Emergency medical team interventions in Poland during out-of-hospital deliveries: A retrospective analysis.

BACKGROUND: Emergency medical teams are a crucial component of healthcare systems, routinely providing essential care to pregnant patients in various situations. OBJECTIVES: To evaluate the rate and outcomes of out-of-hospital deliveries attended by Emergency Medical Services (EMS) in Poland and identify areas for improvement in the care provided by emergency medical teams. MATERIAL AND METHODS: This retrospective study was based on 41,335 EMS emergency calls to women in advanced pregnancy, of which 879 births were delivered directly by medical teams between January 2018 and December 2022. Data were obtained from the Polish National Monitoring Center for Emergency Medical Services, encompassing all EMS interventions in Poland. RESULTS: The study involved 879 EMS team interventions for pregnant women, with an average patient age of 29.87 years. Most patients were in their 2nd pregnancy (28.26%) and delivering for the 2nd time (25.77%). The postnatal condition of newborns, assessed using the Apgar score, was missing in 408 cases (46.52%) due to incorrect completion of documentation. Emergency Medical Services teams, predominantly P-type (basic) teams, handled 69.78% of deliveries, while S-type (specialist) teams were involved in 30.22% of cases. Medical procedures often performed during childbirth included manual assistance in spontaneous delivery, pulse oximetry, physical examination, examination of systemic blood pressure, obtaining peripheral intravenous access, and gynecological examination. CONCLUSIONS: Given the rate of encountered cases and the gaps identified in medical documentation, there is merit in potentially implementing a dedicated form to be completed by medical teams when caring for a pregnant patient. Ongoing training and enhancements in the range of assistance provided to the mother and newborn are imperative for ensuring appropriate care.

Geriatric patient in the practice of emergency medical teams - observation in 2020-2022.

Purpose: Analysis of interventions of medical rescue teams for geriatric patients in a three-year period, taking into account the causes, circumstances, medical management, pharmacology. Materials and methods: The study included a 3-year retrospective analysis of the trips of medical rescue teams in the northern part of the Lubelskie Voivodeship in the period from January 1, 2020 to December 31, 2022. The data comes from medical documentation. Interventions caused by a health risk in a patient in the 90+ age group were qualified as events. 897 EMT interventions were qualified (2020-327, 2021-269, 2022-301) constituting 4.29% of all interventions carried out in the operational area. In addition, a quantitative analysis of a comparative group of patients aged 80-89 was performed. Results: It was shown that the time of rescue activities was the longest for injuries and the shortest for mental disorders (60 ± 31 vs. 43 ± 21 min). It was shown that specialist EMT teams (S) were statistically significantly more often called for cardiology disorders (63%). It was shown that pharmacological agents were used statistically significantly more often in respiratory disorders (83%) compared to neurology disorders (47%, p < 0.001). It was also shown that patients whose call was caused by neurology disorders were statistically more often transported to the emergency department (N = 76, 76%, p < 0.001). Conclusion: The causes of calls regarding disorders of the circulatory and respiratory systems most often require the implementation of pharmacology during EMT interventions, mainly short-term and symptomatic drugs. Interventions to rural areas dominate in the presented analysis in each year of the analysis and in each group of reasons for calls, which may be associated with more difficult access to a primary care physician. Most EMT interventions concern exacerbation of chronic diseases. Transport to the hospital was necessary mainly due to neurological and traumatic calls.

Team Dynamics and Nontechnical Skills Perception During the Disaster Response in Mozambique in 2019: A Survey Study Among the Italian Emergency Medical Team.

OBJECTIVE: Team dynamics and nontechnical skills in general are crucial for emergency medical teams (EMT). No study has ever examined these important issues during a real mission in the field. This study aimed to better investigate team dynamics and nontechnical skills for EMTs; it tried to understand if a real mission, when the people are obliged to work together for the first time, without a prior specific training focused on teamwork, is enough or not to work as an effective team in the field. METHODS: The study is designed as a pre-test/post-test survey study, and it collected data from 51 people deployed to Mozambique in 2019. Three indexes (the self-efficacy (SE), the teamwork (TW), and the overall team's performance (TW12)) were calculated as the average value of the rating given by all the participants. Open text feedback was also collected. RESULTS: A positive trend was observed comparing the "post" data to the "pre" data, but results did not show a statistical significance, with the only exception of stratified analyses showing a P-value less than 0.05 for SE and TW12 for some categories. CONCLUSIONS: According to the study findings, humanitarian workers feel good but not at their best; training programs focused on team dynamics can be really useful to improve self-confidence of people leaving for a mission.

Long-term Development of Fibrosarcoma in the Practice of Emergency Medical Teams: a Case Report.

Fibrosarcoma is a relatively rapidly growing, poorly delineated spindle cell tumour. It has generally good prognosis and rarely metastasizes. Soft tissue sarcomas account for less than 1% of all malignancies in adults. High rates of sarcomas are, for example, seen in patients with tuberous sclerosis complex. This paper presents the case of a patient with knee joint destruction caused by a fibrosarcoma, on account of which an emergency medical team was summoned several times. We present data from three medical rescue team interventions to a patient with a tumour in the left lower leg. The data was obtained from the documentation generated during the interventions: dispatch order record (DOR) and medical emergency treatment report (METR). The patient had a history of the following chronic diseases (ICD-10): E11.8, I50.9, I10, and M15. Two interventions involved patient transportation to a hospital, whereas the third intervention was completed in the patient's home. The fibrosarcoma caused only slight pain. Frequent bleeding from an open cancerous wound was the main problem in this patient. Difficulty in wound healing could have been related to complications of diabetes mellitus and the patients advanced age.

Deployment of the French Civil Protection Field Hospital (ESCRIM) in Gölbasi, Turkey after the February 2023 Earthquake: Lessons Learned.

Following the two earthquakes that occurred in Turkey on February 6, 2023 with magnitudes of 7.8 and 7.5, causing over 50,000 deaths and 100,000 injuries, France proposed to deploy, via the European Union Civil Protection Mechanism (EUCPM), the French Civil Protection Field Hospital (ESCRIM [Élément de Sécurité Civile Rapide d'Intervention Médicale]): the French World Health Organization (WHO)-classified Emergency Medical Team (EMT) Level 2 (EMT2).After the acceptance from Turkey on February 8, a disaster assessment team (DAT) was sent on February 10, 2023. It was decided, with local health authorities (LHA), to set up the field hospital in Gölbasi, Adiyaman Province where the State Hospital was closed due to a structural risk.Arriving in Gölbasi on February 13 at 2:00am in -12°C (10°F) temperatures, the detachment had no choice but to begin setting up the base of operation (BoO). At dawn, the cold was so intense that one doctor suffered from frostbite. Once the BoO was installed, the team set up the hospital tents. From 11:00am, the sun melted the snow and the ground became very muddy. The objective being to open the hospital as soon as possible, installation of the hospital continued, and it opened on February 14 at 12:00pm/noon, less than 36 hours after on-site arrival.This article describes the mechanics of setting up an EMT-2 in a cold climate, the many problems encountered, and the solutions imagined and proposed.

Emergency Medical Team Response during the Hokkaido Eastern Iburi Earthquake 2018: J-SPEED Data Analysis.

INTRODUCTION: In the last ten years, Japan has experienced several large-scale earthquakes with devastating social and health impacts. Earthquakes directly and indirectly cause a variety of health problems. Further investigation is required to increase preparedness and preventive efforts. In response to the Hokkaido Eastern Iburi Earthquake on September 6, 2018, 32 Emergency Medical Teams (EMTs) employed the Japanese version of Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED) as a national standard daily reporting template, gathering data on the number and type of health problems treated. STUDY OBJECTIVE: The purpose of the study is to conduct a descriptive epidemiology study using the J-SPEED data to better understand the health problems during the earthquake disaster. METHODS: Reported items in J-SPEED (Ver 1.0) form were analyzed by age, gender, and time to better understand the health issues that have arisen from the earthquake. RESULTS: Most consultations (721; 97.6%) occurred between Day 1 and Day 13 of the 32-day EMT response. During the response period, disaster stress-related symptoms were the most common health event (15.2%), followed by wounds (14.5%) and skin diseases (7.0%). CONCLUSION: The most often reported health event during the response period was stress-associated illnesses related to disasters, followed by wounds and skin conditions. The health consequences of natural disasters depend on diverse local environment and population. As a result, this initial study was hard to generalize; however, it is expected that data accumulated using the J-SPEED system in the future will strengthen and extend the conclusions.

Rapid Expansion and Adaptability of California Medical Disaster Teams.

The California Medical Assistance Team (CAL-MAT) program is coordinated by the California Emergency Medical Services Authority (EMSA). The program was developed to deploy and support medical personnel for disaster medical response. During the coronavirus disease (COVID-19) pandemic, the program and missions grew rapidly in response to medical surge, programs for testing and vaccination, and other concurrent disasters. CAL-MAT enrollment increased 10-fold from approximately 200 members at the beginning of 2020, to an estimated 2200 members by June 2021. This article describes the flexible use of a state-managed disaster medical response program within California and some of the challenges associated with rapid expansion and varied demands during the COVID-19 surges of March 2020-March 2022. CAL-MAT may serve as a model for development of similar state-sponsored or other disaster medical response teams.

The Emergency Medical Team Operating System: design, implementation, and evaluation of a field hospital information management system.

In case of sudden-onset disasters (SODs), the World Health Organization deploys specialized emergency medical teams (EMTs); yet, the coordination and operation of such teams pose significant challenges. One issue is the lack of digital information systems and standards. We developed a highly customizable and scalable electronic medical record (EMR) system, tailored to EMT requirements, called the "Emergency Medical Team Operating System" (EOS). EOS was successfully tested through 9 realistic clinical tasks during a full-scale EU Module Exercise. During the initial evaluation, 21 team members from 9 countries evaluated the system positively, stressing the urgent need for an EMR for EMTs. EMTs face unique challenges during disaster relief missions. To provide an effective and coordinated delivery of care, there is a great need for an EMR tailored to the specific needs of EMTs. EOS may serve as an effective EMR during SOD missions.

Analysis of Resilience, Coping Style, Anxiety, and Depression Among Rescue Nurses on EMTs During the Disaster Preparedness Stage in Sichuan, China: A Descriptive Cross-Sectional Survey.

OBJECTIVE: The purpose of this study was to investigate the current situation and influencing factors of resilience, coping style, anxiety, and depression among rescue nurses on Emergency Medical Teams (EMTs) during the disaster preparedness stage, and to explore the relationship between resilience, coping style, anxiety, and depression. METHODS: A descriptive cross-sectional survey was used. The convenience sampling method was used to select rescue nurses from 4 national EMTs in Sichuan Province, China. CD-RISC, SCSQ, Zung SAS, and SDS were used as research tools. RESULTS: A total of 197 valid questionnaires were returned, with a 98.5% response rate. The results of multiple regression analysis showed that average monthly income, depression level, and coping style were the main factors affecting nurses' resilience. Resilience was significantly and positively correlated with coping style and negatively correlated with anxiety and depression. There were significant differences in SCSQ, Zung SAS, and SDS scores among Clusters. CONCLUSION: In the disaster preparedness stage, rescue nurses on EMTs have a medium level of resilience and good coping styles, but their levels of anxiety and depression are high. It is suggested that more attention should be devoted to the target population to formulate effective intervention plans, reduce psychological pressures, and improve their capacity for coping with disasters.

First Activation of the WHO Emergency Medical Team Minimum Data Set in the 2019 Response to Tropical Cyclone Idai in Mozambique.

INTRODUCTION: During a disaster, comprehensive, accurate, timely, and standardized health data collection is needed to improve patient care and support effective responses. In 2017, the World Health Organization (WHO) developed the Emergency Medical Team (EMT) Minimum Data Set (MDS) as an international standard for data collection in the context of disasters and public health emergencies. The EMT MDS was formally activated for the first time in 2019 during the response to Cyclone Idai in Mozambique. STUDY OBJECTIVE: The aim of this study was to analyze data collected through the EMT MDS during Cyclone Idai of 2019 and to identify the benefits of and opportunities for its future use. METHODS: The EMT MDS was used for data collection. All 13 international EMTs deployed from March 27 through July 12 reported data in accordance with the EMT MDS form. The collected data were analyzed descriptively. RESULTS: A total of 18,468 consultations, including delivery of 94 live births, were recorded. For children under-five and those five-years and older, the top five reasons for consultation were minor injuries (4.5% and 10.8%, respectively), acute respiratory infections ([ARI] 12.6% and 4.8%, respectively), acute watery diarrhea (18.7% and 7.7%, respectively), malaria (9.2% and 6.1%, respectively), and skin diseases (5.1% and 3.1%, respectively). Non-disaster-related health events accounted for 84.7% of the total health problems recorded. Obstetric care was among the core services provided by EMTs during the response. CONCLUSION: Despite of challenges, the EMT MDS reporting system was found to support the responses and coordination of EMTs. The role of the Mozambican Ministry of Health (MOH), its cooperation with EMTs, and the dedicated technical support of international organizations enabled its successful implementation.

The role of emergency medical teams in Eswatini during the COVID-19 pandemic.

The paper documents experiences and lesson learned in responding to COVID-19 pandemic in Eswatini with the support of the Emergency Medical Teams. WHO databases, operation reports and hospitalization records were reviewed. The WHO Emergency Medical Teams built the capacity of the local response teams in Eswatini. The conclusion is that following the intervention of the WHO Emergency Medical Teams, Eswatini is better prepared to respond to the ongoing COVID-19 pandemic and future outbreaks.

Prevalence of Mental Health Problems among Patients Treated by Emergency Medical Teams: Findings from J-SPEED Data Regarding the West Japan Heavy Rain 2018.

It is crucial to provide mental health care following a disaster because the victims tend to experience symptoms such as anxiety and insomnia during the acute phase. However, little research on mental health during the acute phase has been conducted, and reported only in terms of the temporal transition of the number of consultations and symptoms. Thus, the aim of the study was to examine how mental health care needs are accounted for in the overall picture of disaster relief and how they change over time. Using data from the Japanese version of Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED), we assessed the mental health of injured and ill patients to whom Emergency Medical Teams (EMTs) were providing care during the acute period of a disaster. Approximately 10% of all medical consultations were for mental health issues, 83% of which took place within the first 2 weeks after the disaster. The findings showed that, from the start of the response period to the 19th response day, the daily proportion of mental health problems declined substantially, and then gradually increased. Such a V-shaped pattern might be helpful for identifying phase changes and supporting the development of EMT exit strategies.

Development and preliminary validation of a public health emergency competency model for medical staffs of national health emergency teams in China.

BACKGROUND: In the present study, we attempted to develop and validate a participatory competency model for medical workers and then evaluate the current status of competency characteristics of Chinese medical workers. METHODS: The competency model was constructed in a multistage process, including literature review, expert consultation, critical incident and focus group interview. A pilot study was conducted to refine the initial model among 90 participators and the viability and reliability were evaluated by a questionnaire survey among 121 medical workers. Then, the current status of competency characteristics was measured based on the final version of competency model. RESULTS: In the pilot study, ten questionnaires were dropped for the poor quality and thus the eligible rate was 92% (138/150). KMO value was 0.785 and Bartlett test showed that the χ2 = 6464.546 (df = 903) and p value < 0.001. Then, 10 items with double loading and factor loading < 0.4 were deleted. Finally, 33 items were retained with the lowest factor loading value of 0.465. The validity and reliability of competency model were determined with Cronbach's α coefficient of 0.975 and ICC value of 0.933. Finally, a revised competency model with 5 dimensions and 31 items was obtained. The overall competencies of current medical workers were in a high level, except for emergency knowledge related competencies. Age was an independent factor affecting the competencies. CONCLUSIONS: Our competency model was a reliable and validated tool for assessing the competences of medical staffs against public health emergencies, and the overall competencies of current medical workers in China were in a high level, except for emergency knowledge related competencies.

The Response by International Emergency Medical Teams Following the Beirut Harbor Explosion in 2020 - Who Were They, When Did They Arrive, What Did They Do, and Were They Needed?

INTRODUCTION: On August 4, 2020, a massive explosion struck the Beirut Harbor in Lebanon. Approximately 220 people were killed and around 7,000 were injured, of which 12% were hospitalized. Despite being weakened by economic crisis and increasing numbers of coronavirus disease 2019 (COVID-19) cases, the national health care system responded promptly. Within a day, international health care assistance in the form of International Emergency Medical Teams (I-EMTs) started arriving. Previous studies have found that I-EMTs have arrived late and have not been adapted to the context and dominating health care needs. The aim of this study was to document the organization, type, activity, and timing of I-EMTs deployed to Beirut and to discuss their relevance in relation to medical needs. METHODS: Data on all deployed I-EMTs were retrieved from all available sources, including internet searches, I-EMT contacts, and from the World Health Organization (WHO) EMT coordination cell (EMT CC) in Lebanon. The WHO EMT classification was used to categorize deployed teams. Information on characteristics, timing, and activities was retrieved and systematically assessed. RESULTS: Nine I-EMTs were deployed to Beirut following the explosion. Five were equivalent to EMT Type 2 (field hospitals), out of which three were military. The first EMT Type 2 arrived within 24 hours, while the last EMT set up one month after the explosion. Four civilian I-EMTs provided non-clinical support as EMT Specialized Care Teams. A majority of the I-EMTs were focused on trauma care. Three of the four I-EMT Specialized Care Teams were rapidly re-tasked to support COVID-19 care in public hospitals. CONCLUSION: A majority of the deployed I-EMT Type 2 were military and focused on trauma care rather than the normal burden of disease including COVID-19. Re-tasking of EMTs requires flexible EMTs. To be better adapted, the I-EMT response should be guided by a systematic assessment of both health care capacities in the affected country as well as the varying health effects of hazards before deployment.

Italian Field Hospital Experience in Mozambique: Report of Ordinary Activities in an Extraordinary Context.

On March 15, 2019, Cyclone Idai made landfall near the port city of Beira in central Mozambique causing significant casualties and serious damage to infrastructure. The Emergency Medical Team Type 2 - Italy Regione Piemonte (EMT2-ITA) was deployed approximately two weeks after the disaster to support the country in need, providing essential medical and surgical care.The EMT2-ITA staff was composed of 77 team members including two rotations and integrating local staff. A total of 1,121 patients (1,183 triage admissions) were treated during the 27 days of field hospital activity; among all the admissions, only few cases (17; 1%) were directly or indirectly attributed to the disaster event. Only three cases of cholera were confirmed and transferred to one of the treatment centers set up in Beira. The EMT2-ITA performed a total of 62 surgical operations (orthopedic, gynecological, general, and plastic surgery), of which more than one-half were elective procedures.The objective of this manuscript is to report the mission of the EMT2-ITA in Mozambique, raising interesting points of discussion regarding the impact of timing on the mission outcomes, the operational and clinical activities in the field hospital, and the great importance to integrate local staff into the team.

Challenges of Emergency Medical Teams and Deploying a Field Hospital in the Aftermath of the Beirut Blast: A Qualitative Study.

OBJECTIVE: The huge explosion that occurred at Beirut Port led to a high number of casualties. Consequently, 7 field hospitals (FHs) were deployed in Lebanon. The purpose of this study is to explore the challenges that emergency medical teams (EMTs) faced and explain the gaps at the national level related to deploying a FH. METHODS: A qualitative study was conducted. To collect the data, semi-structured interviews were done with 8 key informants (5 from the FHs, 2 from Lebanese Army Forces, and 1 from Ministry of Public Health). In this study, purposive sampling was used and data were analyzed using Braun and Clarke (2006) thematic analysis and MAXQDA software. RESULTS: Three major themes (logistical challenges, staff challenges, and coronavirus disease [COVID-19] pandemic) and 10 subthemes emerged for the challenges that EMTs faced. The gaps at the national level were categorized into 2 themes (absence of needs-based response and limited effective coordination between the host country and donor countries) and 5 sub-themes. CONCLUSION: Lebanon focuses on response rather than preparedness for disasters. EMTs that arrived didn't meet the medical needs. Hence, there is a need to strengthen the national capacities and to ensure better communication and coordination between the disaster-affected country and the EMTs.

Equipa de emergência médica intra hospitalar: um projeto de criação e implementação / Intra-hospital medical emergency team: a project for creation and implementation

As equipas de emergência intra-hospitalar, inicialmente conhecidas como equipas de reanimação, surgiram com o objetivo primário de reverter paragens cardiorrespiratórias, que ocorriam dentro dos hospitais. Mais tarde, percebeu-se que o melhor caminho para diminuir a mortalidade e morbilidade hospitalar é a prevenção desses eventos críticos, que em muitas situações podem ser potencialmente detetados e antecipados. Daí que, atualmente, a ativação destas equipas passa pela identificação de alterações de sinais vitais importantes e interpretados como deterioração clínica aguda. Em Portugal, também se assistiu a essa evolução. Em 2010, por via da Circular Normativa nº 15/DQS/DQCO da Direção Geral de Saúde, as equipas de reanimação evoluíram para Equipas de Emergência Médica Intra-hospitalar (EEMI), tendo como critérios de ativação todas as situações de paragem cardiorrespiratória acontecidas ou eminentes, assim como, disfunções agudas entendidas como potencialmente emergentes. Neste contexto, emerge a importância e a necessidade de solidificar um sistema integrado de resposta à emergência intra-hospitalar, que permita uma intervenção coordenada, eficaz e eficiente por parte de todos os profissionais de saúde, que se venha a traduzir em ganhos em saúde. Como objetivo principal deste trabalho, pretende-se promover a criação e implementação da Equipa de Emergência Médica Intra-hospitalar, numa Unidade Hospitalar da região Norte do país, para uma intervenção precoce e diferenciada à pessoa em situação crítica, em contexto intra-hospitalar. Para a sua realização, optou-se pela Metodologia de Projeto, uma vez que permite estudar um problema atual, centrada na investigação, análise e na implementação de estratégias para a sua resolução. Assim, iniciou-se com o diagnóstico de situação, através da aplicação de um questionário dirigido à equipa médica e de enfermagem e uma entrevista semiestruturada a elementos pertencentes aos órgãos de gestão hospitalar. Os resultados do estudo diagnóstico salientam e reforçam a importância da implementação de equipas dedicadas para a abordagem em situações de emergência intra-hospitalar, uma vez que trará ganhos diretos para o doente, nomeadamente no que concerne a uma atuação mais rápida e diferenciada, refletindo-se na melhoria da qualidade dos cuidados, aumento da sobrevivência e diminuição de complicações imediatas e tardias; e que existem dificuldades na abordagem ao doente crítico, nomeadamente no que respeita à inexistência de uma metodologia de atuação, uniformização de protocolos e necessidade de um plano de formação continua. Depois de validar o objetivo do projeto pelo diagnóstico de necessidades, o plano de ação desenvolveu-se em sete atividades que permitiram desde a divulgação do projeto e dos resultados obtidos, à identificação dos recursos necessários à implementação da EEMI, bem como, a elaboração de um plano de formação para os profissionais que integram a EEMI e a apresentação de uma proposta de protocolo de atuação imediata e ativação da mesma. Acreditamos que os resultados deste trabalho possam constituir a base de trabalho para a implementação da EEMI na referida Unidade Hospitalar, com o propósito da mudança de práticas e aperfeiçoamento dos cuidados, com vista à qualidade dos mesmos e à segurança do doente.

In-hospital emergency teams, initially known as resuscitation teams, appeared with the primary goal of reversing cardiorespiratory arrest, which occurred within hospitals. Later, they realized that the best way to decrease hospital mortality and morbidity is the prevention of these critical events, which in many situations can potentially be detected and anticipated. Hence, currently, the activation of these teams goes through the identification of changes of important vital signs, considered as acute clinical deterioration. In Portugal, this evolution has also been noted. In 2010, through Normative Circular nº 15/DQS/DQCO of the General Directorate of Health, resuscitation teams have evolved into In-Hospital Medical Emergency Teams, with activation criteria of all of cardiopulmonary arrest situations that occurred or are eminent, as well as acute dysfunctions understood as potentially emerging. In this context, the importance and the need to solidify an integrated response system to the intra-hospital emergency emerges, which allows a coordinated, effective and efficient intervention by all health professionals, which will translate into health gains. As the main goal for this research, it is intended to promote the creation and implementation of an In-Hospital Medical Emergency Team, in a Hospital unit in the northern side the country, for an early and differentiated intervention to a person in a critical situation and in an in-hospital context. For its realization, we opted for the Project Methodology, since it allows us to study a current problem, centered on investigation, analysis and implementation of strategies for its resolution. Thus, it started with the diagnosis of the situation, through the application of a questionnaire addressed to the medical and nursing team and a semi-structured interview with elements belonging to the hospital management bodies. The results of the diagnostic study highlight and reinforce the importance of implementing dedicated teams to face in-hospital emergency situations, since it will bring direct benefits for the patient, particularly with a faster and differentiated performance, reflecting it on the improvement in the quality of care, in the increasing of survival and in the decreasing immediate and late complications; and that there are difficulties in approaching critically ill patients, namely when it comes to the lack of a working methodology, the standardization of protocols and the need for a continuous training plan. After validating the project's goal through the needs diagnosis, the action plan was developed in seven activities that allowed, ever since the dissemination of the project and the results obtained, to the identification of the necessary resources for the implementation of In-Hospital Medical Emergency Team, as well as the elaboration of a training plan for the professionals who are part of In-Hospital Medical Emergency Team and the presentation of a proposal for a protocol for immediate action and activation. We believe that the results of this work can form the foundation of work for the implementation of In-Hospital Medical Emergency Team in the referred Hospital, with the purpose of changing practices and improving care, envisioning their quality and patient safety.

Impact of the ARCH Project on National Capacity Development on Disaster Health Management among the ASEAN Member States and Japan.

OBJECTIVE: This report tries to capture the impact of the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) in each ASEAN Member State (AMS) and Japan as a result of the ARCH Project implementation since July 2016. METHODS: Impact on AMS: The analysis of the impact on AMS was based on a comparison of the impact of the project on management and coordination of Emergency Medical Teams (EMTs), and application of the project outcome in actual emergency operations compared to the previous status in each AMS.Impact on Japan: The history of the development of disaster medicine in Japan was reviewed, with an aim to analyze the impact of supporting AMS through the ARCH Project on Japan, and the possibility of bi-directional cooperation in the future. RESULTS: Impact on AMS: Since the initiation of the ARCH Project, AMS has made significant progress in WHO EMT accreditation, strengthening EMTCC capacity for receiving international assistance, as well as the development of legislation or strategic plans related to DHM, and application of the Project products such as standard operating procedures or regional tools in actual disasters/emergencies.Impact on Japan: Disaster medicine in Japan originated from the Cambodian refugees' relief mission in 1979. Since then, the management system has been strengthened including the foundation of the Japan Disaster Relief (JDR) Team, a structure with a legal foundation. The experience gained through international operations has contributed to the development of Japan's domestic disaster response system. Japan learned the operational effectiveness of the post-disaster health surveillance system through the disaster response operation in 2013 Typhoon Yolanda Disaster in Philippines and introduced a modified system in Japan for domestic disaster response, which was later refined and proposed for an international standard. CONCLUSION: ARCH Project is highly appreciated by AMS as the opportunity to share knowledge and experience among countries and thereby contributing to achieving the "One ASEAN, One Response" concept, as well as the driving force for each AMS to develop its capacity in DHM. While the ARCH Project started to support AMS to strengthen its regional capacity in disaster health management, it is important to build a bi-directional relationship between ASEAN and Japan in terms of mutual learning and support to tackle future disasters.

ARCH Project and the Global Initiatives of Disaster Health Management.

OBJECTIVE: The prime aim of Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) is to strengthen the disaster health management (DHM) capacity in the context of personal level, Emergency Medical Team (EMT), and the regional collaboration. The ARCH Project was implemented with reference to international trends of DHM and seeks to contribute to the development of global standards. METHODS: The project established the Project Working Groups that consisted of representatives of ASEAN Member States (AMS) to develop standard operating procedures (SOP) for international EMT (I-EMT) coordination. Furthermore, it aimed to organize training sessions along with implementation of the regional collaboration drill (RCD) in accordance with I-EMT minimum requirements and in line with coordination standards set by the WHO. RESULTS: The ARCH Project developed the SOP and common platform for I-EMT coordination, organized training, and conducted RCDs with reference to the WHO's EMT initiative. Furthermore, it also contributed to the development of the EMT Minimum Data Set (MDS), an international standard DHM tool that underwent testing at the RCDs before the WHO endorsement and its utilization in actual disaster response. CONCLUSION: In the process of strengthening ASEAN regional capacity in DHM, the project is constantly capturing international trends and also making significant contributions in the development of global systems and tools.

Introduction to the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project).

BACKGROUND: Southeast Asia is the second biggest region in the world in terms of the total number of natural disasters since 1900. Therefore, the Association of Southeast Asian Nations (ASEAN) initiated regional challenges toward strengthening regional collaboration for disaster prevention and response since the earthquake of Sumatra in Indonesia occurred in 2004. Moreover, ASEAN Leaders signed "the ASEAN Declaration on One ASEAN, One Response" in 2016. Under these circumstances, ASEAN decided to implement the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project). OBJECTIVES: The objective of the ARCH Project is to strengthen coordination on disaster health management (DHM) for rapid and effective response to disasters occurring in the ASEAN region and to enhance the capacity of each ASEAN Member State (AMS) on DHM. This article aims to overview the outline and its strategy, and review the progress of the project. METHODS: ARCH Project is an ASEAN official project supported by Japan's official development assistance. Five outputs were launched for: (1) coordination platform on DHM; (2) framework of regional collaboration practices; (3) tools for effective regional collaboration; (4) enhancement of academic network on DHM; and (5) capacity development activities for each AMS. The Project was reviewed in terms of accomplishment and evaluation criteria. RESULTS: Regional Coordination Committee on DHM was established as a coordination platform to: Oversee the implementation of the ARCH Project for the Output 1; Regional Collaboration Drill was developed and conducted for the Output 2; The standard operating procedure for coordination of emergency medical teams (EMTs) in ASEAN was developed for the Output 3; Various presentations on ARCH were made in academic conferences for the Output 4; and Several training programs and educational curricula were developed for the Output 5. The Project has accomplished its Project Purpose and satisfied all the indicators set. ARCH Project has high Relevance, Impact, Sustainability, and Effectiveness, while some improvements in Efficiency are needed. CONCLUSIONS: ARCH Project is the first-ever successful regional cooperation mechanism and standardization of DHM in ASEAN, one of the most disaster-prone regions. It also contributes to the capacity building of AMS. The ARCH Project has a remarkable impact on the resilience and flexible medical response to disasters, although continuous efforts of stakeholders to make this initiative sustainable are necessary.