding disciplinary action for physicians unwilling to work in a disaster situation.

METHODS

We surveyed residents and faculty at 7 US teaching institutions with accredited EM residency programs between April and November 2010.

RESULTS

A total of 229 faculty and 259 residents responded (overall response rate, 75.4%). Willingness to report for duty ranged from 54.1% for faculty in a natural disaster to 94.2% for residents in a nonnuclear explosive disaster. The 3 most important factors influencing disaster response were concern for the safety of the family, belief in the physician's duty to provide care, and availability of protective equipment. Faculty and residents recommended minimal or no disciplinary action for individuals unwilling to work, except in the infectious disease scenario.

CONCLUSIONS

Most EM residents and faculty indicated they would report for duty. Residents and faculty responses were similar in all but 1 scenario. Disciplinary action for individuals unwilling to work generally was not recommended.

Development of an “All-Hazards” Hospital Disaster Preparedness Training Course Utilizing Multi-Modality Teaching

Objectives:

The objectives of the study were to develop and evaluate an “all-hazards” hospital disaster preparedness training course that utilizes a combi-nation of classroom lectures, skills sessions, tabletop sessions, and disaster exercises to teach the principles of hospital disaster preparedness to hospital-based employees.

Methods:

Participants attended a two-day, 16-hour course, entitled Hospital Disaster Life Support (HDLS). The course was designed to address seven core competencies of disaster training for healthcare workers. Specific disaster situations addressed during HDLS included: (1) biological; (2) conventional; (3) radiological; and (4) chemical mass-casualty incidents. The primary goal of HDLS was not only to teach patient care for a disaster, but more important-ly, to teach hospital personnel how to manage the disaster itself. Knowledge gained from the HDLS course was assessed by pre- and post-test evaluations. Additionally, participants completed a course evaluation survey at the conclu-sion of HDLS to assess their attitudes about the course.

Results:

Participants included 11 physicians, 40 nurses, 23 administrators/direc-tors, and 10 other personnel (n = 84). The average score on the pre-test was 69.1 ±12.8 for all positions, and the post-test score was 89.5 ±6.7, an improve-ment of 20.4 points (p <0.0001, 17.2–23.5).Participants felt HDLS was edu-cational (4.2/5), relevant (4.3/5) and organized (4.3/5).

Conclusions:

Identifying an effective means of teaching hospital disaster pre-paredness to hospital-based employees is an important task. However, the opti-mal strategy for implementing such education still is under debate.The HDLS course was designed to utilize multiple teaching modalities to train hospital-based employees on the principles of disaster preparedness. Participants of HDLS showed an increase in knowledge gained and reported high satisfaction from their experiences at HDLS. These results suggest that HDLS is an effec-tive way to train hospital-based employees in the area of disaster preparedness.

Bioterrorism training in U.S. emergency medicine residencies: has it changed since 9/11?

OBJECTIVES

To assess the change in prevalence of bioterrorism training among emergency medicine (EM) residencies from 1998 to 2005, to characterize current training, and to identify characteristics of programs that have implemented more intensive training methods.

METHODS

This was a national cross sectional survey of the 133 U.S. EM residencies participating in the 2005 National Resident Matching Program; comparison with a baseline survey from 1998 was performed. Types of training provided were assessed, and programs using experiential methods were identified.

RESULTS

Of 112 programs (84.2%) responding, 98% reported formal training in bioterrorism, increased from 53% (40/76) responding in 1998. In 2005, most programs with bioterrorism training (65%) used at least three methods of instruction, mostly lectures (95%) and disaster drills (80%). Fewer programs used experiential methods such as field exercises or bioterrorism-specific rotations (35% and 13%, respectively). Compared with other programs, residency programs with more complex, experiential methods were more likely to teach bioterrorism-related topics at least twice a year (83% vs. 59%; p = 0.018), to teach at least three topics (60% vs. 40%; p = 0.02), and to report funding for bioterrorism research and education (74% vs. 45%; p = 0.007). Experiential and nonexperiential programs were similar in program type (university or nonuniversity), length of program, number of residents, geographic location, and urban or rural setting.

CONCLUSIONS

Training of EM residents in bioterrorism preparedness has increased markedly since 1998. However, training is often of low intensity, relying mainly on nonexperiential instruction such as lectures. Although current recommendations are that training in bioterrorism include experiential learning experiences, the authors found the rate of these experiences to be low.

Video of a disaster drill is effective in educating registrars on the hospital disaster plan

OBJECTIVE

To test whether an instructional video of edited footage from a disaster drill is effective in educating registrars on the hospital disaster plan.

METHODS

This was a prospective pre- and post-intervention study. Forty hospital registrars were shown a 15 min video based on footage obtained at a simulated mass casualty incident. The video provided information on the ED disaster response plan and principles of hospital disaster management. A survey was developed to assess disaster plan knowledge before and after viewing the video. The survey had a predetermined 'pass mark' of 14/20 (70%).

RESULTS

Thirty-nine registrars completed the surveys. Three of 39 (7.7% 95% confidence interval [CI] 7.0-8.3%) registrars achieved the pass mark in the pre-video survey and 35/39 (89.7% 95% CI 81.2-98.3%) registrars achieved the pass mark in the post-video survey (chi(2)-test P < 0.001) with an absolute increase in the pass rate of 82% (95% CI 75.8-88.2%).

CONCLUSION

This finding justifies compulsory viewing of the video in the registrar orientation package locally and might encourage more widespread use of educational video in hospital disaster preparedness.

Are Surgical Residents Prepared for Mass Casualty Incidents?

OBJECTIVE

We hypothesized that resident education is inadequate with respect to management of mass casualty incidents that may involve chemical, biological, and nuclear exposures.

METHODS

Chief level residents in surgery (n = 10), emergency medicine (n = 10), and anesthesia (n = 8) were asked to complete a survey questionnaire. Responses were tabulated and statistically analyzed with Mann-Whitney Rank Sum, Student's t test, and Kruskal-Wallis one-way analysis of variance.

RESULTS

All of the residents were similar with respect to age, sex, and intended setting of clinical practice. Only a single resident reported military experience. Two residents (7.1%) had administered medical care while wearing a protective suit. Compared with emergency medicine residents, surgical residents reported significantly less formal teaching in mass casual incidents (P = 0.02), trauma triage (P = 0.01), and nuclear, biological, chemical agents (P = 0.002). When surgical residents were compared with anesthesia residents, there was significantly less training for surgical residents in nuclear, chemical, and biological agents (P = 0.02). Multiple/mass casualty incident experience did not differ between residents. However, the most common incident involved only three to five patients with blunt trauma. Emergency medicine residents were significantly more comfortable in treating patients with exposure to anthrax (P = 0.01), sarin (P = 0.04), and nuclear exposure (P = 0.01).

CONCLUSIONS

Surgical residents have significantly less formal training in mass casualties, triage, and chemical, biological, and nuclear exposures than residents in other specialties. Therefore, surgical residents are less comfortable treating these types of patients. Because surgeons often are expected to take leadership roles in mass casualty incidents, surgical education should be modified to match or exceed that of other specialties.