[Virtual staff teamwork during the pandemic - development of digital training formats for community emergency response during the coronavirus pandemic]

Background

In the event of emergency response to large-scale incidents, such as a mass casualty incident (MCI) or a mass casualty incident-infectious disease (MCI-ID), regular training is essential in order to have experienced emergency personnel available in the event of an incident. Due to the pandemic drills often had to be cancelled or were only possible with small groups of people. It was often not possible to simulate a large-scale emergency with actors, so that the trainees could not be offered realistic scenarios of a mass casualty or disease incident. As part of two research projects, a digital platform for conducting training was used to avoid the risk of infection between participants during the exercises, so that on-site personnel deployment could be reduced to a minimum. The goal of this work was to evaluate end-user acceptance of the digital solution approaches.

Methods

Within the framework of the project "Adaptive Resilience Management in Ports" (ARMIHN), a digital exercise platform was applied and evaluated with the help of participant surveys according to the focal points "implementation", "alternative possibilities", "learning effect" and "usability". The participants used the digital platform to exchange information and to communicate. For this purpose, various collaboration tools were embedded in the platform, which enabled simultaneous exchange of information in real time. Constant video communication with in-house and external authorities/teams was also established.

Results

The potential of the digital platform as an alternative to on-site exercises was confirmed by the participating end users in the ARMIHN project with 90% agreement. The increase in subjective skills and knowledge gained during a MCI-ID was also predominantly rated approvingly (up to 70%). Participants who rated the implementation of the online format as well performed were significantly more likely to state that subjectively their ability to handle a MCI-ID had improved (p = 0.016). In contrast, virtual staff teamwork in real crisis situations was viewed critically by about half of respondents.

Conclusion

Overall, the evaluation results point to the high end-user acceptance of the developed concept. Even though the aim is to evaluate the system over a longer period with a larger number of participants, the studies already conducted confirm the positive experiences in the respective projects.

Eating behaviour and weight development of European and Asian seafarers during stay on board and at home

Background

Food choices on board merchant ships are limited and seafarers repeatedly described as being at high risk of developing overweight compared to the general population. Up to date, research has not distinguished whether seafarers gain weight on board or at home and whether eating habits differ in both settings.

Methods

As part of the e-healthy ship project, cross-sectional data were collected in two different measurements. In the first investigation on board of three merchant ships of German shipping companies, differences in eating behaviour at home compared to on board ships were assessed for 18 Burmese, 26 Filipino and 20 European seafarers. In a second study, BMI, weight development and location of body weight change of 543 Filipino and 277 European seafarers were examined using an online questionnaire on 68 ships.

Results

According to the board examinations, foods and beverages consumed on merchant ships varied widely from seafarers’ diets in their home country. Burmese, Filipino and European seafarers equally reported to consume more fruit (z = 4.95, p < .001, r = .62) and vegetables (z = 6.21, p < .001, r = .79), but less coke (z = −5.00, p < .001, r = .76) when at home. Furthermore, culturally different changes were found across all other foods and beverages. The online questionnaire revealed that 45.8% of seafarers were overweight (55.4% Europeans vs. 40.8% Filipinos, p < .001) and 9.8% obese. Moreover, a higher percentage of Europeans compared to Filipinos reported weight gain over the course of their professional career (50.2% vs. 40.7%, p = .007). A sub-analysis of seafarers with weight gain found that more Europeans than Filipinos gained weight at home (43.9% vs. 23.1%, p < .001).

Conclusions

Both, home and working on board merchant ships, represent very different living environments which may affect seafarers’ lifestyle and eating habits in various ways and thus could favour or inhibit weight gain. From our results, it appears that the body weight and eating habits of Asian seafarers in particular are adversely affected by the working and living conditions on board. Further prospective studies are required to prove this hypothesis.

[Prevention and management of COVID-19 outbreaks on merchant ships]

Hintergrund

Eine Pandemie ist eine besondere medizinische Herausforderung für Seeleute, die ohne Arzt/Ärztin an Bord unterwegs sind. Gleichzeitig ist es eine Notwendigkeit für die weltweite Bekämpfung der COVID-19-Pandemie, Warenströme durch eine widerstandsfähige Handelsschifffahrt aufrechtzuerhalten. Für die Infektionsprävention und das Infektionsmanagement an Bord benötigen Verantwortliche ein Portfolio von Schutzmaßnahmen, die auf Schiffen angewendet werden können.

Fragestellung

In der Übersicht wird der Fragestellung nachgegangen, welche technischen, organisatorischen und persönlichen Schutzmaßnahmen auf einem Handelsschiff angewandt werden können, um COVID-19-Ausbrüche an Bord zu verhindern oder bewältigen zu können.

Material und Methoden

Richtlinien, Informationen und Arbeitsschutzstandards aus dem maritimen Setting, aber auch aus anderen Arbeitsbereichen wurden gesichtet, damit Verantwortliche diese angepasst an die Lage (z. B. Schiffsgröße, Ausstattung, Witterung, Betriebszustand, Arbeitsanforderungen, Kontakt mit Schiffsfremden, medizinische Probleme) variabel einsetzen können.

Ergebnisse

Eine Handreichung, die konkrete, im maritimen Kontext erklärte technische, organisatorische und persönliche Schutzmaßnahmen für Crews zur anlassbezogenen Nutzung enthält, wurde erstellt. Kombinationsmöglichkeiten und Timing von Sicherheitsbarrieren werden darin zielgruppenorientiert erklärt.

Fazit

Eine Fülle der aus arbeitsmedizinischer Literatur und den Erfahrungen des Hafenärztlichen Dienstes in Hamburg abgeleiteten Schutzmaßnahmen sind auf hoher See umsetzbar. Handelsschiffe sollten in Pandemiezeiten vorausschauend ausgestattet (z. B. mit Schnelltests) und Verantwortliche ermächtigt werden, begründete Infektionsschutzmaßnahmen angepasst an die Situation an Bord einzusetzen. Seeleute sollten unabhängig von ihrer nationalen Herkunft prioritäre Impfangebote erhalten.

Systematic Review on Outbreaks of SARS-CoV-2 on Cruise, Navy and Cargo Ships

The confined environment of a ship promotes the transmission of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to close contact among the population on board. The study aims to provide an overview of outbreaks of SARS-CoV-2 on board of cruise, navy or cargo ships, to identify relevant outbreak management techniques, related problems and to derive recommendations for prevention. Four databases were searched. The study selection included reports about seroprevalences or clinically/laboratory confirmed infections of SARS-CoV-2 on board ships between the first of January, 2020 and the end of July, 2020. A total of 37 studies were included of whom 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 studies referred to the Diamond Princess). Two studies considered outbreaks on the Grand Princess, three studies informed about Nile River cruises and one study about the MS Westerdam (mention of multiple outbreaks possible in one study). Additionally, three studies reported outbreaks of SARS-CoV-2 on navy vessels and one study referred to a cargo ship. Problems in handling outbreaks resulted from a high number of asymptomatic infections, transportation issues, challenges in communication or limited access to health care. Responsible operators need to implement infection control measures which should be described in outbreak management plans for ships to prevent transmission risks, including, e.g., education, testing strategies, communication lines, social distancing and hygiene regulations.

[Air and maritime transport during the COVID-19 pandemic in Germany: challenges for the public health service]

COVID-19 has been challenging our society since January 2020. Due to global travel, the new coronavirus has rapidly spread worldwide. This article aims to provide an overview of the challenges in implementing measures in the air and maritime transport sector from the perspective of the German Public Health Service (Öffentlicher Gesundheitsdienst, ÖGD). Significant events and measures for air and maritime transport between January and August 2020 were selected. Lessons learned are discussed.During the COVID-19 pandemic, the ÖGD has been operating in a field of tension between the dynamics of scientific knowledge, political decision-making, social acceptance and consent.There are specific challenges at points of entry such as airports and seaports. These include staff shortages and the need to implement measures with a high organisational effort at very short notice such as health authority passenger checks carried out on aircraft, the establishment of test centres at points of entry and control of compliance with quarantine measures. Aggravating the situation, passenger lists, which are necessary for effective contact tracing, are often not available or incomplete. There is also a lack of digital tools for contact tracing but also, for example, the exchange of personal data within the ÖGD. Further difficulties in outbreak management arise from the cramped conditions on board ships and from the potential psychological stress on crew members and passengers, which have not yet been sufficiently considered.In view of all these challenges, it is paramount to strengthen the German Public Health Service in general and at points of entry and to intensify the exchange between the national, federal state and local levels.

When the ship comes in – COVID-19-Ausbrüche an Bord von Frachtschiffen im Hamburger Hafen

Seit Dezember 2019 hält das SARS-CoV-2-Virus die Welt in Atem. Die maritime Welt wird von der Pandemie vielfältig getroffen. Reiserestriktionen schränken den Nachschub von z. B. Ersatzteilen ein und behindern den Crewwechsel massiv. Reguläre und irreguläre Kontakte zur Bevölkerung der jeweiligen Häfen ermöglichen einen Eintrag des Virus in das Schiff. Beengte Lebensverhältnisse an Bord tragen zu einer Ausbreitung des Virus bei. Wir berichten über 2 Ausbruchsgeschehen an Bord von Frachtschiffen, die in ihrer Komplexität die infektionsepidemiologischen Herausforderungen schlaglichtartig beleuchten.

Internationaler Gesundheitsschutz im Fokus

Das europäische Projekt Healthy GateWays Joint Action, gefördert von der Europäischen Union (EU), hat zum Ziel, die internationalen Gesundheitsvorschriften an Grenzübergangsstellen verstärkt umzusetzen. Nach den europäischen Vorläuferprojekten EU SHIPSAN ACT Joint Action und AIRSAN stehen in der aktuellen Joint Action das Management übertragbarer Erkrankungen an allen Schnittstellen des öffentlichen Personenverkehrs im Fokus und wie im Sinne der sogenannten „Preparedness and Response“ auf diese präventiv und im Falle eines Krankheitsausbruchs reagiert werden kann. Zusätzlich zu Flughäfen und Häfen werden auch Landübergänge miteinbezogen, da hier die internationalen Gesundheitsvorschriften nur zu einem geringen Anteil umgesetzt sind.

How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns

The internal jugular veins are considered to be the main pathways of cerebral blood drainage. However, angiographic and anatomical studies show a wide anatomical variability and varying degrees of jugular and non-jugular venous drainage. The study systematically analyses the types and prevalence of human cerebral venous outflow patterns by ultrasound and MRI. Fifty healthy volunteers (21 females; 29 males; mean age 27+/-7 years) were studied by color-coded duplex sonography. Venous blood volume flow was measured in both internal jugular and vertebral veins in the supine position. Furthermore, the global arterial cerebral blood volume flow was calculated as the sum of volume flows in both internal carotid and vertebral arteries. Three types of venous drainage patterns were defined: a total jugular volume flow of more than 2/3 (type 1), between 1/3 and 2/3 (type 2) and less than 1/3 (type 3) of the global arterial blood flow. 2D TOF MR-venography was performed exemplarily in one subject with type-1 and in two subjects with type-3 drainage. Type-1 drainage was present in 36 subjects (72%), type 2 in 11 subjects (22%) and type 3 in 3 subjects (6%). In the majority of subjects in our study population, the internal jugular veins were indeed the main drainage vessels in the supine body position. However, a predominantly non-jugular drainage pattern was found in approximately 6% of subjects.