Abstract
The challenges that the health systems face in the last years increased exponentially. No matter if we are talking about the impact of the COVID-19 pandemic or the Russian military action in Ukraine, the European health ecosystem is facing new problems. In the light of these uncertainties, we assessed which could be the next trends that can impact the healthcare systems, in order to better prepare and adapt to the new contexts.
Using two foresights exercises (FSE), one in 2018 and the second one in 2022, we had identified the most important trends in the political, economic, social, technological, security, environmental and medical sectors that could have an impact on health.
Fifty-three people participated in the first FSE and 40 in the second one. The respondents identified cyber security, an increased reliance on digital technologies for communications, CBRNE management of the patients, centrally coordinated attacks, demographic aging, reduced economic resources, violence against emergency medical staff and the increased need and demand for psychosocial support as the most important trends. Moreover, they considered that wars, hybrid threats, the fake news, pandemics and the influence of artificial intelligence could impact the healthcare systems.
Many of the trends identified in 2018 as having a possible impact on the health system proved to be relevant four years later. Therefore, we consider the FSE a relevant tool in foreseeing the main areas that could have an impact on health and its results could guide the preparedness for the future.
Keywords: Disaster Medicine, Risk Assessment, Forecasting, Crisis Management
Résumé
Les défis auxquels les systèmes de santé se sont confrontés pendant ces dernières années ont augmenté de façon exponentielle. Qu’il s’agisse de l’impact de la pandémie de COVID-19 ou de l’action militaire russe en Ukraine, l’écosystème européen de la santé est confronté à de nouveaux problèmes. Au regard de ces incertitudes, nous avons évalué quelles pourraient être les prochaines tendances pouvant impacter les systèmes de santé, afin de mieux se préparer et s’adapter aux nouveaux contextes.
À l’aide de deux exercices de prospective (FSE), l’un en 2018 et le second en 2022, nous avons identifié les tendances les plus importantes dans les secteurs politique, économique, social, technologique, sécuritaire, environnemental et médical qui pourraient avoir un impact sur la santé.
Cinquante trois personnes ont participé au premier FSE et 40 au second. Le répondants ont identifié la cybersécurité, la dépendance aux technologies digitales pour les communications, la gestion des patients NRBCE, les attaques coordonnées de manière centralisée, le vieillissement démographique, la réduction des ressources économiques, la violence contre le personnel médical d’urgence et le besoin et la demande accrus de soutien psychosocial comme les tendances les plus importantes. De plus, ils ont considéré que les guerres, les menaces hybrides, les informations fallacieuses, les pandémies et l’influence de l’intelligence artificielle pourraient avoir un impact sur les systèmes de santé.
Bon nombre des tendances identifiées en 2018 comme ayant un impact possible sur le système de santé se sont avérées pertinentes quatre ans plus tard. Par conséquent, nous considérons le FSE comme un outil pertinent pour prévoir les principaux domaines qui pourraient avoir un impact sur la santé et ses résultats pourraient guider la préparation pour l’avenir.
Mots clés: Médecine de catastrophe, Évaluation des risques, Prévision, Gestion de crise
Introduction
The healthcare systems around the world are defined by constant change, striving to adapt themselves to the challenges and struggles that emerge. Therefore, regardless of their professional level, healthcare workers need to adapt to the latest society demands. An example strengthening this believe is the COVID-19 pandemic, that proved us that no healthcare system is immune to what is happening around the world and no country is safe in front of a global threat. In the context of the pandemic, the adaptation to the new situation was identified as being one of the main struggles during the response to the pandemic [1], [2].
In the light of this constant demand for change and adaptation, the assessments of how the main trends may change in the future and which scenario approaches are the most suitable to apply could prove useful. A better understanding of the future could help us prepare and adapt better to the new contexts. One method of identifying the most probable evolvement of the existing trends is a foresight exercise (FSE).
A FSE represents a participatory, systematic intelligence gathering exercise, in an effort to understand better what the future could bring. By having the goal of enabling the present decisions towards joint actions, it doesn’t aim to predict the future, but to prepare for the different possibilities that could happen. Nevertheless, it strives to develop a common understanding of what should happen if threats are to be mitigated and opportunities seized [3]. Besides thinking about the future, during a FSE, the participant also debate the future and try to find ways to shape it.
The Network Of practitioners For Emergency medical systems and critical care (NO-FEAR) project is a five-year European funded project that aims to create an active Pan-European network of practitioners, decision and policy makers, suppliers and academia in the security field, sharing knowledge, experience and necessities, thus overcoming the current state of overwhelming fragmentation.
The purpose of the present study was to challenge the members of the NO-FEAR project to identify the most important trends and their evolution in time, in the field of disaster and emergency medicine. Moreover, we analyzed how the identified trends changed over the COVID-19 pandemic.
Methods
During the NO-FEAR project, we ran two FSE. The first one was running in 2018 and the second one 4 years later, in 2022.
In November 2018, using on guided discussion, the participants identified the most important trends in the political, economic, social, technological, security, environmental and medical clusters (PEST-SEM). The PEST analysis approach originates from the business sector, where it is widely used to help managers and organizations scan and predict the external factors impacting an organization [4]. We have added to the PEST analysis the security, environmental and medical (SEM) clusters to personalize the tool fitting our project's objective.
In March 2022, for the second FSE, we recategorized the trends identified in 2018 into four clusters: technological, security, social and health (Table I ). We used an online questionnaire, distributed among the NO-FEAR Participants using the platform provided by the European Commission “EUSurvey” (https://ec.europa.eu/eusurvey/) to reanalyze the participants perception on the trend's relevance, by asking them to rank the trends on a six points scale, ranging from totally irrelevant to totally relevant.
Table I.
The clusters and trends used in the second FSE.
| Cluster | Identified Trends |
|---|---|
| Technological Cluster | Access to medical data |
| Artificial intelligence (AI) applications on big data | |
| Cyber Security | |
| Digital transformation focused on operations | |
| Impact of social media on quantity, reliability and speed of information | |
| Impact of technological support (5G): dangers and opportunities | |
| Increased reliance on digital technologies for communications | |
| Security cluster | CBRNE management of patients |
| CBRNE management of threat | |
| Centrally coordinated attacks | |
| Individual coordinated attacks | |
| Healthcare impact of global climate change | |
| Social cluster | Culture, tradition and religious factors |
| Demographic aging | |
| Generation discrepancy | |
| Instabilities of governments | |
| Reduced economic resources related to health | |
| Health cluster | Higher frequency of mass casualty incidents |
| Increased need and demand for psychosocial support | |
| Less qualified health assistance | |
| Nursing leadership | |
| Violence against emergency medical staff |
Besides analyzing their relevance, we have asked the participants to mention the 3 most important trends in each of the four clusters. Moreover, we allowed the responders to mention any additional trend(s) that they deem relevant, that were not identified during the first FSE in 2018.
Results
First foresight exercise
A total of 53 people participated in the first FSE. The most important trends identified during the 2018 FSE are presented in Table II . When the trends were split according to the PEST-SEM cluster classification, social, technological and security clusters where highly identified in terms of primary positioning, while the political, economic, and environmental clusters were not as highly represented. Moreover, the medical cluster was not represented as much as the social, technological and security ones.
Table II.
Trends identified during the first FSE in 2018.
| Trends in Consequence Trees | |
|---|---|
| 1 | 112 single digit emergency number |
| 2 | 5G |
| 3 | Artificial Intelligence |
| 4 | Automated mobile universal patient monitoring |
| 5 | CBRNE |
| 6 | CBRNE management of wounded patients |
| 7 | Environmental issues: Climate change |
| 8 | Common procedures shared between different agencies |
| 9 | Demography aging |
| 10 | Development of human and material resources for mass causality |
| 11 | Digital transformation focused on human and operators |
| 12 | Education and training in emergency medicine |
| 13 | Education and training in mass casualty incidents |
| 14 | Growth of Artificial intelligence applications |
| 15 | Health economics |
| 16 | Healthy aging |
| 17 | Immersive wearable |
| 18 | Increased need and demand for psychological support |
| 19 | Individual initiative attacks (vs. centrally coordinated attacks) |
| 20 | Instabilities of governments |
| 21 | International (EU) operational organization (command and control practices) |
| 22 | Less qualified assistance: doctor/paramedic behavior |
| 23 | More frequent large-scale incidents |
| 24 | More need for operational integration |
| 25 | New technologies/big data |
| 26 | Professionalization of emergency and disaster medicine |
| 27 | Reduced economical availability |
| 28 | Remote monitoring |
| 29 | Restructuring mass casualty Incidents plans (to scoop and scooter) |
| 30 | Safety treat |
| 31 | Social media and speed of information dangers and opportunity |
| 32 | Standard operating procedures |
| 33 | Technological support |
| 34 | Technology intake/enabler |
| 35 | Training professional to mass causality incidents |
| 36 | Violence against medical personnel |
| 37 | Vulnerability of integrated system |
Second foresight exercise
We received a total of 40 responses to the survey. 18 responders were emergency and crisis managers, eight were practitioners and policy makers, while 14 were suppliers and academia representatives.
When asked to reconsider the importance of the trends identified in 2018 for the technological cluster, cyber security and an increased reliance on digital technologies for communications were considered the two most relevant ones. Regarding the security cluster, the CBRNE management of the patients and the centrally coordinated attacks deemed as the most relevant trends. For the social cluster, demographic aging and the reduced economic resources related to health were the trends consider having the most relevance. Meanwhile, for the health cluster violence against emergency medical staff and the increased need and demand for psychosocial support were ranked as the most relevant trends.
When asked to rank the trends according to their importance, for the technological cluster, cyber security was considered the most important by 39% of the participants, while 29% considered the access to medical data as the most important trend. Regarding the security cluster, 29% of the responders ranked the CBRNE management of patients as being the most important one, while 26% considered the CBRNE management of the threat as the first most important.
In the social cluster, 47% of the participants ranked demographic aging as being the most important, while 32% ranked the reduced economic resources as the most important trend. Finally, in the health cluster, the increased need and demand for psychosocial support was deemed as the most important trend by 37% of the responders, while the less qualified health assistance was ranked by 20% the most important trend.
Besides the trends already identified in the first FSE, the responders identified additional ones. In the technology cluster, the impact of drones, the availability of appropriate staff and the increased number of interconnected medical devices were considered relevant. In the security cluster, wars, hybrid threats and the impact of drones were identified as relevant, while in the social cluster, the fake news, wars and cybersecurity risks in the physical world were mentioned as very important. The participants also identified the mobility of people, pandemics and the influence of artificial intelligence in decision making as relevant for the health cluster.
Discussion
We successfully used two foresight exercises to understand the future trends in emergency and disaster medicine. Surprisingly, infectious outbreaks were not considered an important trend in 2018, although the COVID-19 pandemic proved us wrong.
During the first FSE, healthcare workers safety was identified as very relevant for future: “safety threat”, “violence against medical personnel”, “security” trends being identified as very important. The high number of attacks on healthcare workers led to the development of a number of initiatives e.g. healthcare in danger, attacks on health care initiative etc., emphasizing the high international attention given to these trends [5], [6], [7].
New technologies are arising fast, impacting the medical sector without consideration for professional level or specialty [8], [9]. During the first FSE, high importance was given to “5G”, “e-health”, “social media, digital transformation” and “artificial intelligence”, showcasing that the impact of technology development on the medical field was one of the main interests of the participants. This is in accordance with the existing literature, emphasizing people's natural interest towards novelty, but also people's skepticism regarding emerging technologies [10], [11].
The overwhelming benefits of the new technologies in medicine comes with additional problems. Among them, the “cyber security” and “big data management” were tendencies identified as important during the first FSE.
The different healthcare systems structural problems, e.g. “reduced economical availability”, “less qualified assistance: doctor/paramedic behavior” were rated as important trends during the first FSE. These tendencies were confirmed, the personnel shortage forcing less qualified staff to care for patients [12].
During the second FSE, performed three years later, compared with the first FSE, people's perception about trend's relevance remained similar. Cyber security was once again considered the most important trend in the technology cluster, following the increasing number of cyber security attacks that happened in the last years [13]. Compared with the first FSE, during the second one, “violence against emergency healthcare workers” was still considered very relevant, together with the “increased need and demand for psychosocial support”. One of the reasons of ranking the psychosocial support as very important could be the high impact that the COVID-19 pandemic had on mental health. Considering that both patient's and healthcare worker's mental wellbeing were severely affected by the pandemic, a further increase in psychosocial support is expected in the future [14].
Interestingly, during the second FSE, “demographic aging” was rated as the most important trend in the social cluster, together with reduced economic resources. It is known that the proportion of elderly is increasing, with longer life expectancy and lower birth rates. This population shift already has an impact on the healthcare systems, and this impact is expected to increase, considering that the proportion of the world's population over 60 years is expected to double until 2050 [15].
In the security cluster, the “CBRNE management of patients” and threats were identified as the main trends. This finding could be linked with the Russian military action in Ukraine, since this European conflict reignited the fear of CBRNE threats [16].
Additional to the trends identified in 2018, during the second FSE the participants considered “the impact of drones” as very important in the field of emergency and disaster medicine. In the last years, drones have been used for the delivery of medical products, for biological hazards surveillance, for telemedicine etc. [17]. Their versatility and reliance make them important tools for the future, their usage being expected to increase.
Following the COVID-19 pandemic both governments and scholars emphasized the negative impact that fake news had on the public health management of the outbreak [18]. Therefore, “fake news” was considered very relevant by the participants to the second FSE, confirming the high impact of false news on the medical field, perceived by the participants to our study.
Naturally, after the Russian military action in Ukraine, the responders identified wars as being a relevant trend for the future. Interestingly, while infectious outbreaks and the high mobility of people were not mentioned as important trends in 2018, during the second FSE the participants rated both as very important for the future.
Conclusion
Using the network created by the NO-FEAR project, we have run two FSE to identify the trends that will impact the future of emergency and disaster medicine. Although some important trends were not foreseen, e.g. pandemic, the vast majority of those identified by the first FSE proved relevant 4 years later, while the second FSE brought forward additional tendencies.
Disclosure of interest
The authors declare that they have no competing interest.
Funding
The NO-FEAR project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 786670
References
- 1.Pearson C., Britt H., Schapiro L. Commonwealth Fund; 2021. Adapting Health Care Delivery in Response to COVID-19: International Lessons for the United States. [DOI] [Google Scholar]
- 2.Yaffee A.Q., Peacock E., Seitz R., Hughes G., Haun P., Ross M., et al. Preparedness, Adaptation, and Innovation: Approach to the COVID-19 Pandemic at a Decentralized, Quaternary Care Department of Emergency Medicine. West J Emerg Med. 2020;21(6):63–70. doi: 10.5811/westjem.2020.8.48624. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Masum H., Ranck J., Singer P.A. Five promising methods for health foresight. Foresight. 2010;12(1):54–66. doi: 10.1108/14636681011020182. [DOI] [Google Scholar]
- 4.AHRQ. Political, Economic, Social, and Technological Forces Analysis | Digital Healthcare Research. https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/pest-analysis.
- 5.SHCC. More Than 4000 Attacks Against Health Workers, Facilities, and Transports Since 2016 Underscore Need for Action to Protect Health Care in Conflict - World | ReliefWeb. https://reliefweb.int/report/world/more-4000-attacks-against-health-workers-facilities-and-transports-2016-underscore-need.
- 6.WHO. Stopping attacks on health care. https://www.who.int/activities/stopping-attacks-on-health-care. [DOI] [PMC free article] [PubMed]
- 7.2015. Healthcare in Danger Initiative. ICRC Health Care In Danger. https://healthcareindanger.org/ [Google Scholar]
- 8.Ahuja A.S. The impact of artificial intelligence in medicine on the future role of the physician. PeerJ. 2019;7:e7702. doi: 10.7717/peerj.7702. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.FutureLearn; 2021. The future of healthcare technology: How is medicine changing? https://www.futurelearn.com/info/blog/future-of-healthcare-technology. [Google Scholar]
- 10.Ball W., Holland S. The fear of new technology: a naturally occurring phenomenon. Am J Bioeth. 2009;9(1):14–16. doi: 10.1080/15265160802617977. [DOI] [PubMed] [Google Scholar]
- 11.TFOT; 2022. Why many doctors & patients are scared of new health technologies. https://thefutureofthings.com/16753-why-many-doctors-patients-are-scared-of-new-health-technologies/ [Google Scholar]
- 12.Allkins S. IndependentNurse; 2019. ‘Cause for concern’ as nursing shortages force less qualified staff to step up for patient care. https://www.independentnurse.co.uk/news/cause-for-concern-as-nursing-shortages-force-less-qualified-staff-to-step-up-for-patient-care/221956. [Google Scholar]
- 13.Landi H. Fierce Healthcare; 2022. Healthcare data breaches hit all-time high in 2021, impacting 45M people. https://www.fiercehealthcare.com/health-tech/healthcare-data-breaches-hit-all-time-high-2021-impacting-45m-people. [Google Scholar]
- 14.Talevi D., Socci V., Carai M., Carnaghi G., Faleri S., Trebbi E., et al. Mental health outcomes of the CoViD-19 pandemic. Rivista di Psichiatria. 2020;55(3):137–144. doi: 10.1708/3382.33569. [DOI] [PubMed] [Google Scholar]
- 15.WHO. Ageing and health [Internet]. WHO October 2021. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health.
- 16.Aljazeera; 2022. Putin puts Russia's nuclear deterrent forces on alert. https://www.aljazeera.com/news/2022/2/27/putin-puts-russias-nuclear-deterrent-forces-on-alert. [Google Scholar]
- 17.Johnson A.M., Cunningham C.J., Arnold E., Rosamond W.D., Zègre-Hemsey J.K. Impact of using drones in emergency medicine: what does the future hold? Open Access Emerg Med. 2021;13:487–498. doi: 10.2147/OAEM.S247020. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.van der Linden S., Roozenbeek J., Compton J. Inoculating against fake news about COVID-19. Front Psychol. 2020;11:566790. doi: 10.3389/fpsyg.2020.566790. [DOI] [PMC free article] [PubMed] [Google Scholar]