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Wesemann U, Renner KH, Rowlands K, Köhler K, Hüttermann N, Himmerich H. Incidence of mental disorders in soldiers deployed to Afghanistan who have or have not experienced a life-threatening military incident-a quasi-experimental cohort study. Front Public Health 2024; 12:1357836. [PMID: 38584933 PMCID: PMC10995976 DOI: 10.3389/fpubh.2024.1357836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/09/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction There is very good international research on deployment-related mental disorders in military personnel. The incidence rates show a very wide range. A new strategy is therefore proposed in order to achieve better standardization and thus better comparability of the studies. In addition to a non-deployed comparison group, we propose to compare deployed soldiers with and without critical military incidents during the deployment. This additional distinction makes it possible to differentiate between the influencing variables of actual threat and general deployment stress. Methods N = 358 male combat soldiers deployed to Afghanistan were included in the study. Clinical interviews were conducted several days before deployment and after deployment. Of them, n = 80 soldiers suffered a life-threatening military incident during deployment, whereas 278 soldiers did not. Odds ratios (OR) were calculated for the groups with and without critical military incidents and the new onset for PTSD, anxiety disorders and depressive disorders. Results When comparing both groups, we found significantly higher 1-year incidence rates in the group with critical military incidents: 6.4% vs. 1.1% (OR 6.2) for post-traumatic stress disorder (PTSD); 7.0% vs. 1.1% (OR 6.5) for depression; and 15.9% vs. 2.8% (OR 6.6) for anxiety disorders. The 1-year incidence rate of mental multimorbidity (PTSD with anxiety or depression) was 4.8% vs. 0.4% (OR 12.0). Discussion These results indicate that life-threatening military incidents during military deployment are important to mental health. As the different threat levels of the various missions are taken into account, additional predictors could be determined more precisely in further research.
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Affiliation(s)
- Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Karl-Heinz Renner
- Faculty of Human Sciences, Institute of Psychology, Bundeswehr University Munich, Neubiberg, Germany
| | - Katie Rowlands
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
| | - Kai Köhler
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Nils Hüttermann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Hubertus Himmerich
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
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Alkhathami MG, Al Naam YA, Al Zahrani EM. Advancing military medical research and training in the Saudi Armed Forces: a call to action. BMJ Mil Health 2023:e002528. [PMID: 37923313 DOI: 10.1136/military-2023-002528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Mohammed G Alkhathami
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Y A Al Naam
- Department of Clinical Laboratory Science, Prince Sultan Military College of Health Science, Dammam, Saudi Arabia
| | - E M Al Zahrani
- Department of Biomedical Technology, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
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3
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Alruwaili A, Khorram-Manesh A, Ratnayake A, Robinson Y, Goniewicz K. Supporting the Frontlines: A Scoping Review Addressing the Health Challenges of Military Personnel and Veterans. Healthcare (Basel) 2023; 11:2870. [PMID: 37958012 PMCID: PMC10648823 DOI: 10.3390/healthcare11212870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/13/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Military personnel and veterans meet unique health challenges that stem from the complex interplay of their service experiences, the nature of warfare, and their interactions with both military and civilian healthcare systems. This study aims to examine the myriad of injuries and medical conditions specific to this population, encompassing physical and psychological traumas. (2) Methods: A scoping review (systematic search and non-systematic review) was performed to evaluate the current landscape of military healthcare. (3) Results: A significant change in the injury profile over time is identified, linked to shifts in combat strategies and the integration of advanced technologies in warfare. Environmental exposures to diverse chemical or natural agents further complicate the health of service members. Additionally, the stressors they face, ranging from routine stress to traumatic experiences, lead to various mental health challenges. A major concern is the gap in healthcare accessibility and quality, worsened by challenges in the civilian healthcare system's capacity to address these unique needs and the military healthcare system's limitations. (4) Conclusions: This review underscores the need for holistic, integrated approaches to care, rigorous research, and targeted interventions to better serve the health needs of military personnel and veterans.
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Affiliation(s)
- Abdullah Alruwaili
- Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Al Ahsa 36428, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa 36428, Saudi Arabia
- Ministry of National Guard—Health Affairs, Al Ahsa 36428, Saudi Arabia
- School of Health, University of New England, Armidale, NSW 2350, Australia
| | - Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Goteborg, Sweden;
- Centre for Disaster Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, 413 05 Goteborg, Sweden
| | - Amila Ratnayake
- Department of Surgery, Army Hospital Colombo, Colombo 00800, Sri Lanka;
| | - Yohan Robinson
- Centre for Disaster Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Swedish Armed Forces Centre for Defence Medicine, 426 05 Västra Frölunda, Sweden
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Khorram-Manesh A, Goniewicz K, Burkle FM. Social and Healthcare Impacts of the Russian-Led Hybrid War in Ukraine - A Conflict With Unique Global Consequences. Disaster Med Public Health Prep 2023; 17:e432. [PMID: 37476992 DOI: 10.1017/dmp.2023.91] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Russia's fear of Ukraine becoming a member of the European Union and the North Atlantic Treaty Organization catalyzed the current conflict in Ukraine. The invasion also alarmed other countries, such as Finland and Sweden, who have themselves considered a formal partnership with NATO. Russia's actions to date have created massive instability and political tensions that uniquely influence the health and socio-political life of civilians in Ukraine and the entire region. The direct and indirect threats of war "gone regional," "global", or "nuclear" have energized these countries and their historical alliances to reassess their own socio-political, environmental, and health-care consequences. All countries of the region have clear histories of forced occupation and decades of threats resulting from World War II and its aftermath. The purpose of this rapid communication is 2-fold. First, it discusses the socio-political and health-care consequences of the ongoing Ukrainian conflict in Finland, Russia, Sweden, Poland, and Ukraine. Second, it clarifies the most essential elements of the Hybrid War which cause uniquely distinctive violations of humanitarian laws, treaties, and conventions.
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Affiliation(s)
- Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Disaster Medicine Center, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Krzysztof Goniewicz
- Department of Security, Polish Air Force University of Aviation, Dęblin, Poland
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The Moral, Ethical, Personal, and Professional Challenges Faced by Physicians during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095641. [PMID: 35565036 PMCID: PMC9103076 DOI: 10.3390/ijerph19095641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 12/10/2022]
Abstract
The COVID-19 pandemic, apart from the main problems concerning the health and life of patients, sparked a discussion about physicians’ moral and social professional attitudes. During a pandemic, physicians have the same ethical, moral, and medical responsibilities, however, the situation is different since they are self-exposed to a danger, which may influence their willingness to work. The problem of the professional moral attitudes of health care workers, recurring in ethical discussions, prompts us to define the limits of the duties of physicians in the event of a pandemic, hence this research aimed to assess these duties from an ethical perspective and to define their boundaries and scope. The study was conducted in May and June 2020 in the city of Lublin, covering all medical centers, and the questionnaire was completed by 549 physicians. The research was conducted in four areas: emergency standby in the event of a disaster, even if it is not requested; willingness to work overtime in the event of a disaster, even without payment; willingness to take health risks by caring for people who are infectious or exposed to hazardous substances; readiness to be transferred to other departments in the event of a disaster. Although most of the respondents declared to be agreed on personal sacrifices in the performance of professional duties, they were not prepared for a high level of personal risk when working in a pandemic. Excessive workload, its overwhelming nature, and personal risk are not conducive to readiness to work overtime, especially without pay. Research shows how important it is to respect the rights and interests of all parties involved in a pandemic. Physicians’ duty to care for a patient is also conditioned by the duty to protect themselves and should not be a tool for intimidating and depersonalizing their social and professional lives.
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Civilian Population Victimization: A Systematic Review Comparing Humanitarian and Health Outcomes in Conventional and Hybrid Warfare. Disaster Med Public Health Prep 2022; 17:e192. [PMID: 35400358 DOI: 10.1017/dmp.2022.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The main objective of this study was to summarize the Hybrid War's core characteristics and humanitarian and medical impacts. METHOD A Systematic Literature Review according to PRISMA guidelines, using the following keywords, 'Hybrid War,' 'Humanitarian Law,' 'Human Rights,' 'Lawfare,' and search engines PubMed, Scopus, Web of Science, and Gothenburg University's database to collect literature from 2000 to 2022 in English was conducted. The eligibility of qualified articles was assessed, an inductive qualitative thematic analysis was applied, and the scientific evidence of each selected piece was evaluated. RESULTS The objectives of a Hybrid War are to achieve the tactical and strategic goals in a battle rather than to save civilian lives. It involves networks of state and non-state actors with various means of military and militia influences and strategies, creating difficulties in implementing, controlling, and evaluating the International Humanitarian Law's "A State responsibility" principle, to gain insight into an armed conflict. It targets populated civilian areas and raises ethical and moral concerns by using Lawfare. CONCLUSIONS Hybrid War's multi-domain action should be met with multi-dimensional approaches and a doctrine of 'acceptable losses.' Its characteristics and consequences should be learned and taught. Several measures need to be implemented to counteract its impacts, and a flexible surge capacity should be designed, planned, and executed.
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7
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Norheim AJ, Rannestad B, Howes R, Rein EB, Jørum E, Friedl K, Havenith G, Teien HK, Mercer JB, Melau J, de Weerd L, Smith M, Taylor N, Voie ØA, Bergan-Skar P, Andrews S, Næsheim T, Steinberg T. Abstracts from The Cold Weather Operations Conference 2021. Int J Circumpolar Health 2022; 81:2049491. [PMID: 35275797 PMCID: PMC8920359 DOI: 10.1080/22423982.2022.2049491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A common effort for both military and civil healthcare is to achieve knowledge-based health care in cold weather injuries and fatal accidents in harsh arctic environment. The Cold Weather Operations Conference in November 2021, having more than 300 participants from 20 countries, was addressing the prevention and treatment of injuries and trauma care in cold weather conditions and the challenges for military prehospital casualty care. The intention of the programme was to stimulate further research and systematic knowledge-based clinical work. The abstracts from the conference present cold weather research and clinical experience relevant for readers of the International Journal of Circumpolar Health.
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Affiliation(s)
- Arne Johan Norheim
- Institute of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway.,Norwegian Armed Forces - Joint Medical Services, Sessvollmoen, Norway
| | - Bård Rannestad
- Department of Anesthesiology, University Hospital of North Norway (Unn), Tromsø, Norway
| | - Richard Howes
- Medical Squadron, Commando Logistics Regiment, UK.,Defence Medical Services, UK.,Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Erling Bekkestad Rein
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway.,Norwegian Special Operation Command (NORSOCOM), Oslo, Norway
| | - Ellen Jørum
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karl Friedl
- United States Army Research Institute of Environmental Medicine (USARIEM Natick), Massachusetts, USA
| | - George Havenith
- Environmental Ergonomics Research centre, Loughborough University, Loughborough, UK
| | | | - James Brian Mercer
- Department of Medical Biology, UiT-The Arctic University of Norway, Tromsø, Norway.,Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Jørgen Melau
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway.,Vestfold Hospital Trust - Prehospital Division, Tønsberg, Norway
| | - Louis de Weerd
- Department of Plastic and Reconstructive Surgery, University Hospital of North Norway (Unn), Tromsø, Norway.,Medical Imaging Research Group, Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Michael Smith
- Academic Department of Military General Practice, Birmingham, UK
| | - Natalie Taylor
- Academic Department of Military General Practice, Birmingham, UK
| | | | - Pål Bergan-Skar
- Norwegian Armed Forces - Joint Medical Services, Sessvollmoen, Norway
| | - Steve Andrews
- Medical Squadron, Commando Logistics Regiment, UK.,Defence Medical Services, UK
| | - Torvind Næsheim
- Department of Anesthesiology, University Hospital of North Norway (Unn), Tromsø, Norway
| | - Tuva Steinberg
- Institute of Community Medicine, UiT - the Arctic University of Norway, Tromsø, Norway.,Norwegian Armed Forces - Joint Medical Services, Sessvollmoen, Norway
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8
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Differences in Ethical Viewpoints among Civilian–Military Populations: A Survey among Practitioners in Two European Countries, Based on a Systematic Literature Review. SUSTAINABILITY 2022. [DOI: 10.3390/su14031085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Civilian–military collaboration in humanitarian crises has been encouraged globally; however, little is known about their diverse ethical viewpoints towards challenging and critical situations, which may cause difficulties in the partnership, and influence the outcomes of their mutual activities. The aim of this study was to identify the diversity of viewpoints and ethical decision-making during exceptional circumstances among civilian and military populations from two different countries, each with diverse background and healthcare organization structures. Possible scenarios, based on a systematic review of the literature, were introduced to Swedish and Polish civilian and military healthcare providers. Variations in the participants’ viewpoints and approaches to ethical decision-making were analyzed according to their characteristics, organizational belonging, and nationality. There were differences between both populations but also within the military and civilian groups, respectively. One significant factor influencing ethical viewpoints was participants’ nationality. Differences in ethical viewpoints between multiagency organizations should be considered in planning and implementation of future transdisciplinary and international collaboration in disaster and emergency management. Further studies and renewed educational initiatives are necessary to validate these differences and to navigate civilian–military as well as other multinational partnerships.
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9
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Civilian-Military Collaboration before and during COVID-19 Pandemic—A Systematic Review and a Pilot Survey among Practitioners. SUSTAINABILITY 2022. [DOI: 10.3390/su14020624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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 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.
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10
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Wennman I, Jacobson C, Carlström E, Hyltander A, Khorram-Manesh A. Organizational Changes Needed in Disasters and Public Health Emergencies: A Qualitative Study among Managers at a Major Hospital. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2022; 13:481-494. [PMCID: PMC9361938 DOI: 10.1007/s13753-022-00423-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 09/01/2023]
Abstract
Most hospitals have a contingency plan, based on all-risks and all-hazards assessment principles. However, emerging threats and risks often necessitate a flexible approach to emergency management at several levels of a disaster response system, for example, in hospitals. Sweden, and possibly other countries, has limited possibilities of surge capacity in the management of large-scale disasters and emergencies, which necessitates a local/national partnership and a flexible local disaster and contingency plan. This study evaluates the opinions of a selected managerial group, both at operative and strategic levels, regarding possible changes in a major hospital’s contingency plan during the ongoing COVID-19 pandemic. Semistructured interviews were conducted to explore the elements of surge capacity and an operational tool, consisting of command and control, safety, communication, assessment, triage, treatment, and transport. The results show a need to create feasible management methods that can be evaluated, establish clear leadership, put preparedness as a constant point on the highest managerial agenda, improve external monitoring, and create a regional coordinating center. Furthermore, the results emphasize the significant role played by the incident command system and qualified leadership to facilitate competent and crucial medical decision making, as well as to provide reliable communication, collaboration, and coordination in a multi-agency response system during dynamic and unexpected emergencies. These steps enable a constant connection between reactive contingency plans and the proactivity in continuous risk assessment and enhance the flexibility of the contingency plans.
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Affiliation(s)
- Ingela Wennman
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 413 46, Gothenburg, Sweden
| | - Catharina Jacobson
- Preparedness Unit, Sahlgrenska University Hospital, 413 05 Gothenburg, Sweden
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 413 46, Gothenburg, Sweden
| | - Anders Hyltander
- Preparedness Unit, Sahlgrenska University Hospital, 413 05 Gothenburg, Sweden
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45, Gothenburg, Sweden
| | - Amir Khorram-Manesh
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 413 46, Gothenburg, Sweden
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45, Gothenburg, Sweden
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11
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The Influence of War and Conflict on Infectious Disease: A Rapid Review of Historical Lessons We Have Yet to Learn. SUSTAINABILITY 2021. [DOI: 10.3390/su131910783] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Armed conflicts degrade established healthcare systems, which typically manifests as a resurgence of preventable infectious diseases. While 70% of deaths globally are now from non-communicable disease; in low-income countries, respiratory infections, diarrheal illness, malaria, tuberculosis, and HIV/AIDs are all in the top 10 causes of death. The burden of these infectious diseases is exacerbated by armed conflict, translating into even more dramatic long-term consequences. This rapid evidence review searched electronic databases in PubMed, Scopus, and Web of Science. Of 381 identified publications, 73 were included in this review. Several authors indicate that the impact of infectious diseases increases in wars and armed conflicts due to disruption to surveillance and response systems that were often poorly developed to begin with. Although the true impact of conflict on infectious disease spread is not known and requires further research, the link between them is indisputable. Current decision-making management systems are insufficient and only pass the baton to the next unwary generation.
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12
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Abstract
Traditional healthcare services have demonstrated structural shortcomings in the delivery of patient care and enforced numerous elements of integration in the delivery of healthcare services. Integrated healthcare aims at providing all healthcare that makes humans healthy. However, with mainly chronically ill people and seniors, typically suffering from numerous comorbidities and diseases, being recruited for care, there is a need for a change in the healthcare service structure beyond direct-patient care to be compatible in peacetime and during public health emergencies. This article’s objective is to discuss the opportunities and obstacles for increasing the effectiveness of healthcare through improved integration. A rapid evidence review approach was used by performing a systematic followed by a non-systematic literature review and content analysis. The results confirmed that integrated healthcare systems play an increasingly important role in healthcare system reforms undertaken in European Union countries. The essence of these changes is the transition from the episodic treatment of acute diseases to the provision of coordinated medical services, focused on chronic cases, prevention, and ensuring patient continuity. However, integrated healthcare, at a level not yet fully defined, will be necessary if we are to both define and attain the integrated practice of both global health and global public health emergencies. This paper attains the necessary global challenges to integrate healthcare effectively at every level of society. There is a need for more knowledge to effectively develop, support, and disseminate initiatives related to coordinated healthcare in the individual healthcare systems.
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13
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Khorram-Manesh A, Goniewicz K, Burkle FM, Robinson Y. Review of Military Casualties in Modern Conflicts-The Re-emergence of Casualties From Armored Warfare. Mil Med 2021; 187:e313-e321. [PMID: 33742659 PMCID: PMC8963150 DOI: 10.1093/milmed/usab108] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/08/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction The re-emergence of armored warfare in modern conflicts has resulted in a higher number of extremity injuries, burns, and brain injuries. Despite this dramatic increase, little is reported on the type of injuries caused and their management. This review summarizes the publicly available literature and reports on the rate and type of injuries related to armored warfare, their medical outcomes, and management limitations. Materials and Methods This rapid evidence review involves a systematic literature search, followed by a non-systematic literature review. The reason for choosing this approach was the inherent lack of quantitative outcome data in the literature to satisfy the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study also used content analysis to study all peer-reviewed articles, focusing on similarities and differences in the findings necessary to formulate tentative results. The electronic search included PubMed, Scopus, and Web of Science, using the following search string: “Armored; Injuries; Mechanized; Morbidity; Mortality; War; Warfare”, alone or in combination. Results Modern conflicts are associated with higher number of extremity injuries, burns, and brain injuries among military casualties. Several publications claim that the characteristics of armored warfare and anticipated injuries in this type of warfare might require the far forward deployment of medical support supported by a reliable casualty evacuation chain. Still the quality of the available casualty data is low. Conclusions Because of the limited availability of reliable data or military trauma registries, up-to-date military casualty estimation remains a recognized knowledge gap, which needs to be addressed by armed forces worldwide. The future management of modern war casualties requires professional and well-trained staff in all levels, indicating a need for educational initiatives to provide both nurses and medics a greater proportion of medical care and management capabilities and responsibilities than in past conflicts.
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Affiliation(s)
- Amir Khorram-Manesh
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 413 45, Sweden
- Department of Development and Research, Armed Forces Center for Defense Medicine, Västra Frölunda 426 76, Sweden
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, Dęblin 08-521, Poland
| | - Frederick M Burkle
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Yohan Robinson
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg 413 45, Sweden
- Department of Development and Research, Armed Forces Center for Defense Medicine, Västra Frölunda 426 76, Sweden
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14
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A Cross-Sectional Study on the Flood Emergency Preparedness among Healthcare Providers in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031329. [PMID: 33540547 PMCID: PMC7908384 DOI: 10.3390/ijerph18031329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 12/23/2022]
Abstract
This study used a descriptive cross-sectional methodology to measure healthcare workers’ knowledge, attitudes, perceptions, and willingness to respond to a flood scenario in Saudi Arabia. A validated survey was distributed to collect data using a convenience sampling technique through multiple social media platforms. A total of 227 participants were included in this study: 52% of them were aged between 26 to 34 years, 74% were residents from Riyadh, and 52.4% worked in nursing divisions. A significant number of respondents (73.2%) had positive perceptions towards their hospitals’ ability to provide an effective response to a flood, 89% were willing to report to work following a flood, and 90% of participants reported the need to develop both guidelines and training for flood disaster preparedness. Preparation and successful flood mitigation in the hospital setting requires staff that have both knowledge and training in emergency management. One way to obtain such readiness is through competency-based training, including both table-top and full-scale live exercises. Although the willingness to respond to such a flooding emergency was high among staff, the development of guidelines and educational programs is needed in order to develop the competencies and skills sets to improve disaster preparedness response and preparedness efforts.
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15
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Goniewicz K, Goniewicz M, Włoszczak-Szubzda A, Burkle FM, Hertelendy AJ, Al-Wathinani A, Molloy MS, Khorram-Manesh A. The importance of pre-training gap analyses and the identification of competencies and skill requirements of medical personnel for mass casualty incidents and disaster training. BMC Public Health 2021; 21:114. [PMID: 33422033 PMCID: PMC7796807 DOI: 10.1186/s12889-021-10165-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/04/2021] [Indexed: 12/29/2022] Open
Abstract
Background Effective preparedness to respond to mass casualty incidents and disasters requires a well-planned and integrated effort by all involved professionals, particularly those who are working in healthcare, who are equipped with unique knowledge and skills for emergencies. This study aims to investigate and evaluate the level of knowledge and skills related to mass casualty and disaster management in a cohort of healthcare professionals. Methods A cross-sectional brief study was conducted using a validated and anonymous questionnaire, with a sample of 134 employees at a clinical hospital in Lublin, Poland. Results The findings of this study may indicate a need for standardization of training for hospitals employees. It also suggests a knowledge gap between different professional groups, which calls for adjusting such general training, to at least, the weakest group, while special tasks and mission can be given to other groups within the training occasion. Conclusion Pre-Training gap analyses and identification of participants’ competencies and skills should be conducted prior to training in mass casualty incidents and disasters. Such analyses provides an opportunity to develop training curriculum at various skill and knowledge levels from basic to advance. All training in mass casualty incidents and disasters should be subject to ongoing, not just periodic, evaluation, in order to assess continued competency. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10165-5.
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Affiliation(s)
- Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08-521, Dęblin, Poland.
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, 20-059, Lublin, Poland
| | | | - Frederick M Burkle
- Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Attila J Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, 33174, USA
| | - Ahmed Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Michael Sean Molloy
- Department of Emergency Medicine, Wexford General Hospital, Wexford, Y35 Y17D, Ireland.,School of Medicine, University College Dublin, Donnybrook, D4, Ireland.,BIDMC Fellowship in Disaster Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Centre, 457 Brookline Avenue, Boston, MA, 02215, USA
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 413 45, Gothenburg, Sweden.,Research Advisor, Department of Development and Research, Armed Forces Center for Defense Medicine, 426 76, Gothenburg, Västra Frölunda, Sweden
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Al-Wathinani A, Hertelendy AJ, Alhurishi S, Mobrad A, Alhazmi R, Altuwaijri M, Alanazi M, Alotaibi R, Goniewicz K. Increased Emergency Calls during the COVID-19 Pandemic in Saudi Arabia: A National Retrospective Study. Healthcare (Basel) 2020; 9:14. [PMID: 33374453 PMCID: PMC7823911 DOI: 10.3390/healthcare9010014] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/23/2022] Open
Abstract
The impact on the utilization of emergency medical services (EMS) in Saudi Arabia during the COVID-19 pandemic. We studied cumulative data from emergency calls collected from the SRCA. Data were separated into three periods: before COVID-19 (1 January-29 February 2020), during COVID-19 (1 March-23 April 2020), and during the Holy Month of Ramadan (24 April-23 May 2020). A marked increase of cases was handled during the COVID-19 period compared to the number before pandemic. Increases in all types of cases, except for those related to trauma, occurred during COVID-19, with all regions experiencing increased call volumes during COVID-19 compared with before pandemic. Demand for EMS significantly increased throughout Saudi Arabia during the pandemic period. Use of the mobile application ASAFNY to request an ambulance almost doubled during the pandemic but remained a small fraction of total calls. Altered weekly call patterns and increased call volume during the pandemic indicated not only a need for increased staff but an alteration in staffing patterns.
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Affiliation(s)
- Ahmed Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia; (A.M.); (R.A.); (R.A.)
| | - Attila J. Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL 33174, USA;
| | - Sultana Alhurishi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Abdulmajeed Mobrad
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia; (A.M.); (R.A.); (R.A.)
| | - Riyadh Alhazmi
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia; (A.M.); (R.A.); (R.A.)
| | - Mohammad Altuwaijri
- Deputy of General Manager of EMS Administration, Saudi Red Crescent Authority, Riyadh 11451, Saudi Arabia;
| | - Meshal Alanazi
- General Manager of Medical Supply, Saudi Red Crescent Authority, Riyadh 11451, Saudi Arabia;
| | - Raied Alotaibi
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia; (A.M.); (R.A.); (R.A.)
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08521 Dęblin, Poland;
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