War in the COVID-19 era: Mental health concerns in Armenia and Nagorno-Karabakh

Markosian, Christopher; Layne, Christopher; Petrosyan, Varduhi; Shekherdimian, Shant; Kennedy, Cheryl A.; Khachadourian, Vahe

doi:10.1177/00207640211003940

“…14 The six-week war saw at least a seven-fold increase in the daily number of cases of COVID-19, 13-15 as population displacement, overcrowded living spaces, war, and social mobilization encouraged disease proliferation. 8,13,16 Armenia's EMS system, already stretched to capacity by the COVID-19 pandemic, was given the additional burden of caring for and evacuating war casualties, sometimes requiring ambulances dispatched from Yerevan six hours away. 6 During the height of the pandemic, YMAS calls increased to 1,000-1,200 calls daily.…”

Section: Introductionmentioning

confidence: 99%

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia

Woodward

¹

,

Hertelendy²,

Hart³

et al. 2022

Prehosp. Disaster med.

0

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Introduction: 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. Study Objective: 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. Methods: 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. Results: 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%). Conclusion: 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.

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“…14 The six-week war saw at least a seven-fold increase in the daily number of cases of COVID-19, [13][14][15] as population displacement, overcrowded living spaces, war, and social mobilization encouraged disease proliferation. 8,13,16 Armenia's EMS system, already stretched to capacity by the COVID-19 pandemic, was given the additional burden of caring for and evacuating war casualties, sometimes requiring ambulances dispatched from Yerevan six hours away. 6 During the height of the pandemic, YMAS calls increased to 1,000-1,200 calls daily.…”

Section: Introductionmentioning

confidence: 99%

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia

Woodward

¹

,

Hertelendy

²

,

Hart

³

et al. 2022

Prehosp. Disaster med.

0

View full text Add to dashboard Cite

Introduction: 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. Study Objective: 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. Methods: 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. Results: 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%). Conclusion: 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.

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“…1 These compounding events put a much greater strain on the health care system, creating a complex humanitarian crisis that resulted in significant psychosocial consequences for health care workers in Armenia. 2,3 The Nagorno-Karabakh region is a contested territory internationally recognized as part of Azerbaijan, but inhabited and controlled primarily by Armenians. Since the dissolution of the former Soviet Union, there have been two wars and numerous skirmishes over the territory.…”

mentioning

confidence: 99%

The Psychosocial Impact of Compounding Humanitarian Crises Caused by War and COVID-19 Informing Future Disaster Response

Harutyunyan

¹

,

Mukhaelyan²,

Hertelendy

³

et al. 2021

Prehosp. Disaster med.

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The coronavirus disease 2019 (COVID-19) pandemic has caused the greatest global loss of life and economic impact due to a respiratory virus since the 1918 influenza pandemic. While health care systems around the world faced the enormous challenges of managing COVID-19 patients, health care workers in the Republic of Armenia were further tasked with caring for the surge of casualties from a concurrent, large-scale war. These compounding events put a much greater strain on the health care system, creating a complex humanitarian crisis that resulted in significant psychosocial consequences for health care workers in Armenia.

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War in the COVID-19 era: Mental health concerns in Armenia and Nagorno-Karabakh

Cited by 9 publications

References 11 publications

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia

The Psychosocial Impact of Compounding Humanitarian Crises Caused by War and COVID-19 Informing Future Disaster Response

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