Health care organizations have been challenged by the coronavirus disease 2019 (COVID-19) pandemic for some time, while in January 2020, it was not immediately suspected that it would take such a ...global expansion. In the past, other studies have already pointed out that health care systems, and more specifically hospitals, can be a so-called “soft target” for terrorist attacks. This report has now examined whether this is also the case in the context of the COVID-19 pandemic. During the lockdown, hospitals turned out to be the only remaining soft targets for attacks, given that the other classic targets were closed during the lockdown. On the other hand, other important factors have limited the risk of such attacks in hospitals. The main delaying and relative risk-reducing factors were the access control on temperature and wearing a mask, no visits allowed, limited consultations, and investigations. But even then, health care systems and hospitals were prone to (cyber)terrorism, as shown by other COVID-19-related institutions, such as pharmaceuticals involved in developing vaccines and health care facilities involved in swab testing and contact tracing. Counter-terrorism medicine (CTM) and social behavioral science can reduce the likelihood and impact of terrorism, but cannot prevent (state-driven) cyberterrorism and actions of lone wolves and extremist factions.
Introduction
In previous studies, physicians have been identified as a high-risk group for burnout.
Although the work environment has received more attention than specific determinants of personality ...traits, the latter might contribute to burnout.
Study objective.
We aimed to investigate the association of Type D personality, job and organizational determinants with burnout, stress and work engagement as outcome factors among emergency physicians and hospital physicians working in intensive care and surgery departments.
We specifically focused on our group of emergency physicians.
Methods
In this cross-sectional study, self-report questionnaires were distributed via social media using a specific survey link to 531 Belgian hospital physicians working at the Emergency Department, Intensive Care, and Surgery Department between October 21, 2018, and April 11, 2019. The survey instrument included questions about sociodemographic characteristics, job characteristics, organizational factors, job satisfaction, social support by supervisors and colleagues (Leiden Quality of Work Questionnaire for Medical Doctors) and Type D personality (Distress Scale-14) and as outcomes burnout (Oldenburg Burnout Inventory) and work engagement (Utrecht Work Engagement Scale). A multiple regression analysis was used to examine the associations between the determinants and each of the outcomes with emergency physicians as the study population.
Results
Eligible data were available for 436 questionnaires and involved 212 emergency physicians, 162 other hospital physicians (Intensive Care and Surgery Department) and 62 residents concerning both groups of physicians. Type D personality ranged from 28.5 to 29.1% in emergency physicians and other hospital physicians. Additionally, even after correcting for job-related and organizational factors, emergency physicians with Type D personality were seven times more likely to have a high risk for burnout.
Conclusion
As a result, this study offers a new perspective on the associations between burnout, stress and Type D personality. Type D personality might be a personality-related risk factor for burnout among emergency physicians. Therefore, we recommend enhanced prevention measures that take into account this individual factor in the further development of coaching programs. Improving the professional well-being of emergency physicians is necessary, especially in the scope of the recent COVID-19 pandemic, which has put a high demand on acute and emergency care departments.
Since December 2019, the world is affected by an outbreak of a new disease named COVID-19, which is an acronym of ‘coronavirus disease 2019’. Coronaviruses (CoV) were assumed to be associated with ...mild upper respiratory tract infections, such as common cold. This perception changed in time due to occurrence of the Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV in 2002 and the Middle East Respiratory Syndrome (MERS) caused by MERS-CoV in 2012, both inducing an epidemic severe viral pneumonia with potentially respiratory failure and numerous extra-pulmonary manifestations. The novel coronavirus, SARS-CoV-2, is likewise a causative pathogen for severe viral pneumonia with the risk of progression to respiratory failure and systemic manifestations. In this review, we will give a summary of the neurological manifestations due to SARS and MERS, as those might predict the neurological outcome in the novel COVID-19. Additionally, we provide an overview of the current knowledge concerning neurological manifestations associated with COVID-19, to the extent that literature is already available as the pandemic is still ongoing.
In recent decades, an increasing number of terrorist attacks have been carried out against medical institutions, hospitals, and health care workers. These attacks, that often result in high numbers ...of casualties and impaired access to health services, have a more significant impact on people's sense of security than attacks against military and police targets. Attacks on ambulances - especially on the African continent - have been sparsely studied. This study examines attacks on ambulances on the African continent during the period from 1992-2022 (until December 31, 2021).
Reports of ambulance terrorism were extracted from the Global Terrorism Database (GTD), RAND Database of Worldwide Terrorism Incidents (RDWTI), United Nation's Safeguarding Health in Conflict Coalition (SHCC) database, Armed Conflict Location and Event Data Project (ACLED), Surveillance System for Attacks on Health Care (SSA) database, and Aid Worker Security Database (AWSD). Furthermore, a grey literature search was performed. The date and location of the attacks, perpetrators, weapon and attack types, and the number of victims (dead and wounded) and hostages were collected. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.
During the 30-year study period, 166 attacks were observed in 18 African countries. The number of attacks significantly increased since 2016, with 81.3% of the attacks taking place from 2016 to 2022. In total, 193 people died and another 208 were injured. Attacks with firearms were most frequently noted (92 cases; 55.4%), followed by attacks with explosive devices (26 cases; 15.7%). A significant number of ambulances were hijacked (26 cases; 15.7%) and subsequently used for other terrorist attacks. In seven attacks, ambulances were used as vehicle-born improvised explosive devices (VBIEDs).
In this database study on ambulance terrorism in Africa, it was found that the reported occurrence of attacks increased from 2013 onwards, including the rise of ambulances used as VBIEDs. These findings suggest that ambulance terrorism represents a real, significant risk that both governments and health care institutions must address.
The COVID-19 pandemic has resulted in an increased need for ventilators. The potential to ventilate more than one patient with a single ventilator, a so-called split ventilator setup, provides an ...emergency solution. Our hypothesis is that ventilation can be individualized by adding a flow restrictor to limit tidal volumes, add PEEP, titrate FiO
2
and monitor ventilation. This way we could enhance optimization of patient safety and clinical applicability. We performed bench testing to test our hypothesis and identify limitations. We performed a bench testing in two test lungs: (1) determine lung compliance (2) determine volume, plateau pressure and PEEP, (3) illustrate individualization of airway pressures and tidal volume with a flow restrictor, (4a) illustrate that PEEP can be applied and individualized (4b) create and measure intrinsic PEEP (4c and d) determine PEEP as a function of flow restriction, (5) individualization of FiO
2
. The lung compliance varied between 13 and 27 mL/cmH
2
O. Set ventilator settings could be applied and measured. Extrinsic PEEP can be applied except for settings with a large expiratory time. Volume and pressure regulation is possible between 70 and 39% flow restrictor valve closure. Flow restriction in the tested circuit had no effect on the other circuit or on intrinsic PEEP. FiO
2
could be modulated individually between 0.21 and 0.8 by gradually adjusting the additional flow, and minimal affecting FiO
2
in the other circuit. Tidal volumes, PEEP and FiO
2
can be individualized and monitored in a bench testing of a split ventilator. In vivo research is needed to further explore the clinical limitations and outcomes, making implementation possible as a last resort ventilation strategy.
Healthcare workers in the emergency department are exposed to a wide range of physical and psycho-social risks or hazards in the workplace. The aim of this study was to investigate the impact of ...exposure to, the occurrence and perceived risks of, and the worry about, occupational hazards among emergency and hospital physicians in the time of COVID.
Based on the review of occupational hazards in emergency physicians, a questionnaire already used and validated in another study, conducted in 2016, was constructed. The questionnaire consisted of both socio-demographic questions and questions regarding the exposure to, the occurrence and perceived risks of, and the worry about, the following occupational hazards: infectious diseases, COVID-19, physical hazards, violence at work, and stressful situations at work that can cause burnout. A total of 497 questionnaires were distributed to Belgian emergency and hospital physicians in April 20-May 26, 2020.
Overall, 319 responses (out of 497 questionnaires) were collected, of which 196 were eligible for statistical analysis. Of the respondents, 32% stated to be confronted with violence and 54% to suffer from health problems related to their work. The exposure to, and the occurrence and perceived risks of, occupational hazards and, more specifically, the exposure to COVID-19 (88%) and its occurrence (10%), and also the worry about these hazards, appear to be high in physicians working in the emergency department. The worry about each of these outcomes is predicted by the supposed exposure, occurrence, and perceived risks.
The exposure to, and the occurrence and perceived risks of, physical hazards, violence and burnout are generally high in physicians in the time of COVID-19. Emergency and hospital physicians in Belgium worry the most about the impact of violence, burnout and COVID-19.
As one of Europe's most densely populated countries with multiple nuclear installations and a prominent petrochemical industry, Belgium is at some reasonable risk for terrorist attacks or accidental ...chemical, biological, radiation, and nuclear (CBRN) incidents. We hypothesize that local hospitals are not sufficiently prepared to deal with these incidents.
All 138 Belgian hospitals with an emergency department (ED) were sent a survey on their preparedness. Data on hospital disaster planning, risk perception, availability of decontamination units, personal protective equipment, antidotes, radiation detection, infectiologists, isolation measures, and staff training were collected.
The response rate was 72%. Although 71% of hospitals reported being at risk for CBRN incidents, only 53% planned for the same in their disaster plans. Only 11% of hospitals had decontamination facilities in front of or at the ED entrance and only 6% had appropriate personal protective equipment for triage and decontaminating teams. Atropine was available at all centers, but more specific antidotes such as hydroxycobolamine, thiosulphate, or pralidoxime were less available (47, 47, and 19%, respectively). Six percent of hospitals had radiodetection equipment with an alarm function and 14% had a nuclear specialist available 24/7. Infectiologists were continuously available in 26% of the total EDs surveyed. Individual isolation facilities were present in 36% of the EDs, and isolation facilities capable of housing larger groups were present in 9%. University hospitals were significantly better prepared than community hospitals.
There are serious gaps in hospital preparedness for CBRN incidents in Belgium. Lack of financial resources is a major obstacle in achieving sufficient preparedness.
Patients with Down syndrome are at increased risk of respiratory syncytial virus- and H1N1-related death. Literature on COVID-19 in Down syndrome patients is unavailable thus far. We describe the ...clinical course of 4 patients with Down syndrome during an outbreak of COVID-19. In all four patients, disease course was severe, warranting hospital care in three patients, with fatal outcome in one patient. Another patient receives supportive care in our institution. Our case series is the first report on probable increased risk of life-threatening disease course of COVID-19 in patients with Down syndrome. Proper surveillance, the adherence of social distancing, and the use of personal protective equipment will be essential in reducing morbidity and mortality in our patients.
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