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Neves SCT, Horta LRP, Machado RV, Furuya DEG, Shimada PS, Arana ARA, Favareto APA, Andrade ER. Lost life expectancy following a hypothetical urban radiological incident. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2024; 273:107391. [PMID: 38316100 DOI: 10.1016/j.jenvrad.2024.107391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
The consequences of mass radiological events, particularly those involving the activation of a radiological dispersion device (RDD), have been extensively studied by scientific groups. However, the critical initial period of such an event, usually spanning the first 100 h, can be characterized by a scarcity of information, potentially leading to delays in mitigating strategies. In response, a research group utilized computer simulations to generate solid, conservative analytical details that can aid decision-making and guide the prioritization of initial care based on variables such as age, sex, location, and local atmospheric stability conditions. The study estimates the Lost Life Expectancy (LLE) and provides relevant information to increase support for decision-making and allow evaluation of data closer to the lay public. The research team behind the study has been granted funding by the Brazilian National Council for Scientific and Technological Development (CNPq), and further simulations will be conducted utilizing codes that implement numerical models, specifically in atmospheric data forecasting. The methodology used to evaluate the LLE can be applied to any location, provided that the relevant variables are updated accordingly. Overall, this study offers critical insights into the impact of mass radiological events and enhances simulations' predictive capacity and precision.
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Affiliation(s)
- Suzana C T Neves
- Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, Brazil.
| | - Luis R P Horta
- Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, Brazil.
| | - Rodrigo V Machado
- Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, Brazil.
| | | | | | - Alba R A Arana
- Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, Brazil.
| | | | - Edson R Andrade
- Universidade do Oeste Paulista (UNOESTE), Presidente Prudente, Brazil; Defense Eng. Graduate Program, Military Institute of Engineering (IME), Rio de Janeiro, Brazil; Nuclear Eng. Graduate Program, Military Institute of Engineering (IME), Rio de Janeiro, Brazil; Institute for Advanced Studies (IEAv), Brazilian Air Force, São Paulo, Brazil; Federal University of Itajubá, Institute of Physics and Chemistry, Itajubá, Minas Gerais, Brazil.
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Erickson TB, Harvin D, Schmid A, Loevinsohn G, Poriechna A, Martyshyn O, Kliukach K, Sydlowski M, Strong J, Kivlehan SM. Evaluation of Chemical, Biological, Radiological, Nuclear, Explosives (CBRNE) Knowledge Change and Skills Confidence Among Frontline-Line Providers During the Russia-Ukraine War. Disaster Med Public Health Prep 2023; 17:e387. [PMID: 37157855 PMCID: PMC10171778 DOI: 10.1017/dmp.2023.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the change in knowledge and skill confidence after implementation of a chemical, biological, radiological, nuclear, and explosive (CBRNE) training course during the Russia-Ukraine War. METHODS Pre/post-test study in the Ukrainian cities of Kyiv, Dnipro, Zaporizhzhia, and Odesa. Fifteen CBRNE courses were conducted over a 3-mo period, August to October 2022. Change in knowledge and skills confidence were evaluated with pre/post-course written exams and practical skill assessments that were observed during the training exercises. Changes were analyzed based on nonparametric Wilcoxon matched-pairs signed-rank testing. Pre/post self-efficacy surveys were analyzed with McNemar's test for paired data. Course evaluations were conducted with standardized questions which assessed instruction quality, teaching relevance, knowledge gained, and post-course skills confidence. RESULTS A total of 523 participants registered and completed 1 of the 15 courses. Overall mean pre-course test score: 57.8% (SD 20.7%); mean post-course test score: 81.4% (SD 11.3%); participants with increasing test scores: 90.7%; mean difference in score (95% confidence interval) 23.6% (21.2%-25.9%), P < 0.0001. Pre/post self-efficacy surveys (4-point Likert scale) noted participants recognized signs and symptoms of a CBRNE incident, and necessary skills to manage CBRNE exposures, P < 0.0001. CONCLUSIONS The implementation of this CBRNE course for front-line providers in Ukraine was successful. To our knowledge, it was the first implementation of a field course during the current Russian-Ukraine war. Future research should evaluate knowledge retention and impact of our innovative Train-the-Trainer model. Further iterations should emphasize expanding the quantity of training equipment and practical skill sessions.
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Affiliation(s)
- Timothy B. Erickson
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
| | - Donell Harvin
- Rand Corporation, Homeland Security Operational Analysis Center and Georgetown University, Applied Intelligence and Emergency and Disaster Management Program, Washington, D.C
| | - Alexis Schmid
- Boston Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Global Health Program, Boston, MA
| | - Gideon Loevinsohn
- Division of Global Emergency Care and Humanitarian Studies, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Jonathan Strong
- Division of Global Emergency Care and Humanitarian Studies, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
| | - Sean M. Kivlehan
- Division of Global Emergency Care and Humanitarian Studies, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
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Goralnick E, Chai PR, Erickson TB. Health and Safety Threats to Ukraine From Nonconventional Weapons: A Clear and Present Danger. JAMA 2022; 328:2301-2302. [PMID: 36469331 DOI: 10.1001/jama.2022.22661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This Viewpoint discusses the potential for use of nonconventional warfare threats (chemical, biological, radiological, nuclear, and explosives) in the conflict in Ukraine and how health care professionals need to recognize and respond to these threats.
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Affiliation(s)
- Eric Goralnick
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Ariadne Labs, Boston, Massachusetts
| | - Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
| | - Timothy B Erickson
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Cambridge, Massachusetts
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Patel SS, Neylan JH, Bavaro K, Chai PR, Goralnick E, Erickson TB. Chemical, biological, radiological, nuclear, and explosives (CBRNEs) preparedness for sporting event mass gatherings: A systematic review of the literature. Am J Disaster Med 2022; 17:57-74. [PMID: 35913184 DOI: 10.5055/ajdm.2022.0420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Sporting events often constitute mass gatherings (MGs) featuring large crowds of spectators and participants. Our objective is to understand the current state of emergency preparedness for sporting events by examining past MG sporting events to evaluate mitigation, preparedness, response, and recovery against chemical, biological, radiological, nuclear, and explosive (CBRNE) events. METHODS In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was carried out among 10 literature databases. The quality and risk of bias in each reviewed publication was assessed using the Mixed Methods Appraisal Tool. RESULTS A total of 5,597 publications were identified. Of these, 81 papers were selected for full text reads and 25 publications were accepted. The included articles documented sporting events worldwide, ranging from incidents occurring from 1972 to 2020. Cross-cutting themes found in best practices and recommendations were strategic communication, surveillance, planning and preparedness, and training and response. CONCLUSION More evidence-based guidelines are needed to ensure best practices in response and recovery for CBRNE incidents at sporting events. Public health risks as well as implementation barriers and opportunities to prepare for potential CBRNE threats at sporting event MGs require further investigation.
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Affiliation(s)
- Sonny S Patel
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts; Transcultural Conflict and Violence Initiative, Georgia State University, Atlanta, Georgia. ORCID: https://orcid.org/0000-0002-9810-0055
| | - Julian H Neylan
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts
| | - Katerina Bavaro
- Health Studies Program, University College, University of Toronto - St. George, Toronto, Canada
| | - Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
| | - Eric Goralnick
- Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts; Harvard T.H. Chan School of Public Health Boston, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Timothy B Erickson
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts; Division of Medical Toxicology, Department of Emergency Medicine, Brigham Health, Harvard Medical School, Boston, Massachusetts
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Kivlehan SM, Allen A, Viun O, Makarov DA, Schnorr D, Patel S, Ryzhenko SA, Pham P, Erickson TB. Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study. BMJ Open 2022; 12:e050871. [PMID: 35701058 PMCID: PMC9198692 DOI: 10.1136/bmjopen-2021-050871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Evaluate the change in participant emergency care knowledge and skill confidence after implementation of the WHO-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) course. DESIGN Pretest/post-test quasi-experimental study. SETTING Mechnikov Hospital in Dnipro, Ukraine. PARTICIPANTS Seventy-nine participants engaged in the course, of whom 50 (63.3%) completed all assessment tools. The course was open to healthcare providers of any level who assess and treat emergency conditions as part of their practice. The most common participant profession was resident physician (24%), followed by health educator (18%) and prehospital provider (14%). INTERVENTIONS The 5-day WHO-ICRC BEC course. PRIMARY AND SECONDARY OUTCOME MEASURES Change in pre-course and post-course knowledge and skill confidence assessments. Open-ended written feedback was collected upon course completion and analysed for common themes. RESULTS Participant knowledge assessment scores improved from 19 (IQR 15-20) to 22 (IQR 19-23) on a 25-point scale (p<0.001). Participant skill confidence self-assessment scores improved from 2.5 (IQR 2.1-2.8) to 2.9 (IQR 2.5-3.3) on a 4-point scale (p<0.001). The most common positive feedback themes were high-quality teaching and useful skill sessions. The most common constructive feedback themes were translation challenges and request for additional skill session time. CONCLUSIONS This first implementation of the WHO-ICRC BEC course for front-line healthcare providers in Ukraine was successful and well received by participants. This is also the first report of a BEC implementation outside of Africa and suggests that the course is also effective in the European context, particularly in humanitarian crisis and conflict settings. Future research should evaluate long-term knowledge retention and the impact on patient outcomes. Further iterations should emphasise local language translation and consider expanding clinical skills sessions.
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Affiliation(s)
- Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Amy Allen
- Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Olha Viun
- Oles Honchar Dnipro National University, Dnipro, Ukraine
| | - Dmitry A Makarov
- Department of Anesthesiology and Intensive Care for Patients with Polytrauma, City Hospital No 17, Kiev, Ukraine
| | - Daniel Schnorr
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Sonny Patel
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Transcultural Conflict and Violence Initiative, Georgia State University, Atlanta, GA, USA
| | | | - Phuong Pham
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Timothy B Erickson
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Patel SS, Erickson TB. The new humanitarian crisis in Ukraine: Coping with the public health impact of hybrid warfare, mass migration, and mental health trauma. Disaster Med Public Health Prep 2022; 16:1-5. [PMID: 35317883 PMCID: PMC9500109 DOI: 10.1017/dmp.2022.70] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One of the largest mass movements of displaced people from their homelands in recent history must be recognized and assisted by the Free World. The unprovoked Russian attacks on Ukraine during February-March 2022 will leave long-lasting devastating effects on millions of innocent victims. Nations worldwide, especially NATO member countries, will need to intervene to ameliorate the situation. This letter describes major public health issues apart from the COVID-19 pandemic that are emerging concerns, such as shortages of healthcare professionals, chronic care treatments and health prevention services, disinformation communication campaigns affecting the healthcare infrastructure, and the generational impact of the conflict on people's mental health. A global response and public health support need immediate action including humanitarian assistance, food security, clean water supplies, adequate shelter, and safe transportation out of the active military zones.
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Affiliation(s)
- Sonny S Patel
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, New South Wales, Australia
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
| | - Timothy B Erickson
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Boston, MA, USA
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Patel SS, Sukhovii O, Zvinchuk O, Neylan JH, Erickson TB. Converging Impact of the Ongoing Conflict and COVID-19 Pandemic on Mental Health and Substance Use Disorders in Ukraine. JOURNAL OF EMERGENCY MANAGEMENT (WESTON, MASS.) 2021; 19:63-68. [PMID: 35281482 DOI: 10.5055/jem.0603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Since the Russian annexation of the Autonomous Republic of Crimea and the subsequent occupation of parts of the Donetsk and Luhansk regions, Ukraine has been facing increasing security and healthcare challenges. The seven-year war in East Ukraine has led to a rise in substance and alcohol use and increasing addiction rates among veterans, internally displaced persons, and civilian survivors. This article examines the combined impact of the ongoing Russo-Ukrainian conflict and COVID-19 pandemic on substance use in Ukraine. It also gives an overview of the institutions in place to monitor and improve mental health in the country. The article highlights the urgent need for further funding and research on substance and alcohol addiction, with vulnerable populations affected by the conflict during the COVID-19 pandemic. Frontline healthcare workers in this region should anticipate an increased burden of patients suffering from substance use disorders who are in need of emergency management intervention and proper behavioral health referrals.
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Affiliation(s)
- Sonny S Patel
- Harvard Humanitarian Initiative, Harvard University, 14 Story St Cambridge, MA, 02138 USA.,Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, NSW, Australia
| | - Oleksii Sukhovii
- Center for Mental Health and Monitoring of Drugs and Alcohol Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Oleksandr Zvinchuk
- Fulbright Visiting Scholar, UIC Center for Global Health, 1940 W. Taylor M/C 584 Chicago, IL 60612 Chicago, IL, USA
| | - Julian H Neylan
- Harvard Humanitarian Initiative, Harvard University, 14 Story St Cambridge, MA, 02138 USA.,Leiden University, Rapenburg 70, 2311 EZ Leiden, The Netherlands
| | - Timothy B Erickson
- Harvard Humanitarian Initiative, Harvard University, 14 Story St Cambridge, MA, 02138 USA.,Division of Medical Toxicology, Department of Emergency Medicine, Brigham Health, Harvard Humanitarian Initiative, Harvard Medical School, Boston, MA, USA
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Patel SS, Moncayo OE, Conroy KM, Jordan D, Erickson TB. The Landscape of Disinformation on Health Crisis Communication During the COVID-19 Pandemic in Ukraine: Hybrid Warfare Tactics, Fake Media News and Review of Evidence. JCOM, JOURNAL OF SCIENCE COMMUNICATION 2020; 19:AO2. [PMID: 34504624 PMCID: PMC8425291 DOI: 10.22323/2.19050202] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has impacted the world in ways not seen since the 1918-1920 Spanish Flu. Disinformation campaigns targeting health crisis communication during this pandemic seek to cripple the medical response to the novel coronavirus and instrumentalize the pandemic for political purposes. Propaganda from Russia and other factions is increasingly infiltrating public and social media in Ukraine. Still, scientific literature has only a limited amount of evidence of hybrid attacks and disinformation campaigns focusing on COVID-19 in Ukraine. We conducted a review to retrospectively examine reports of disinformation surrounding health crisis communication in Ukraine during the COVID-19 response. Based on the themes that emerged in the literature, our recommendations are twofold: 1) increase transparency with verified health crisis messaging and, 2) address the leadership gap in reliable regional information about COVID-19 resources and support in Ukraine.
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Affiliation(s)
- Sonny S. Patel
- NIH Fogarty Global Health Scholar, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
| | - Omar E. Moncayo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kristina M. Conroy
- Communications Manager, Ukrainian Research Institute, Harvard University, Cambridge, MA, USA
| | - Doug Jordan
- Doctoral Candidate, Communication, University of South Florida; Course Director, Joint Special Operations University, United States Special Operations Command, MacDill AFB, FL; Former Ministry of Defense Advisor Ukraine, Strategic Communication, US Embassy, Kyiv, Ukraine
| | - Timothy B. Erickson
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham Health, Harvard Medical School, Boston, MA, USA
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