Care in emergencies and disasters: Can it be person-centered?

OBJECTIVES: While person-/patient-centered care aims to influence policymakers' rules and regulations to improve the care of individuals worldwide, exploration of the concept in the context of disaster and public health emergencies as an alternative ethical approach is lacking. This study aims to provide a nuanced understanding of the advantages and challenges of diverse ethical approaches in emergencies, to improve patient care. METHODS: A survey, created after several rounds of Delphi methodology, with 22 statements, was applied to 39 participants from nine different countries. The questionnaire's results, including participants' comments, were analyzed. RESULTS: The results show that practitioners chose to use a combination of diverse ethical approaches in managing victims of disasters and public health emergencies. CONCLUSION: The selection of an approach is context- and situation-dependent and seems to primarily respond to the nature of underlying etiology, creating a possibility to use diverse approaches to offer individualized care on a later occasion and when a flexible surge capacity is available. PRACTICE IMPLICATIONS: The outcomes of this study will enhance the future ethical discussion in person/patient-centered care during situations with limited resources and help to develop necessary ethical and educational guidelines.

Employees Perception of Organizational Crises and Their Reactions to Them - A Norwegian Organizational Case Study.

Organizational sensemaking is crucial for resource planning and crisis management since facing complex strategic problems that exceed their capacity and ability, such as crises, forces organizations to engage in inter-organizational collaboration, which leads to obtaining individual and diverse perspectives to comprehend the issues and find solutions. This online qualitative survey study examines how Norwegian Sea Rescue Society employees perceived the concept of an organizational crisis and how they sensed their co-workers react to it. The scope was the ongoing COVID-19 pandemic, a global event affecting all countries and organizations and responding similarly globally. Data were collected during the Fall of 2020. The instrument of choice was the Internal Crisis Management and Crisis Communication survey (ICMCC). The results showed that the overall sample strongly believed in their organization's overall resilience level. However, a somewhat vague understanding of roles and responsibilities in a crisis where detected, together with some signs of informal communication, rumor spreading, misunderstanding, frustration, and insecurity. This study contributes to the academic field of organizational research, hence crisis management and sensemaking, and could be valuable to managers and decision-makers across sectors. Increased knowledge about how employees react to a crisis may help optimize internal crisis management planning and utilize robust mitigation and response strategies.

A Literature Review on the Impact of Wildfires on Emergency Departments: Enhancing Disaster Preparedness.

INTRODUCTION: Global climate change (global warming) has been identified as the primary factor responsible for the observed increase in frequency and severity of wildfires (also known as bushfires in some countries) throughout the majority of the world's vegetated environments. This trend is predicted to continue, causing significant adverse health effects to nearby residential populations and placing a potential strain on local emergency departments (EDs). STUDY OBJECTIVE: The aim of this literature review was to identify papers relating to wildfires and their impact on EDs, specifically patient presentation characteristics, resource utilization, and patient outcomes. METHOD: This integrative literature review was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines for data collection, and Whittemore and Knafl's framework for data analysis. Data were collected from OvidSP, MEDLINE, DARE, CINAHL, PubMed, and Scopus databases. Various Medical Subject Headings (MeSH) and keywords identified papers relevant to wildfires/bushfires and EDs. RESULTS: Literature regarding the relationship between ED presentations and wildfire events, however, is primarily limited to studies from the United States and Australia and indicates particulate matter (PM) is principally linked to adverse respiratory and cardiovascular outcomes. Observable trends in the literature principally included a significant increase in respiratory presentations, primarily with a lag of one to two days from the initial event. Respiratory and cardiovascular studies that stratified results by age indicated individuals under five, over 65, or those with pre-existing conditions formed the majority of ED presentations. CONCLUSION: Key learnings from this review included the need for effective and targeted community advisory programs/procedures, prior to and during wildfire events, as well as pre-event planning, development, and robust resilience strategies for EDs.

Current Perspectives and Concerns Facing Hospital Evacuation: The Results of a Pilot Study and Literature Review.

OBJECTIVE: To analyze the evacuation preparedness of hospitals within the European Union (EU). METHOD: This study consisted of 2 steps. In the first step, a systematic review of the subject matter, according to the PRISMA flow diagram, was performed. Using Scopus (Elsevier, Amsterdam, Netherlands), PubMed (National Library of Medicine, Bethesda, MD), and Gothenburg University´s search engine, 11 questions were extracted from the review and were sent to representatives from 15 European Union (EU)- and non-EU countries. RESULTS: The findings indicate that there is neither a full preparedness nor a standard guideline for evacuation within the EU or other non-EU countries in this study. A major shortcoming revealed by this study is the lack of awareness of the untoward consequences of medical decision-making during an evacuation. Some countries did not respond to the questions due to the lack of relevant guidelines, instructions, or time. CONCLUSION: Hospitals are exposed to internal and external incidents and require an adequate evacuation plan. Despite many publications, reports, and conclusions on successful and unsuccessful evacuation, there is still no common guide for evacuation, and many hospitals lack the proper preparedness. There is a need for a multinational collaboration, specifically within the EU, to establish such an evacuation planning or guideline to be used mutually within the union and the international community.

Importance of Immediate Electronic-Based Feedback to Enhance Feedback for First-Time CPR Trainees.

Sudden cardiac arrest is one of the leading causes of death globally. The recommended clinical management in out-of-hospital cardiac arrest cases is the immediate initiation of high-quality cardiopulmonary resuscitation (CPR). Training mannequins should be combined with technology that provides students with detailed immediate feedback on the quality of CPR performance. This study aimed to verify the impacts of the type of feedback (basic or detailed) the responders receive from the device while learning CPR and how it influences the quality of their performance and the motivation to improve their skills. The study was conducted at the Medical University of Lublin among 694 multi-professional health students during first aid classes on basic life support (BLS). The students first practiced on an adult mannequin with a basic control panel; afterward, the same mannequin was connected to a laptop, ensuring a detailed record of the performed activities through a projector. Next, the participants expressed their subjective opinion on how the feedback provided during the classes, basic vs. detailed, motivated them to improve the quality of their CPR performance. Additionally, during the classes, the instructor conducted an extended observation of students' work and behavior. In the students' opinion, the CPR training with detailed feedback devices provided motivation for learning and improving CPR proficiency than that with a basic control panel. Furthermore, the comments given from devices seemed to be more acceptable to the students, who did not see any bias in the device's evaluation compared to that of the instructor. Detailed device feedback motivates student health practitioners to learn and improve the overall quality of CPR. The use of mannequins that provide detailed feedback during BLS courses can improve survival in out-of-hospital cardiac arrest.

Emergency Healthcare Providers' Perceptions of Preparedness and Willingness to Work during Disasters and Public Health Emergencies.

This study evaluates the perceptions of preparedness and willingness to work during disasters and public health emergencies among 213 healthcare workers at hospitals in the southern region of Saudi Arabia by using a quantitative survey (Fight or Flight). The results showed that participants' willingness to work unconditionally during disasters and emergencies varied based on the type of condition: natural disasters (61.97%), seasonal influenza pandemic (52.58%), smallpox pandemic (47.89%), SARS/COVID-19 pandemic (43.56%), special flu pandemic (36.15%), mass shooting (37.56%), chemical incident and bombing threats (31.92%), biological events (28.17%), Ebola outbreaks (27.7%), and nuclear incident (24.88%). A lack of confidence and the absence of safety assurance for healthcare workers and their family members were the most important reasons cited. The co-variation between age and education versus risk and danger by Spearman's rho confirmed a small negative correlation between education and danger at a 95% level of significance, meaning that educated healthcare workers have less fear to work under dangerous events. Although the causes of unsuccessful management of disasters and emergencies may vary, individuals' characteristics, such as lack of confidence and emotional distractions because of uncertainty about the safety issues, may also play a significant role. Besides educational initiatives, other measures, which guarantee the safety of healthcare providers and their family members, should be established and implemented.

Help we are sinking! Stories from Norwegian dispatch centers on decision-making in unfamiliar and ambiguous situations.

The aim of this exploratory case study was to examine whether sensemaking processes may influence decision-making of emergency call center dispatchers when dealing with maritime crises. This article focuses on sensemaking and decision-making in an emergency services context using Norwegian operators as a case and reports on data collected from five focus-group interviews with emergency dispatchers at five different locations. Each focus group consisted of three dispatchers, representing the three main Norwegian emergency response dispatch centers: police, fire and rescue, and the Emergency Medical Communication Centre (AMK). The study's purpose was to see whether choices made when responding to maritime crisis calls are influenced by sensemaking processes, and whether these processes may have influenced the dispatcher's choice of which search and rescue resources to contact. The study found that the sensemaking processes that occurred prior to the decision-making might have been influenced by the dispatcher's past experiences, in particular, experiences from land-based operations. The findings also suggested that the emergency dispatchers made decisions based on intuitive sensemaking, as they were perceived pressed on time and experienced maritime crisis in a more transboundary nature than everyday land-based emergencies. The effects of sensemaking processes and intuitive decision-making shown in this study are of possible relevance to emergency services educators and managers outside a Norwegian framework.