Editorials
Health in the Context of Global Health
- Samuel J. Stratton
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- Published online by Cambridge University Press:
- 11 November 2015, pp. 545-546
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Frameworks for Disaster Research and Evaluation
- Samuel J. Stratton
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- 11 November 2015, p. 547
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Original Research
Hospital Nurses’ Competencies in Disaster Situations: A Qualitative Study in the South of Brazil
- Sandra M. Marin, Regina R. Witt
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- Published online by Cambridge University Press:
- 21 October 2015, pp. 548-552
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Introduction
Hospital nurses play a key role in the aftermath of the occurrence of disasters and need specific competencies to work in these situations. From a global perspective, few models exist that focus on disaster nursing.
ProblemThis study aimed to identify hospital nurses’ competencies in disaster situations.
MethodA qualitative, descriptive, exploratory study was developed using focus groups as a method of data collection. Three meetings were held from June through September 2012 with nurses who worked at a hospital used as reference for disaster situations in the South of Brazil. Thematic analysis of collected data generated the competencies. For statement standardization, a format consistent with a verb, a noun, and a complement was adopted.
ResultsThe group validated 17 competencies, which were organized according to the phases of emergency management described by the World Health Organization (WHO) and classified in domain areas of management, health care, communication, and education.
ConclusionsThe competencies identified in this study can contribute to the education and practice of nurses in the hospital ambience, strengthening its capacity to face disaster situations.
,Marin SM .Witt RR Hospital Nurses’ Competencies in Disaster Situations: A Qualitative Study in the South of Brazil . Prehosp Disaster Med.2015 ;30 (6 ):548 –552 .
Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study
- Annelies De Wulf, Adam R. Aluisio, Dana Muhlfelder, Christina Bloem
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- 21 October 2015, pp. 553-559
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Introduction
The North East Department is a resource-limited region of Haiti. Health care is provided by hospitals and community clinics, with no formal Emergency Medical System and undefined emergency services. As a paucity of information exists on available emergency services in the North East Department of Haiti, the objective of this study was to assess systematically the existing emergency care resources in the region.
MethodsThis cross-sectional observational study was carried out at all Ministry of Public Health and Population (MSPP)-affiliated hospitals in the North East Department and all clinics within the Fort Liberté district. A modified version of the World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care and Generic Essential Emergency Equipment Lists were completed for each facility.
ResultsThree MSPP hospitals and five clinics were assessed. Among hospitals, all had a designated emergency ward with 24 hour staffing by a medical doctor. All hospitals had electricity with backup generators and access to running water; however, none had potable water. All hospitals had x-ray and ultrasound capabilities. No computed tomography scanners existed in the region. Invasive airway equipment and associated medications were not present consistently in the hospitals’ emergency care areas, but they were available in the operating rooms. Pulse oximetry was unavailable uniformly. One hospital had intermittently functioning defibrillation equipment, and two hospitals had epinephrine. Basic supplies for managing obstetrical and traumatic emergencies were available at all hospitals. Surgical services were accessible at two hospitals. No critical care services were available in the region. Clinics varied widely in terms of equipment availability. They uniformly had limited emergency medical equipment. The clinics also had inconsistent access to basic assessment tools (sphygmomanometers 20% and stethoscopes 60%). A protocol for transferring patients requiring a higher level of care was present in most (80%) clinics and one of the hospitals. However, no facility had a written protocol for transferring patients to other facilities. One hospital reported intermittent access to an ambulance for transfers.
ConclusionsDeficits in the supply of emergency equipment and limited protocols for inter-facility transfers exist in North East Department of Haiti. These essential areas represent appropriate targets for interventions aimed at improving access to emergency care within the North East region of Haiti.
,De Wulf A ,Aluisio AR ,Muhlfelder D .Bloem C Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study . Prehosp Disaster Med.2015 ;30 (6 ):553 –559 .
Doctor’s Knowledge and Practices of Traumatic Brain Injury Management in Chinese Prehospital Settings
- Kou Kou, Xiang-Yu Hou, Jian-Dong Sun, Kevin Chu
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- 22 October 2015, pp. 560-568
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Objectives
The incidence and mortality of traumatic brain injury (TBI) has increased rapidly in the last decade in China. Appropriate ambulance service can reduce case-fatality rates of TBI significantly. This study aimed to explore the factors (age, gender, education level, clinical experience, professional title, organization, specialty before prehospital care, and training frequency) that could influence prehospital doctors’ knowledge level and practices in TBI management in China, Hubei Province.
MethodsA cross-sectional questionnaire survey was conducted in two cities in Hubei Province. The self-administered questionnaire consisted of demographic information and questions about prehospital TBI management. Independent samples t-test and one-way ANOVA were used to analyze group differences in the average scores in terms of demographic character. General linear regression was used to explore associated factors in prehospital TBI management.
ResultsA total of 56 questionnaires were handed out and 52 (93%) were returned. Participants received the lowest scores in TBI treatment (0.64; SD=0.08) and the highest scores in TBI assessment (0.80; SD=0.14). According to the regression model, the education level was associated positively with the score of TBI identification (P=.019); participants who worked in the emergency department (ED; P=.011) or formerly practiced internal medicine (P=.009) tended to get lower scores in TBI assessment; participants’ scores in TBI treatment were associated positively with the training frequency (P=.011); and no statistically significant associated factor was found in the overall TBI management.
ConclusionThis study described the current situation of prehospital TBI management. The prehospital doctors’ knowledge level and practices in TBI management were quantified and the influential factors hidden underneath were explored. The results indicated that an appropriate continuing medical education (CME) program enables improvement of the quality of ambulance service in China.
,Kou K ,Hou XY ,Sun JD .Chu K Doctor’s Knowledge and Practices of Traumatic Brain Injury Management in Chinese Prehospital Settings . Prehosp Disaster Med.2015 ;30 (6 ):560 –568 .
Disaster Management and General Dental Practitioners in India: An Overlooked Resource
- Kumar Gaurav Chhabra, Gururaghavendran Rajesh, Chaya Chhabra, Almas Binnal, Ashish Sharma, Yashpal Pachori
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- Published online by Cambridge University Press:
- 19 October 2015, pp. 569-573
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Objective
To assess General Dental Practitioners’ (GDPs) in India willingness to participate in disaster management and their previous training pertaining to disaster management, and to assess GDP objective knowledge, attitude, and behavior regarding disaster management.
Materials and MethodsThis study was a cross-sectional survey conducted on all GDPs of Jodhpur, Rajasthan, India. Willingness to participate, perceived knowledge, perceived effectiveness, objective knowledge, attitude, and behavior regarding disaster management were assessed through questionnaire method. Information also was collected regarding age, gender, religion, and residence.
ResultsA total of 142 out of 180 GDPs participated in the study, representing a response rate of 79%. A majority (85%) of respondents were willing to participate in disaster management. Mean score for knowledge was 12.21%, for attitude was 33.56%, for behavior was 14.50%, and for perceived effectiveness was 9.08%. Significant correlations were observed between qualification and perceived effectiveness (P=.003), and between attitude and years of practice (P=.04). Willingness to participate in disaster management and age showed significant association (P=.000).
ConclusionsHigh willingness and attitude to participate in disaster management was observed among respondents. Low knowledge and behavior scores were observed among GDPs.
,Chhabra KG ,Rajesh G ,Chhabra C ,Binnal A ,Sharma A .Pachori Y Disaster Management and General Dental Practitioners in India: An Overlooked Resource . Prehosp Disaster Med.2015 ;30 (6 ):569 –573 .
Wilderness First Aid Training as a Tool for Improving Basic Medical Knowledge in South Sudan
- Lindsay B. Katona, William S. Douglas, Sean R. Lena, Kyle G. Ratner, Daniel Crothers, Robert L. Zondervan, Charles D. Radis
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- Published online by Cambridge University Press:
- 23 October 2015, pp. 574-578
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Introduction
The challenges presented by traumatic injuries in low-resource communities are especially relevant in South Sudan. This study was conducted to assess whether a 3-day wilderness first aid (WFA) training course taught in South Sudan improved first aid knowledge. Stonehearth Open Learning Opportunities (SOLO) Schools designed the course to teach people with limited medical knowledge to use materials from their environment to provide life-saving care in the event of an emergency.
MethodsA pre-test/post-test study design was used to assess first aid knowledge of 46 community members in Kit, South Sudan, according to a protocol approved by the University of New England Institutional Review Board. The course and assessments were administered in English and translated in real-time to Acholi and Arabic, the two primary languages spoken in the Kit region. Descriptive statistics, t-test, ANOVA, and correlation analyses were conducted.
ResultsResults included a statistically significant improvement in first aid knowledge after the 3-day training course: t(38)=3.94; P<.001. Although men started with more health care knowledge: (t(37)=2.79; P=.008), men and women demonstrated equal levels of knowledge upon course completion: t(37)=1.56; P=.88.
ConclusionsThis research, which may be the first of its kind in South Sudan, provides evidence that a WFA training course in South Sudan is efficacious. These findings suggest that similar training opportunities could be used in other parts of the world to improve basic medical knowledge in communities with limited access to medical resources and varying levels of education and professional experiences.
,Katona LB ,Douglas WS ,Lena SR ,Ratner KG ,Crothers D ,Zondervan RL .Radis CD Wilderness First Aid Training as a Tool for Improving Basic Medical Knowledge in South Sudan . Prehosp Disaster Med.2015 ;30 (6 ):574 –578 .
Effect of First Aid Education on First Aid Knowledge and Skills of Commercial Drivers in South West Nigeria
- Adesola O. Olumide, Michael C. Asuzu, Oladele O. Kale
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- 28 October 2015, pp. 579-585
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Background
Prompt prehospital care is essential for improving outcomes of road crash victims; however, this service is sub-optimal in developing countries because Emergency Medical Services (EMS) are not readily available. Training of lay responders in first aid has been suggested as a means of filling this gap in settings with inadequate EMS. This study was conducted to determine the effect of first aid training on the first aid knowledge and skills of commercial drivers.
MethodsA before-and-after study was conducted among 128 commercial drivers (62 intervention and 66 controls) selected by multi-stage sampling. Drivers’ first aid knowledge and skills were assessed at baseline, immediate, and three months post-intervention. The intervention involved a 2-day training session in first aid. Repeated measures ANOVA was used to test for differences in respondents’ pre- and post-intervention scores over the three assessment points.
ResultsMean first aid knowledge scores for intervention drivers were 48.9% (SD=12.0), 57.8% (SD=11.2), and 59.2% (SD=9.0) at baseline, immediate, and three months post-intervention. Corresponding scores for the controls were 48.3% (SD=12.8), 39.2% (SD=15.3), and 46.8% (SD=15.3). Mean first aid skill scores for intervention drivers were 17.5% (SD=3.8), 80.7% (SD=8.3), and 72.3% (SD=16.8). Scores for control drivers were 16.5% (SD=4.5), 16.3% (SD=4.7), and 20.4% (SD=9.1), respectively. Repeated measures ANOVA showed significant differences in first aid knowledge and skills scores over the three phases. Independent t-test revealed significant differences in scores between the intervention and control groups post-intervention.
ConclusionThe training led to significant improvement in first aid knowledge and skills of intervention drivers. This confirms that lay responders can be trained in provision of first aid. The slight drop in skills scores, which occurred three months post-intervention, highlights the need for periodic refresher trainings to be conducted for the drivers in order to maintain the knowledge and skills acquired.
,Olumide AO ,Asuzu MC .Kale OO Effect of First Aid Education on First Aid Knowledge and Skills of Commercial Drivers in South West Nigeria . Prehosp Disaster Med.2015 ;30 (6 ):579 –585 .
Deaths due to Intentional Explosions in Selected Governorates of Iraq from 2010 to 2013: Prospective Surveillance
- Oleg O. Bilukha, Eva Z. Leidman, Abdul-Salam Saleh Sultan, Syed Jaffar Hussain
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- Published online by Cambridge University Press:
- 30 October 2015, pp. 586-592
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Introduction
The aim of this study was to describe the most recent trends and epidemiologic patterns of fatal injuries resulting from explosions in Iraq, one of the countries most affected by violence from explosive devices.
MethodsIraqi Ministry of Health (MoH) routine prospective injury surveillance collects information on all fatal injuries recorded by coroners from physical examinations, police reports, and family members in eight governorates of Iraq: Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya. This study analyzed explosive-related fatal injuries that occurred from January 1, 2010 through December 31, 2013.
ResultsAnalysis included 2,803 fatal injuries. The number of fatal injuries declined from 2010 through 2012, followed by an increase in 2013. One-thousand one-hundred and one explosion-related fatalities were documented in 2013, more than twice as many as in 2012 or in 2011. Most fatalities were among men aged 20-39 years. Of all causalities, 194 (6.9%) were among females and 302 (10.8%) were among children aged less than 18 years. The majority of fatalities were caused by improvised explosive devices (IEDs): car bombs (15.3%), suicide bombs (4.0%), and other IEDs (29.6%). The highest number of fatalities occurred in streets and roads. Of all deaths, 95.6% occurred in three governorates: Baghdad, Ninevah, and Al-Anbar.
ConclusionsExplosives continue to result in a high number of fatal injuries in Iraq. Following a period of declining violence from explosives, in 2013, fatalities increased. Most explosion-related injuries resulted from IEDs; males aged 20-39 years were at greatest risk.
,Bilukha OO ,Leidman EZ ,Sultan ASS .Hussain SJ Deaths due to Intentional Explosions in Selected Governorates of Iraq from 2010 to 2013: Prospective Surveillance . Prehosp Disaster Med.2015 ;30 (6 ):586 –592 .
Profile of Patients Hospitalized through the Emergency Room to the Medicine Ward and their Short-term Outcome at a Tertiary Care Hospital in Delhi
- Rahul Choudhary, Ashish Goel, Sonal Pruthi, Sarathi Kalra, Sunil Agarwal, Om Prakash Kalra
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- 05 November 2015, pp. 593-598
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Introduction
With an increasing number of sicker patients, limited hospital beds, and an emphasis on day care, the profile of patients hospitalized to medicine wards has undergone a radical re-definition. The increasing share of patients hospitalized through the emergency department for acute care to medicine wards has left little space for hospitalization through the outpatient department (OPD). There are some global data available on the profile of patients presenting to the emergency rooms (ERs) and their subsequent outcome. Data from developing countries, especially India, in this regard are lacking.
MethodsThis cross-sectional study included all patients hospitalized to the medicine ward through the medical emergency services, provided by the Department of Medicine, each Wednesday and every sixth Sunday for the entire year (a total of 62 days), from November 2010 through October 2011, and followed their outcome up to seven days after hospitalization.
ResultsOf the 3,618 cases presenting to medicine emergency on these days, 1,547 (42.3%) were advised admission. Nine hundred sixty-seven reported to the medicine wards. One hundred eleven (7.73%) expired within 24 hours; others absconded, were lost in transit, did not consent to participation, or were discharged. During the next seven days, 452 (46.7%) recovered sufficiently and were discharged to go home. Two hundred thirty (23.8%) left the hospital without informing the medical staff. Fourteen (1.4%) patients were transferred to other departments. One hundred thirty-seven (8.8%) patients died during the next six days of hospitalization. After Multivariate Logistic Regression analysis, abnormal Glasgow Coma Scale (GCS) score, high systolic blood pressure (BP), age, increased total leucocyte count, increased globulin, low bicarbonate in arterial blood, low Mini Mental Status Examination (MMSE) score, and a raised urea >40 mg/dL were found to be associated significantly with mortality.
ConclusionOf the 1,547 patients who needed urgent hospitalization, 248 (16%) died within the first week, one-half of them within the first 24 hours. An advanced age, abnormal GCS score, low MMSE score, increased systolic BP, leukocytosis, acidosis, and uremia were found to be associated with a fatal outcome. Therefore, nearly one-half of the patients who would have a fatal short-term outcome were likely to do so within the first 24 hours, making the first day of presentation “the golden day” period.
,Choudhary R ,Goel A ,Pruthi S ,Kalra S ,Agarwal S .Kalra OP Profile of Patients Hospitalized through the Emergency Room to the Medicine Ward and their Short-term Outcome at a Tertiary Care Hospital in Delhi . Prehosp Disaster Med.2015 ;30 (6 ):593 –598 .
Epidemiology of Traumatic Injuries in the Northeast Region of Haiti: A Cross-sectional Study
- Adam R. Aluisio, Annelies De Wulf, Ambert Louis, Christina Bloem
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- Published online by Cambridge University Press:
- 09 November 2015, pp. 599-605
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Introduction
More than 90% of traumatic morbidity and mortality occurs in low- and middle-income countries (LMIC). Haiti is the poorest country in the Western Hemisphere and lacks contemporary statistics on the epidemiology of traumatic injuries. This study aimed to characterize the burden of traumatic injuries among emergency department patients in the Northeast region of Haiti.
MethodsData were collected from the emergency departments of all public hospitals in the Northeast region of Haiti, which included the Fort Liberté, Ouanaminthe, and Trou du Nord sites. All patients presenting for emergent care of traumatic injuries were included. Data were obtained via review of emergency department registries and patient records from October 1, 2013 through November 30, 2013. Data on demographics, mechanisms of trauma, and anatomical regions of injury were gathered using a standardized tool and analyzed using descriptive statistics. Temporal analysis of injury frequency was explored using regression modeling.
ResultsData from 383 patient encounters were accrued. Ouanaminthe Hospital treated the majority of emergent injuries (59.3%), followed by Fort Liberté (30.3%) and Trou du Nord (10.4%). The median age in years was 23 with 23.1% of patients being less than 15 years of age. Road traffic accidents (RTAs) and interpersonal violence accounted for 65.8% and 30.1% of all traumatic mechanisms, respectively. Extremity trauma was the most frequently observed anatomical region of injury (38.9%), followed by head and neck (30.3%) and facial (19.1%) injuries. Trauma due to RTA resulted in a single injury (83.8%) to either an extremity or the head and neck regions most frequently. A minority of patients had medical record documentation (37.9%). Blood pressure, respiratory rate, and mental status were documented in 19.3%, 4.1%, and 0.0% of records, respectively. There were 6.3 injuries/day during the data collection period with no correlation between the frequency of emergent trauma cases and day of the week (R^2=0.01).
ConclusionsTraumatic injuries are a common emergent presentation in the Northeast region of Haiti with characteristics similar to other LMIC. Documentation and associated data to adequately characterize the burden of disease in this region are lacking. Road traffic accidents are the predominate mechanism of injury, suggesting that interventions addressing prevention and treatment of this common occurrence may provide public health benefits in this setting.
,Aluisio AR ,De Wulf A ,Louis A .Bloem C Epidemiology of Traumatic Injuries in the Northeast Region of Haiti: A Cross-sectional Study . Prehosp Disaster Med.2015 ;30 (6 ):599 –605 .
Prehospital Airway Management in Emergency and Trauma Patients: A Cross-sectional Study of Ambulance Service Providers and Staff in a Low- and Middle-income Country
- Samina Ismail, Nukhba Zia, Khalid Samad, Rubaba Naeem, Haris Ahmad, Amir Raza, Muhammad Baqir, Uzma Rahim Khan
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- Published online by Cambridge University Press:
- 12 November 2015, pp. 606-612
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Background
Prehospital airway management (AM) is the first priority in the care of emergency and trauma victims as it has shown to improve survival in these patients.
ObjectiveThe aim of this study was to assess training and knowledge of ambulance staff and availability of AM equipment in ambulances of Karachi, Pakistan.
MethodsThis cross-sectional study was conducted from June through September 2014. Interviews were conducted with management of six ambulance service providers and 165 ambulance staff. Data from the management included availability of AM equipment in the ambulances, number and designation of staff sent for emergency calls, and AM training of staff. Ambulance staff were assessed for their awareness, knowledge, and training pertaining to AM.
ResultsAll the ambulance services (A through F) had basic equipment for AM but lacked qualified and trained staff. All services had solo drivers (98.3%) for emergency calls; however, Ambulance Service A also had doctors and paramedics. Only 35.7% (59/165) of ambulance staff had awareness regarding AM, out of which 77.9% (46/59) belonged to Ambulance Service A. Of these 59 staff, 81.4% received some form of AM training. Staff with AM awareness, when assessed for knowledge pertaining to AM steps and AM equipment, had a mean score of 4.7/5 and 8.4/12, respectively.
ConclusionEven though ambulances are equipped with basic equipment, due to lack of trained staff, these ambulances only serve the mere purpose of transportation. There is a need to train ambulance staff and increase ambulance to staff ratio to improve prehospital AM and patient survival.
,Ismail S ,Zia N ,Samad K ,Naeem R ,Ahmad H ,Raza A ,Baqir M .Khan UR Prehospital Airway Management in Emergency and Trauma Patients: A Cross-sectional Study of Ambulance Service Providers and Staff in a Low- and Middle-income Country . Prehosp Disaster Med.2015 ;30 (6 ):606 –612 .
Special Report
Developing Legacy: Health Planning in the Host City of Porto Alegre for the 2014 Football World Cup
- Regina Rigatto Witt, Mauro Kruter Kotlhar, Marilise Oliveira Mesquita, Maria Alice Dias da Silva Lima, Sandra Mara Marin, Carolina Baltar Day, Andrea Goncalves Bandeira, Alison Hutton
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- Published online by Cambridge University Press:
- 21 October 2015, pp. 613-617
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Aim
To describe the process adopted to identify, classify, and evaluate legacy of health care planning in the host city of Porto Alegre for the Football World Cup 2014.
BackgroundThere is an emerging interest in the need to demonstrate a sustainable health legacy from mass gatherings investments. Leaving a public health legacy for future host cities and countries is now an important part of planning for these events.
ProcessThe Ministry of Sports initiated and coordinated the development of projects in the host cities to identify actions, projects, and constructions to be developed to prepare for the World Cup. In Porto Alegre, a common structure was developed by the coordinating team to instruct legacy identification, classification, and evaluation. This structure was based on international documentary analysis (including official reports, policy documents, and web-based resources) and direct communication with recognized experts in the field.
Findings and InterpretationSixteen total legacies were identified for health surveillance (5) and health services (11). They were classified according to the strategic area, organizations involved, dimension, typology, planned or unplanned, tangible or intangible, territorial coverage, and situation prior to the World Cup. Possible impacts were then assessed as positive, negative, and potentiating, and mitigating actions were indicated.
ConclusionsThe project allowed the identification, classification, and development of health legacy, including risk analysis, surveillance, mitigation measures, and provision of emergency medical care. Although the project intended the development of indicators to measure the identified legacies, evaluation was not possible at the time of publication due to time.
,Witt RR ,Kotlhar MK ,Mesquita MO ,Lima MADS ,Marin SM ,Day CB ,Bandeira AG .Hutton A Developing Legacy: Health Planning in the Host City of Porto Alegre for the 2014 Football World Cup . Prehosp Disaster Med.2015 ;30 (6 ):613 –617 .
Brief Report
War Wounded and Victims of Traffic Accidents in a Surgical Hospital in Africa: An Observation on Injuries
- Martin Schneider
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- Published online by Cambridge University Press:
- 21 October 2015, pp. 618-620
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Introduction
Weapon injuries in armed conflict are likely to receive medical attention. Other types of injuries, like traffic accidents, continue to occur during armed conflict.
ProblemInjuries caused by weapons and by traffic accidents require treatment, but reports and figures to help in prioritizing care are scarce.
MethodsIn a prospective observational study, all emergency patients admitted to the surgical ward in a public hospital of the Central African Republic were evaluated for the cause of their main injury. The proportion of patients injured by weapons and by traffic accidents was analyzed with respect to the level of violence.
ResultsSeventy-eight patients were included in this study. Weapon injuries accounted for 50 (64%) admissions and traffic accidents for 28 (36%). These proportions varied significantly according to the weekly level of violence (χ2=46.8; P<.001).
ConclusionPeople injured in traffic accidents are an important, but overlooked, drain on surgical resources in low-income countries with armed conflict. Their proportion in relation to weapon wounded fluctuates with the level of violence. Humanitarian medical organizations might prepare themselves not only for weapon injuries, but also for wounds caused by traffic accidents.
.Schneider M War Wounded and Victims of Traffic Accidents in a Surgical Hospital in Africa: An Observation on Injuries . Prehosp Disaster Med.2015 ;30 (6 ):618 –620 .
Case Reports
Mass-gathering Events: The Public Health Challenge of the Kumbh Mela 2013
- Suresh Dwivedi, Mudera P. Cariappa
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- Published online by Cambridge University Press:
- 19 October 2015, pp. 621-624
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Mass-gathering (MG) events pose challenges to the most adept of public health practitioners in ensuring the health safety of the population. These MGs can be for sporting events, musical festivals, or more commonly, have religious undertones. The Kumbh Mela 2013 at Allahabad, India may have been the largest gathering of humanity in history with nearly 120 million pilgrims having thronged the venue. The scale of the event posed a challenge to the maintenance of public health security and safety. A snapshot of the experience of managing the hygiene and sanitation aspects of this mega event is presented herein, highlighting the importance of proactive public health planning and preparedness. There having been no outbreaks of disease is vindication of the steps undertaken in planning and preparedness, notwithstanding obvious limitations of insanitary behaviors and traditional beliefs of those attending the festival. The evident flaw on post-event analyses was the failure to cater adequately for environmental mopping-up operations after the festival. Besides, a system of real-time monitoring of disease and morbidity patterns, harnessing low cost technology alternatives, should be planned for at all such future events.
,Dwivedi S .Cariappa MP Mass-gathering Events: The Public Health Challenge of the Kumbh Mela 2013 . Prehosp Disaster Med.2015 ;30 (6 ):621 –624 .
Potential Exposure to Ebola Virus from Body Fluids due to Ambulance Compartment Permeability in Sierra Leone
- Megan L. Casey, Duong T. Nguyen, Barrie Idriss, Sarah Bennett, Angela Dunn, Stephen Martin
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- Published online by Cambridge University Press:
- 28 October 2015, pp. 625-627
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Introduction
Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control.
ProblemAn ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance.
MethodsA convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed.
ResultsMany vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a sealant.
ConclusionWaterproof separation between the patient compartment and driver cabin may be essential for patient transport vehicles in infectious disease outbreaks, especially when chlorine sprayers are used for decontamination or in resource-limited settings where cleaning supplies may be limited.
,Casey ML ,Nguyen DT ,Idriss B ,Bennett S ,Dunn A .Martin S Potential Exposure to Ebola Virus from Body Fluids due to Ambulance Compartment Permeability in Sierra Leone . Prehosp Disaster Med.2015 ;30 (6 ):625 –627 .
Special Reports
Research and Evaluations of the Health Aspects of Disasters, Part III: Framework for the Temporal Phases of Disasters
- Marvin L. Birnbaum, Elaine K. Daily, Ann P. O’Rourke
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- Published online by Cambridge University Press:
- 11 November 2015, pp. 628-632
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Each of the elements described in the Conceptual Framework for disasters has a temporal designation; each has a beginning and end time. The Temporal Framework defines these elements as phases that are based on characteristics rather than on absolute times. The six temporal phases include the: (1) Pre-event; (2) Event; (3) Structural Damage; (4) Functional Damage (changes in levels of functions of the Societal Systems); (5) Relief; and (6) Recovery phases. Development is not a phase of a disaster. The use of the Temporal Framework in studying and reporting disasters allows comparisons to be made between similar phases of different disasters, regardless of the hazard involved and/or the community impacted. For research and evaluation purposes, assessments, plans, and interventions must be described in relation to the appropriate temporal phase.
. ,Birnbaum ML ,Daily EK .O’Rourke AP Research and Evaluations of the Health Aspects of Disasters, Part III: Framework for the Temporal Phases of Disasters . Prehosp Disaster Med.2015 ;30 (6 ):628 –632
Research and Evaluations of the Health Aspects of Disasters, Part IV: Framework for Societal Structures: the Societal Systems
- Marvin L. Birnbaum, Elaine K. Daily, Ann P. O’Rourke
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- Published online by Cambridge University Press:
- 11 November 2015, pp. 633-647
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For the purposes of research and/or evaluation, a community/society is organized into 13 Societal Systems under the umbrella of an overall Coordination and Control System. This organization facilitates descriptions of a community/society or a component of a community for assessment at any designated time across the Temporal Phases of a disaster. Such assessments provide a picture of the functional status of one or more Systems that comprise a community. Since no system operates in isolation from the other systems, information of the concomitant status of several Societal Systems is crucial to gaining a complete understanding of compromised functions, as well as the effects and side effects of any intervention directed at restoring the functional state of the affected community or risk-reduction interventions of a community-at-risk. The 13 Societal Systems include: (1) Public Health; (2) Medical Care; (3) Water and Sanitation; (4) Shelter and Clothing; (5) Food and Nutrition; (6) Energy Supply; (7) Public Works and Engineering; (8) Social Structures; (9) Logistics and Transportation; (10) Security; (11) Communications; (12) Economy; and (13) Education. Many functions and sub-functions of the Systems overlap, or share some common sub-functions with other systems. For the purposes of research/evaluation, it is necessary to assign functions and sub-functions to only one of the Societal Systems.
,Birnbaum ML ,Daily EK .O’Rourke AP Research and Evaluations of the Health Aspects of Disasters, Part IV: Framework for Societal Structures: the Societal Systems . Prehosp Disaster Med.2015 ;30 (6 ):633 –647 .
Research and Evaluations of the Health Aspects of Disasters, Part V: Epidemiological Disaster Research
- Marvin L. Birnbaum, Elaine K. Daily, Ann P. O’Rourke
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- Published online by Cambridge University Press:
- 11 November 2015, pp. 648-656
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Studies of the health aspect of disasters focus either on the epidemiology of disasters to define the causes and the progression from a hazard to a disaster, or the evaluations of interventions provided during any phase of a disaster. Epidemiological disaster research studies are undertaken for the purposes of: (1) understanding the mechanisms by which hazards evolve into a disaster; (2) determining ways to mitigate the risk(s) that a specific hazard will progress into a disaster; (3) predicting the likely damages and needs of the population-at-risk for an event; and (4) identifying potential measures to increase the resilience of a community to future events. Epidemiological disaster research utilizes the Conceptual, Temporal, and Societal Frameworks to define what occurs when a hazard manifests as an event that causes a disaster. The findings from such studies should suggest interventions that could augment the absorbing, buffering, or/and response capacities to lessen the probability of similar damages occurring from the next event. Ultimately, the use of these Frameworks in studying the health aspects of a disaster will help define what to expect in a specific setting and the standards and best practices upon which education, training, competencies, performance, and professionalization will be built.
,Birnbaum ML ,Daily EK .O’Rourke AP Research and Evaluations of the Health Aspects of Disasters, Part V: Epidemiological Disaster Research . Prehosp Disaster Med.2015 ;30 (6 ):648 –656 .
Front Cover (OFC, IFC) and matter
PDM volume 30 issue 6 Cover and Front matter
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- Published online by Cambridge University Press:
- 04 December 2015, pp. f1-f8
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