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Rahman GR, Liang SY, Tian L, Sin SS, Jasani GN. Trends and Characteristics of Terrorist Attacks Against Nightclub Venues Over 5 Decades. Disaster Med Public Health Prep 2024; 18:e12. [PMID: 38287687 DOI: 10.1017/dmp.2023.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Nightclubs are entertainment and hospitality venues historically vulnerable to terrorist attacks. This study identified and characterized terrorist attacks targeting nightclubs and discotheques documented in the Global Terrorism Database (GTD) over a 50-y period. METHODS A search of the Global Terrorism Database (GTD) was conducted from 1970 to 2019. Precoded variables for target type "business" and target subtype "entertainment/cultural/stadium/casino" were used to identify attacks potentially involving nightclubs. Nightclub venues were specifically identified using the search terms "club," "nightclub," and "discotheque." Two authors manually reviewed each entry to confirm the appropriateness for inclusion. Descriptive statistics were performed using R (3.6.1). RESULTS A total of 114 terrorist attacks targeting nightclub venues were identified from January 1, 1970, through December 31, 2019. Seventy-four (64.9%) attacks involved nightclubs, while forty (35.1%) attacks involved discotheques. A bombing or explosion was involved in 84 (73.7%) attacks, followed by armed assault in 14 (12.3%) attacks. The highest number of attacks occurred in Western Europe and Sub-Saharan Africa. In total, 284 persons died, and 1175 persons were wounded in attacks against nightclub venues. CONCLUSIONS While terrorist attacks against nightclub venues are infrequent, the risk for mass casualties and injuries can be significant, mainly when explosives and armed assaults are used.
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Affiliation(s)
- Grace R Rahman
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Stephen Y Liang
- Department of Emergency Medicine and Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Linlin Tian
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Steve S Sin
- National Consortium for the Study of Terrorism and Responses to Terrorism, University of Maryland, College Park, MD, USA
| | - Gregory N Jasani
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Walk CT, Ross A, Kranker L, Whitmill M, Ballester M, Parikh PP, Semon G, Ekeh AP. The Oregon District Shooting: Reviewing the Pre-Hospital Protocols and the Role of the Resident During a Multiple Casualty Event. Am Surg 2023; 89:6215-6220. [PMID: 35802891 DOI: 10.1177/00031348221114044] [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: 11/16/2022]
Abstract
Background: Review of multiple casualty events (MCEs) protocols in an academic trauma center and more importantly role of residents in management of MCEs has not been discussed. Also, no real-world examples have been described. This study reviews utilization of multiple casualty protocols by the area hospitals and EMS along with role of residents in one such real-world MCEMethods: A mass shooting event in the Oregon District in Dayton, Ohio from 2019 was reviewed. MCE protocols from a Level I trauma center were reviewed as well as patient outcomes and role of residents.Results: A total of 10 casualties were observed and 38 patients presented to hospitals throughout the city. There were 25 patients presented to the Level I trauma center, 1 to the Level II trauma center, and 12 to the Level III trauma centers in the community. Surgical and Emergency residents performed initial triage upon arrival to the ED, managed resuscitation, and performed various procedures under supervision of attending staff. A total of 5 patients required emergent surgery and 4 patients required tourniquets. All patients that were presented to the hospitals survived.Conclusion: MCEs are going to continue, and healthcare systems should have protocols in place. Residents are a valuable resource to hospital systems that provide trauma services. Creation of a protocol with the assistance of EMS will allow first responders to utilize resources available. We recommend testing of this protocol, as an MCE in your area may not be a matter of if, but when.
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Affiliation(s)
- Casey T Walk
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Ashleigh Ross
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Lindsey Kranker
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | | | - Michael Ballester
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Priti P Parikh
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Gregory Semon
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Akpofure P Ekeh
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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Nyberger K, Strömmer L, Wahlgren CM. A systematic review of hemorrhage and vascular injuries in civilian public mass shootings. Scand J Trauma Resusc Emerg Med 2023; 31:30. [PMID: 37337265 DOI: 10.1186/s13049-023-01093-x] [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: 02/06/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Civilian public mass shootings (CPMSs) are a major public health issue and in recent years several events have occurred worldwide. The aim of this systematic review was to characterize injuries and mortality after CPMSs focusing on in-hospital management of hemorrhage and vascular injuries. METHOD A systematic review of all published literature was undertaken in Medline, Embase and Web of Science January 1st, 1968, to February 22nd, 2021, according to the PRISMA guidelines. Literature was eligible for inclusion if the CPMS included three or more people shot, injured or killed, had vascular injuries or hemorrhage. RESULTS The search identified 2884 studies; 34 were eligible for inclusion in the analysis. There were 2039 wounded in 45 CPMS events. The dominating anatomic injury location per event was the extremity followed by abdomen and chest. The median number of operations and operated patients per event was 22 (5-101) and 10.5 (4-138), respectively. A total of 899 deaths were reported with a median mortality rate of 36.1% per event (15.9-71.4%) Thirty-eight percent (13/34) of all studies reported on vascular injuries. Vascular injuries ranged from 8 to 29%; extremity vascular injury the most frequent. Specific vascular injuries included thoracic aorta 18% (42/232), carotid arteries 6% (14/232), and abdominal aorta 5% (12/232). Vascular injuries were involved in 8.3%-10% of all deaths. CONCLUSION This systematic review showed an overall high mortality after CPMS with injuries mainly located to the extremities, thorax and abdomen. About one quarter of deaths was related to hemorrhage involving central large vessel injuries. Further understanding of these injuries, and structured and uniform reporting of injuries and treatment protocols may help improve evaluation and management in the future. Level of Evidence Systematic review and meta-analysis, level III.
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Affiliation(s)
- Karolina Nyberger
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden.
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Lovisa Strömmer
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Carl-Magnus Wahlgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Evidence-based Principles of Time, Triage and Treatment; Refining the Initial Medical Response to Massive Casualty Incidents. J Trauma Acute Care Surg 2022; 93:S160-S164. [PMID: 35583968 DOI: 10.1097/ta.0000000000003699] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The overall approach to massive casualty triage has changed little in the past 200 years. As the military and civilian organizations prepare for the possibility of future large scale combat operations, terrorist attacks and natural disasters, potentially involving hundreds or even thousands of casualties, a modified approach is needed to conduct effective triage, initiate treatment and save as many lives as possible. METHODS Military experience and review of analyses from the Department of Defense Trauma Registry are combined to introduce new concepts in triage and initial casualty management. FINDINGS The classification of the scale of MASCAL, timeline of lifesaving interventions, immediate first pass actions prior to formal triage decisions during the first hour after injury, simplification of triage decisions, and the understanding that ultra-MASCAL will primarily require casualty movement and survival needs with few prehospital life-saving medical interventions are discussed. CONCLUSION Self-aid, bystander and first responder interventions are paramount and should be trained and planned extensively. Military and disaster planning should not only train these concepts, but should seek innovations to extend the timelines of effectiveness and to deliver novel capabilities within the timelines to the greatest extent possible. LEVEL OF EVIDENCE Level III, Prognostic and Epidemiological.
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Tracy BM, Whitson AK, Chen JC, Weiss BD, Sims CA. Examining Violence Against Women at a Regional Level 1 Trauma Center During the COVID-19 Pandemic. Am Surg 2022; 88:404-408. [PMID: 34645329 PMCID: PMC8859477 DOI: 10.1177/00031348211047467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is a growing concern that certain public health restrictions imposed to prevent the spread of coronavirus disease 2019 (COVID-19) could result in more violence against women (VAW). We sought to determine if the rates and types of VAW changed during the COVID-19 pandemic at our level 1 trauma center (L1TC). METHODS We performed a retrospective review of female patients who presented to our L1TC because of violence from 2019 through 2020. Patients were grouped into a pre-COVID or COVID period. The primary aim of this study was to compare rates of VAW between groups. Secondary aims sought to evaluate for any difference in traumatic mechanism between periods and to determine if a temporal relationship existed between COVID-19 and VAW rates. RESULTS There was no difference in rates of VAW between the pre-COVID and COVID period (3.1% vs 3.6%, P = .6); however, rates of penetrating trauma were greater during the COVID period (38.2% vs 10.3%, P = .01). After controlling for patient age and race, the odds of penetrating trauma increased during the pandemic (OR 5.8, 95% CI 1.6-28.5, P < .01). From February 2020 through October 2020, there was a direct relationship between rates of COVID-19 and VAW (r2 .78, P < .01). CONCLUSION Rates of VAW were unchanged between the pre-COVID and COVID periods, yet the odds of penetrating VAW were 5 times greater during the pandemic. Moving forward, trauma surgeons must remain vigilant for signs of violence and ensure that support services are available during future crises.
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Affiliation(s)
- Brett M. Tracy
- Division of Trauma, Critical Care, Burn, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amy K. Whitson
- Division of Trauma, Critical Care, Burn, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - JC Chen
- Division of Trauma, Critical Care, Burn, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian D. Weiss
- Division of Trauma, Critical Care, Burn, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carrie A. Sims
- Division of Trauma, Critical Care, Burn, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Mobilization of Resources and Emergency Response on the National Scale. Surg Clin North Am 2022; 102:169-180. [PMID: 34800385 PMCID: PMC8598287 DOI: 10.1016/j.suc.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Mass casualty incidents are increasingly common. They are defined by large numbers of patients arriving nearly simultaneously, overwhelming available resources needed for optimal care. They require rapid mobilization of resources to provide optimal outcomes and limit disability and death. Because the mechanism of injury in a mass casualty incident is often traumatic in nature, surgeons should be aware of the critical role they play in planning and response. The coronavirus disease 2019 pandemic is a notable, resulting in a sustained surge of critically ill patients. Initial response requires local mobilization of resources; large-scale events potentially require a national response.
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Atia A, Halligan L, Brezina L, Levites H, Hollins A, Blau J, Hernandez JA, Lohmeier S, Suresh V, Powers DB. Distribution of wounding patterns in casualties from mass shooting events. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211049636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The incidence and severity of public mass shootings, and mass casualty incidents (MCI), continues to rise. Understanding the wounding pattern and incidence of potentially preventable death after these incidents is key not only to Health System and Trauma Center emergency response planning but also to community outreach and initial emergency interventions. Methods A retrospective study of autopsy reports after events with at least 10 fatalities exclusive of the assailants identified via the Federal Bureau of Investigation database from 1 January 1999 to 31 December 2020 was performed. Sites of injury, identification of weaponry, and identification of potentially survivable wounds were compiled. Results Nine events including 203 victims were reviewed. Overall, 56% of gunshots were to the head/neck/face; 37% were to the chest; 43% were to the abdomen/torso/back; 31% were to the lower extremity; and 36% were to the upper extremity. On average, there were 29 fatalities per event. Conclusion Emergency response disaster care strategy should focus on immediate point of care at the site of wounding by both the civilian population and medical personnel, as well as rapid extrication of victims for definitive medical care. Review of these autopsy results indicates exsanguination, often treatable, is the primary cause of death—supporting community education efforts in hemorrhage control. The location of the wounding patterns seen in this study warrants primary integration of craniomaxillofacial, orthopedic trauma, neurotrauma, and surgical critical care/trauma surgical specialists into the initial response team for MCI.
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Affiliation(s)
- Andrew Atia
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, USA
| | - Lauren Halligan
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Libor Brezina
- Duke University School of Medicine, Durham, NC, USA
- Medical Student Researcher, Barts Health NHS Trust, London, England, UK
| | - Heather Levites
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, USA
| | - Andrew Hollins
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, USA
| | - Jared Blau
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, USA
| | - J Andres Hernandez
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, USA
| | - Steven Lohmeier
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, USA
| | - Visakha Suresh
- Department of Plastic Surgery, Johns Hopkins Hospital, Baltimore, MD; Duke University School of Medicine, Durham, NC, USA
| | - David B Powers
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Hospital, Durham, NC, USA
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Preparedness for Mass Casualty Incidents: The Effectiveness of Current Training Model. Disaster Med Public Health Prep 2021; 16:2120-2128. [PMID: 34711298 DOI: 10.1017/dmp.2021.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The importance of MCI organization and training was highlighted by the events of September 11, 2001. Training focuses on the management of physical injuries caused by a single traumatic event over a well-defined, relatively short timeframe. MCI management is integrated into surgical and trauma training, with disaster management training involving the emergency services, law enforcement, and state infrastructure agencies. The COVID-19 pandemic revealed gaps in the preparedness of nation states and global partners in disaster management. The questions that arose include 'has training really prepared us for an actual emergency,' 'what changes need to be made to training to make it more effective,' and 'who else should training be extended to?' This article focuses on the importance of involving multiple sectors in mass casualty training and asks whether greater involvement of non-medical agencies and the public, in operational drills might improve preparedness for global events such as the COVID-19 pandemic.
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Mass Casualty Mini Drills on Trauma Surgery Department Staff Knowledge: An Educational Improvement Study. J Trauma Nurs 2021; 28:135-141. [PMID: 33667210 DOI: 10.1097/jtn.0000000000000571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Over the last decade, the United States has witnessed an increase in mass casualty incidents (MCIs). The outcome of an MCI depends upon hospital preparedness, yet many hospitals are unfamiliar with their facility MCI procedure. Educational training drills may be one method to improve staff knowledge of policy and procedure. OBJECTIVE This study aimed to improve knowledge gained through educational MCI mini drills of institutional mass casualty policy and procedure in surgery department staff at a level II trauma center. METHODS A pre-/posttest design was utilized. The hospital implemented MCI mini training drills as a quality improvement project using Plan-Do-Study-Act iterative cycles with prospective data collection. Knowledge scores were measured using a 12-item surgery department MCI policy and procedure questionnaire that was developed by the author and leadership. RESULTS A one-way analysis of covariance analysis in participants that mini drilled more than once indicated significant effect on mean cycle score differences among three cycles F(2,21) = 12.96, p = .00. Multiple comparison using Games-Howell indicated the mean score for Cycle 4 (M = 96.15, SD = 6.54) was significantly different from Cycle 3 (M = 59.71, SD = 25.15). Gender, shift, and credentials of participants influenced knowledge improvement. CONCLUSION Implementation of hospital MCI mini drills improved staff knowledge of institutional mass casualty policy and procedure in the surgery department and may be applied to surgery departments with similar policy, procedure, and participant characteristics. Hospital mass casualty response education and preparation is essential to saving lives.
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Jørgensen JJ, Monrad-Hansen PW, Gaarder C, Næss PA. Disaster preparedness should represent an augmentation of the everyday trauma system, but are we prepared? Trauma Surg Acute Care Open 2021; 6:e000760. [PMID: 34307894 PMCID: PMC8264881 DOI: 10.1136/tsaco-2021-000760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/11/2021] [Indexed: 01/09/2023] Open
Abstract
Background The increased frequency, geographical spread and the heterogenicity in mass casualty incidents (MCIs) challenge healthcare systems worldwide. Trauma systems constitute the base for disaster preparedness. Norway is sparsely populated, with four regional trauma centers (TCs) and 35 hospitals treating trauma (non-trauma centers (NTCs)). We wanted to assess whether hospitals fill the national trauma system requirements for competence and the degree of awareness of MCI plans. Methods We conducted a cross-sectional survey of on-call trauma teams in all 39 hospitals during two time periods: July–August (holiday season (HS)) and September–June (non-holiday season (NHS)). A standardized questionnaire was used to evaluate the MCI preparedness. Results A total of 347 trauma team members participated (HS: 173 and NHS: 174). Over 95% of the team members were aware of the MCI plan; half had read the plan during the last 6 months, whereas 63% at the TCs and 74% at NTCs were confident with their MCI role. Trauma team exercises were conducted regularly and 86% had ever participated. Only 63% at the TCs and 53% at the NTCs had participated in an MCI exercise. The proportion of resident surgeons and anesthetists with >4 years’ clinical experience was significantly higher in TCs (88% and 63%) than in NTCs (27% and 17%). All the on-call consultant surgeons were at home, leaving interns in charge at several of the hospitals. All resident surgeons at the TCs were ATLS providers compared with 64% at the NTCs, and almost 90% of the consultant surgeons had participated in advanced trauma surgical courses. Discussion Despite increased national focus on disaster preparedness, we identified limited compliance with trauma system requirements concerning competency and training. Strict guidelines to secure immediate notification and early presence of consultants whenever a situation that might turn into an MCI occurs should be a prerequisite. Level of evidence Level IV. Study type: cross- sectional.
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Affiliation(s)
- Jørgen Joakim Jørgensen
- Departments of Traumatology and Vascular Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Peter Wiel Monrad-Hansen
- Departments of Traumatology and Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Christine Gaarder
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Traumatology, Oslo University Hospital, Oslo, Norway
| | - Paal Aksel Næss
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Departments of Traumatology and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
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Wyte-Lake T, Schmitz S, Kornegay RJ, Acevedo F, Dobalian A. Three case studies of community behavioral health support from the US Department of Veterans Affairs after disasters. BMC Public Health 2021; 21:639. [PMID: 33794812 PMCID: PMC8015747 DOI: 10.1186/s12889-021-10650-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/18/2021] [Indexed: 11/12/2022] Open
Abstract
Background Community disaster resilience is comprised of a multitude of factors, including the capacity of citizens to psychologically recover. There is growing recognition of the need for public health departments to prioritize a communitywide mental health response strategy to facilitate access to behavioral health services and reduce potential psychological impacts. Due to the US Department of Veterans Affairs’ (VA) extensive experience providing trauma-informed behavioral healthcare to its Veterans, and the fact that VA Medical Centers (VAMCs) are located throughout the United States, the VA is well situated to be a key partner in local communities’ response plans. In this study we examined the role the VA can play in a community’s behavioral health response using case studies from three disasters. Methods This study investigated experiences of VA employees in critical emergency response positions (N = 17) in communities where disasters occurred between 2017 and 2019. All respondents were interviewed March–July 2019. Data were collected via semi-structured interviews exploring participants’ experiences and knowledge about VA activities provided to communities following the regional disasters. Data were analyzed using thematic and grounded theory coding methods. Results Respondents underscored VA’s primary mission after a disaster was to maintain continuity of care to Veterans. The majority also described the VA supporting community recovery. Specifically, three recent events provided key examples of VA’s involvement in disaster behavioral health response. Each event showed VA’s integration into local response structures was facilitated by pre-existing emergency management and clinical relationships as well as prioritization from VA leadership to engage in humanitarian missions. The behavioral health interventions were provided by behavioral health teams integrated into disaster assistance centers and non-VA hospitals, VA mobile units deployed into the community, and VA telehealth services. Conclusions Recent disasters have revealed that coordinated efforts between multidisciplinary agencies can strengthen communities’ capacity to respond to mental health needs, thereby fostering resilience. Building relationships with local VAMCs can help expedite how VA can be incorporated into emergency management strategies. In considering the strengths community partners can bring to bear, a coordinated disaster mental health response would benefit from involving VA as a partner during planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10650-x.
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Affiliation(s)
- Tamar Wyte-Lake
- Department of Veterans Affairs, Veterans Emergency Management Evaluation Center (VEMEC), 16111 Plummer St. MS-152, North Hills, CA, 91343, USA. .,Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Susan Schmitz
- Department of Veterans Affairs, Veterans Emergency Management Evaluation Center (VEMEC), 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
| | | | - Felix Acevedo
- VA Southern Nevada Healthcare System, 6900 N. Pecos Road, North Las Vegas, NV, 89086, USA
| | - Aram Dobalian
- Department of Veterans Affairs, Veterans Emergency Management Evaluation Center (VEMEC), 16111 Plummer St. MS-152, North Hills, CA, 91343, USA.,Division of Health Systems Management and Policy, University of Memphis School of Public Health, Memphis, TN, USA
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Emotional intelligence, cortisol and α-amylase response to highly stressful hyper-realistic surgical simulation of a mass casualty event scenario. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 5:100031. [PMID: 35754451 PMCID: PMC9216348 DOI: 10.1016/j.cpnec.2021.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 11/29/2022] Open
Abstract
Lifetime exposure to stress leads to risk of suffering from cumulative detrimental physiological and psychological ailments. Due to the nature of healthcare and exposure to trauma, medical professionals are particularly susceptible to the negative impacts of high stress environments. emotional intelligence plays a role in ameliorating the risk of being negatively impacted by these stressors. As such, there is special interest to develop and implement training interventions for medical personnel that would allow them to improve emotional intelligence potential with the goal of enabling them to handle stress better and mitigate burnout. A hyper-realistic surgical simulation training session, replicating the intensity of a Mass-Casualty Event scenario, was implemented to allow medical professionals to experience this in real time. Overall, the training led to increased emotional intelligence, correlating with decreased hypothalamus-pituitary-adrenal axis and sympathetic nervous system stress biomarkers, cortisol and α-amylase. This novel training provides, at least, short-term improvements in emotional intelligence that is reflected with a physiological response. These results guide the ongoing effort to develop therapeutic tools to improve long term stress management, mitigate burnout and reduce post-traumatic stress risk after an exposure to a Mass-Casualty event scenario. This study examines the relationship between emotional intelligence and stress response. Higher values in self-perception and stress management correlate with lower cortisol and α-amylase values. Alpha-amylase is more predictive of pre-event emotional intelligence while cortisol levels are better for post-event. Training improves short-term emotional intelligence, that may be useful to enhance stress management and mitigate burnout. Monitoring α-amylase and cortisol levels may help identify individuals at risk or with lower resilience potential.
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Abstract
This article provides a perspective on the reciprocal relationships between public and private sector resilience planning activities and the ongoing COVID responses in the U.S. Through the lens of the built environment, this article provides selected insights into how various disaster, organizational, and engineering resilience activities have likely positively shaped COVID responses within the healthcare sector. These positive influences are contextualized within extensive efforts within public health and healthcare management to calibrate community resilience frameworks and practices for utilization in everything from advancing community health to the continuity of facilities operations. Thereafter, the article shifts focus to speculate on how ongoing experiences under COVID might yield positive impacts for future resilience designs, plans and policies within housing and the built environment. Through this perspective, the article hopes to explore those often overlooked aspects of the physical and social parameters of the built environment that may be understood as providing opportunities to inform future disaster, public health, and climate change preparations and responses.
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