Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MassachusettsUSA.
Harvard Medical School, Boston, MassachusettsUSA.
Prehosp Disaster Med. 2022 Dec;37(6):749-754. doi: 10.1017/S1049023X22002163. Epub 2022 Nov 4.
Emergency Medical Services (EMS) is a critical part of Disaster Medicine and has the ability to limit morbidity and mortality in a disaster event with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training in the country. As a result, EMS physicians are trained in a variety of specialties.Armenia is also a country prone to disasters, and recently, the Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War broke out in the midst of the SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic.
This study aims to assess the current state of disaster preparedness of the Armenian EMS system and the effects of the simultaneous pandemic and war on EMS providers.
This was a cross-sectional study conducted by anonymous survey distributed to physicians still working in the Yerevan EMS system who provided care to war casualties and COVID-19 patients.
Survey response rate was 70.6%. Most participants had been a physician (52.1%) or EMS physician (66.7%) for three or less years. The majority were still in residency (64.6%). Experience in battlefield medicine was limited prior to the war, with the majority reporting no experience in treating mass casualties (52.1%), wounds from explosives (52.1%), or performing surgical procedures (52.1%), and many reporting minimal to no experience in treating gunshot wounds (62.5%), severe burns (64.6%), and severe orthopedic injuries (64.6%). Participants had moderate experience in humanitarian medicine prior to war. Greater experience in battlefield medicine was found in participants with more than three years of experience as a physician (z-score -3.26; P value <.01) or as an EMS physician (z-score -2.76; P value <.01) as well as being at least 30 years old (z-score -2.11; P value = .03). Most participants felt they were personally in danger during the war at least sometimes (89.6%).
Prior to the COVID-19 pandemic and simultaneous 2020 Nagorno-Karabakh War, EMS physicians in Armenia had limited training and experience in Disaster Medicine. This system, and the frontline physicians on whom it relies, was strained by the dual disaster, highlighting the need for Disaster Medicine training in all prehospital medical providers.
紧急医疗服务（EMS）是灾难医学的重要组成部分，具有在充分培训和经验的情况下限制灾害事件发病率和死亡率的能力。亚美尼亚的紧急系统仍处于发展的早期阶段，该国没有急诊医学住院医师培训。因此，EMS 医生接受各种专业的培训。亚美尼亚也是一个容易发生灾害的国家，最近，亚美尼亚的 EMS 系统在 2020 年纳戈尔诺-卡拉巴赫战争爆发期间同时面临两次灾害时受到了挑战，当时 SARS-CoV-2/新冠肺炎 2019 大流行（COVID-19）。
本研究旨在评估亚美尼亚 EMS 系统的备灾现状以及同时发生的大流行和战争对 EMS 提供者的影响。
这是一项通过匿名调查进行的横断面研究，调查对象为仍在埃里温 EMS 系统工作并为战争伤员和 COVID-19 患者提供护理的医生。
调查回复率为 70.6%。大多数参与者是医生（52.1%）或 EMS 医生（66.7%），工作年限在 3 年以下。大多数人仍在住院医师培训中（64.6%）。在战争之前，战地医学经验有限，大多数人报告没有治疗大批伤员（52.1%）、爆炸伤（52.1%）或进行手术（52.1%）的经验，许多人报告在治疗枪伤（62.5%）、严重烧伤（64.6%）和严重骨科损伤（64.6%）方面经验很少或没有。参与者在战争前具有中等水平的人道主义医学经验。具有 3 年以上医生（z 分数-3.26；P 值<.01）或 EMS 医生（z 分数-2.76；P 值<.01）经验或年龄至少 30 岁（z 分数-2.11；P 值=.03）的参与者发现具有更多的战地医学经验。大多数参与者表示在战争期间至少有时感到个人处于危险之中（89.6%）。
在 COVID-19 大流行和同时发生的 2020 年纳戈尔诺-卡拉巴赫战争之前，亚美尼亚的 EMS 医生在灾难医学方面的培训和经验有限。这一系统及其所依赖的前线医生因双重灾难而承受压力，凸显了所有院前医疗服务提供者都需要接受灾难医学培训。
