Journal of Emergency Medicine, Trauma and Acute Care - 2 - International Conference in Emergency Medicine and Public Health-Qatar Proceedings, October 2016

Background: There are cases of ED visits with chief complaints of Shortness of Breath which are managed as a Case of Bronchial Asthma, URTI or Cardiac Origin with the total number of 13047 ED visits in Female Urgent Area in December 2014, random sample of 180 patients with complaints of SOB and diagnosed as BA, 90% were given nebulization therapy without measuring PEFR. There is 0% compliance of PEFR measurement of the staff.

Methods: Retrospective data was collected from patient's record who presented with shortness of breath from 01 December 2014 to 30 December 2014 at Emergency Department, Hamad General Hospital. Data was analyzed to find out the compliance rate of peak flow measurement. Vigorous teaching was carried out among the staff nurses in Emergency Department to improve the awareness of the peak flow measurement as a standard of care for all Asthma patients. Prospective data was collected to compare the compliance rate of post-educational period.

Results: The 50 patients who received nebulization in ED (MST, FST) were reviewed to identify the compliance rate of PEFR measurement Before, After and In-between the nebulization. Retrospective data of pre implementation phase showed poor compliance rate. (Eighteen percentage (18%) before nebulization, six percentage (6%) after nebulization and zero (0%) in between nebulization's. Prospective data of post-implementation showed tremendous improvement. The compliance rate of PEFR measurement before nebulization increased to seventy six percentage (76%), after nebulization to seventy two percentage(72%) and in between nebulization monitoring to 10%.

Conclusions: The implementation of the Peak flow project made a tremendous improvement in the staff compliance in measuring PEFR which can lead to better care and management Bronchial Asthma patients. Meticulous teaching is required to improve PEFR monitoring in between the nebulization in order to achieve 100% compliance.

Critically ill shock patients presenting to the Emergency Department (ED) in Hamad General Hospital (HGH), Doha Qatar often needs central line when fluid resuscitation fails to improve their blood pressure (BP). Triple lumen central lines are used when vasopressor or inotropic support becomes necessary. In some of these patients, a double lumen dialysis line is later inserted (often in the femoral vein), when it becomes clearer that the patient will need urgent dialysis for worsening renal function or acid-base physiology. Another clinical scenario we often encounter is when patient admitted to the ED for emergency dialysis session. Some of these patients have borderline to low BP that become obvious during the dialysis, eventually needing some vasopressor support to enable the dialysis session to be continued. More than 2 years ago we introduced the use of dialysis line with extra port (Trilyse Expert by Vygon) in the Intensive Care Unit and now its use has spread to front line ED resuscitation room. Indications for Trilyse Expert insertion are: 1. Patients who needed vasopressor or inotropic support who may need dialysis, 2. Patients who needed dialysis with borderline to low BP who may need vasopressor support during dialysis, 3. Patients who needed both dialysis and vasopressor/inotropic support on presentation to ED. In this retrospective cohort we looked into the effectiveness of Trilyse Expert inserted in our ED resuscitation room in preventing the need of a second central line insertion. We also reviewed all relevant complications related to the device and its insertion. We also conducted a systematic literature review in the use of dialysis line with extra port in critically ill patients to support our findings. Results is shown in charts and tables. Concluding better outcome when using double lumen CVC with extra port.

MERS-COV is an emerging zoonotic disease primarily originated in Arabian Peninsula, where camel industry and trade are part of the local culture and economy. Camels were proposed to be the possible reservoir. A convenient sample of 78 camel owners were interviewed through a structured questionnaire to assess their risk perception and practices. All were males, mean age of 42.5 ± 12.7 years. Most of camel owners were Qatari (94.9%), working with camels for 10 years or more (85.8%). Most of the owners are aware about the disease (93.6%), mostly from T.V (75.6%). However, only 37% of them know that the disease can be transmitted from camel to human or from human to human. The majority of owners (79.5%) had low to moderate knowledge score regarding MERS-COV. More than half of them had low perceived susceptibility to catch the disease. Perceived reasons for susceptibility were being in close contact with camels (82.2%) or exposure to camel products (76.7%). The majority (74%) feel to be protected from the disease, mostly because their farms are clean (78.1) or due to long history of working with camels without catching disease (69.9%). More than half of owners (54.8%) had high perceived severity score, and thought it can lead to hospitalization (86.3%) or death (69.9%). The most perceived protective measures were washing hands with soap and water (84.9%) and keeping away from sick people (78.1%). The most perceived barriers to using protective measures were being unavailable (56.2%), or unpractical (43.8%). Sixty percent of owners have high self -efficacy score, however, very low percentages were using protective measures (4–12%). Health education sessions should be conducted to camel owners in Qatar to increase their awareness and risk perception about MERS-COV.

Despite substantial progress emergency public health and medicine, there is no doubt that recent European Union (EU) migration crisis has provide a new dimension and complexity in public health and lives of millions are in peril, while international aid organizations are unable to effectively deal with associated emergencies. Health risks related to migration process associated with emergency or crises situations are not fully studied despite the growing number and intensity of such events. In globalization and health systems are increasingly becoming topical issues due to range of risks diseases vulnerability challenges irrespective of race, ethnic and gender across all levels of the society. The paper aimed at examining the quality of care and effectiveness of emergency public health services delivery in contemporary Mediterranean, Balkans and Africa to EU migration crisis. Our finding showed that the quality of care of migrants in emergency situations varied considerable from one entry points to another and limited optimal Emergency public health engagement and responsibility of EU members' countries. Barriers and challenges to quality care included limited health access to traveller preventive services such as vaccines, essential medicines, and basic health care, chaotic over-crowding, long queue of asylum claims, linguistics, social exclusion, limited emergency local and humanitarian staff availability, police barricades, detentions centers, culture and limited protection against pathogens dynamics, infectious diseases and importation vulnerability. In addition to decreased hygiene, unsanitary conditions, and exposure to disease vectors, increased risk of physical and sexual violence, mental distress, and scarcity of food and water. The quality care index was highly compromised particular methodological strengths and weaknesses in most camps and transitory shelters centers. In conclusion, practical and efficient evidence-based emergency public health policies, services delivery quality and effectiveness metrics in preventing human suffering are crucial in upholding the common moral imperatives and responsibility to global health security.

Background: Each hospital in the UK has a hospital trauma team which includes a multi-disciplinary team. However, the use of such team for minor trauma can lead to inappropriate use of healthcare resources. Thus, an “Emergency Department (ED) trauma team” including only ED staff was developed. The 2 teams together form the 2-tiered trauma system. Each team has its own activation criteria. Its effectiveness in the UK still requires further evaluations. Thus, an evaluation of its effectiveness is important. Only a few UK hospitals adopt this system. St Helier Hospital (SHH) is one of them.

Objectives: Our aim is to evaluate the effectiveness of new service which has been implemented in the Trauma Unit and its impact on the trauma care and service delivery.

Methods: Patients who activated the ED trauma system at SHH from 01/11/2014 to 30/04/2015 were included. This is a retrospective work, clinical notes were reviewed against two tiered trauma calls using SHH database.

Results: A total of 103 ED trauma calls were recorded. 65 cases (63.1%) should have been managed using the hospital team but were not. Overall, patient care was not adversely affected. In most cases, guidelines on “initial assessors”, “primary survey” and “fast scans” were followed. The survival rate was 100% with 55.3% home discharges. Injury mechanism was looked at to explain for the deviation. The “2 or more systems involved” sub-criterion was activated the most and could be argued to bring about most over-triage cases if trust trauma calls had been used.

Conclusions: The ED team at SHH have managed its patients safely and effectively despite a high guideline non-adherence rate. Improvements of the 2-tiered system effectiveness need an increase in the system awareness and a review of the system activation criteria.

Background: There appear to be variations in the time of presentation patients with ACS around the world. The working days and weekends differ in Qatar from the Western world.

Methods: In 1846 patients admitted with ACS, 721 had Primary PCI for STEMI and 1125 had Non-ST Elevation ACS (NSTE-ACS). The days and time of onset of symptoms, Door to Balloon Time (DBT) and Out of Hospital Delay were compared in different time periods in relation to the weekend (Friday/Saturday), and 2-days before (B-WKE), or 2-days after (A-WKE). The intra-day variation was compared in day time (6AM-6PM), and night time (6PM-6AM).

Results: Overall, almost half ACS patients (both STEMI and NSTE-ACS) presented in 2 days After WKE (Sun & Mon), with 60% of these presenting on Sunday alone, compared to only 16% over WKE (Fri & Sat). This was true for males with both STEMI and NSTEMI and for females with NSTE-ACS. However, the pattern was reversed in females with STEMI, 39% presented during week days vs only 19% After WKE (Sun & Mon). For both sexes and all ages, most (58%) presented early day time with modal symptoms starting time around 4 AM. In Primary PCI patients, the DBT was longer (77.5 min) during the night vs (61 min) during day, but in both >90% were within 90 min. 66% of STEMI total occlusion (TIMI-0) during the night. TIMI-3 flow was achieved in 94% during the day vs (87%) at night. Out of Hospital Delay was longer at night (270 min) vs (200 min) during the day. However, in-hospital mortality and LV function was similar.

Conclusions: There are interesting variations diurnal and gender variation in time of presentation of ACS. However, this does not seem to make significant impact on in-hospital outcome in the Primary PCI, perhaps because majority achieved optimal Door to Balloon Time.

Background: Cerebrovascular Accident or stroke is a global health problem and is a leading cause of disability. It is one of the leading causes of mortality and morbidity worldwide.

Materials and methods: A retrospective case-control study carried out on stroke patients admitted to the main Ministry of Health hospitals from May to November 2014. The study consisted of 110 proved cases of stroke and 110 controls (selected from patients who attended the study hospital for conditions other than stroke). For each case of stroke, one control was selected. The controls matched to cases in respect to age ( ± 3 years), sex and locality. Analyses performed by calculation of Chi-Square test and confidence interval using SPSS program version 20.

Results: Out of 110 patients, (61.8%) were females and (38.2%) males. Mean age of cases was 65.80 years compared to 65.46 for controls. Most of them were living in Gaza city. The ischemic type found in 81.8% patients. The most important medical risk factors associated with CVA was diabetes mellitus and hypertension; which represent 61.9% diabetes mellitus among cases compared to 38.1% among controls (P-value < 0.001) and represent 61.4% among hypertension cases compared to 38.6% among controls (P-value < 0.001). For cardiac disorders, 60.3% of cases compared to 39.7% of controls have cardiac disorders (P-value < 0.021). For lifestyle risk factors, obese represent 56.9% among cases compared to 43.1% among controls (P-value < 0.010), smoking represent 63.6% among cases compared to 36.4% among controls (P-value < 0.001). Sedentary level represent 78.2% among cases compared to 21.8% among controls, (P-value < 0.001) and stress represent 83.8% among cases compared to 16.2% among controls, (P-value < 0.001).

Conclusion: Hypertension and diabetes are the biggest risk factors for stroke in, which can be controlled with appropriate medication and lifestyle changes.

Background: Ebola viral disease (EVD) outbreak 2014 in West Africa declared as Public Health Emergency of International Concern (PHEIC) according to IHR (2005), Sudanas member state committed to plan and respond to PHEIC. Sudan was in a great risk to be affected by EVD due to the previous history of EVD outbreaks in 1976, 2004 and 1979, long open borders with Limited resource and poor infrastructure, presence of united nation mission in Darfur (UNAMID) coming from all over Africa.

Objective: To assess preparedness and response of Sudan to EVD 2015 within the context of IHR 2005.

Methods: This descriptive cross-sectional assessment was conducted using; WHO checklist to evaluate Ebola preparedness in different sectors, reviewing Ebola committee's reports, and IHR focal points reports.

Results: According to the IHR Domains analysis; existing of coordination mechanism at all level and active participation of National Focal Point (NFP) was (92%) Surveillance core capacity (53%), surveillance system was sensitized and capacity-building for surveillance officers were achieved. However Event and community based surveillance were still lacking behind Response and preparedness core capacity (40%); national response plan in place, command center was identified; border states were classified as high risk states accordingly, rehabilitation of isolation centers were priority, although the Protocols, guidelines and case managements were available. Majority of IHR requirements for ground crossing (POEs) were not fulfilled, although the preparedness at Khartoum International Airport scored (60%) Risk communication core capacity (42%); Distribution of fact sheets, awareness raising sessions of different group conducted. Risk communication plan should be implemented.

Conclusion: Risk of importation of EVD cases is moderate. Strong political commitment exists, urgent coordination mechanize with neighboring countries needs to be activated. Appropriate training for staff in case management and IPC is needed. Sudan need to Enhance and implement Event base and community based surveillance.

Background: As part of improving the service in ED, we conduct Pharmacist-led Pharmacy round (PLPR) led by Pharmacist to ensure best patient care is provided by pharmacist.

Objective: No such experience was reported in the literature up to our knowledge so we decided to describe our experience, in the successful establishment of PLPR in ED and to identify whether implementing a pharmacy based round, provide better patients care in terms of finding more drug related problems and providing educations to all clinical pharmacists.

Methods: The PLPR started daily at 11 am by brief meeting to discuss any pharmacy related issue then the PRPR team start rounding according to a planned schedule. The PLPR often involves ED pharmacists of different levels of experience the ED pharmacy specialist, clinical pharmacists who have reviewed the patient's case, pharmacy fellows and medical and pharmacy students. During the round, the pharmacist assigned for the area present each case using the Care Plan Form (CPF) to review the suggested recommendations or interventions, further recommendations to the clinical pharmacist may be given if necessary. The extra recommendations or discussion (ERD) conducted during the PLPR are documented and analyzed to evaluate the impact of the pharmacy based round. For each intervention, the following data were documented: date, time, medication, types of intervention.

Results: A total of seventy five ERD were documented during this period. Interventions related to adding, initiating or selecting drug therapy were the most common performed 58 (77%), pharmacotherapy options were the second most common interventions done by the team 13 (17.3%), requesting laboratory tests to optimize pharmacotherapy management were made 7 (9%) followed by dosage adjustment 6 (8%).

Conclusion: Implementation of PLPR is an initiative to improve pharmaceutical care in ED and training among Clinical pharmacist at point of care.

Background: Heat stroke contributes considerably to cause morbidity and mortality during hot season. The main factors associated with severity and mortality of disease unclear. In Sudan heat stroke occurred mainly in Red Sea State during previous years. The purpose of this study is to assess association between heat stroke and pre-existing medical conditions in Northern State of Sudan.

Study: Descriptive analysis of Heat Stroke outbreak at Northern State of Sudan.

Methods: Analysis of secondary data of diseases surveillance system was used. The pattern of the outbreak was described and other risk factors were studied to assess their associated with Heat stroke in Northern State of Sudan 2015.

Results: Northern State was reported 44 probable cases of Heat stroke with case fatality (CFR) 72.3% (32 deaths), among them 64% were males and 36% were female. Halfa locality was reported 82% of cases due to decreased of humidity. The majority of the cases (81.8%) were represented in age groups more than 45 years. Majority of reported deaths had chronic illness and significant statistical association with their age group. All deaths were complained from high grade fever, hypotension (65.5%) and unconsciousness (46.9%) while the alive cases were complained from high grade fever and hypotension. Seventy eight percent of deaths occurred in the age group more than 45 years.

Conclusion: Northern State experienced a climatic change during last two year and heat waves became more augmented lead to heat related illness in the area. Elderly, chronic medical condition and humidity were found to be the main risk factors associated with deaths.

A security Survey of Emergency Department Hamad General Hospital Background The problem of Emergency Department (ED) violence is a worldwide issue, and a systematic approach to mitigating the threat to our colleagues and patients is fundamental to the advancement of Emergency Medicine (EM). One of the important step to this is to assess and improve knowledge of the staff on workplace violence and how to react to it. Aim of this survey was to assess staff knowledge about measures against workplace violence.

Methods: We conducted a survey between, July 2015 to August 2015, in Hamad General Hospital Emergency Department (HGH-ED). Doctors and non-doctors health professionals working in the HGH-ED were asked to fill a paper survey. Data was collected and analyzed anonymously. The categorical outcomes are presented in proportions and continuous outcomes as mean with SD.

Results: A total of 180 staffs were approached to fill this survey. 61.1% was the response rate. Of 110 who completed the survey, 68 (61.8%) were doctors working as ED physicians, and 42 (38.2%) were nurses and clerks. The male proportion was 62.27%. Median age category was 30-39 years with work experience less than five years. Only 24 out of 110 responders (21.8%) were aware about HMC policy dealing with workplace violence. 56 (50.9%) of the staff members were not sure about how to deal with if the incidence happen involving them or their colleague. Non-doctor staff was found to have higher percentage of feeling unsafe at work.

Conclusion: We found poor knowledge about workplace violence policy and how to deal with it in the ED staff. Dedicated efforts are needed to make the staff aware and prepare for such situations.

Background: The Syrian civil war since 2011 is one of the most complex humanitarian emergencies in history. This protracted disaster has but negative aspects, especially on living, educational and health care infrastructure and services. The goal of this study is to document the impact of four years of war on Syrian children's social, educational and health status.

Methods: A cross sectional observational study was conducted in May 2015. Health care workers, especially trained for this study, visited home by home in four Syrian governorates with a prospectively designed questionnaire.

Results: Of 1080 filled-out questionnaires, 1001 were complete and included in this study. Most lived in the Aleppo governorate (n = 413; 41%), 359 in Idleb (36%), 147 in Hamah (15%) and 82 in Lattakia (8%). Median age was 6 years (IQR; 0-15), most were male (n = 611; 61%). Almost 20% of all children were Internally Displaced Persons (n = 196), 45 lost their father (5%) and 41 (4%) had their father missing, 19 (2%) lost their mother and of 27 (3%) the mother was missing. Of all, 855 (86%) had access to safe drinking water, and 775 (77%) could access appropriate sanitation. About 16% (n = 156) had interrupted access to nutrition. Almost 27% suffered from diseases related to malnutrition. Access to specific health care providers was disturbed in 64% (n = 646), and only 28% had an updated vaccination status. Of all school-aged children, 450 (51%) had no access to education at the time of the study. Most children suffered from respiratory (29%), neurological (19%) or digestive (17%) diseases, 4% was victim of injury or violence, and 2% suffered from mental problems.

Discussion and conclusion: After four years of civil war in Syria, children have lost parents, live in substandard life quality circumstances, and are at risk for outbreaks because of worsening vaccination status and specific healthcare provider attention.

Background: Managing a weekly educational planner for an Emergency Residency can be a challenging task in a busy Department due to shift pattern of work, personal development and travelling issues. In this descriptive case study, we outline the challenges and solutions to facilitate this issue. We found that key interventions in the form of timely reminders to instructors and faculty, prospectively consulting them before topic allocation and timely reminders and backup plans helps in reducing drop outs.

Methods: In this quality improvement study, we describe the interventions undertaken to ensure 100% compliance by the faculty for the teaching schedule for the year 2015/2016. We demonstrated a reduction of the dropouts to almost zero despite significant external pressures. An initial scoping exercise revealed that in the 2014/2015 planner 68.75% presentations were conducted as per the planner where as 31.25% did not follow the planner. The reasons included apologies to present (10%), eleventh hour swapping because presenter was not ready or available in country (12.5%) and non-availability of presenter (8.75%) due to leave issues. An initial questionnaire survey was undertaken to elucidate the factors that were disruptive to the faculty and the planner. We also sought ideas to help improve to the planner. A tentative planner for the year 2015/2016 was announced in advance to the whole department and all the staff and faculty were consulted to send the topics of their interest as well as their dates of annual leaves and holidays. Each presenter was called individually to confirm their availability and topics were assigned to them.

Results: We compared the first four month educational planer starting from July 2015 till October 2015 and found the compliance 100% with zero drop outs.

Conclusion: Proactive measures in making educational planner always help in maintaining compliance of the planner and reducing drop outs.

Background: The tremendous increase in disasters in the Middle East whether natural or man-made is unforeseen in its characters and/or catastrophic effects to the communities and infrastructure, thus making public awareness is a mandate to plan, respond and mitigate the community.

Methods: We run Public Awareness program targeting non-medical university students, aiming at raising their knowledge about first aid and response during disasters by designing and conducting hands on First Aid and disaster preparedness course, pretest and post-test was done, graded from 0 to 10 for evaluation of the candidates and their level of knowledge, aiming at achieving 3 grades or above change in the candidates knowledge.

Results: Of 95 candidates attended the course, 84 pre and dost were complete and included in this study. More than half of them were male (n = 55; 65%). There was a significant difference in the candidates grades in the pre and post-test, with near 95% achieved the goal and almost 90% was satisfied by the program.

Discussion and conclusion: The surge in disasters over the last decades is unforeseen, in order to meet that threat national disaster plans should focus on effective disaster public awareness programs, targeting especially the most active and largest part of the community, which is university students.

Exercise-associated hyponatraemia (EAH) is a potentially serious and occasionally fatal outcome in marathons and other long duration events. In the last 30 years, there have been more than 500 publications on hyponatraemia and exercise. Some studies, who point to the fatalities that have occurred, consider this as a major concern while others dismiss it as a rare and unimportant condition. This work critically assessed and summarized the main evidence on the prevalence and aetiology of the condition and on possible preventive measures. Hence, more than 400 relevant articles were identified by a search in PubMed and other secondary sources like NICE and 112 abstracts and 42 full text were reviewed. Level and strength of evidence supporting the conclusions were assessed by Strength of Recommendation Taxonomy (SORT). EAH is more frequently asymptomatic. If its frequency through finishers of an endurance event is estimated from 0 to 51%, the incidence of symptomatic EAH in marathon is estimated to less than 1% of all participants. Actual evidence correlates EAH incidence to 2 major etiologies: an overhydration by excessive fluid intake and a persistent secretion of arginine vasopressin. The prevention consists primarily of avoiding overdrinking. In this context, the key recommendation is to drink according to thirst to avoid dehydration and overhydration. To provide such prevention, besides educating athletes, education for the supporting event staff is recommended to avoid errors in fluid supplementation advices. Furthermore, the medical staff covering such events should be familiar with early recognition and diagnosis of EAH to avoid complications and improper real-time drink supplementation. In conclusion, EAH is a life threatening condition during endurance sport events. Besides a limited incidence, the increasing numbers of participants in events like marathons induce a higher rate of symptomatic EAH. It seems, according to actual evidence to be a serious concern in endurance sports.

Introduction: Pre-hospital care professionals work outside or in confined spaces. Issues like population demography, cultural diversity, geography, roads, and climate regularly challenge them. Some of these factors might be overlooked by the hospital-based mentality of other clinicians. Providing them an opportunity to accompany paramedics in their own environment may help them better understand the paramedics' role and scope of practice, and improve the patient handover process between these two “alienated worlds” of medical professionals.

Methods: An Emergency Medicine Specialist spent 12 months within Qatar's national Ambulance Service. Regular rotations through its various departments were facilitated, including an 8-week ride along with a Rapid Response Vehicle (Delta unit) dealing with emergency calls. A daily journal was written to record the experiences and audit data was accessed to gain a deeper understanding of the Service.

Results: This experience was an eye opener. Delta officers are very experienced and can provide a global perspective of the operations. Their main focus is safety from a 360-degree scene perspective, team leadership, and communication. The type of calls and circumstances provided a unique view of the scene realities. Ambulance crews were observed dealing with difficult situations, assessing patients, and initiating treatment in challenging environments. Depending on the type of emergency, Ambulance Paramedics were joined by a Critical Care Paramedic who has more advanced skills and the ability to administer a broader range of medications.

Conclusion: This program has been effective at introducing a hospital-based clinician to the pre-hospital world and should be Considered to all Emergency Fellows. It highlighted the complexities of working in the community with limited resources and the importance of communication to ensure the provision of safe and effective care. Understanding the Ambulance Service staff's level of competency will also enhance the handover process and help build trust in the Paramedics.

Background: Globalization, increasing intense urbanization and climate changes has been linked to natural and man-made evolution and curiosity resulting in multiple threats and vulnerability. The degree, nature and extent community and household preparedness and resiliency programs and activities defined the robustness and effectiveness of local, national to regional EMRO timely response policy decision maker by policy makers, health planners and implementers.

Methods: This paper analyses existing community emergency preparedness and resilience implementation and translation challenges and bottlenecks against emerging natural and man-made threats and epidemics disaster in Saudi Arabia and other EMRO countries.

Results: Our results showed inefficiencies to identify, understanding and mapping of potential risks/threats and weak community early alarm and surveillance systems in threats or disaster occurrence. Also, showed that real time community-based programs are poorly interrelated and nurtured in most EMRO countries, and require fostering community guidelines and prevention and control activities. Such include social mobilization, health education in increasing alertness, awareness and community mass literacy outreach. Critically, adequate community knowledge and attitudes on preparedness and resilience on mass pilgrims influx during Hajj and Ramadan seasons, potential vulnerability to epidemics and floods indicates that policy planners and implementers could capitalize on these strengths and address the weaknesses in scaling up practical community and household emergency preparedness and management approach on and across borders populations for common beneficial expectations in upholding safety and security, healthy lives and well-being. In conclusion, we advocate that establishment of a comprehensive evidence-based local, national and regional laboratory and digital surveillance systems, community-based partnerships, investment projects and related preventive resilient measures are vital in revamping the evolving and future threats and disaster situations in Saudi Arabia and other EMRO countries in line with One Health Surveillance systems.

Introduction: A large number of patients present to the Emergency Department (ED) with sepsis, severe sepsis or septic shock. Septic shock is associated with 40% mortality risk and is the most common cause of death in the ICU. Moreover, survivors of septic shock are at risk of permanent organ dysfunction, prolonged hospital stay and long term institutionalization. Many of these complications can be minimized and may be avoided by prevention via public health improvement and education, early identification of sepsis, and timely effective intervention.

Methods: IHI quality improvement methodology applied to guide our work. The Quality Leaders from ED, ICUs and general wards were invited to participate and collaborate to develop and test the Sepsis 6 Pathway. From the data collected so far we noted the following: Sepsis patients ages range from as young as 19 to 89 years. The most common sepsis diagnoses are septic shock, pneumonia and urosepsis. For the initial management of sepsis patients 49% are managed in the ED. In August we started monitoring delays in time between the patient's admission and criteria met for sepsis diagnosis; and the time between criteria met for sepsis and referral to ICU. If the patient is admitted to the ward this can be as long as days. If the patient is admitted to MICU or ED it ranges from 0 minutes – 1 hrs. The time between criteria met for sepsis and treatment initiated is the most important indicator we are monitoring, which based on the data collected so far averages between 0 minutes – 1 day.

Conclusion: Sepsis causes avoidable and preventable patient harm. A multi-faceted approach may help reduce morbidity and mortality. Early implementation of the sepsis 6 pathway is underway in HMC across main acute care areas. Outcome measures will be collected and compared against international standards.

Background: The conventional landlines and bleeps that are commonly used in recalling physicians during major casualty incident (MCI) have shown multiple defects. Despite the remarkable advancement of handheld devices, social media and short text messaging (SMS), only a few studies on the comparison between the conventional communication and the social media have been found in the literature. This research compares (1) bleeps, (2) SMS and (3) WhatsApp as communication tools for recalling doctors. These tools were selected because they are commonly used in our region.

Method: We selected two periods for communications: social-friendly (09:00–19:00) and anti-social (23:00–06:00) periods. A total of 120 emergency physicians from Hamad General Hospital were contacted by the three communication tools in the two selected periods. We investigated the percentage of the responders and the time of response because this is the first step to the MCI response.

Results: Bleep had the fastest response (mean 7.6 minutes in the social-friendly period and 9 minutes in the anti-social period), but with a least response of 10.8% and 3.0% for the social-friendly and anti-social periods, respectively. WhatsApp had the majority of responses (45.0% in the social-friendly period and 47.5% in the anti-social period, respectively). However, its response time was long (146 and 141 minutes), respectively. Therefore, it is not suitable for recalling doctors during MCI. In contrast, SMS showed a bizarre response, with a mean response time of 43 and 154 minutes for the social-friendly and anti-social periods, respectively. This showed a marked increase in response from 30.8% for the social-friendly period to 44.2% for the anti-social period.

Conclusion: At present, there is not even one satisfactory and reliable communication tool for recalling physicians during MCI. Unsatisfactory response may be due to human factors that can be improved by training to achieve optimal compliance in both percentage and response time. This could in turn help achieve the ultimate response in MCI. More research is needed in this field to obtain the best and most accurate communication tool.

Background: Children cite needlesticks and invasive procedures as anxiety-provoking, which can have a negative impact on coping. This distress can lead to increased fear of medical settings and avoidance of care. Providing children with care that reduces the fear of pain associated with medical procedures can support positive experiences that can reduce anxiety. Thus, this will allow the child to better cope with and cooperate during medical procedures.

Methods: The available literature and the authors' professional experiences highlight the implementation and effectiveness of these approaches.

Results: Four main practices highlight a child-friendly approach: language, information, procedural support, and comfort positioning. Child-friendly language includes using a clear, concise, directed language. It avoids using confusing terms and focuses on the sensory experience of the child. Information is provided both in timing and content to children based on their developmental level and allows for the safe exploration of the equipment being used to promote mastery. Procedural support includes distraction, oral sucrose use, and encouraging positive coping skills such as breathing and imagery. Comfort positioning maintains access and safety for the healthcare professional while meeting the needs of the child to stay in proximity to its caregiver and not to lie on its back.

Conclusions: Child-friendly practices raise the standard of care for children in emergency settings. These practices can reduce procedural challenges for staff and improve the patient's experience. Implementation can be done across the provider spectrum and can be enhanced through the use of a child life specialist, a pediatric healthcare professional trained in supporting patients, families, and staff in the medical environment.