Collaboration and capacity-building
This keynote presentation highlighted shared ambitions and collaborations between Monash University and the Jordan University of Science and Technology (JUST). This collaboration continues to demonstrate important capacity-building for the paramedic profession in Jordan. The presentation outlined the outcomes achieved in the past 3 years from our current PhD scholars, highlighting the significance of their research and scholarship and the impact for the paramedic profession.
Emergency medical service delays in ST-elevation myocardial infarction: a systematic review and meta-analysis
In this keynote presentation, Ahmad reported the findings of his latest study explaining that there are currently no evidence-based benchmarks for emergency medical service (EMS) delays in patients with ST-elevation myocardial infarction (STEMI). This review study sought to evaluate EMS delays and its impact on time-to-treatment in patients with STEMI, and describe system characteristics associated with these delays.
In this review, the authors systematically collected studies examining time in minutes of EMS-related system delays and its sub-intervals and included 100 studies (125 343 patients) conducted in 20 countries between 1990 and August 2018. The authors also performed a meta-analysis with random effects models to estimate the weighted mean (WM) delay time, and univariate and multivariable meta-regression to identify factors associated with EMS delays and the impact of EMS delays on time-to-treatment and the proportion of STEMI patients treated in <90 minutes. Findings showed that shorter EMS delay was significantly associated with a higher proportion of patients treated within the standard of care.
Introduction of Taiwan EMS and its professional development
In this presentation, Jack provided an insight into the background and professional development stages of the emergency medical services (EMS) system in Taiwan. Jack is a paramedic educator and disaster medical assistant team promoter in Taiwan. Furthermore, he explained the role he played in designing and organising all levels of emergency medical technician (EMT) and disaster-related training in the fire department and hospital. He also highlighted the various and joint efforts to establish the Taiwan Society of Paramedicine (TSP).
Dead Sea tragedy, can we manage better?
Dr Emad highlighted the facts, lessons learned and ways to avoid future tragedy. The Deadsea tragedy involved a flash flood and 21 deaths including school kids and teachers. In his presentation, Dr Emad reported the time points starting from the time of EMS activation to the arrival at hospital. He also explained how the civil defence, police and hospital staff operated during this mass casualty incident, explaining the challenges of the crowded emergency department. He concluded his presentation by recommending various steps to avoid future tragedies including prevention and protection strategies, floods early warning systems, accurate triage, early activation of EMS, and giving accurate and correct reports to the media as well as the receiving hospitals.
Flash floods in Jordan: Lessons learned
Dr Mahmoud highlighted that natural and human-caused disasters are currently on the rise in terms of their intensity and frequency. Unfortunately, developing countries bear the highest costs of such disasters as reports say that 95% of deaths from disasters occur in developing countries. Natural disasters, such as floods, droughts, and earthquakes, therefore pose a great challenge for development in poor countries, as their recurrence can further impoverish them and hinder their efforts for development.
He then turned his attention to Jordan, noting it is one of the countries that is susceptible to multiple hazards. Flash flood is the type of hazard with the most adverse consequences to human life in Jordan. Over the last several decades, Jordan experienced several episodes of flash floods that resulted in hundreds of deaths and major damages. On 25 October 2018, a flash flood in the Dead Sea area swept the life of 21 people and resulted in 35 injuries, most of them in schoolchildren.
The tragedy of the Dead Sea flash flood highlighted the importance of implementing the four phases of disaster management. In Jordan, we generally focus on response and recovery, but we give little attention to mitigation and preparedness—which are not less important. Drills and exercises as well as the installation of early warning systems are some of the most important measures to prevent or alleviate the effect of flood hazards. Literature review show that early warning systems are understudied in Jordan. There is therefore a need to study the social aspect of installation of early warning systems in Jordan and how people should behave at the time of warning systems activation.
Many lessons can be learned from the Dead Sea event. Perhaps disaster preparedness through exercises and drills and installation of early warning systems are among the measures that can make the difference between life and death, and make our community resilient to such events.
Vitamin C prevents memory impairment induced by waterpipe smoke: role of oxidative stress
This presentation aimed to highlight the results of Ghida'a's master thesis study. She explained that waterpipe tobacco smoking (WTS) was previously shown to be associated with memory deficits, which were related to oxidative stress. Vitamin C (VitC) has established antioxidant properties against memory deficits associated with several diseases and conditions. In this study, the potential protective effect of VitC on memory impairment induced by WTS exposure was evaluated in a rat model. VitC was administered to animals via oral gavage (100 mg/kg/day, 6 days a week for 4 weeks). In the same period, animals were exposed to WTS for 1 hour/day, 6 days a week for 4 weeks.
Using radial arm water maze (RAWM), behavioural tests were conducted to evaluate the spatial learning and memory. In addition, hippocampal levels of oxidative stress biomarkers were analysed. WTS exposure impaired both short- and long-term memory (p<0.05). On the other hand, VitC protected memory impairment induced by WTS (p<0.05). Moreover, VitC prevented the reduction in hippocampus ratio of GSH/GSSG (p<0.05) induced by WTS. In conclusion, Ghaida'a highlighted that WTS resulted in inducing memory impairment, which was prevented by VitC administration. This could be related to preserving hippocampus antioxidant mechanisms by VitC during WTS exposure.
The inflammatory response as a target therapy in myocardial infarction
In the final presentation, Mr Nasser demonstrated that salvaging myocardial tissue after the onset of myocardial infarction (MI) is the primary goal of treatment. However, early targeting of the cause of consequences that result in the long term, most notably congestive heart failure (CHF), might result in an optimised outcome regarding the individuals, who are prone to such risk.
A systematic search was conducted using various databases and key terms and resulted in 1825 relative records. After reviewing the titles and removing duplicates, only 247 articles remained relative to the research question. Of these, 76 articles were excluded after reviewing the abstracts, leaving 171 full-text articles to assess for eligibility. For the interest of time and purposes of this presentation, four recent (most relative) articles were included in the discussion.
The studies demonstrated the detailed underlying mechanism of the inflammatory process and how it causes remodelling. This remodelling leads to congestive heart failure, along with hopes and challenges of finding an intervention to prevent it, providing insights into potential targets for therapy. He added that the biochemistry of the underlying inflammatory process is a double-edged sword that should be thoroughly investigated to find a site-specific therapy in order to prevent cardiac remodeling after MI, and learning from our past failures is an essential step in such task. He concluded that if the answer seems ambiguous, then it lies clearly within the pathophysiology.