Papers by Rafael Castro Delgado
World Journal of Emergency Surgery, 2021
Introduction Quality in medical care must be measured in order to be improved. Trauma management ... more Introduction Quality in medical care must be measured in order to be improved. Trauma management is part of health care, and by definition, it must be checked constantly. The only way to measure quality and outcomes is to systematically accrue data and analyze them. Material and methods A systematic revision of the literature about quality indicators in trauma associated to an international consensus conference Results An internationally approved base core set of 82 trauma quality indicators was obtained: Indicators were divided into 6 fields: prevention, structure, process, outcome, post-traumatic management, and society integrational effects. Conclusion Present trauma quality indicator core set represents the result of an international effort aiming to provide a useful tool in quality evaluation and improvement. Further improvement may only be possible through international trauma registry development. This will allow for huge international data accrual permitting to evaluate resu...
Effects of mass casualty incidents on anxiety, depression and PTSD among doctors and nurses: a systematic review protocol
BMJ Open, Aug 31, 2023
Disaster Medicine and Public Health Preparedness
Understanding the relationship between infectious disease outbreaks and natural disasters is impo... more Understanding the relationship between infectious disease outbreaks and natural disasters is important in developing response and disaster risk reduction strategies. The aim of this study was to identify outbreaks associated with natural disasters during the past 20 y, and outline risk factors and mechanisms for postdisaster outbreaks. Review of the international disaster database (EM-DAT) and systematic review of the literature were conducted. The records of disaster events in EM-DAT during the past 20 y were screened. A literature search was carried out in the databases PubMed and Embase. Articles in English language published between 2000 and 2020 were searched. Data were extracted from articles and Narrative synthesis was used to summarize the findings. We found 108 events associated with epidemics, the majority being floods. We found 36 articles, most of them focused on outbreaks after floods. Risk factors and mechanisms that contributed to the outbreaks were mainly related to ...
Risk Management and Healthcare Policy
Background: The COVID-19 pandemic, declared by the World Health Organization as a public health i... more Background: The COVID-19 pandemic, declared by the World Health Organization as a public health international emergency concern in March 2020, has caused serious impacts on individuals, families, communities, and societies across the globe. The COVID-19 pandemic not only disrupted the health systems and the economy, but also significantly impacted routine immunization programs. Aim: To study the impact of the COVID-19 pandemic lockdown on the routine immunization coverage program in the province of Laghman, Afghanistan. Methods: A comparative cross-sectional quantitative study was conducted to understand the impact of COVID-19 on routine childhood immunization during the study period. Secondary data was used from the Ministry of Health from April to July 2020 and compared with the historical data of the same period in 2019. Student t-test was used to test the association between the mean changes in the daily immunization coverage. A p-value<0.05 was considered as statistically significant with 95% confidence interval. Results: There was a 21.4% significant (p<0.01) decline in the total immunization coverage during April-July 2020 compared to April-July 2019. This reduction was diverse across all districts and all vaccine antigens. The most affected district was Alingar, and the most affected vaccines were measles and OPV4, with 28% declines, followed by PCV3 at 26%, and DPT3, IPV, OPV3, PCV2 and rotavirus at 23%. The outreach vaccination coverage declined by 56.1% compared to the fixed, at 13.4%. Conclusion: The COVID-19 pandemic seriously affected the routine immunization in Afghanistan. On average, 325 children per day missed out on a lifesaving vaccine in Laghman province which put them at risk of getting preventable diseases. To provide access to routine immunization during pandemics, the study suggests a set of customized interventions to strengthen and sustain routine immunization.
Journal of Global Health
COVID lockdown has impacted the routine vaccination programme in Afghanistan, what can rise to an... more COVID lockdown has impacted the routine vaccination programme in Afghanistan, what can rise to an increase in vaccination preventable diseases in the afghan population.
Burkina Faso is a West African Sahelian country with climate-related risks because the disaster r... more Burkina Faso is a West African Sahelian country with climate-related risks because the disaster risk profile, and drought and floods are the main damaging natural disasters, aggravated by the phenomenon of climate change. An effective design and implementation of disaster reduction management strategies requires an understanding of risk factors and vulnerabilities, but also and an assessment of the strengths and weaknesses of national disaster response systems.In this perspective, a literature review and an analysis of climate information were conducted in order to reveal the risks and vulnerabilities to droughts and floods in the country. This was accompanied by a critical evaluation of the performance of the national prevention and intervention system.Vulnerabilities to drought and floods are exacerbated by the combined effect of climate change and the low performance of the national disaster risk reduction management system. National institutions and frameworks exist for disaster...
Emergency transfers under cardiopulmonary resuscitation: Zero survival?
La mortalidad por desastres en España: un análisis del periodo 1950-2012
Index de Enfermería, 2017
International Journal of Environmental Research and Public Health
This paper provides a comprehensive set of methodologies that have been used in the literature to... more This paper provides a comprehensive set of methodologies that have been used in the literature to give a monetary value to the human impact in a natural disaster setting. Four databases were searched for relevant published and gray literature documents with a set of inclusion and exclusion criteria. Twenty-seven studies that quantified the value of a statistical life in a disaster setting or discussed methodologies of estimating value of life were included. Analysis highlighted the complexity and variability of methods and estimations of values of statistical life. No single method to estimate the value of a statistical life is universally agreed upon, although stated preference methods seem to be the preferred approach. The value of one life varies significantly ranging from USD 143,000 to 15 million. While an overwhelming majority of studies concern high-income countries, most disaster casualties are observed in low- and middle-income countries. Data on the human impact of disaste...
Terrorism and Public Health: Health Care Management of Terrorist Attacks by Bomb
Ten years using the advanced triage model for out-of-hospital emergencies (META): the 2020 version
Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias, 2021
Análisis comparativo en el uso del triage META y triage START en un ejercicio de múltiples víctimas simulado: efectos sobre el tratamiento y tiempos de evacuación
Emergencias, 2018
Objetivo: El objetivo principal es comparar el uso de dos sistemas de triage (Simple Triage and R... more Objetivo: El objetivo principal es comparar el uso de dos sistemas de triage (Simple Triage and Rapid Treatmet, START; y Modelo Extrahospitalario de Triage Avanzado, META) ante un mismo incidentes de multiples victimas (IMV) simulado. Son objetivos secundarios analizar el tratamiento y la evacuacion. Metodo : Estudio aleatorizado comparativo de gestion de victimas en un ejercicio de simulacion. Se realizaron dos simulacros similares y se aleatorizaron los 48 participantes entre los dos grupos de estudio: grupo START y grupo META. Se midieron tiempos de evacuacion y tratamientos realizados. Resultados : En el grupo START el tiempo de evacuacion de todos los pacientes fue de 48’39’’ (DE 15’52’’), siendo de 48’4’’ (DE 17’21’’) en el caso del grupo META (p=0,897). Los pacientes rojos se evacuaron antes en el grupo META (31’36’’ (DE 8’27’’)) que en el START (41’6’’ (DE 10’39’’)) (p=0,024). Los pacientes rojo quirurgicos tambien se evacuaron antes en el grupo META (24’12’’ (DE 4’)) que e...
Cardiac arrest: epidemiologic research on providing appropriate emergency management
Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias, 2021
Traslados Con Reanimación en Ruta: ¿Supervivencia Cero?
Emergencias, 2018
[Results of provisional use of a system for voluntary anonymous reporting of incidents that threaten patient safety in the emergency medical services of Asturias]
Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias, 2016
OBJECTIVES To describe the reported incidents and adverse events in the emergency medical service... more OBJECTIVES To describe the reported incidents and adverse events in the emergency medical services of Asturias, Spain, and assess their consequences, delays caused, and preventability. MATERIAL AND METHODS Prospective, observational study of incidents reported by the staff of the emergency medical services of Asturias after implementation of a system devised by the researchers. RESULTS Incident reports were received for 0.48% (95% CI, 0.41%-0.54%) of the emergencies attended. Patient safety was compromised in 74.7% of the reported incidents. Problems arising in the emergency response coordination center (ERCC) accounted for 37.6% of the incidents, transport problems for 13.4%, vehicular problems for 10.8%, and communication problems for 8.8%. Seventy percent of the reported incidents caused delays in care; 55% of the reported incidents that put patients at risk (according to severity assessment code ratings) corresponded to problems related to human or material resources. A total of...
Comparison of the Simple Triage and Rapid Treatment system versus the Prehospital Advanced Triage Model in multiple-casualty events
Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias, 2018
OBJECTIVES . The main purpose of this simulation of a multiple-casualty event was to compare the ... more OBJECTIVES . The main purpose of this simulation of a multiple-casualty event was to compare the performance of 2 triage methods: the Simple Triage and Rapid Treatment (START) system and the Prehospital Advanced Triage Model (META in its Spanish acronym). The secondary objectives were to analyze times, order of evacuations, and appropriateness of treatments. MATERIAL AND METHODS Cluster randomized trial that included 16 groups assigned to use either the START system or the META for managing casualties in a simulated event (an airline crash). Each group had 4 members. We recorded times, order of evacuation, and appropriateness of treatment. RESULTS The mean (SD) evacuation time was 48 minutes and 39 seconds (15 minutes, 52 seconds) in the START arm and 48 minutes and 4 seconds (17 minutes, 21 seconds) in the META arm (P=.829). The patients with greatest need of immediate care were evacuated more quickly in the META arm (31 minutes and 36 seconds [8 minutes, 27 seconds]) than in the S...
Resultados de Instauración provisional de un sistema voluntario y anónimo de notificación de incidentes en Seguridad del Paciente en el Servicio de Atención Médica Urgente (SAMU) de Asturias
Emergencias, 2016
Objetivos : El objetivo principal de nuestro estudio fue conocer los Incidentes/Eventos Adversos ... more Objetivos : El objetivo principal de nuestro estudio fue conocer los Incidentes/Eventos Adversos (EA) que se notificaron en el Servicio de Atencion Medica urgente (SAMU)-Asturias y caracterizarlos, evaluando sus consecuencias, el retraso asistencial provocado y su evitabilidad. Metodos : Estudio observacional y prospectivo en el que se analizan las notificaciones realizadas por los profesionales sanitarios del SAMU-Asturias, en un sistema de notificacion disenado por los investigadores. Resultados : Se obtuvo una tasa de notificacion de 0,48% (IC 95%: 0,412-0,549). Un 75% supusieron dano al paciente. El 37.6% de los problemas estaban relacionados con el Centro Coordinador Urgencias (CCU), 13.4% con el transporte, 10.8% con el vehiculo y 8.8% fueron problemas de comunicacion. Un 70% de los sucesos adversos (SA) notificados conllevaron un retraso en la asistencia sanitaria. Un 55% de las notificaciones del CCU en las que hubo riesgo SAC (Severity Assessment Code) correspondian a prob...
Self-perception of theoretical knowledges and practical skills by primary health care physicians in life-threatening emergencies according to their gender
Medicine, 2021
To assess the training received in Emergency Medicine (EM) by the Primary Health Care physicians ... more To assess the training received in Emergency Medicine (EM) by the Primary Health Care physicians of Asturias, as well as their perception of their own theoretical knowledge and practical skills in a series of procedures employed in life-threatening emergencies, and also to analyze the differences according to gender. The degree of preparation of Primary Health Care physicians for handling emergencies, according to the gender of the professionals, has never been studied before. Cross-sectional study of a sample of 213 Primary Health Care physicians from the Primary Health Care Service of Asturias, Spain, from among the total of 851 physicians on the staff of the Primary Health Care Service of Asturias. The survey was design ad hoc using the Body of Doctrine of Emergency Medicine proposed by the Spanish Society of Emergency Medicine, which indicates the theoretical and practical procedures that must be mastered by the Primary Health Care physicians. There are nonsignificant difference...
Epidemiology and Health, 2021
Sub-Saharan African countries, like many other low-income countries, have experienced urban socio... more Sub-Saharan African countries, like many other low-income countries, have experienced urban socioeconomic inequalities due to rapid and unplanned urbanization. These processes have resulted in the creation of poor urban areas lacking basic sanitation, water, and hygiene facilities, and subjacent public health issues such as the spread of waterborne diseases. A system for the demarcation of disease transmission areas already exists, but the traditional framework is less appropriate in sub-Saharan Africa, making it necessary to divide these urban areas more adequately. In addition, the construction of frameworks and tools more specific to waterborne disease-related issues is essential. We propose restructuring sub-Saharan urban areas into more specific areas of exposure to waterborne diseases and associated exposomes, and then use this restructuring of urban areas of exposure to waterborne diseases in a conceptual framework that takes into account causes of exposure, impacts, and inte...
Uploads
Papers by Rafael Castro Delgado