Applying Human-Centered Design Principles to Digital Syndromic Surveillance at a Mass Gathering in India: Viewpoint

In the wake of the COVID-19 pandemic, digital health tools have been deployed by governments around the world to advance clinical and population health objectives. Few interventions have been successful or have achieved sustainability or scale. In India, government agencies are proposing sweeping changes to India’s digital health architecture. Underpinning these initiatives is the assumption that mobile health solutions will find near universal acceptance and uptake, though the observed reticence of clinicians to use electronic health records suggests otherwise. In this practice article, we describe our experience with implementing a digital surveillance tool at a large mass gathering, attended by nearly 30 million people. Deployed with limited resources and in a dynamic chaotic setting, the adherence to human-centered design principles resulted in near universal adoption and high end-user satisfaction. Through this use case, we share generalizable lessons in the importance of contextual relevance, stakeholder participation, customizability, and rapid iteration, while designing digital health tools for individuals or populations.

EU-SENSE detection system in mass gathering evacuation

Current CBRNe detection systems are mainly available as standalone detectors, and seldom offer the potential of networking and data fusion. The research objective is to simulate the scenario-based models built in a virtual environment to examine the possible impact of the EU-SENSE system on chemical detection technology, based on an innovative CBRNe detection and identification system, which is a network of heterogeneous sensor nodes, on the evacuation of a mass gathering. The chemical detection system presents real possibilities of understanding situations that depend on the first symptoms of human health and behaviour. This information will facilitate taking appropriate measures when CBRNe hazard forces to evacuation, including quick identification of the hazard and necessity to modify preliminary evacuation gates (in terms of their localization and width).

Development of On-Site Medical System for Mass-Gathering Events During TOKYO 2020: Vulnerability Analysis Using Healthcare Failure Mode and Effect Analysis

At mass-gathering events of the Olympic and Paralympic Games, a well-organized, on-site medical system is essential. This study evaluated the vulnerabilities of the prehospital medical system of the TOKYO 2020 Olympic and Paralympic Games (TOKYO2020) to propose corrections that can be generalized to other mass gatherings. The healthcare failure mode and effect analysis (HFMEA) was adopted to analyze vulnerabilities of the on-site medical system proposed by the organizing committee of TOKYO2020. Processes from detecting a patient on the scene to completing transport to a hospital were analyzed. Ten processes with 47 sub-processes and 122 possible failure modes were identified. HFMEA revealed 9 failure modes as vulnerabilities: misidentification of patient, delayed immediate care at the scene, misjudgment of disposition from the on-site medical suite, and inappropriate care during transportation to hospital. Proposed corrections included surveillance to decrease blind spots, first aid brochures for spectators, and uniform protocol for health care providers at the scene. The on-site medical system amended by HFMEA seemed to work appropriately in TOKYO2020.

Simulated-Scenario and Peer-Mentorship Curriculum to Train Prehospital Providers in the Practice of Mass Gathering Medicine

Objective: A mass gathering medicine training program was established for a 7,200-seat arena. The objectives of this study were to describe the program schema and determine its impact in preparing novice emergency medical technicians (EMTs) to manage the difficulties of large-venue emergency medical services (EMS). Methods: Optional, anonymous surveys were administered to EMTs. Novice EMTs were assessed pre-/post-program implementation, and both novice and experienced EMTs completed self-reported Likert scales. Data were analyzed with nonparametric methods. Results: A total of 43/56 responses (response rate = 76.8%) were received. Only 37.2% of providers felt prepared to work mass gatherings before the training, and 60.5% stated that their previous education did not prepare them for large-venue challenges. After the training program, novice EMTs were significantly associated with increased knowledge of large-venue EMS procedures (P = 0.0170), higher proficiency using extrication equipment (P = 0.0248), increased patient care skills (P = 0.0438), and both increased confidence working events (P = 0.0002) and better teamwork during patient encounters (P = 0.0001). The majority of EMTs reported the program as beneficial. Conclusion: Upon hire, EMS providers felt unprepared to work large-venue EMS. The analyses demonstrated that this training program improved select large-venue emergency skills for prehospital providers and may fill a gap in the education system regarding mass gathering medicine.

Comparison of Unmanned Aerial Vehicle Technology versus Standard Practice of Scene Assessment by Paramedic Students of a Mass-Gathering Event

Introduction: The proliferation of unmanned aerial vehicle (UAV) technology has the potential to change the situational awareness of medical incident commanders’ (ICs’) scene assessment of mass gatherings. Mass gatherings occur frequently and the potential for injury at these events is considered higher than the general population. These events have generated mass-casualty incidents (MCIs) in the past. The aim of this study was to compare UAV technology to standard practice (SP) in scene assessment using paramedic students during a mass-gathering event (MGE). Methods: This study was conducted in two phases. Phase One consisted of validation of the videos and accompanying data collection tool. Phase One was completed by 11 experienced paramedics from a provincial Emergency Medical Services (EMS) service. Phase Two was a randomized comparison with 47 paramedic students from the Holland College Paramedicine Program (Charlottetown, Prince Edward Island, Canada) of the two scene assessment systems. For Phase Two, the paramedic students were randomized into a UAV or a SP group. The data collection tool consisted of two board categories: primary importance with 20 variables and secondary importance with 25 variables. After a brief narrative, participants were either shown UAV footage or the ground footage depending on their study group. After completion of the videos, study participants completed the data collection tool. Results: The Phase One validation showed good consensus in answers to most questions (average 79%; range 55%-100%). For Phase Two, a Fisher’s exact test was used to compare each variable from the UAV and SP groups using a P value of .05. Phase Two demonstrated a significant difference between the SP and UAV groups in four of 20 primary variables. Additionally, significant differences were found for seven out of 25 secondary variables. Conclusion: This study demonstrated the accurate, safe, and feasible use of a UAV as a tool for scene assessment by paramedic students at an MGE. No observed statistical difference was noted in a majority of both primary and secondary variables using a UAV for scene assessment versus SP.

`Representing and Being Represented in Turn’ - A Symposium on Hélène Landemore’s Open Democracy.”

Hélene Landemore’s Open Democracy challenges today’s democracies to meet their legitimacy deficits by opening up a wide array of participatory opportunities, from enhanced forms of direct democracy, to internet crowdsourcing, to representation through random selection to a citizens’ assembly: “representing and being represented in turn” (p. xvii).  Her aim: to replace citizen consent with citizen power.  The critics advance both praise and misgivings.  Joshua Cohen would prefer Landemore’s proffered innovations as supplements, not alternatives, to the current system. Daniela Cammack would prefer more emphasis on the many forms of mass gathering, not representation.  Peter Stone considers citizens’ assemblies inadequate for popular sovereignty.  Christopher Achen warns of problems inaccurate representation, through both self-selection into the lottery and domination in the discussion. Ethan Lieb argues that particular innovations are useful only in some contexts, and that in each citizens should learn their appropriate role responsibilities. Landemore responds by agreeing, clarifying and rebutting.

Knowledge, Attitude, and Training of Health-Care Workers and Preparedness of Hospital Emergency Departments for the Threat of Communicable Diseases at Mass Gathering Events in Qatar: A Cross-Sectional Study

Objective: This study aimed to assess the knowledge, attitude, and training of health-care workers (HCW), and their perception of the preparedness of hospitals for communicable disease (CD) threats during mass gathering (MG) events. Methods: This was a cross-sectional study conducted from June 1 to July 31, 2019, of doctors and registered nurses working in the emergency departments (EDs) of 5 main hospitals in Qatar. A self-administered online survey was used for data collection. Results: The overall mean knowledge score about CD threat among study participants was 75.0% (SD ± 18.1). The majority of the participants had a favorable attitude toward CD preparedness during MG events. The participants achieved high scores in attending workshops on triaging, first aid, and infection control. Study participants as well had favorable perceptions about the current preparedness of their respective hospitals to respond to CD outbreaks in MG events. Conclusions: The participants were knowledgeable about the risk of CD outbreaks during MG events (eg, Federation of International Football Association (FIFA) World Cup games 2022) and had a favorable attitude and necessary training to respond to such outbreaks. Regular practice drills are necessary to ensure that all members of the workforce are knowledgeable of the necessary actions to take in emergent high-risk situations.

Persistence of Anti-SARS-CoV-2 Antibodies Six Months After Infection in an Outbreak With Five Hundred COVID-19 Cases in Borriana (Spain): A Prospective Cohort Study

In March 2020, several mass gathering events were related to the Falles festival in Borriana (Spain), resulting in a 536 laboratory-confirmed COVID-19 cases outbreak among participants. Our objective was to estimate anti-SARS-CoV-2 antibodies persistence six months after and factors associated with antibody response. A prospective population-based cohort study was carried out by the Public Health Center of Castellon and the Emergency and Clinical Analysis and Microbiology Services of Hospital de la Plana in Vila-real. In October 2020, sero-epidemiologic study to estimate the persistence of anti-SARS-CoV-2 antibodies by a electrochemiluminescence immunoassay (ECLIA) was implemented. We enrolled 484 (90.2%) of the 536 members of the initial outbreak cohort and detected persistent antibodies in 479 (99%) without re-infection episodes. Five participants had a negative antibody test. Factors associated with a negative result were a lower body mass index (BMI), and less contact with other COVID-19 cases. Among the 469 participants with two ECLIA tests, 96 (20.5%) had an increase of antibodies and 373 (79.5%) a decline. Increased antibodies were associated with older age, higher BMI, more severe illness, and low current smokers. After a COVID-19 infection, a high proportion of cases maintained detectable anti-SARS-CoV-2 antibodies.