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An under-developed and fragmented prehospital Emergency Medical Services (EMS) system is a major obstacle to the timely care of emergency patients. Insufficient emphasis on prehospital emergency systems in low- and middle-income countries (LMICs) currently causes a substantial number of avoidable deaths from time-sensitive illnesses, highlighting a critical need for improved prehospital emergency care systems. Therefore, this systematic review aimed to assess the prehospital emergency care services across LMICs. This systematic review used four electronic databases, namely: PubMed/MEDLINE, CINAHL, EMBASE, and SCOPUS, to search for published reports on prehospital emergency medical care in LMICs. Only peer-reviewed studies published in English language from January 1, 2010 through November 1, 2022 were included in the review. The Newcastle-Ottawa Scale (NOS) and Critical Appraisal Skills Programme (CASP) checklist were used to assess the methodological quality of the included studies. Further, the protocol of this systematic review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (Ref: CRD42022371936) and has been conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Of the 4,909 identified studies, a total of 87 studies met the inclusion criteria and were therefore included in the review. Prehospital emergency care structure, transport care, prehospital times, health outcomes, quality of information exchange, and patient satisfaction were the most reported outcomes in the considered studies. The prehospital care system in LMICs is fragmented and uncoordinated, lacking trained medical personnel and first responders, inadequate basic materials, and substandard infrastructure.

Introduction:Mass gathering events (MGE), can attract sufficient attendees to strain the planning and response resources of the host community, state, or nation, thereby delaying the response to emergencies. The organization of such a MGE can be even more problematic when the event continues across much of downtown (including hospitals) and makes some parts of the city inaccessible. The aim of this study was describing the health care management of the Grand Départ of the Tour de France, July 6-7th, 2019. On both days, the stages drew crowds of 300,000 attendees, adding a quarter of the regular number of inhabitants of Brussels (1,2 million) and closing parts of downtown Brussels.Method:Data were retrospectively collected from the in-event health services (coordinated by the University Hospital Brussels). Data regarding medical interventions, as well as data generated by the advanced medical posts (AMP) were recorded and handed to us after anonymization. For analysis, patients were divided into two groups: those seen by first-aid responders and paramedics (triage code green) and those seen and treated by health professionals (emergency nurses and physicians) (triage codes yellow or red).Results:During the event, three AMPs were established along the route of the stage as were six ambulances, three mobile medical crews (one emergency nurse and one physician), and seven mobile first aid teams. Over the two days, 84 patients were seen; 80 green codes (95,2%), 3 yellow (3,6%), and one red (1,2%) resulting in a patient presentation rate of 0.28/1,000. In total eight patients were transported to hospital for further diagnosis and treatment (ambulance transfer rate: 0.02/1,000).Conclusion:In-event health services for this event proved adequate according to the number of attendees and the severity of the patients. No hospital reported disruptions to their standard operational capacity.

Background: On 16 January 2021 (EB148/18 Session), the World Health Organization (WHO) and Member States emphasized the importance of expanding the WHO Emergency Medical Teams (EMT) Initiative, investing in a global health workforce and multidisciplinary teams capable of being rapidly deployed, equipped, and fully trained to respond to all-hazard emergencies effectively. This resulted in the need to define a comprehensive framework. To achieve this, the EMT Initiative proposes the application of the four components of Surge Capacity, known as the 4“S” (Staff, Systems, Supplies, and Structure/Space), to build global capacities and capabilities, ensuring rapid mobilization and efficient coordination of national and international medical teams for readiness and response, complying with crisis standards of care defined in an ethical and evidence-based manner. Methods: A mixed-qualitative research approach was used, incorporating expert consensus through focus group discussions (FGDs), between 2021 and July 2022. This facilitated a detailed process analysis for the application of the surge capacity components to build global capacities and capabilities. This research highlighted the similarities between surge capacity and capacity building from an initial desk review and unified these concepts within the EMT Initiative. A standardized formal pathway was developed to enhance local, regional, and global capacities for emergency readiness and response. Results: The results showed that the framework successfully integrated the essential components of surge capacity and capacity building, making it adaptable to various settings. Conclusions: This framework provides a unified and replicable approach for readiness and response for all-hazards emergencies.

Introduction:Electronic dance music festivals (EDMF) are a unique subset of music mass gatherings. Besides the already more significant burden on in-event health services (IEHS) that comes with these festivals, EDMF are also known for their illicit drug use, with their attendees at high risk for illegal drug use.Method:Encounter data from all patients seen and treated by IEHS at an annual outdoor multi-day EDMF (focused on hardstyle dance music) in August 2019 were analyzed. Based on the chief complaint, and medical and nursing notes, a list was consolidated into 31 reasons for the consultation of IEHS. The most common reasons for consulting IEHS were analyzed.Results:This outdoor hardstyle dance event had 30,000 attendees, of which 580 visited IEHS. This resulted in a patient presentation rate of 19.3/1,000 attendees. Four were transported to the hospital (transport to hospital rate: 0.13/1,000 attendees). The most prevalent reason to consult IEHS were lacerations and abrasions (9.66%), sprains (9.48%), and headaches (7.59%). Only 4.83% of all patients (n = 12) presented with adverse effects of illicit drug use. Of interest is that twelve patients with intoxications (42.86% of all intoxicated patients) were initially triaged as life-threatening, mainly due to obstructed airways. Only one of these twelve needed endotracheal intubation and was transported to the hospital. All other intoxicated patients returned to the event. No direct relationship between gender and the chief complaint was found.Conclusion:Besides typical patient presentations, illicit drug use with its adverse effects can seriously impact IEHS. These results confirm the need for highly trained (Advanced life support level) IEHS at EDMF. Competent IEHS can mitigate the burden of these events on regular EMS.

As heatwaves increase and intensify worldwide, so has the research aimed at outlining strategies to protect individuals from their impact. Interventions that promote adaptive measures to heatwaves are encouraged, but evidence on how to develop such interventions is still scarce. Although the Health Belief Model is one of the leading frameworks guiding behavioral change interventions, the evidence of its use in heatwave research is limited. This rapid review aims to identify and describe the main themes and key findings in the literature regarding the use of the Health Belief Model in heatwaves research. It also highlights important research gaps and future research priorities. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 10 articles were included, with a geographic distribution as follows: United States (n = 1), Australia (n = 1), Pakistan (n = 1), and China (n = 1), as well as Malaysia (n = 2), Germany (n = 1), and Austria (n = 1). Results showed a lack of research using the Health Belief Model to study heatwaves induced by climate change. Half of the studies assessed heatwave risk perception, with the 2 most frequently used constructs being Perceived Susceptibility and Perceived Severity. The Self-efficacy construct was instead used less often. Most of the research was conducted in urban communities. This review underscores the need for further research using the Health Belief Model.

Ambulatory care sensitive conditions (ACSCs) are health conditions for which appropriate primary care intervention could prevent hospital admission. ACSC hospitalization rates are a well-established parameter for assessing the performance of primary health care (PHC). Although this indicator has been extensively used to monitor the performance of PHC systems in peacetime, its consideration during disasters has been neglected. The World Health Organization (WHO) has acknowledged the importance of PHC in guaranteeing continuity of care during and after a disaster for avoiding negative health outcomes. We conducted a systematic review to evaluate the extent and nature of research activity on the use of ACSCs during disasters, with an eye toward finding innovative ways to assess the level of PHC function at times of crisis. Online databases were searched to identify papers. A final list of nine publications was retrieved. The analysis of the reviewed articles confirmed that ACSCs can serve as a useful indicator of PHC performance during disasters, with several caveats that must be considered. The reviewed articles cover several disaster scenarios and a wide variety of methodologies showing the connection between ACSCs and health system performance. The strengths and weaknesses of using different methodologies are explored and recommendations are given for using ACSCs to assess PHC performance during disasters.

Background Sepsis and septic shock are associated with high mortality and morbidity despite adequate standard care. Vitamin C deficiency is a common, potentially reversible, contributor to morbidity and mortality in sepsis. Previous studies have shown mixed and conflicting results. Our study aimed to determine the potential benefit of early administration (within 6 h after admission) of vitamin C in patients with sepsis or septic shock. Methods This was a phase 3b prospective, multicenter, double-blinded, randomized placebo-controlled trial. Participants were enrolled in the Emergency Departments of 8 hospitals throughout Belgium. Patients were randomized to receive 1.5 g of vitamin C, or matching placebo, every 6 h for 4 days. The primary outcome was the average post-baseline patient Sequential Organ Failure Assessment (SOFA) score on day 2 to 5. Key secondary outcomes were the maximum SOFA score, 28-day mortality and length of ICU and hospital stay. Results A total of 300 patients were recruited between June 4th, 2021, and August 19th, 2023. 292 patients, of which 147 were assigned to the vitamin C and 145 to the placebo group, completed the trial and were included in the analysis. The primary outcome (vitamin C, 1.98; placebo, 2.19) was 8.7% lower in the vitamin C group, but not significantly (ratio 0.91, 95% CI 0.77 to 1.08, P  = 0.30). In a planned subgroup analysis, patients with a baseline SOFA score of 6 or above had a significant lower average post-baseline SOFA score in the vitamin C group (ratio 0.76, 95% CI 0.86 to 0.99, P  = 0.042). Findings were similar in the two groups regarding secondary outcomes and adverse events, except for a lower probability of being on renal replacement therapy in the vitamin C group of the per protocol analysis (ratio 0.28, 95% CI 0.078 to 1.0, P  = 0.05). Conclusions Early treatment with vitamin C did not result in a statistically significant reduction in organ dysfunction. Therefore, this study does not support the use of vitamin C in sepsis patients. Trial registration : ClinicalTrials.gov Identifier: NCT04747795 . Registered 4 February 2021. Key Points Question Does early treatment with vitamin C lead to a less severe disease course in patients with sepsis or septic shock? Findings In this randomized clinical trial that included 292 patients, treatment with intravenous vitamin C compared to placebo did not result in a lower average post-baseline patient Sequential Organ Failure Assessment (SOFA) score on day 2 to 5 (1.98 vs 2.19), except for a subgroup of patients with a baseline SOFA score of 6 or above. Meaning Early treatment with vitamin C did not result in a significant improvement of the disease course.

IntroductionMigration is a complex global phenomenon, with millions of people relocating each year driven by various social or personal reasons. Among them, refugees and asylum seekers form a particularly vulnerable subgroup, often forced to escape conflicts, persecution or life-threatening conditions. Most mental health assessment tools, originally developed in high-income countries and validated primarily in Western populations, may lack the cultural validity needed for this demographic. The primary objective is to systematically review and synthesise the psychometric properties and cultural validity of mental health assessment tools validated for refugees and asylum seekers. Secondary objectives are to (a) identify the range of mental health symptoms these tools assess and (b) describe the geographical coverage in terms of the regions of origin and host countries where tools have been validated.Methods and analysisReported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, the review will conduct searches across different databases (ie, MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO, Global Index Medicus, CINAHL and Scopus), from inception to January 2025, with no restrictions on language. We will include validation, adaptation or diagnostic accuracy studies, as well as any other study design that reports at least one psychometric property of a mental health assessment tool. Two pairs of reviewers will screen, extract and appraise each study independently. Methodological quality will be assessed with the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Risk-of-Bias checklist for measurement studies and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) for diagnostic accuracy studies; the certainty of the evidence per property will be graded using the COSMIN-GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Narrative synthesis will be performed for all properties; where appropriate, meta-analyses will pool Cronbach’s α (Fisher-Z), intraclass correlations and sensitivity/specificity estimates using random-effects models. Inconsistency will be explored with subgroup analyses and meta-regressions; publication bias will be investigated with funnel plots and Egger’s test when ≥10 studies are available.Ethics and disseminationEthical approval is not required for this systematic review, as no empirical data will be collected. Results will be disseminated through a peer-reviewed publication in a scientific journal and presented at relevant conferences.PROSPERO registration numberCRD42024510901.

(1) Background: Colombia hosts one of the world’s largest mixed-displacement crises, combining longstanding internal displacement with the influx of Venezuelan migrants. This case study examines how the Emergency Medical Team (EMT) Hospital Barco San Raffaele (HBSR) adapted its service-delivery model to respond simultaneously to internal displacement in the Colombian Pacific region and the Venezuelan refugee influx. Using the WHO EMT Surge Capacity Framework, the study analyses how health services were adapted across two concurrent displacement contexts. (2) Methods: A mixed-methods comparative case study was conducted using mission reports, epidemiological surveillance data, policy reports and institutional documents collected between November 2020 and May 2021. Data were analyzed through a thematic analysis structured around the four domains of the WHO EMT Surge Capacity Framework (Staff, Structure, Supplies and Systems), to examine how service adaptation was operationalized across different geographic, sociocultural and legal environments; (3) Results: EMT HBSR adapted staffing composition, supply chains, infrastructure, and operational systems across both settings. Its hybrid model, combining a hospital boat platform with mobile outreach teams, enabled continuity of primary care, mental, maternal and child health, and community-based services in geographically isolated and culturally diverse communities; (4) Conclusions: The findings illustrate how flexible EMT operational models can support the adaptation of health services, and reduce health access inequalities in displacement contexts characterized by high mobility, confinement and limited health system capacity. Mobile platforms, such as hospital boats, appear to be a viable strategy for ensuring continuity of care along migratory routes and in geographically isolated areas affected by protracted instability.

Heatwaves pose an important risk for population health and are associated with an increased demand for emergency care. To find factors causing such overload, an online Delphi study included 15 experts in emergency medicine, disaster medicine, or public health. One open-ended question was delivered in the first round. After content analysis, the obtained statements were sent to the experts in two rounds to be rated on a 7-point linear scale. Consensus was defined as a standard deviation ≤ 1.0. Thirty-one statements were obtained after content analysis. The experts agreed on 18 statements, mostly focusing on the input section of patient processing and identifying stakeholders, the population, and primary care as targets of potential interventions. Additional dedicated resources and bed capacity were deemed important as per throughput and output sections, respectively. These findings could be used in the future to implement and test solutions to increase emergency healthcare resilience during heatwaves and reduce disaster risk due to climatic change.