Informing COVID-19 related activities of the Belgian Red Cross

The Belgian Red Cross is dedicated to assisting individuals, families and communities during the COVID-19 pandemic. To inform COVID-19 related activities (such as testing donor blood for COVID-19 antibodies, collecting plasma of male donors recovered from COVID-19, supporting crisis volunteers in Flanders, and raising awareness in African countries) with scientific evidence, CEBaP researchers routinely assessed the relevance of recent scientific studies and systematic reviews. In close collaboration with the Belgian Red Cross Communications Department, CEBaP conducted factchecks and assessed the quality of studies on relevant topics such as the link between blood type and COVID-19 susceptibility.


Contributing to a live map of COVID-19 studies

Experts, policy makers and researchers worldwide were and are still scrambling to keep up with the influx of potentially relevant COVID-19 studies to assist local governments, NGOs, hospitals, etc with the development of evidence-based policy guidelines. The Norwegian Institute of Public Health (NIPH) therefore set up an international project, screening and categorising COVID-19 studies into specific subgroups, to provide policy makers and researchers quick access to specific topic-relevant publications. The live map of COVID-19 evidence not only identifies current research but also highlights research gaps which might guide future research efforts. From April 2020 until October 2020, one of CEBaP’s researchers was involved in this categorisation effort in collaboration with Cochrane Belgium. CEBaP also benefitted from this collaboration as NIPH sent CEBaP researchers a weekly list of COVID-19 studies which were likely to be relevant to Belgian Red Cross. This drastically cut down the time CEBaP spent searching and assessing the published COVID-19 studies each week.


Conducting rapid systematic reviews on COVID-19 related topics

Factors affecting mental health of health care workers during coronavirus disease outbreaks

CEBaP performed a rapid systematic review to identify the best possible evidence on risk and protective factors for psychological outcomes in health care workers during coronavirus epidemics. Out of 2605 references, 33 observational studies were selected and the identified risk and protective factors were categorized in ten thematic categories. 

Several organizational factors, including clear communication and directives, and organizational support seem paramount in addition to protective factors such as health care workers’ perceptions of coping ability and social support. Embedding access to mental health support in a safe and efficient working environment which promotes collegial social support and personal sense of control could help to maximize resilience of health workers during a global health crisis. 

Our results may inform decisions to safeguard the mental health of care providers during this and future respiratory infectious disease outbreaks. The Belgian Red Cross built further on the findings of this rapid review and implemented several strategies to protect their crisis volunteers from developing mental health problems. In addition to providing psychosocial self-help advice to the care providers, they continuously monitor their mental health status, ensure awareness of mental health initiatives and launch information campaigns on mental health support and education.  

The effect of hand hygiene promotion programs during epidemics 

CEBaP summarized the effectiveness of hand hygiene promotion programs on reducing infection transmission of respiratory droplet-transmissible diseases. Following systematic searches in 3 databases and the Norwegian living COVID-19 evidence map, 12 relevant cluster randomized controlled trials were identified. The results suggested that preventive hand hygiene promotion programs can be effective in reducing laboratory-confirmed influenza transmission in school settings during interepidemic periods. However, no improvement could be demonstrated when these programs were implemented in household settings to prevent secondary transmission from previously identified cases. Publication of this review is expected in 2021.

First aid

Update of our first aid guidelines

Every 5 years CEBaP is involved in the update of Belgian Red Cross’ evidence-based first aid guidelines and corresponding first aid manual. We updated existing evidence summaries, and developed several new ones, based on the input of our operational colleagues of the First Aid Service, resulting in 490 up-to-date first aid evidence summaries. In addition we consulted the “Consensus on Science and Treatment Recommendations” of the International Liaison Committee on Resuscitation, developed by the First Aid Task Force (in which we also actively collaborate) and Adult Basic Life Support Task Force.

In addition, CEBaP was closely involved in the development of the International Federation of Red Cross and Red Crescent Societies (IFRC) “International first aid, resuscitation, and education guidelines” which will soon be available online. In addition to taking part in the steering committee for the development of these guidelines, CEBaP was responsible for the methodological quality of the guidelines, and delivered most of the evidence to support the recommendations.

First aid in case of mental health problems: dissemination and implementation

In 2018 and 2019, CEBaP developed an evidence-based guideline for first aid in case of mental health problems, adapted to the Flemish context. Within the Belgian Red Cross, the guideline was used to create a training manual ("Listen", in Dutch: "Luister"), and a corresponding training course "First aid for mental health problems". A free mobile app ("Support", in Dutch: "Houvast") was released, that presents our evidence-based recommendations in a short, clear and accessible form. At the international level, parts of the guideline were used in the development of the 2020 International First aid, Resuscitation and Education Guidelines, which will be published in February 2021.

In addition, CEBaP published a peer-reviewed research article that provides an overview of the best available evidence on one of the topics addressed by the guideline. It concerns communicative first aid interventions that can be performed by laypeople for the prevention and relief of post-traumatic stress disorder-related symptoms in the aftermath of traumatic events. Communication with family members in a safe and comfortable environment and the expression of feelings may be associated with improved mental health status. 

First aid systematic reviews in collaboration with ILCOR


Already since 2013, CEBaP conducts systematic reviews in collaboration with the First Aid Task Force of the International Liaison Committee on Resuscitation (ILCOR). 



In 2020, we developed a systematic review on the effectiveness of compression wrapping for acute closed extremity joint injuries. We identified 6 randomized controlled trials and 2 non-randomized studies, all examining compression as a treatment for ankle sprains. No difference in reduction of pain or swelling, ankle-joint function, or range of motion could be demonstrated. In addition, for the outcome of recovery time, no benefit was shown when comparing compression with no compression. One study, however, showed benefit for compression bandage when compared with no compression. In addition, the evidence was insufficient to inform a conclusion about the outcomes of time to return to work or sport. All evidence was of low to very low certainty. ILCOR concluded in their annual CoSTR summary publication that there is insufficient evidence to recommend for or against the application of a compression bandage for an acute closed extremity joint injury.

We completed a systematic review on how to best store an avulsed tooth prior to reimplantation. Out of 4118 screened references, 33 studies (19 randomized controlled trials, 7 non-randomized controlled trials and 7 prospective cohort studies) were included. The identified evidence was of low to very low certainty, but the results could nevertheless be used by ILCOR to adapt their treatment recommendations for storage of an avulsed tooth. ILCOR concluded that an avulsed tooth is best placed in Hank’s balanced salt solution, propolis, oral rehydration salt solutions or cling film or, in case those are not available, in cow's milk. The use of saline or water should be avoided. 

We also provided methodological support for a systematic review on stroke recognition scales for first aid providers. 

Blood donation and transfusion

Blood donations in times of disaster

Blood services must be prepared to respond quickly to unexpected changes in the everyday world, for instance when a natural or man-made disaster strikes. In this scenario, the blood supply chain may be affected in different ways. Damaged donor centers, staffing issues or a lower availability of blood donors, in combination with an increased need for blood, may lead to blood shortages. On the other hand, altruistic responses of people may lead to unnecessarily high stocks of blood, which may need to be destroyed because of their limited shelf life. To find out how disasters affect the blood supply chain, CEBaP is currently conducting a systematic review, not only on the impact on blood donation rates, but also on the rates of transfusion transmitted infections. This systematic review will be finalized in 2021, in cooperation with the International Department of the Belgian Red Cross. The International Department is currently setting up projects to raise awareness on the importance of voluntary donations, donor recruitment and retention as measures to prepare for and reduce the impact of disasters. In addition, they aim to optimize the blood services by delivering expertise and support, and support mobile collections, in order to ensure a safe and sustainable blood supply and bridge the gap between supply and demand.

Data collection of Hepatitis B virus prevalence in first-time blood donors in Flanders, Belgium

To prevent transfer of transfusion-transmissible infections such as hepatitis B virus (HBV) to the patient during blood transfusion, the donor health questionnaire is an important safety measure to identify risk behaviour and defer people from donation. In 2019, the Belgian Red Cross shortened the deferral window for donors born in HBV endemic countries to recruit blood donors in certain ethnic groups for saving the lives of patients who share their background.
Together with the Blood Service, CEBaP aimed to scientifically underpin the current deferral policies by assessing the trend of prevalence of HBV infection and associated risk factors in blood donors in Flanders (Belgium) between 2010 and 2018. We collected data of 211,331 first-time blood donors (43.7% males, median age 25 years), donating blood at the Belgian Red Cross in Flanders. Among this first-time blood donor population, about 0.05% were currently infected with HBV (presence of surface antigen and viral DNA) and 0.86% showed evidence of HBV exposure (detection of core antibodies). The main finding of this study is that being born in an HBV endemic country is by far the most important risk factor for HBV positivity among first-time blood donors in Flanders. Other findings and strengths and limitations of our analyses will be published in 2021

Social and psychosocial care

Protocols for systematic reviews on social care for older adults 

Within the Care Library at Home (In Dutch: Zorgbib aan Huis) project of the Belgian Red Cross, volunteers pay regular home visits to isolated older adults, while providing them with library materials. During their visits, volunteers also engage in friendly chats, playing games or reading a book together. By paying regular visits to isolated older adults, the Belgian Red Cross volunteers aim to combat the loneliness epidemic.
To provide a scientific base for these activities, CEBaP performed two evidence reviews in 2018. The first one investigated the effect of friendly (home) visiting by a volunteer on loneliness, whereas the second one looked at the impact of book reading on physical and mental health in older adults. 
The Campbell Collaboration, an international social science research network that produces high quality, open and policy-relevant evidence syntheses, showed an interest in publishing these evidence reviews as full systematic reviews. Therefore we developed systematic review protocols on recreational book reading and on friendly visiting by a volunteer, which have now been published in Campbell Systematic Reviews. The systematic reviews are ongoing and are expected to be completed in 2021.

Volunteer survey in the aftermath of the 2016 Brussels terrorist attacks

After the 2016 terrorist attacks in Brussels, the Social Intervention Service of the Belgian Red Cross (BRC) wanted to assess how the BRC volunteers were feeling after the attacks. While Relief Service volunteers provided mainly medical support, Social Intervention Service volunteers delivered psychosocial support to those affected by the traumatic event. These volunteers not only interacted with the victims, but also provided information to their friends and family and supported them during the identification of deceased victims in the case of casualties. 

The Social Intervention Service sent out several surveys to all volunteers, both those of the Relief Service as well as their own volunteers regardless of whether they were actively involved in the response, standby at home or on location or not activated. By using standardised questionnaires such as the PANAS (Positive Affects and Negative Affects Scale) and IES (Impact of Events Scale), the Social Intervention Service wanted to gauge how the volunteers themselves were feeling in the aftermath of the attacks and whether the support offered by the BRC to its volunteers actually reached them. 

Volunteers who were actively deployed and probably in contact with victims and people directly affected by the attacks were not more negatively affected than those who were not active. Stress symptoms decreased over time in all volunteers. 

The support options offered to the volunteers such as debriefing, defusing and telephone support, were well known by volunteers. The option for telephone support was deemed to be very important by many volunteers, but was only used by a handful of volunteers. 

The detailed results of this survey will be published as a peer reviewed research paper in the course of 2021. They will also assist the Social Intervention Service to further develop their support for BRC volunteers.

Disaster preparedness

Disaster preparedness is one of the topics in the research strategy of the Belgian Red Cross. Each year, the Belgian Red Cross provides first aid services at >8000 public events (music, sport, festival, etc.). Together with the Emergency Service Department of the Belgian Red Cross, CEBaP aims to scientifically underpin pre-event planning and resource provision at these events.
In 2020, we published a systematic review that identified 16 prediction modelling studies that developed or validated a multivariate statistical model with biomedical and environmental predictors of increased medical usage rates. We included 16 studies in the USA (n = 8), Australia (n = 4), Japan (n = 1), Singapore (n = 1), South Africa (n = 1) and The Netherlands (n = 1), with a combined audience of >48 million people in >1700 mass gatherings. Variables to predict medical usage rates were biomedical (i.e. age, gender, level of competition, training characteristics and type of injury) and environmental predictors (i.e. crowd size, accommodation, weather, free water availability, time of the manifestation and type of the manifestation) (low-certainty evidence). Evidence from 3 studies indicated that using existing models in other contexts significantly over- or underestimated medical usage rates (from 22% overestimation to 81% underestimation). Since the overall certainty of the evidence is low and the predictive performance is generally poor, proper development and validation of a context-specific model is recommended.

Subsequently, we are currently working on the development and validation of a model specific for the Belgian Red Cross setting. Detailed info about our analyses will be published in 2021.

Water, sanitation and hygiene

The Department of International Cooperation of the Belgian Red Cross provides Water, Sanitation, and Hygiene (WASH) interventions as part of their development aid program. In order to scientifically underpin these activities, CEBaP developed a systematic overview of WASH interventions, based on existing systematic reviews listed in the 3ie (International Initiative for Impact Evaluation) WASH Evidence Gap Map. The objective was to determine which WASH interventions are most effective for improving WASH behavior (i.e. latrine use) and health (i.e. diarrhea). The overview included data from 41 systematic reviews, which involved information from a total of 839 unique individual studies. The evidence was categorized in a visual way and the results are being used to develop the WASH strategic plan of the Department of International Cooperation for 2020-2025.