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Background: Ethiopian policy and strategy aim to make health care systems capable of dealing with emergencies. However, Ethiopian health care still lacks a comprehensive “all-hazard” approach and a disaster preparedness program. Thus, this study aimed to assess the level of disaster preparedness in selected public hospitals for mass-casualty incidents (MCIs) in Amhara Regional State, Northwest Ethiopia. Methods: A descriptive cross-sectional study was conducted at general and comprehensive specialized hospitals (CSHs) in Amhara Regional State, Ethiopia using a World Health Organization (WHO) hospital emergency response checklist that included a domain on mass-casualty management (MCM) adapted from a literature review. Results: Seventeen (17) hospitals were evaluated (response rate: 81%). Five (29.4%) were teaching hospitals (tertiary health care) and 12 (70.5%) were non-teaching (secondary health care) hospitals. With an average mean of 97.3 (SD = 33.68; range 31-160), most hospitals under WHO required an Acceptable level of preparedness. Two were at an Unacceptable (0-67) level of preparedness, 12 (70.5%) hospitals were at an Insufficient (68-134) state, while the other three had an Acceptable (135-192) level of preparedness. Conclusion: The preparedness level of hospitals is Insufficient for potential MCIs in this region and needs prior attention in implementing existing strategic guidelines to develop and activate hospital disaster plans if and when needed.

Objective:The aim of this study was to establish the frequency and profile of disasters and to analyze trends in disasters and their impact on Spanish public health.Methods:Retrospective observational study of disasters that occurred in Spain from 1950 through 2020 was conducted. The variables studied for each episode were number of people affected, number of injured/sick, and number of deaths. Absolute and relative frequencies, population rates, mean, median, standard error of the mean (SEM), and 95% confidence intervals (CI) were used, and trend analysis was performed using exponential smoothing and linear regression.Results:A total of 491 disasters were identified in Spain. Of these, 255 (51.9%) were natural disasters, 224 (45.7%) technological disasters, and 12 (2.4%) man-made disasters. The average number of disasters per year was 7.01 (95% CI, 5.99-9.34). These disasters affected a total of 820,489 people, with an average of 3,491 people (SEM = 2.18) per episode. There was a significant increase (P Conclusions:Spain has a disaster profile of mixed type, combining natural with technological disasters. From 1950 through 2020, there was a significant increase in the number of disasters, with an overall profile similar to that of Europe, with climatological disasters being the most frequent type.

Introduction Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the fascial layer with a high mortality rate. It is a life-threatening medical emergency that requires urgent treatment. Lack of skin finding in NF made diagnosis difficult and required a high clinical index of suspicion. The use of ultrasound may guide clinicians in improving diagnostic speed and accuracy, thus leading to improved management decisions and patient outcomes. This literature search aims to review the use of point-of-care ultrasonography in diagnosing necrotizing fasciitis. Method We searched relevant electronic databases, including PUBMED, MEDLINE, and SCOPUS, and performed a systematic review. Keywords used were “necrotizing fasciitis” or “necrotising fasciitis” or “necrotizing soft tissue infections” and “point-of-care ultrasonography” “ultrasonography” or “ultrasound”. No temporal limitation was set. An additional search was performed via google scholar, and the top 100 entry was screened. Results Among 540 papers screened, only 21 were related to diagnosing necrotizing fasciitis using ultrasonography. The outcome includes three observational studies, 16 case reports, and two case series, covering the period from 1976 to 2022. Conclusion Although the use of ultrasonography in diagnosing NF was published in several papers with promising results, more studies are required to investigate its diagnostic accuracy and potential to reduce time delay before surgical intervention, morbidity, and mortality.

Introduction: “Table-top” exercises can improve knowledge and skills related to mass casualty incidents (MCIs) with little logistical efforts. We aim to evaluate the learning process of 5th year medical school students related to MCI response using table-top simulation and measure their methodology perception. Methods: A theoretical part plus an MCI simulation board exercise was organized. Knowledge pretest and 1 mo after posttest was scored, and an assessment questionnaire with 27 questions with a Likert-type scale with 3 dimensions: methodology, knowledge acquisition, and skills acquisition was administered. Students did not receive any written or training material between pretest and posttest. Results: A total of 108 (80%) completed the evaluation questionnaire, pretest, and posttest. For the pretest, average grade was 4.25 (SD = 1.71) and 42% passed, and for the posttest, average grade was 8.33 (SD = 1.28) and 97 % pass (P < 0.0001). All variables measuring methodology perception scored more than 8, except for the duration of the exercise (7.3). Most knowledge acquisition scored above 9. Self-perception skill acquisition scores were slightly lower, although all above 7. Conclusions: “Table-top” methodology is useful for acquiring knowledge and skills related to MCI response. Retention of knowledge is very high. Students consider that this methodology can be very useful for medical studies. Active or nonactive role is a factor that only influences final results in specific items.

This paper provides a comprehensive set of methodologies that have been used in the literature to give a monetary value to the human impact in a natural disaster setting. Four databases were searched for relevant published and gray literature documents with a set of inclusion and exclusion criteria. Twenty-seven studies that quantified the value of a statistical life in a disaster setting or discussed methodologies of estimating value of life were included. Analysis highlighted the complexity and variability of methods and estimations of values of statistical life. No single method to estimate the value of a statistical life is universally agreed upon, although stated preference methods seem to be the preferred approach. The value of one life varies significantly ranging from USD 143,000 to 15 million. While an overwhelming majority of studies concern high-income countries, most disaster casualties are observed in low- and middle-income countries. Data on the human impact of disasters are usually available in disasters databases. However, lost lives are not traditionally translated into monetary terms. Therefore, the full financial cost of disasters has rarely been evaluated. More research is needed to utilize the value of life estimates in order to guide policymakers in preparedness and mitigation policies.

Dynamic complexity is often a characteristic of public health issues; to visualize these problems as a system rather than isolated elements, system dynamics modeling may be an appropriate tool. The dynamic complexity of risk factors for lymphatic filariasis (LF) as an urban vector-borne disease has been addressed using system dynamics methodology. Some causal loop diagrams (CLDs) were designed to display the network of interactions of risk factors for urban transmission of LF and a potential set of public health interventions. A stock and flow diagram was also designed to capture the transmission dynamics as an accumulation and flow system, and a simulation model was built and executed. The system dynamics (SD) methodology is suitable for addressing the dynamic complexity of risk factors for LF in urban settings and is well-suited for public health interventions.

Zabihulah Abid, Rafael Castro Delgado, José Antonio Cernuda Martinez, Pedro Arcos González Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Oviedo, SpainCorrespondence: Pedro Arcos González, Unit for Research in Emergency and Disaster, Faculty of Medicine, 7th Floor, Campus del Cristo, Oviedo, 33006, Spain, Tel +34 985103545, Email arcos@uniovi.esBackground: The COVID-19 pandemic, declared by the World Health Organization as a public health international emergency concern in March 2020, has caused serious impacts on individuals, families, communities, and societies across the globe. The COVID-19 pandemic not only disrupted the health systems and the economy, but also significantly impacted routine immunization programs.Aim: To study the impact of the COVID-19 pandemic lockdown on the routine immunization coverage program in the province of Laghman, Afghanistan.Methods: A comparative cross-sectional quantitative study was conducted to understand the impact of COVID-19 on routine childhood immunization during the study period. Secondary data was used from the Ministry of Health from April to July 2020 and compared with the historical data of the same period in 2019. Student t-test was used to test the association between the mean changes in the daily immunization coverage. A p-value< 0.05 was considered as statistically significant with 95% confidence interval.Results: There was a 21.4% significant (p< 0.01) decline in the total immunization coverage during April–July 2020 compared to April–July 2019. This reduction was diverse across all districts and all vaccine antigens. The most affected district was Alingar, and the most affected vaccines were measles and OPV4, with 28% declines, followed by PCV3 at 26%, and DPT3, IPV, OPV3, PCV2 and rotavirus at 23%. The outreach vaccination coverage declined by 56.1% compared to the fixed, at 13.4%.Conclusion: The COVID-19 pandemic seriously affected the routine immunization in Afghanistan. On average, 325 children per day missed out on a lifesaving vaccine in Laghman province which put them at risk of getting preventable diseases. To provide access to routine immunization during pandemics, the study suggests a set of customized interventions to strengthen and sustain routine immunization.Keywords: vaccination, children, COVID-19, pandemics, lockdown

More than half of the world population lives in the cities and around one billion in poor urban areas. These numbers are projected to increase, while Sub-Saharan Africa is the region with the highest rate of informal settlements due his rapid urbanization. The urban informal settlements of Sub-Saharan Africa house everyday health risks. These risks have considerable cumulative impacts on the wellbeing and health of the urban vulnerable group. Despite the public health consequences of urbanization and the increase of informal settlements number in African cities, there is a paucity in data about the risks at small scale and the vulnerability in poor urban areas. Through the database search engine of MEDLINE, WHO Library and Information Networks for Knowledge and website of Urban Africa Risk Knowledge; from information of the existing literature, this paper tried to analyse the everyday health risks, and vulnerabilities in urban informal settlement in Sub-Saharan Africa region. A search combining keywords associated with health risks and informal settlement in Sub-Saharan Africa were used to identify the relevant documents, and this search yielded 86 articles, of which 15 met the criteria for inclusion in the analysis. The risks of communicable diseases due to inadequate sanitation have been the most frequent subjects of study. Informal settlers in Sub-Saharan Africa face everyday health risks arising from lack of clean water, adequate sanitation, and life in overcrowding houses. Consequently, there is a burden of communicable and non-communicable diseases, undernourishment and injuries. The most vulnerable group is children under five with a high rate of mortality. Everyday health risks in urban informal settlements must be taken into account for a better understanding of the full spectrum of urban risks. This is essential in the establishment of efficient public health policies and intervention in urban areas.

Introduction:Ebola Virus Disease (EVD) is the international health emergency paradigm due to its epidemiological presentation pattern, impact on public health, resources necessary for its control, and need for a national and international response.Study Objective:The objective of this work is to study the evolution and progression of the epidemiological presentation profile of Ebola disease outbreaks since its discovery in 1976 to the present, and to explore the possible reasons for this evolution from different perspectives.Methods:Retrospective observational study of 38 outbreaks of Ebola disease occurred from 1976 through 2019, excluding laboratory accidents. United Nations agencies and programs; Ministries of Health; the US Centers for Disease Control and Prevention (CDC); ReliefWeb; emergency nongovernmental organizations; and publications indexed in PubMed, EmBase, and Clinical Key have been used as sources of data. Information on the year of the outbreak, date of beginning and end, duration of the outbreak in days, number of cases, number of deaths, population at risk, geographic extension affected in Km2, and time of notification of the first cases to the World Health Organization (WHO) have been searched and analyzed.Results:Populations at risk have increased (P = .024) and the geographical extent of Ebola outbreaks has grown (P = .004). Reporting time of the first cases of Ebola to WHO has been reduced (P = .017) and case fatality (P = .028) has gone from 88% to 62% in the period studied. There have been differences (P = .04) between the outbreaks produced by the Sudan and Zaire strains of the virus, both in terms of duration and case fatality ratio (Sudan strain 74.5 days on average and 62.7% of case fatality ratio versus Zaire strain with 150 days on average and 55.4% case fatality ratio).Conclusion:There has been a change in the epidemiological profile of the Ebola outbreaks from 1976 through 2019 with an increase in the geographical extent of the outbreaks and the population at risk, as well as a significant decrease in the outbreaks case fatality rate. There have been advances in the detection and management capacity of outbreaks, and the notification time to the WHO has been reduced. However, there are social, economic, cultural, and political obstacles that continue to greatly hinder a more efficient epidemiological approach to Ebola disease, mainly in Central Africa.

Alexandre Zerbo, Rafael Castro Delgado, Pedro Arcos González Unit of Research in Emergency and Disaster, Department of Medicine, Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Asturias, SpainCorrespondence: Alexandre Zerbo, Unit of Research in Emergency and Disaster, Department of Medicine, Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Asturias, 33006, Spain, Email crateva@yahoo.frAbstract: In sub-Saharan Africa, many urban dwellers are at risk of faecal-orally transmitted diseases due to unplanned and growing urbanization with inadequate sanitation. Making it essential to understand the urban transmission of these diseases and the associated responses. This perspective paper discussed an approach to design a diagram of transmission dynamic from a combination of an urban exposome framework and transmission of faecal-oral diseases. The result is an exposome diagram displaying the interconnection of exposure components and potential barriers to stop the transmission of faecal-oral diseases in the urban area subdivided into public, domestic and individual. As an exposome diagram, it helps to follow the dynamics of exposure over time and to plan targeted surveillance and intervention.Keywords: faecal oral diseases, transmission dynamic, exposome diagram, urban areas, sub- Saharan Africa

Objective:The objective of this study was to identify the perceived problems by medical and nursing professionals that have arisen in the Spanish Emergency Medical Services (EMS) as a consequence of the first wave of the severe acute respiratory syndrome-coronavirus-2/SARS-CoV-2 pandemic, as well as the measures or solutions adopted to manage those problems and improve response.Method:This was a cross-sectional study of quantitative and qualitative methodology (“mixed methods”) using a self-administered questionnaire in 23 key informants of EMS of Spain selected by purposeful sampling, followed by the statistical analysis of both types of variables and an integration of the results in the discussion.Results:Common problems had been identified in many EMS, as well as similar solutions in some of them. Among the former, the following had been found: lack of leadership and support from managers, initial shortage of personal protective equipment (PPE), lack of participation in decision making, initial lack of clinical protocols, and slowness and/or lack of adaptability of the system, among others. Among the solutions adopted: reinforcement of emergency call centers, development of specific coronavirus disease 2019 (COVID-19) telephone lines and new resources, personal effort of professionals, new functions of EMS, support to other structures, and reinforcement of the role of nursing.Conclusion:The general perception among the respondents was that there was a lack of support and communication with health care managers and that the staff expertise was not used by policy makers to make decisions adapted to reality, also expressing the need to improve the capacity for analysis of the EMS response. Few respondents reported good overall satisfaction with their EMS response. The EMS adopted different types of measures to adapt to the COVID-19 pandemic.

This work was supported by the University of Nicosia Medical School (internal funding)., Achilleos S, Quattrocchi A, Gabel J, Heraclides A, Kolokotroni O, Constantinou C, Pagola Ugarte M, Nicolaou N, Rodriguez-Llanes JM, Bennett CM, Bogatyreva E, Schernhammer E, Zimmermann C, Costa AJL, Lobato JCP, Fernandes NM, Semedo-Aguiar AP, Jaramillo Ramirez GI, Martin Garzon OD, Mortensen LH, Critchley JA, Goldsmith LP, Denissov G, Rüütel K, Le Meur N, Kandelaki L, Tsiklauri S, O'Donnell J, Oza A, Kaufman Z, Zucker I, Ambrosio G, Stracci F, Hagen TP, Erzen I, Klepac P, Arcos González P, Fernández Camporro Á, Burström B, Pidmurniak N, Verstiuk O, Huang Q, Mehta NK, Polemitis A, Charalambous A, Demetriou CA.

To analyze the association between the perceived care demand in the emergency call center of Castilla La Mancha (and hospital and ICU admissions for COVID-19, as well as their temporal characteristics, to explore its potential capacity as a predictive tool for COVID hospital admissions.Retrospective observational study on the daily calls made to the emergency call center of Castilla La Mancha, both calls to 112 and those made to COVID line, in the period between March 1 and October 14, 2020. The data were analyzed by codes "diarrhea", "dyspnea", "fever" and "general discomfort" that were used as predictor variables, and their relationship with hospital admissions and ICU admissions.A total of 831,943 calls were received at the CLM emergency call center through 112, with a maximum on March 13, 2020 with 10,582 calls. On COVID line, a total of 208,803 calls were received in that period, with a maximum on March 15 with 23,744. A statistically significant relationship was found between the regulation codes studied (specific symptoms) and the number of calls with hospital admissions and ICU admissions, with a predictive capacity of 2 weeks in relation to occupancy peaks. The codes with the greatest relationship were "general malaise" and "diarrhea".We have found an association between the number of calls to a CCUE due to dyspnea, fever, general discomfort, diarrhea and the number of calls with hospital admissions and ICU for COVID-SARS-2 2 weeks in advance, mainly due to general discomfort and diarrhea. The design of predictive expert systems and their automation using artificial intelligence could be part of the preparation, planning and anticipation programs of health systems in the near future in the event of future pandemics.Analizar la asociación entre la demanda asistencial percibida en el Centro Coordinador de Urgencias y Emergencias (CCUE) de Castilla La Mancha (CLM) y los ingresos hospitalarios y en unidades de cuidados intensivos (UCI) por COVID-19, así como sus características temporales, para valorar la potencial aplicación como herramienta predictiva de ingresos por COVID-19.Estudio observacional retrospectivo de las llamadas diarias realizadas al CCUE de CLM entre el 1 de marzo y el 14 de octubre de 2020. Se analizaron los códigos “diarrea”, “disnea”, “fiebre” y “malestar general” que fueron usados como variables predictoras, y su relación con los ingresos hospitalarios y en UCI.A través del 112 se recibieron 831.943 llamadas (máximo el 13 de marzo: 10.582 llamadas). En la línea 900 fueron 208.803 llamadas (máximo el 15 de marzo: 23.744 llamadas). Se encontró una relación estadísticamente significativa entre los códigos de regulación estudiados y el número de llamadas con los ingresos hospitalarios y en UCI, con una capacidad predictora de 2 semanas en relación a los picos de ocupación. Los códigos con mayor relación fueron “malestar general” y “diarrea”.Se encontró una asociación entre el número de llamadas a un CCUE por disnea, fiebre, malestar general y diarrea y el número de llamadas con los ingresos hospitalarios y en UCI por COVID-19 con una antelación de 2 semanas, principalmente por malestar general y diarrea. El diseño de sistemas expertos predictivos y su automatización mediante inteligencia artificial podría formar parte de los programas de preparación, planificación y anticipación de los sistemas de salud ante futuras pandemias.

Introduction:The Richter Scale measures the magnitude of the seismic activity for an earthquake; however, it does not quantify the humanitarian need at the point of impact. This poses a challenge for humanitarian stakeholders in decision and policy making, especially in risk reduction, response, recovery, and reconstruction. The new disaster metrics tool titled “The YEW Disaster Severity Index” (DSI) was developed and presented at the 2017 World Congress of Disaster and Emergency Medicine, May 2017, Toronto, Canada. It uses a median score of three for vulnerability and exposure indicators, a median score percentage of 100%, and medium YEW DSI scoring of four to five as baseline, indicating the ability to cope within local capacity. Therefore, scoring more than baseline coping capacity indicates that external assistance is needed. This special real-time report was presented at the 2nd National Pre-Hospital Care Conference and Championship, October 2018, Malaysia.Report:The aim of this analysis is to present the real-time humanitarian impact and response to the 2018 earthquake and tsunami at Donggala and Palu, Sulawesi in Indonesia using the new disaster metrics YEW DSI. Based on the earthquake (measuring 7.7 on the Richter Scale) and tsunami at Donggala, the humanitarian impact calculated on September 29, 2018 scored 7.4 High in the YEW DSI with 11 of the total 17 indicators scoring more than the baseline coping capacity. The same YEW DSI score of 7.4 was scored on the earthquake and tsunami at Palu, with 13 of the total 17 indicators scoring more than baseline ability to cope within local capacity. Impact analysis reports were sent to relevant authorities on September 30, 2018.Discussion & Conclusion:A State of Emergency was declared for a national response, which indicated an inability to cope within the local capacity, shown by the YEW DSI. The strong correlation between the earthquake magnitude, intensities, and the humanitarian impact at Donggala and Palu reported could be added into the science of knowledge in prehospital care and disaster medicine research and practice. As a conclusion, the real-time disaster response was found to be almost an exact fit with the YEW DSI indicators, demonstrating the inability to cope within the local capacity.

Sub-Saharan African countries, like many other low-income countries, have experienced urban socioeconomic inequalities due to rapid and unplanned urbanization. These processes have resulted in the creation of poor urban areas lacking basic sanitation, water, and hygiene facilities, and subjacent public health issues such as the spread of waterborne diseases. A system for the demarcation of disease transmission areas already exists, but the traditional framework is less appropriate in sub-Saharan Africa, making it necessary to divide these urban areas more adequately. In addition, the construction of frameworks and tools more specific to waterborne disease-related issues is essential. We propose restructuring sub-Saharan urban areas into more specific areas of exposure to waterborne diseases and associated exposomes, and then use this restructuring of urban areas of exposure to waterborne diseases in a conceptual framework that takes into account causes of exposure, impacts, and interventions. The division of urban areas into public, domestic, and individual exposure areas facilitates a more straightforward understanding of the dynamics of waterborne exposomes. Moreover, the inclusion of this division in the driving force–pressure–state–exposure–effect–action framework allows an effective stratified implementation of urban public health policies.

Sub-Saharan Africa (SSA) has a rapidly growing urban population, with water, sanitation, and hygiene (WASH) services representing the central needs for this population. Incidentally, this region has the lowest global WASH coverage. Data from the ‘WHO/UNICEF Joint Monitoring Programme for Water supply, Sanitation and Hygiene’ and the ‘Global Burden of Disease’ study from the Institute for Health Metrics and Evaluation were used to assess WASH coverage and related health burden in SSA, its subregions, and rural and urban areas in SSA. WASH coverage in the SSA region appears to be low, but urban coverage is better than that in rural areas; however, there is unequal access to urban WASH and poor urban areas are underserved. In addition, 7.75% (5.99–9.7%) of total deaths due to diarrheal diseases across SSA are attributed to unsafe WASH with a risk factor attribution (RFA) percentage of 95.93% (91.94–98.24%). Therefore, a correlation between WASH coverage and mortality due to diarrheal diseases could be established.There is a lack of data on WASH coverage in poor urban areas, although these areas have high incidence of WASH-related diseases including diarrhea. Disaggregated urban WASH data are needed to better understand the WASH service needs of poor urban areas, which would be helpful in ensuring a more inclusive implementation of WASH services.

To study nurse staffing at emergency response coordination centers (ERCCs) and determine nurses' functions and activities within the structure and organization of ERCCs.Observational cross-sectional study in January and April 2019 in the 17 Spanish autonomous communities and the autonomous cities of Ceuta and Melilla. We consulted ERCC institutional reports and webpages, conducted telephone interviews, and maintained email correspondence with key informants (nurse supervisors and staff directly implicated in managing emergency calls).All the ERCCs except those in Asturias, Rioja, and the 2 autonomous cities have nurses on staff. Their usual functions are prevention and health promotion; supporting primary care physicians; managing health alerts, multiple victim incidents, and secondary patient transport; activating response codes; coordinating transport for transplants; and contacting hospitals so they expect arrivals.Nurses in Spanish ERCCs have similar functions, but they are developed at different levels in each center.Conocer la dotación de personal de enfermería de los centros de coordinación de urgencias (CCU) españoles, así como las funciones y actividades de los profesionales dentro de la estructura y organización de los CCU.Estudio observacional transversal realizado entre enero y abril del 2019 mediante consulta de la información institucional en memorias y páginas web de los servicios de emergencia, así como entrevistas telefónicas y correos electrónicos a informantes clave (responsables de enfermería o profesionales implicados directamente en la gestión de llamadas) de las 17 comunidades autónomas (CCAA) y las ciudades autónomas de Ceuta y Melilla.Todas las CCAA, excepto Asturias, La Rioja y las dos ciudades autónomas, tienen personal de enfermería cuyas funciones más habituales son la prevención y promoción de la salud, atención a consultas sanitarias, apoyo a atención primaria, alertas epidemiológicas, gestión de incidentes de múltiples víctimas, transporte secundario, activación de códigos asistenciales, coordinación de trasplantes y preavisos hospitalarios.El personal de enfermería en los CCU de España tiene funciones similares, pero con distinto nivel de desarrollo en cada CCAA.

Burkina Faso is a West African Sahelian country with climate-related risks because the disaster risk profile, and drought and floods are the main damaging natural disasters, aggravated by the phenomenon of climate change. An effective design and implementation of disaster reduction management strategies requires an understanding of risk factors and vulnerabilities, but also and an assessment of the strengths and weaknesses of national disaster response systems.In this perspective, a literature review and an analysis of climate information were conducted in order to reveal the risks and vulnerabilities to droughts and floods in the country. This was accompanied by a critical evaluation of the performance of the national prevention and intervention system.Vulnerabilities to drought and floods are exacerbated by the combined effect of climate change and the low performance of the national disaster risk reduction management system. National institutions and frameworks exist for disaster prevention and management, but difficulties persist in implementation due to financial constraints and insufficient human skills. Current trends and estimates suggest that the drawbacks of these natural hazards may be more serious in the future if solutions are not taken to improve early warning forecasts, infrastructure and the implementation of adequate agricultural policies.

ObjectivesThe Richter Scale measures the magnitude of a seismic occurrence, but it does not feasibly quantify the magnitude of the “disaster” at the point of impact in real humanitarian needs, based on United Nations International Strategy for Disaster Reduction (UNISDR; Geneva, Switzerland) 2009 Disaster Terminology. A Disaster Severity Index (DSI) similar to the Richter Scale and the Mercalli Scale has been formulated; this will quantify needs, holistically and objectively, in the hands of any stakeholders and even across timelines.BackgroundAn agreed terminology in quantifying “disaster” matters; inconsistency in measuring it by stakeholders posed a challenge globally in formulating legislation and policies responding to it.MethodsA quantitative, mathematical calculation which uses the median score percentage of 100% as a baseline, indicating the ability to cope within the local capacity, was used. Seventeen indicators were selected based on the UNISDR 2009 disaster definition of vulnerability and exposure and holistic approach as a pre-condition. The severity of the disaster is defined as the level of unmet needs. Thirty natural disasters were tested, retrospectively, and non-parametric tests were used to test the correlation of the DSI score against the indicators.ResultsThe findings showed that 20 out of 30 natural disasters tested fulfilled the inability to cope, within local capacity in disaster terminology. Non-parametric tests showed that there was a correlation between the 30 DSI scored and the indicators.ConclusionBy computing a median fit percentage score of 100% as the ability to cope, and the correlation of the 17 indicators, in this DSI Scale, 20 natural disasters fitted into the disaster definition. This DSI will enable humanitarian stakeholders to measure and compare the severity of the disaster objectively, as well as enable future response to be based on needs.YewYY, Castro DelgadoR, HeslopDJ, Arcos GonzálezP. The Yew Disaster Severity Index: a new tool in disaster metrics. Prehosp Disaster Med. 2019;34(1):8–19.

To assess the training received in Emergency Medicine (EM) by the Primary Health Care physicians of Asturias, as well as their perception of their own theoretical knowledge and practical skills in a series of procedures employed in life-threatening emergencies, and also to analyze the differences according to gender. The degree of preparation of Primary Health Care physicians for handling emergencies, according to the gender of the professionals, has never been studied before.Cross-sectional study of a sample of 213 Primary Health Care physicians from the Primary Health Care Service of Asturias, Spain, from among the total of 851 physicians on the staff of the Primary Health Care Service of Asturias. The survey was design ad hoc using the Body of Doctrine of Emergency Medicine proposed by the Spanish Society of Emergency Medicine, which indicates the theoretical and practical procedures that must be mastered by the Primary Health Care physicians.There are nonsignificant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied depending on the gender.Female and male Asturian Primary Health Care physicians are generally well prepared to handle life-threatening emergencies. The degree of self-perception and acquisition of general theoretical knowledge and general practical skills for handling life-threatening emergencies is heterogeneous, and differences according to gender are not statistically significant.

Introduction:Within out-of-hospital emergencies, Primary Health Care (PHC) pediatricians will likely be the first to provide health care at the scene of a life-threatening emergency (LTE) in children. Pediatricians should be trained to initially intervene, safely and effectively the LTEs, including the activation of Emergency Medical Systems (EMS), an adequate stabilization of patients and transport to the hospital.Study Objectives:The aims of this study are to know the training received for out-of-hospital LTEs by PHC pediatricians of the Principality of Asturias (Spain) and the perception they have about their own theoretical knowledge and practical skills in a series of emergency procedures used in LTEs; also, to analyze the differences according to the geographical context of their work.Methods:This was a cross-sectional, descriptive, and observational study of a sample of 27 PHC pediatricians from PHC Service of Asturias, Spain, from among the total of 88 pediatricians who make up the staff of pediatricians, conducted from April through May 2019. The survey was designed ad hoc using the Curriculum in Primary Care Pediatrics (CPCP) proposed by the European Confederation of Primary Care Pediatricians (ECPCP; Europe), which indicates the theoretical and practical procedures that must be acquired by the PHC pediatricians. It is composed of 30 procedures or techniques employed in LTEs using a 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to 10 (“Maximum”).Results:There are significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.Conclusion:Asturian pediatricians are generally well-prepared to solve LTEs with a few exceptions. The degree of self-perception and acquisition of general theoretical knowledge and general practical skills in LTEs is heterogeneous, with differences according to the scope of work.

Se evaluó el efecto de distintos niveles de cobre (II) sobre la velocidad específica de crecimiento de Trametes villosa en medio PDA 4% y medio PDA 4% con 25% (v/v) de vinaza. La velocidad específica de crecimiento se obtuvo a partir de los datos de área micelial y de la ecuación para el modelo logístico de crecimiento. Las mejores condiciones para el crecimiento micelial fueron PDA 4% con 25% (v/v) de vinaza y niveles de cobre divalente de 0,5 y 1,0 mM. Estos resultados indican que, de acuerdo con las condiciones de cultivo utilizadas, ambos suplementos favorecen el crecimiento micelial y entregan información esencial para el desarrollo de potenciales procesos de reutilización y valorización de la vinaza. The effect of different levels of copper (II) on the specific growth rate of Trametes villosa was evaluated. The strain was grown on 4% PDA and 4% PDA on a 25% (v/v) vinasse dilution. The specific growth rate was obtained from the mycelial area data which was modeled with the logistic equation. The best growth condition was 4% PDA in a 25% (v/v) vinasse dilution with copper (II) concentrations of 0.5 and 1.0 mM. These results indicate that under the utilized culture conditions, both supplements favor mycelial growth and provide essential information for potential processes of vinasse reuse and valorization.

Background In mass casualty incidents (MCI), death usually occurs within the first few hours and thus early transfer to a trauma centre can be crucial in selected cases. However, most triage systems designed to prioritize the transfer to hospital of these patients do not assess the need for surgery, in part due to inconclusive evidence regarding the value of such an assessment. Therefore, the aim of the present study was to evaluate the capacity of a new triage system—the Prehospital Advanced Triage Method (META)—to identify victims who could benefit from urgent surgical assessment in case of MCI. Methods Retrospective, descriptive, observational study of a multipurpose cohort of patients included in the severe trauma registry of the Gregorio Marañón University General Hospital (Spain) between June 1993 and December 2011. All data were prospectively evaluated. All patients were evaluated with the META system to determine whether they met the criteria for urgent transfer. The META defines patients in need of urgent surgical assessment: (a) All penetrating injuries to head, neck, torso and extremities proximal to elbow or knee, (b) Open pelvic fracture, (c) Closed pelvic fracture with mechanical or haemodynamic instability and (d) Blunt torso trauma with haemodynamic instability. Patients who fulfilled these criteria were designated as “Urgent Evacuation for Surgical Assessment” (UESA) cases; all other cases were designated as non-UESA. The following variables were assessed: patient status at the scene; severity scales [RTS, Shock index, MGAP (Mechanism, Glasgow coma scale, Age, pressure), GCS]; need for surgery and/or interventional procedure to control bleeding (UESA); and mortality. The two groups (UESA vs. non-UESA) were then compared. Results A total of 1882 cases from the database were included in the study. Mean age was 39.2 years and most (77%) patients were male. UESA patients presented significantly worse on-scene hemodynamic parameters (systolic blood pressure and heart rate) and greater injury severity (RTS, shock index, and MGAP scales). No differences were observed for respiratory rate, need for orotracheal intubation, or GCS scores. The anatomical injuries of patients in the UESA group were less severe but these patients had a greater need for urgent surgery and higher mortality rates. Conclusion These findings suggest that the META triage classification system could be beneficial to help identify patients with severe trauma and/or in need of urgent surgical assessment at the scene of injury in case of MCI. These findings demonstrate that, in this cohort, the META fulfils the purpose for which it was designed. Sin financiación 3.693 JCR (2020) Q1, 6/32 Emergency Medicine 0.641 SJR (2020) Q2, 30/88 Critical Care and Intensive Care Medicine No data IDR 2020 UEM

Summary: The current spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Europe threats Italian’s capacity and that of other national health systems to effectively respond to the needs of patients who require intensive care, mostly due to pneumonia and derived complications from concomitant disease and age. Predicting the surge in capacity has proved difficult due to the requirement of a subtle combination of diverse expertise and difficult choices to be made on selecting robust measures of critical care utilization, and parsimonious epidemic modelling which account for changing government measures. We modelled the required surge capacity of ICU beds in Italy exclusively for COVID-19 patients at epidemic peak. Because new measures were imposed by the Italian government, suspending nearly all non-essential sectors of the economy, we included the potential impacts of these new measures. The modelling considered those hospitalized and home isolated as quarantined, mimicking conditions on the ground. The percentage of patients in intensive care (out of the daily active confirmed cases) required for our calculations were chosen based on clinical relevance and robustness, and this number was consistently on average 9·9% from February 24 to March 6, 2020. Five different scenarios were produced (two positive and three negative). Under most positive scenarios, in which R0 is reduced below 1 (i.e., 0 ·71), the number of daily active confirmed cases will peak at nearly 89 000 by the early days of April and the total number of intensive care beds exclusively dedicated to COVID-19 patients required in Italy estimated at 8791. Worst scenarios produce unmanageable numbers. Our results suggest that the decisive moment for Italy has come. Jointly reinforcement by the government of the measures approved so far, including home confinement, but even more important the full commitment of the civil society in respecting home confinement, social distancing and hygiene will be key in the next days. Yet, even under the best circumstances, intensive care capacity will need to get closer to 9000 units in the country to avoid preventable mortality. So far, only strong measures were effective in Italy, as shown by our modelling, and this may offer an opportunity to European countries to accelerate their interventions. Funding Statement: Activity at University of Padova was partly supported by MIUR (Italian Minister for Education) under the initiative "Departments of Excellence" (Law 232/2016). Declaration of Interests: The authors declare no competing interests.

Background:Within out-of-hospital emergencies, primary health care (PHC) nurses must face life-threatening emergencies (LTEs), which are defined as “a situation associated with an imminent life risk that entails the start-up of resources and special means to resolve the situation.”Objectives:The objectives of this study were to know the training received for out-of-hospital LTEs by PHC nurses of Asturias, Spain and the perception they have about their theoretical knowledge and practical skills in a series of emergency procedures or techniques used in LTE emergencies; as well as to analyze the differences according to the geographical area of their work.Design:Cross-sectional, descriptive, and observational study was conducted in 2018 of a sample of PHC service nurses of Asturias, Spain.Methods:A total of 236 nurses from PHC service centers of Asturias, Spain, from among the total of 730 nurses who make up the staff of nurses of the PHC service of Asturias, between April and May 2018, were surveyed. The survey was designed ad hoc using the Doctrinal Body of Emergency Nursing (DBEN) proposed by the Spanish Society of Emergency Medicine (SEMES; Madrid, Spain), which indicates the theoretical and practical procedures that must be acquired by the PHC nurses. It is composed of 37 procedures or techniques employed in LTEs using an 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to ten (“Maximum”).Results:There were significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.Conclusions:All PHC nurses must be perfectly trained to provide initial quality assistance to the LTE, with both theoretical and practical knowledge of the different techniques, so that it can continue to be attended by the corresponding Emergency Service.