Trauma stabilization points and humanitarian emergencies: implications for disaster and mass casualty incident response systems in the United States

Trauma stabilization points (TSPs) are mobile trauma clinics that are located very close (\u3c 5 kM/10 minutes) to the point of injury or mass casualty incident. These temporary clinics are staffed by doctors, nurses and/or paramedics and are designed to rapidly triage, treat and transfer patients. TSPs are now increasingly being used by a diverse set of global health organizations to respond to humanitarian emergencies, most notably in Mosul, Iraq and the Gaza Strip. Recent research has highlighted several promising outcomes associated with the use of TSPs, including decreased mortality and increased emergency health system optimization. In the United States, emergency response and management systems continue to grapple with how best to respond to mass casualty incidents such as natural disasters and active shooter events. Significant gaps associated with interagency coordination and prehospital emergency treatment are widespread within current response frameworks. Integrating TSPs into a complete mass casualty incident response plan represents a novel solution that aims to improve patient outcomes, strengthen interagency coordination and facilitate efficient transport resource allocation. Positioning advanced emergency clinicians close to the point of injury ensures the rapid treatment and stabilization of critical patients, while also allowing for the discharge of patients with relatively minor injuries that would otherwise further burden strained ambulance and hospital resources. TSPs constitute a potentially valuable adjunct to current mass casualty incident response strategies and future in-depth studies are needed to assess their utility within the United States

Factors influencing community-facility linkage for case management of possible serious bacterial infection (PSBI) among young infants in Kenya

Despite evidence showing the feasibility and acceptability of implementing the World Health Organization’s guidelines on managing possible serious bacterial infections (PSBI) in Kenya, the initial implementation revealed sub-optimal community-facility referrals and follow-up of PSBI cases. This study explores facilitators and barriers of community-facility linkages in implementing PSBI guidelines in Busia and Migori counties, Kenya. We used an exploratory qualitative study design drawing on endline evaluation data from the ‘COVID-19: Mitigating Neonatal Mortality’ project collected between June and July 2022. Data include case narratives with caregivers of SYIs 0-59 days old (18), focus group discussions with community health volunteers (CHVs) (6), and in-depth interviews with facility-based providers (18). Data were analysed using an inductive thematic analysis framework. Between August 2021 and July 2022, CHVs assessed 10 187 newborns, with 1176 (12%) identified with PSBI danger signs and referred to the nearest facility, of which 820 (70%) accepted referral. Analysis revealed several factors facilitating community-facility linkage for PSBI treatment, including CHVs’ relationship with community members and facilities, availability of a CHV desk and tools, use of mobile app, training, and supportive supervision. However, challenges such as health system-related factors (inadequate providers, stockout of essential commodities and supplies, and lack of transport/ambulance), and individual-related factors (caregivers’ refusal to take referrals) hindered community-facility linkage. Addressing common barriers and fostering positive relationships between community health workers and facilities can enhance acceptance and access of PSBI services at the community level. Combining community health workers’ efforts with a mobile digital strategy can improve the efficiency of the identification, referral, and tracking of PSBI cases in the community and facilitate linkage with primary healthcare facilities

Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges

Abstract Background Ethiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies. Methods From November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies. Results Strategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery. Conclusion Pragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system’s capacity for PSBI treatment