Tehnaz Parakh Boyle

Acute pediatric radiation injury is fortunately rarely encountered in pediatric emergency medicine and trauma. Most reported experience with the condition has arisen from unanticipated, untoward events associated with radiation therapy for pediatric oncologic illness, as scientific study of pediatric outcomes following major radiation and nuclear events, such as Hiroshima, Nagasaki, Chernobyl, and Fukushima, has focused on long term morbidity, mostly with respect to thyroiditis and thyroid neoplasia, instead of acute care—for which data cannot be found in the English language scientific literature. As such, recent efforts have centered on development of medical countermeasures for pediatric patients based upon expert judgment, including but not limited to administration of antidotes and cytokines. The authors advocate for the creation of a multi-agency and multi-disciplinary working group to ensure the strategic mitigation of the critical gaps in preparedness and response to radiation injuries in children cited below.

Background: Disaster telehealth can be used to provide rapid access to remote specialty expertise and virtual surge capacity for overwhelmed local clinicians. The Regional Disaster Health Response System (RDHRS) is developing a disaster teleconsultation system for cross-jurisdictional care in the United States. In 2020, the Region 1 RDHRS provided Massachusetts hospitals access to disaster teleconsultation services with out-of-state critical care experts during the first wave of the COVID-19 pandemic response. Objective: We aimed to field-test (1) the acceptability and feasibility of using a prototype, web-based disaster teleconsultation platform with minimal-to-no user training and (2) the feasibility of deploying a national volunteer expert pool to access out-of-state expertise. Methods: This was a prospective, mixed methods, observational study. We recruited field clinicians from Massachusetts hospitals and out-of-state critical-care physicians as experts for a 2-week pilot (June 2020). Experts were trained to use a prototype platform, while field clinicians received a just-in-time tool. Field clinicians requested teleconsultations for hospitalized patients with COVID-19 (clinical call) or simulated patients (test call). We collected demographics, call performance data, and Telehealth Usability Questionnaire (TUQ) ratings to measure acceptability (primary outcome; total usability score ≥6 of 7) and feasibility (secondary outcome; interface, interaction quality, and reliability items), and interviewed participants. We report descriptive statistics and key themes using the Technology Acceptance Model framework. Results: Ten experts from 6 states and 17 field clinicians from 4 hospitals participated. All experts and 10 field clinicians completed postpilot questionnaires (74% response overall). Of these, 20% had previously used telemedicine in a disaster. In total, 50 test calls and no clinical calls were logged. Most (70%) made ≥1 call; 22% (95% CI 10%‐34%) connected successfully. The median time to connect was 1.6 (IQR 3.2) minutes. Among field clinician respondents, 50% used smartphone devices, 40% hospital desktop computers, and 10% laptop computers to access RDHRS teleconsultation services. Calls failed due to platform routing errors (49%), hospital computers without cameras or microphones (10%), firewalls (8%), and expert notification failures (5%). The mean total usability score was 5.6 (SD 1.3). TUQ item scores were highest in usefulness (mean 6.0, SD 1.1) and ease-of-use (mean 6.0, SD 1.4), and lowest in reliability (mean 2.4, SD 1.4). Participants were comfortable using the platform. Those with difficulty identified discomfort with technology as the cause. All experts were willing to participate in a national expert registry and obtain emergency licensure, and most (80%) were willing to serve on a volunteer, unpaid basis. Conclusions: Clinicians found the prototype platform acceptable, but the workflow requires revision to reduce call failure and improve feasibility and reliability for future use with minimal-to-no training. Using familiar clinical workflows for emergency consultation and mobile devices with camera and microphone capabilities could improve call performance and reliability.

Tactical nuclear weapons pose a threat to life and health that we cannot ignore

Objectives: The SDMPH 10-year anniversary conference created an opportunity for a researcher to present at a professional association conference to advance their research by seeking consensus of statements using Delphi methodology. Methods: Conference attendees and SDMPH members who did not attend the conference were identified as Delphi experts. Experts rated their agreement of each statement on a 7- point linear numeric scale. Consensus amongst experts was defined as a standard deviation < = 1. Presenters submitted statements relevant to advancing their research to the authors to edit to fit Delphi statement formatting. Statements attaining consensus were included in the final report after the first round. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for opportunity to reconsider their rating for that round. If reconsideration attained consensus, these statements were included in the final report. This process repeated in a third and final round. Results: 37 Experts agreed to participate in the first round; 35 completed the second round, and 34 completed the third round; 35 statements attained consensus; 3 statements did not attain consensus. Conclusions: A Delphi technique was used to establish expert consensus of statements submitted by the SDMPH conference presenters to guide their future education, research, and training.

Background: In December 2021, the Region 1 Disaster Health Response System, the state of Vermont, and the National Emergency Tele-Critical Care Network partnered to provide statewide access to disaster teleconsultations during COVID-19 surge conditions. In this case report, we describe how a disaster teleconsultation system was implemented in Vermont to provide access to temporary tele-critical care consultations during the Omicron COVID-19 surge. Methods: We measured the time from request of service to implementation and calculated descriptive statistics. Results: Seven of Vermont's 14 hospitals requested the service. Despite a technology solution capable of providing services within hours, mean time to service implementation was 27 days (interquartile range 20–41 days). Conclusions: Integration of disaster teleconsultation systems into state and local emergency management plans are needed to bring administrative start-up times in line with technical readiness.