Editorial
Research in Prehospital and Disaster Health and Medicine: The Introduction Section of a Study Manuscript
- Samuel J. Stratton
-
- Published online by Cambridge University Press:
- 17 October 2014, pp. 439-440
-
- Article
-
- You have access Access
- HTML
- Export citation
Original Research
Does Hospital Disaster Preparedness Predict Response Performance During a Full-scale Exercise? A Pilot Study
- Ahmadreza Djalali, Luca Carenzo, Luca Ragazzoni, Massimo Azzaretto, Roberta Petrino, Francesco Della Corte, Pier Luigi Ingrassia
-
- Published online by Cambridge University Press:
- 05 August 2014, pp. 441-447
-
- Article
- Export citation
-
Introduction
The assessment of hospital disaster preparedness and response performance is a way to find and remove possible gaps and weaknesses in hospital disaster management effectiveness. The aim of this pilot study was to test the association between the level of preparedness and the level of response performance during a full-scale hospital exercise.
MethodThis pilot study was conducted in a hospital during a full-scale exercise in the Piedmont region of Italy. The preparedness evaluation was conducted by a group of three experts, three days before the exercise, and the response evaluation was conducted during the exercise. The functional capacity module was used for preparedness evaluation, and the response performance of the “command and control” function of the hospital was evaluated by nine semiquantitative performance indicators.
ResultsThe preparedness of the chosen hospital was 59%, while the response performance was evaluated as 70%. The hospital staff conducted Simple Triage and Rapid Transport (START) triage while they received 61 casualties, which was 90% correct for the yellow group and 100% correct for the green group.
ConclusionThis pilot study showed that it is possible to use standardized evaluations tools, to simultaneously assess the relationship between preparedness elements and response performance measures. An experimental study including a group of hospitals, also using more comprehensive evaluation tools, should be done to evaluate the correlation between the level of preparedness and the response performance of a hospital, and the impact of hospital disaster planning, on the outcome of disasters victims.
. ,Djalali A ,Carenzo L ,Ragazzoni L ,Azzaretto M ,Petrino R ,Della Corte F .Ingrassia PL Does Hospital Disaster Preparedness Predict Response Performance During a Full-scale Exercise? A Pilot Study . Prehosp Disaster Med.2014 ;29 (4 ):1 -7
What Are the Research Needs for the Field of Disaster Nursing? An International Delphi Study
- Jamie Ranse, Alison Hutton, Basseer Jeeawody, Rhonda Wilson
-
- Published online by Cambridge University Press:
- 27 August 2014, pp. 448-454
-
- Article
- Export citation
-
Background
Internationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature.
AimThe aim of this research was to determine the international research priorities for disaster nursing.
MethodThis research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed.
ResultsParticipants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking.
ConclusionsFuture disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial wellbeing of nurses who assist in disaster health activities.
. ,Ranse J ,Hutton A ,Jeeawody B .Wilson R What Are the Research Needs for the Field of Disaster Nursing? An International Delphi Study . Prehosp Disaster Med.2014 ;29 (5 ):1 -7
Pediatric Triage and Allocation of Critical Care Resources During Disaster: Northwest Provider Opinion
- Erin Margaret Johnson, Douglas S. Diekema, Mithya Lewis-Newby, Mary A. King
-
- Published online by Cambridge University Press:
- 23 September 2014, pp. 455-460
-
- Article
- Export citation
-
Introduction
Following Hurricane Katrina and the 2009 H1N1 epidemic, pediatric critical care clinicians recognized the urgent need for a standardized pediatric triage/allocation system. This study collected regional provider opinion on issues of care allocation and pediatric triage in a disaster/pandemic setting.
MethodsThis study was a cross-sectional survey of United States (US) health care providers and public health workers who demonstrated interest in critical care and/or disaster care medicine by attending a Northwest regional pediatric critical care symposium on disaster preparation, held in 2012 at Seattle Children's Hospital in Seattle, Washington (USA). The survey employed an electronic audience response system and included demographic, ethical, and logistical questions. Differences in opinions between respondents grouped by professions and work locations were evaluated using a chi-square test.
ResultsOne hundred and twelve (97%) of 116 total attendees responded to at least one question; however, four of these responders failed to answer every question. Sixty-two (55%) responders were nurses, 29 (26%) physicians, and 21 (19%) other occupations. Fifty-five (51%) responders worked in pediatric hospitals vs 53 (49%) in other locations. Sixty-three (58%) of 108 successful responses prioritized children predicted to have a good neuro-cognitive outcome. Seventy-one (68%) agreed that no pediatric age group should be prioritized. Twenty-two (43%) of providers working in non-pediatric hospital locations preferred a triage system based on an objective score alone vs 14 (26%) of those in pediatric hospitals (P = .038).
. ,Johnson EM ,Diekema DS ,Lewis-Newby M .King MA Pediatric Triage and Allocation of Critical Care Resources During Disaster: Northwest Provider Opinion . Prehosp Disaster Med.2014 ;29 (5 ):1 -6
Making Disaster Care Count: Consensus Formulation of Measures of Effectiveness for Natural Disaster Acute Phase Medical Response
- Rajesh K. Daftary, Andrea T. Cruz, Erik J. Reaves, Frederick M. Burkle, Jr., Michael D. Christian, Daniel B. Fagbuyi, Andrew L. Garrett, G. Bobby Kapur, Paul E. Sirbaugh
-
- Published online by Cambridge University Press:
- 16 September 2014, pp. 461-467
-
- Article
- Export citation
-
Introduction
No standard exists for provision of care following catastrophic natural disasters. Host nations, funders, and overseeing agencies need a method to identify the most effective interventions when allocating finite resources. Measures of effectiveness are real-time indicators that can be used to link early action with downstream impact.
HypothesisGroup consensus methods can be used to develop measures of effectiveness detailing the major functions of post natural disaster acute phase medical response.
MethodsA review of peer-reviewed disaster response publications (2001-2011) identified potential measures describing domestic and international medical response. A steering committee comprised of six persons with publications pertaining to disaster response, and those serving in leadership capacity for a disaster response organization, was assembled. The committee determined which measures identified in the literature review had the best potential to gauge effectiveness during post-disaster acute-phase medical response. Using a modified Delphi technique, a second, larger group (Expert Panel) evaluated these measures and novel measures suggested (or “free-texted”) by participants for importance, validity, usability, and feasibility. After three iterations, the highest rated measures were selected.
ResultsThe literature review identified 397 measures. The steering committee approved 116 (29.2%) of these measures for advancement to the Delphi process. In Round 1, 25 (22%) measures attained >75% approval and, accompanied by 77 free-text measures, graduated to Round 2. There, 56 (50%) measures achieved >75% approval. In Round 3, 37 (66%) measures achieved median scores of 4 or higher (on a 5-point ordinal scale). These selected measures describe major aspects of disaster response, including: Evaluation, Treatment, Disposition, Public Health, and Team Logistics. Of participants from the Expert Panel, 24/39 (63%) completed all rounds. Thirty-three percent of these experts represented international agencies; 42% represented US government agencies.
ConclusionExperts identified response measures that reflect major functions of an acute medical response. Measures of effectiveness facilitate real-time assessment of performance and can signal where practices should be improved to better aid community preparedness and response. These measures can promote unification of medical assistance, allow for comparison of responses, and bring accountability to post-disaster acute-phase medical care. This is the first consensus-developed reporting tool constructed using objective measures to describe the functions of acute phase disaster medical response. It should be evaluated by agencies providing medical response during the next major natural disaster.
. ,Daftary RK ,Cruz AT ,Reaves EJ ,Burkle FM Jr ,Christian MD ,Fagbuyi DB ,Garrett AL ,Kapur GB .Sirbaugh PE Making Disaster Care Count: Consensus Formulation of Measures of Effectiveness for Natural Disaster Acute Phase Medical Response . Prehosp Disaster Med.2014 ;29 (5 ):1 -7
Assessing Pediatric and Young Adult Substance Use Through Analysis of Prehospital Data
- Elizabeth L. Seaman, Mathew J. Levy, J. Lee Jenkins, Cassandra Chiras Godar, Kevin G. Seaman
-
- Published online by Cambridge University Press:
- 04 August 2014, pp. 468-472
-
- Article
- Export citation
-
Introduction
Substance use in young adults is a significant and growing problem. Emergency Medical Services (EMS) personnel often encounter this problem, yet the use of prehospital data to evaluate the prevalence and magnitude of substance abuse has been limited.
Hypothesis/ProblemThis study evaluated drug and alcohol use through the use of prehospital and EMS data in one suburban county in Maryland (USA). The primary hypothesis was that the type of drug being abused is associated with age. The secondary hypothesis was substance abuse incidence is associated with location. The tertiary hypothesis was that substance abuse is associated with a history of mental illness.
MethodsDeidentified patient care reports (PCRs) were obtained during a 24-month period from October 2010 through September 2012 for patients 0 through 25 years of age. Inclusion criteria included chief complaint of alcohol overdose, drug overdose, or the use of naloxone.
ResultsThe primary hypothesis was supported that age was associated with drug category (P < .001). Younger adolescents were more likely to use household items, prescription drugs, or over-the-counter drugs, whereas older adolescents were more likely to use illicit drugs. The secondary hypothesis was supported that both alcohol (P < .001) and drugs (P < .001) were associated with location of call. Calls involving alcohol were more likely to be at a home or business, whereas calls involving drugs were more likely to be at home or at a public venue. The tertiary hypothesis was supported that both alcohol (P = .001) and drug use (P < .001) were associated with history of mental illness. Older adolescents were more likely to report a history of mental illness. Chi-squared tests indicated there were significant differences between genders and drug category (P = .002) and gender and current suicide attempt (P = .004). Females were more likely to use prescription drugs, whereas males were more likely to use illicit drugs. Calls involving younger adolescents under 18 were more likely to be at school or the mall, whereas calls involving older adolescents were likely to be at a prison, public venue, or a business.
ConclusionAll three hypotheses were supported: the type of substance being abused was associated with both age and location, and substance abuse was associated with a history of mental illness. This research has important implications for understanding how EMS resources are utilized for substance use. This information is valuable in not only the education and training of prehospital care providers, but also for the targeting of future public health interventions.
. ,Seaman EL ,Levy MJ ,Jenkins JL ,Godar CC .Seaman KG Assessing Pediatric and Young Adult Substance Use Through Analysis of Prehospital Data . Prehosp Disaster Med.2014 ;29 (4 ):1 -6
Prehospital Care and In-hospital Mortality of Trauma Patients in Iran
- Mohammad Paravar, Mehrdad Hosseinpour, Mahdi Mohammadzadeh, Azade Sadat Mirzadeh
-
- Published online by Cambridge University Press:
- 08 September 2014, pp. 473-477
-
- Article
- Export citation
-
Introduction
The aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center.
MethodsThis study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome.
ResultsTwo thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001).
ConclusionIn-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.
. ,Hosseinpour M ,Paravar M ,Mohammadzadeh M .Mirzadeh AS Prehospital Care and In-hospital Mortality of Trauma Patients in Iran . Prehosp Disaster Med.2014 ;29 (5 ):1 -5
The State of Leadership Education in Emergency Medical Services: A Multi-national Qualitative Study
- William Joseph Leggio, Jr.
-
- Published online by Cambridge University Press:
- 08 September 2014, pp. 478-483
-
- Article
- Export citation
-
Objective
This study investigated how leadership is learned in Emergency Medical Services (EMS) from a multi-national perspective by interviewing EMS providers from multiple nations working in Riyadh, Kingdom of Saudi Arabia.
MethodsA phenomenological, qualitative methodology was developed and 19 EMS providers from multiple nations were interviewed in June 2013. Interview questions focused on how participants learned EMS leadership as an EMS student and throughout their careers as providers. Data were analyzed to identify themes, patterns, and codes to be used for final analysis to describe findings.
ResultsEmergency Medical Services leadership is primarily learned from informal mentoring and on-the-job training in less than supportive environments. Participants described learning EMS leadership during their EMS education. A triangulation of EMS educational resources yielded limited results beyond being a leader of patient care. The only course that yielded results from triangulation was EMS Management. The need to develop EMS leadership courses was supported by the findings. Findings also supported the need to include leadership education as part of continuing medical education and training.
ConclusionEmergency Medical Services leadership education that prepares students for the complexities of the profession is needed. Likewise, the need for EMS leadership education and training to be part of continuing education is supported. Both are viewed as a way to advance the EMS profession. A need for further research on the topic of EMS leadership is recognized, and supported, with a call for action on suggested topics identified within the study.
. .Leggio WJ Jr The State of Leadership Education in Emergency Medical Services: A Multi-national Qualitative Study . Prehosp Disaster Med.2014 ;29 (5 ):1 -6
Predictability of the Call Triage Protocol to Detect if Dispatchers Should Activate Community First Responders
- Kenji Narikawa, Tetsuya Sakamoto, Katsuaki Kubota, Masayuki Suzukawa, Chikara Yonekawa, Keisuke Yamashita, Yoshiki Toyokuni, Yasuharu Yasuda, Akihiro Kobayashi, Kazunori Iijima
-
- Published online by Cambridge University Press:
- 16 September 2014, pp. 484-488
-
- Article
- Export citation
-
Introduction
Shortening response time to an emergency call leads to the success of resuscitation by chest compression and defibrillation. However, response by ambulance or fire truck is not fast enough for resuscitation in Japan. In rural areas, response times can be more than 10 minutes. One possible way to shorten the response time is to establish a system of first responders (eg, police officers or firefighters) who are trained appropriately to perform resuscitation. Another possible way is to use a system of Community First Responders (CFRs) who are trained neighbors. At present, there are no call triage protocols to decide if dispatchers should activate CFRs.
ObjectiveThe aim of this study was to determine the predictability to detect if dispatchers should activate CFRs.
MethodsTwo CFR call triage protocols (CFR protocol Ver.0 and Ver.1) were established. The predictability of CFR protocols was examined by comparing the paramedic field reports. From the results of sensitivity of CFR protocol, the numbers of annual CFR activations were calculated. All data were collected, prospectively, for four months from October 1, 2012 through January 31, 2013.
ResultsThe ROC-AUC values appear slightly higher in CFR protocol Ver.1 (0.857; 95% CI, 79.8-91.7) than in CFR protocol Ver.0 (0.847; 95% CI, 79.0-90.3). The number of annual CFR activations is higher in CFR protocol Ver.0 (7.47) than in CFR protocol Ver.1 (5.45).
ConclusionTwo call triage protocols have almost the same predictability as the Medical Priority Dispatch System (MPDS). The study indicates that CFR protocol Ver.1 is better than CFR protocol Ver.0 because of the higher predictability and low number of activations. Also, it indicates that CFRs who are not medical professionals can respond to a patient with cardiac arrest.
. ,Narikawa K ,Sakamoto T ,Kubota K ,Suzukawa M ,Yonekawa C ,Yamashita K ,Toyokuni Y ,Yasuda Y ,Kobayashi A .Iijima K Predictability of the Call Triage Protocol to Detect if Dispatchers Should Activate Community First Responders . Prehosp Disaster Med.2014 ;29 (5 ):1 -5
Formula One Night Race in Singapore: A 4-Year Analysis of a Planned Mass Gathering
- Weng Hoe Ho, Kristi L. Koenig, Lit Sin Quek
-
- Published online by Cambridge University Press:
- 16 September 2014, pp. 489-493
-
- Article
- Export citation
-
Introduction
Every mass gathering presents its unique characteristics that influence medical resource utilization. Medical planning for mass gatherings involves both use of predictive models and analysis of data from similar past events. This study aimed to describe the medical presentations and the unique challenges influencing medical planning at the Formula One Singtel Singapore Grand Prix, the inaugural Formula One night race. Patient presentation characteristics, rates of patient presentation, and transportation to hospitals in association with attendance and heat index were evaluated over a 4-year period from 2009 through 2012. This will facilitate medical planning for similar events.
MethodsA database containing patient presentations from the 3-day Singapore Grand Prix in 2009, 2010, 2011, and 2012 was analyzed. Patient presentations were categorized by time of day and presenting complaints. Patient presentation rates (PPRs) were analyzed to determine correlation with attendance numbers and heat index.
ResultsThe average annual attendance at the Singapore Grand Prix was 81,992 from 2009 through 2012. The average PPR was 2.17 (SD=0.63)/1,000 attendees. The average transport to hospital rate (TTHR) was 0.033 (SD=0.026)/1,000 attendees. While medical coverage was provided at the circuit park between 2:00 pm to 1:00 am daily, most attendees presented from 5:00 pm to 10:00 pm. The most common presenting complaints included: musculoskeletal conditions (59%) and heat related illnesses (19%). There was no correlation between attendance numbers and PPR and the heat index and PPR.
ConclusionMusculoskeletal conditions and heat-related illnesses were the most common presenting complaints at the Singapore Grand Prix from 2009-2012. The lack of correlation between heat index and PPR is a new finding compared with prior studies. This could be due to the minimal heat variation that occurred during the night event. Further study is required to refine models that can be used in specialized events.
. ,Ho WH ,Koenig KL .Quek LS Formula One Night Race in Singapore: A 4-Year Analysis of a Planned Mass Gathering . Prehosp Disaster Med.2014 ;29 (5 ):1 -5
Comprehensive Review
Child Disaster Mental Health Interventions: Therapy Components
- Part of:
- Betty Pfefferbaum, Jennifer L. Sweeton, Pascal Nitiéma, Mary A. Noffsinger, Vandana Varma, Summer D. Nelson, Elana Newman
-
- Published online by Cambridge University Press:
- 16 September 2014, pp. 494-502
-
- Article
- Export citation
-
Children face innumerable challenges following exposure to disasters. To address trauma sequelae, researchers and clinicians have developed a variety of mental health interventions. While the overall effectiveness of multiple interventions has been examined, few studies have focused on the individual components of these interventions. As a preliminary step to advancing intervention development and research, this literature review identifies and describes nine common components that comprise child disaster mental health interventions. This review concluded that future research should clearly define the constituent components included in available interventions. This will require that future studies dismantle interventions to examine the effectiveness of specific components and identify common therapeutic elements. Issues related to populations studied (eg, disaster exposure, demographic and cultural influences) and to intervention delivery (eg, timing and optimal sequencing of components) also warrant attention.
,Pfefferbaum B ,Sweeton JL ,Nitiéma P ,Noffsinger MA ,Varma V ,Nelson SD .Newman E Child Disaster Mental Health Interventions: Therapy Components . Prehosp Disaster Med.2014 ;29 (5 ):1 -9 .
Special Report
Health Care Workers in Danger Zones: A Special Report on Safety and Security in a Changing Environment
- Lynda J. Redwood-Campbell, Sharonya N. Sekhar, Christine R. Persaud
-
- Published online by Cambridge University Press:
- 23 September 2014, pp. 503-507
-
- Article
- Export citation
-
Introduction
Violence against humanitarian health care workers and facilities in situations of armed conflict is a serious humanitarian problem. Targeting health care workers and destroying or looting medical facilities directly or indirectly impacts the delivery of emergency and life-saving medical assistance, often at a time when it is most needed.
ProblemAttacks may be intentional or unintentional and can take a range of forms from road blockades and check points which delay or block transport, to the direct targeting of hospitals, attacks against medical personnel, suppliers, patients, and armed entry into health facilities. Lack of access to vital health care services weakens the entire health system and exacerbates existing vulnerabilities, particularly among communities of women, children, the elderly, and the disabled, or anyone else in need of urgent or chronic care. Health care workers, especially local workers, are often the target.
MethodsThis report reviews the work being spearheaded by the Red Cross and Red Crescent Movement on the Health Care in Danger initiative, which aims to strengthen the protections for health care workers and facilities in armed conflicts and ensure safe access for patients. This includes a review of internal reports generated from the expert workshops on a number of topics as well as a number of public sources documenting innovative coping mechanisms adopted by National Red Cross and Red Crescent Societies. The work of other organizations is also briefly examined. This is followed by a review of security mechanisms within the humanitarian sector to ensure the safety and security of health care personnel operating in armed conflicts.
ResultsFrom the existing literature, a number of gaps have been identified with current security frameworks that need to be addressed to improve the safety of health care workers and ensure the protection and access of vulnerable populations requiring assistance. A way forward for policy, research, and practice is proposed for consideration.
ConclusionWhile there is work being done to improve conditions for health care personnel and patients, there need to be concerted actions to stigmatize attacks against workers, facilities, and patients to protect the neutrality of the medical mission.
. ,Redwood-Campbell LJ ,Sekhar SN .Persaud CR Health Care Workers in Danger Zones: A Special Report on Safety and Security in a Changing Environment . Prehosp Disaster Med.2014 ;29 (5 ):1 -5
Nationwide Program of Education for Undergraduates in the Field of Disaster Medicine: Development of a Core Curriculum Centered on Blended Learning and Simulation Tools
- Pier Luigi Ingrassia, Luca Ragazzoni, Marco Tengattini, Luca Carenzo, Francesco Della Corte
-
- Published online by Cambridge University Press:
- 22 August 2014, pp. 508-515
-
- Article
- Export citation
-
In recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of “Disaster Health” according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants’ knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine. This experience might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools.
Table 1 List of Modules and Topics
Module Topics 1. Introduction to disaster medicine and public health during emergencies - Modern taxonomy of disaster and common disaster medicine definitions - Differences between disaster and emergency medicine - Principles of public health during disasters - Different phases of disaster management 2. Prehospital disaster management - Mass-casualty disposition, treatment area, and transport issues - Disaster plans and command-and-control chain structure - Functional response roles 3. Specific disaster medicine and triage procedures in the - Mass-casualty triage definitions and principles management of disasters - Different methodologies and protocols - Patient assessment, triage levels and tags 4. Hospital disaster preparedness and response - Hospital disaster laws - Hospital preparedness plans for in-hospital and out-hospital disasters with an all-hazard approach - Medical management for a massive influx of casualties 5. Health consequences of different disasters - Characteristics of different types of disasters - Health impact of natural and man-made disasters - Disaster-related injury after exposure to a different disasters with an all-hazard approach 6. Psychosocial care - Techniques to deal with psychic reactions caused by exposure to disaster scenarios - Treatment approaches to acute and delayed critical incident stress reactions 7. Presentation of past disasters and public health emergencies, and Case study: review of assistance experiences - Haiti earthquake - Cholera outbreaks in Haiti - National and international disaster response mechanism . ,Ingrassia PL ,Ragazzoni L ,Tengattini M ,Carenzo L .Della Corte F Nationwide Program of Education for Undergraduates in the Field of Disaster Medicine: Development of a Core Curriculum Centered on Blended Learning and Simulation Tools . Prehosp Disaster Med.2014 ;29 (5 ):1 -8
Clinical Characteristics of the Inhabitants of an Internally Displaced Persons Camp in Brazzaville, Republic of Congo After the Arms Dump Blast on March 4, 2012
- Inge Roggen, Gerlant van Berlaer, Geert Gijs, Ives Hubloue
-
- Published online by Cambridge University Press:
- 27 August 2014, pp. 516-520
-
- Article
- Export citation
-
Background
On March 4, 2012, an arms dump exploded in a densely populated area in Brazzaville, Republic of the Congo. At least 250 people were killed, 2,500 wounded, and 13,800 left homeless, of which 5,000 were relocated to a newly constructed internally displaced person (IDP) camp.
AimTo describe the medical complaints of persons presenting to the IDP camp for medical evaluation.
Patients and MethodsAll patients seen and treated by the Belgian First Aid and Support Team (B-FAST) in the IDP camp on March 10 and 11, 2012 were included. A unique number, age, gender, and inventory of complaints were registered on standard World Health Organization (WHO) forms.
ResultsOut of 245 presenting patients, 242 files were processed. One in two patients were minors (<18 years-old), the male/female ratio was 50/50 in minors and 28/72 in adults; median (range) age in minors was three years (0-17) and for adults was 32.5 years (18-68). Twenty percent of the children were determined to be malnourished. Signs and symptoms related to infectious diseases were present in 75% of minors and 53% of adults. Trauma was present in 12% of minors and 21% of adults.
ConclusionsOne week following the disaster event, after people had relocated to IDP camps, infectious diseases became the predominate reason for seeking medical evaluation. Less than one in five people presenting to the medical post had injuries directly related to the event. Demographic data showed that around 50% of people in the IDP camp presenting for medical care were children, of which one in five was malnourished.
. ,Roggen I ,van Berlaer G ,Gijs G .Hubloue I Clinical Characteristics of the Inhabitants of an Internally Displaced Persons Camp in Brazzaville, Republic of Congo After the Arms Dump Blast on March 4, 2012 . Prehosp Disaster Med.2014 ;29 (5 ):1 -5
Using Poison Center Data for Postdisaster Surveillance
- Amy Wolkin, Amy H. Schnall, Royal Law, Joshua Schier
-
- Published online by Cambridge University Press:
- 10 September 2014, pp. 521-524
-
- Article
- Export citation
-
The role of public health surveillance in disaster response continues to expand as timely, accurate information is needed to mitigate the impact of disasters. Health surveillance after a disaster involves the rapid assessment of the distribution and determinants of disaster-related deaths, illnesses, and injuries in the affected population. Public health disaster surveillance is one mechanism that can provide information to identify health problems faced by the affected population, establish priorities for decision makers, and target interventions to meet specific needs. Public health surveillance traditionally relies on a wide variety of data sources and methods. Poison center (PC) data can serve as data sources of chemical exposures and poisonings during a disaster. In the US, a system of 57 regional PCs serves the entire population. Poison centers respond to poison-related questions from the public, health care professionals, and public health agencies. The Centers for Disease Control and Prevention (CDC) uses PC data during disasters for surveillance of disaster-related toxic exposures and associated illnesses to enhance situational awareness during disaster response and recovery. Poison center data can also be leveraged during a disaster by local and state public health to supplement existing surveillance systems. Augmenting traditional surveillance data (ie, emergency room visits and death records) with other data sources, such as PCs, allows for better characterization of disaster-related morbidity and mortality. Poison center data can be used during a disaster to detect outbreaks, monitor trends, track particular exposures, and characterize the epidemiology of the event. This timely and accurate information can be used to inform public health decision making during a disaster and mitigate future disaster-related morbidity and mortality.
. ,Wolkin A ,Schnall AH ,Law R .Schier J Using Poison Center Data for Postdisaster Surveillance . Prehosp Disaster Med.2014 ;29 (5 ):1 -4
Conceptualizing the Impact of Special Events on Community Health Service Levels: An Operational Analysis
- Adam Lund, Sheila A. Turris, Ron Bowles
-
- Published online by Cambridge University Press:
- 04 September 2014, pp. 525-531
-
- Article
- Export citation
-
Mass gatherings (MG) impact their host and surrounding communities and with inadequate planning, may impair baseline emergency health services. Mass gatherings do not occur in a vacuum; they have both consumptive and disruptive effects that extend beyond the event itself. Mass gatherings occur in real geographic locations that include not only the event site, but also the surrounding neighborhoods and communities. In addition, the impact of small, medium, or large special events may be felt for days, or even months, prior to and following the actual events. Current MG reports tend to focus on the events themselves during published event dates and may underestimate the full impact of a given MG on its host community.
In order to account for, and mitigate, the full effects of MGs on community health services, researchers would benefit from a common model of community impact. Using an operations lens, two concepts are presented, the “vortex” and the “ripple,” as metaphors and a theoretical model for exploring the broader impact of MGs on host communities. Special events and MGs impact host communities by drawing upon resources (vortex) and by disrupting normal, baseline services (ripple). These effects are felt with diminishing impact as one moves geographically further from the event center, and can be felt before, during, and after the event dates. Well executed medical and safety plans for events with appropriate, comprehensive risk assessments and stakeholder engagement have the best chance of ameliorating the potential negative impact of MGs on communities.
. ,Lund A ,Turris SA .Bowles R Conceptualizing the Impact of Special Events on Community Health Service Levels: An Operational Analysis . Prehosp Disaster Med.2014 ;29 (5 ):1 -7
Emergency Medical Support for a Manned Stratospheric Balloon Test Program
- Rebecca S. Blue, Sean C. Norton, Jennifer Law, James M. Pattarini, Erik L. Antonsen, Alejandro Garbino, Jonathan B. Clark, Matthew W. Turney
-
- Published online by Cambridge University Press:
- 05 September 2014, pp. 532-537
-
- Article
- Export citation
-
Introduction
Red Bull Stratos was a commercial program that brought a test parachutist, protected by a full-pressure suit, in a stratospheric balloon with pressurized capsule to over 127,582 ft (38,969 m), from which he free fell and subsequently parachuted to the ground. Given that the major risks to the parachutist included ebullism, negative Gz (toe-to-head) acceleration exposure from an uncontrolled flat spin, and trauma, a comprehensive plan was developed to recover the parachutist under nominal conditions and to respond to any medical contingencies that might have arisen. In this report, the project medical team describes the experience of providing emergency medical support and crew recovery for the manned balloon flights of the program.
MethodsThe phases of flight, associated risks, and available resources were systematically evaluated.
ResultsSix distinct phases of flight from an Emergency Medical Services (EMS) standpoint were identified. A Medical Support Plan was developed to address the risks associated with each phase, encompassing personnel, equipment, procedures, and communications.
DiscussionDespite geographical, communications, and resource limitations, the medical team was able to implement the Medical Support Plan, enabling multiple successful manned balloon flights to 71,615 ft (21,828 m), 97,221 ft (29,610 m), and 127,582 ft (38,969 m). The experience allowed refinement of the EMS and crew recovery procedures for each successive flight and could be applied to other high altitude or commercial space ventures.
. ,Blue RS ,Norton SC ,Law J ,Pattarini JM ,Antonsen EL ,Garbino A ,Clark JB .Turney MW Emergency Medical Support for a Manned Stratospheric Balloon Test Program . Prehosp Disaster Med.2014 ;29 (5 ):1 -6
Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident
- Benjamin W. Wachira, Ramadhani O. Abdalla, Lee A. Wallis
-
- Published online by Cambridge University Press:
- 10 September 2014, pp. 538-541
-
- Article
- Export citation
-
At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital.
This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.
. ,Wachira BW ,Abdalla RO .Wallis LA Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident . Prehosp Disaster Med.2014 ;29 (5 ):1 -4
The 2012 Derecho: Emergency Medical Services and Hospital Response
- Randy D. Kearns, Mark S. Wigal, Antonio Fernandez, March A. Tucker, Jr., Ginger R. Zuidgeest, Michael R. Mills, Bruce A. Cairns, Charles B. Cairns
-
- Published online by Cambridge University Press:
- 18 September 2014, pp. 542-545
-
- Article
- Export citation
-
During the early afternoon of June 29, 2012, a line of destructive thunderstorms producing straight line winds known as a derecho developed near Chicago (Illinois, USA). The storm moved southeast with wind speeds recorded from 100 to 160 kilometers per hour (kph, 60 to 100 miles per hour [mph]). The storm swept across much of West Virginia (USA) later that evening. Power outage was substantial as an estimated 1,300,000 West Virginians (more than half) were without power in the aftermath of the storm and approximately 600,000 citizens were still without power a week later. This was one of the worst storms to strike this area and occurred as residents were enduring a prolonged heat wave. The wind damage left much of the community without electricity and the crippling effect compromised or destroyed critical infrastructure including communications, air conditioning, refrigeration, and water and sewer pumps. This report describes utilization of Emergency Medical Services (EMS) and hospital resources in West Virginia in response to the storm. Also reported is a review of the weather phenomena and the findings and discussion of the disaster and implications.
. ,Kearns RD ,Wigal MS ,Fernandez A ,Tucker MA Jr ,Zuidgeest GR ,Mills MR ,Cairns BA .Cairns CB The 2012 Derecho: Emergency Medical Services and Hospital Response . Prehosp Disaster Med.2014 ;29 (5 ):1 -4
Case Report
Diffuse Cutaneous Allergic Reaction to Dermabond
- Joseph A. Ricci, Nirav N. Parekh, Naman S. Desai
-
- Published online by Cambridge University Press:
- 16 September 2014, pp. 546-548
-
- Article
- Export citation
-
Wound closure with 2-octyl cyanoacrylate (Dermabond; Ethicon, Somerville, New Jersey USA) has recently increased in popularity across a wide spectrum of physicians ranging from surgeons to emergency medicine practitioners. Generally, very few complications are associated with Dermabond and are usually related to application techniques. Uncommonly, patients present with allergic reactions to the adhesive compounds; these allergies are often misdiagnosed as cellulitis or another infectious process, and are incorrectly treated. This report describes a rare case of a diffuse cutaneous allergic reaction to Dermabond following its use to close a surgical incision, its prompt identification, and treatment after presentation to an emergency department.
. ,Ricci JA ,Parekh NN .Desai NS Diffuse Cutaneous Allergic Reaction to Dermabond . Prehosp Disaster Med.2014 ;29 (5 ):1 -3