Editorial
The Columbia Mall Shooting: Reflections of a Physician Responder
- Matthew J. Levy
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- Published online by Cambridge University Press:
- 25 April 2014, pp. 113-114
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Original Research
Education and Training Initiatives for Crisis Management in the European Union: A Web-based Analysis of Available Programs
- Pier Luigi Ingrassia, Marco Foletti, Ahmadreza Djalali, Piercarlo Scarone, Luca Ragazzoni, Francesco Della Corte, Kubilay Kaptan, Olivera Lupescu, Chris Arculeo, Gotz von Arnim, Tom Friedl, Michael Ashkenazi, Deike Heselmann, Boris Hreckovski, Amir Khorrram-Manesh, Radko Komadina, Kostanze Lechner, Cristina Patru, Frederick M. Burkle, Jr., Philipp Fisher
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- 18 March 2014, pp. 115-126
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Introduction
Education and training are key elements of disaster management. Despite national and international educational programs in disaster management, there is no standardized curriculum available to guide the European Union (EU) member states. European- based Disaster Training Curriculum (DITAC), a multiple university-based project financially supported by the EU, is charged with developing a holistic and highly-structured curriculum and courses for responders and crisis managers at a strategic and tactical level. The purpose of this study is to qualitatively assess the prevailing preferences and characteristics of disaster management educational and training initiatives (ETIs) at a postgraduate level that currently exist in the EU countries.
MethodsAn Internet-based qualitative search was conducted in 2012 to identify and analyze the current training programs in disaster management. The course characteristics were evaluated for curriculum, teaching methods, modality of delivery, target groups, and funding.
ResultsThe literature search identified 140 ETIs, the majority (78%) located in United Kingdom, France, and Germany. Master level degrees were the primary certificates granted to graduates. Face-to-face education was the most common teaching method (84%). Approximately 80% of the training initiatives offered multi- and cross-disciplinary disaster management content. A competency-based approach to curriculum content was present in 61% of the programs. Emergency responders at the tactical level were the main target group. Almost all programs were self-funded.
ConclusionAlthough ETIs currently exist, they are not broadly available in all 27 EU countries. Also, the curricula do not cover all key elements of disaster management in a standardized and competency-based structure. This study has identified the need to develop a standardized competency-based educational and training program for all European countries that will ensure the practice and policies that meet both the standards of care and the broader expectations for professionalization of the disaster and crisis workforce.
. ,Ingrassia PL ,Foletti M ,Djalali A ,Scarone P ,Ragazzoni L ,Della Corte F ,Kaptan K ,Lupescu O ,Arculeo C ,von Arnim G ,Friedl T ,Ashkenazi M ,Heselmann D ,Hreckovski B ,Khorrram-Manesh A ,Komadina R ,Lechner K ,Patru C ,Burkle FM Jr. .Fisher P Education and Training Initiatives for Crisis Management in the European Union: A Web-based Analysis of Available Programs . Prehosp Disaster Med.2014 ;29 (2 ):1 -12
A Mixed-methods Pilot Study of Disaster Preparedness and Resiliency Among Faith-based Organizations
- Valerie M. Muller, Rita V. Burke, Bridget M. Berg, Ann C. Lin, Jeffrey S. Upperman
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- 21 February 2014, pp. 127-133
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Introduction
Faith-based organizations represent a source of stability and are an established presence in a community. They frequently serve their community following disasters. They are not formally included or identified as a disaster resource; thus, there is an opportunity to increase the effectiveness with which faith-based organizations prepare for and respond to disasters.
ProblemThis pilot study aimed to assess perceptions of the level of disaster preparedness and resiliency among faith-based organizations as a first step in understanding how to improve disaster preparedness and resiliency among these organizations and their communities.
MethodsSurvey and semi-structured interviews were conducted with six faith-based organizations, one with a leader and one with a staff member. Frequency distributions of survey questions were obtained. Interviews were transcribed and thematic analysis was supported by analytical software, ATLAS. ti.
ResultsResults of the survey indicated strong social networks among congregation and community members. However, half of the members indicated that they did not socialize often with other races and other neighborhoods. Additionally, trust of other groups of people was generally low. Themes that emerged from qualitative analysis were: (1) perceived disaster preparedness and resiliency; (2) barriers to community preparedness and resiliency; (3) lessons learned from past disasters; (4) social services and networks; and (5) willingness to be prepared.
ConclusionsThe results suggest that there is a need for interventions to improve disaster preparedness and resiliency among faith-based organizations.
. ,Muller V ,Burke R ,Berg B ,Lin A .Upperman J A Mixed-methods Pilot Study of Disaster Preparedness and Resiliency Among Faith-based Organizations . Prehosp Disaster Med.2014 ;29 (2 ):1 -7
General Household Emergency Preparedness: A Comparison Between Veterans and Nonveterans
- Claudia Der-Martirosian, Tara Strine, Mangwi Atia, Karen Chu, Michael N. Mitchell, Aram Dobalian
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- 19 March 2014, pp. 134-140
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Background
Despite federal and local efforts to educate the public to prepare for major emergencies, many US households remain unprepared for such occurrences. United States Armed Forces veterans are at particular risk during public health emergencies as they are more likely than the general population to have multiple health conditions.
MethodsThis study compares general levels of household emergency preparedness between veterans and nonveterans by focusing on seven surrogate measures of household emergency preparedness (a 3-day supply of food, water, and prescription medications, a battery-operated radio and flashlight, a written evacuation plan, and an expressed willingness to leave the community during a mandatory evacuation). This study used data from the 2006 through 2010 Behavioral Risk Factor Surveillance System (BRFSS), a state representative, random sample of adults aged 18 and older living in 14 states.
ResultsThe majority of veteran and nonveteran households had a 3-day supply of food (88% vs 82%, respectively) and prescription medications (95% vs 89%, respectively), access to a working, battery-operated radio (82% vs 77%, respectively) and flashlight (97% vs 95%, respectively), and were willing to leave the community during a mandatory evacuation (91% vs 96%, respectively). These populations were far less likely to have a 3-day supply of water (61% vs 52%, respectively) and a written evacuation plan (24% vs 21%, respectively). After adjusting for various sociodemographic covariates, general health status, and disability status, households with veterans were significantly more likely than households without veterans to have 3-day supplies of food, water, and prescription medications, and a written evacuation plan; less likely to indicate that they would leave their community during a mandatory evacuation; and equally likely to have a working, battery-operated radio and flashlight.
ConclusionThese findings suggest that veteran households appear to be better prepared for emergencies than do nonveteran households, although the lower expressed likelihood of veterans households to evacuate when ordered to do so may place them at a somewhat greater risk of harm during such events. Further research should examine household preparedness among other vulnerable groups including subgroups of veteran populations and the reasons why their preparedness may differ from the general population.
. ,Der-Martirosian C ,Strine T ,Atia M ,Chu K ,Mitchell MN .Dobalian A General Household Emergency Preparedness: A Comparison Between Veterans and Nonveterans . Prehosp Disaster Med.2014 ;29 (2 ):1 -7
The Swine Flu Emergency Department: The Relationship Between Media Attention for the Swine Flu and Registrations in an Emergency Medicine Unit
- Sara Nelissen, Kathleen Beullens, Marc Sabbe, Jan Van den Bulck
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- 18 March 2014, pp. 141-145
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Introduction
When the world is faced with a new potential pandemic outbreak, the media report heavily about it. Media are an important disseminator of health threat information. This study examined potential media effects during the 2009 outbreak of A/H1N1 influenza.
HypothesisTo examine the relationship between media reports of the swine flu and self-registrations in an emergency department (ED) of a tertiary hospital in Flanders, Belgium.
MethodsAll articles concerning swine flu published in seven Flemish newspapers were selected during the biggest flu peak in Belgium. This number was compared with the number of patients who presented themselves with a self-diagnosis of swine flu symptoms during the same time frame. The Pearson's correlation coefficient was selected to determine the relationship. The cross-correlation function determined the direction of this relationship.
ResultsA strong correlation was found between the number of potential patients (n = 308) and the number of articles in the Flemish press (n = 1657). The number of patients was the leading indicator; increases in the volume of written press followed increases in the number of patients.
ConclusionMedia reporting is extensive when a new infectious disease breaks out and intensifies when it is feared that pandemic levels are reached. This was also the case with the swine flu outbreak in Flanders. These findings suggest that a rise in the number of media reports follows a rise in the number of cases, rather than the reverse.
. ,Nelissen S ,Beullens K ,Sabbe M .Van den Bulck J The Swine Flu Emergency Department: The Relationship Between Media Attention for the Swine Flu and Registrations in an Emergency Medicine Unit . Prehosp Disaster Med.2014 ;29 (2 ):1 -5
Water and Power Reserve Capacity of Health Facilities in the Greek Islands
- Lykourgos-Christos G. Alexakis, Tudor A. Codreanu, Samuel J. Stratton
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- 13 February 2014, pp. 146-150
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Introduction
Geographically isolated islands are vulnerable during natural or technological disasters. During disasters, island health facilities should be able to secure power and water in order to continue operations.
ObjectiveThis study sought to determine the existence of Greek island health facility backup systems for water and power. When such systems existed, reserve capacity was quantified and compared to the Pan American Health Organization (PAHO) Hospital Safety Index standards.
MethodsA standardized, self-administered questionnaire was sent to major health care facilities belonging to the national health system in all Greek islands. The biggest facility available in each island was included (hospital, health center, or health post). For Crete and Euboea, all hospitals were included.
ResultsFifty-four of 85 facilities queried (27 hospitals, 17 health centers and 41 health posts) responded, for a response rate of 64%. Responding to the survey were 16 hospitals, 12 health centers and 26 health posts. In 70% of responding facilities (all 16 hospitals, 10 health centers, and 12 health posts) a backup water tank was available, while 72% (all 16 hospitals, 11 health centers, and 12 health posts) had a backup power supply system. Twenty-seven facilities provided data on water reserve, with 15 (56%) reporting a reserve for three or more days. Twenty facilities provided data on fuel stock and power consumption; six (30%) had energy reserves for more than 72 hours, and eight (40%) had reserves for 24-72 hours.
ConclusionsGreek state-supported island health facilities responding to the questionnaire had water and power reserves for use in an emergency. Health centers and health posts were less prepared than hospitals. Of the responding health facilities, half had a water backup system and approximately one-third had power backup systems with reserves that would last for at least 72 hours.
. ,Alexakis LC ,Codreanu TA .Stratton SJ Water and Power Reserve Capacity of Health Facilities in the Greek Islands . Prehosp Disaster Med.2014 ;29 (1 ):1 -5
A Paramedic Field Supervisor's Situational Awareness in Prehospital Emergency Care
- Teija Norri-Sederholm, Rauno Kuusisto, Jouni Kurola, Kaija Saranto, Heikki Paakkonen
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- 03 March 2014, pp. 151-159
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Introduction
Situational awareness (SA), or being aware of what is going on and what might happen next, is essential for the successful management of prehospital emergency care. However, far too little attention has been paid to the flow of information. Having the right information is important when formulating plans and actions.
ProblemThe aim of this study was to analyze and describe the type of information that is meaningful for SA in the work of paramedic field supervisors, and to create an information profile for them in the context of prehospital emergency care.
MethodsData were collected from January through March 2012 from semi-structured interviews with ten paramedic field supervisors representing four rescue departments in Finland. The interviews were based on three different types of real-life scenarios in the context of prehospital emergency care, and deductive content analysis was employed according to the information exchange meta-model. Data management and analysis were performed using Atlas.ti 7.
ResultsA paramedic field supervisor information interest profile was formulated. The most important information categories were Events, Means, Action Patterns, and Decisions. The profile showed that paramedic field supervisors had four roles – situation follower, analyzer, planner and decision maker – and they acted in all four roles at the same time in the planning and execution phases.
ConclusionParamedic field supervisors are multitasking persons, building SA by using the available data, combining it with extensive know-how from their working methods and competencies, and their tacit knowledge. The results can be used in developing work processes, training programs, and information systems.
. ,Norri-Sederholm T ,Kuusisto R ,Kurola J ,Saranto K .Paakkonen H A Paramedic Field Supervisor's Situational Awareness in Prehospital Emergency Care . Prehosp Disaster Med.2014 ;29 (2 ):1 -9
Understanding the Characteristics of Patient Presentations of Young People at Outdoor Music Festivals
- Alison Hutton, Jamie Ranse, Naomi Verdonk, Shahid Ullah, Paul Arbon
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- 21 February 2014, pp. 160-166
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Outdoor music festivals are unique events given that they are, for the most part, bounded and ticketed, and alcohol is served. They frequently have a higher incidence of patient presentations when compared with similar types of mass gatherings. Often, however, single events are reported in the literature, making it difficult to generalize the findings across multiple events and limiting the understanding of the “typical” patient presentations at these mass gatherings. The aim of this paper was to understand the characteristics of young people who have presented as patients to on-site health care at outdoor music festivals in Australia, and the relative proportion and type of injury and illness presentations at these events. This research used a nonexperimental design, utilizing a retrospective review of patient report forms from outdoor music festivals. Data were collected from 26 outdoor music festivals across four States of Australia during the year 2010. Females presented at greater numbers than males, and over two-thirds presented with minor illnesses, such as headaches. Males presented with injuries, in particular lacerations to their face and their hands, and alcohol and substance use made up 15% of all presentations.
. ,Hutton A ,Ranse J ,Verdonk N ,Ullah S .Arbon P Understanding the Characteristics of Patient Presentations of Young People at Outdoor Music Festivals . Prehosp Disaster Med.2014 ;29 (2 ):1 -7
Comprehensive Review
A Systematic Review of Noncommunicable Health Issues in Mass Gatherings
- Ahmed H. Alquthami, Jesse M. Pines
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- 28 February 2014, pp. 167-175
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Introduction
The review was conducted to evaluate if the field of mass-gathering medicine has evolved in addressing: (1) the lack of uniform standard measures; (2) the effectiveness of and needs for various interventions during a mass gathering; and (3) the various types of noncommunicable health issues (trauma and medical complaints) encountered and their severity during a gathering.
MethodsA systematic review of papers published from 2003 through 2012 was conducted using databases of MEDLINE, Ovid, CINHAL, EBSCOHost, National Library of Medicine (NLM), Agency for Healthcare Research and Quality (AHRQ), Elsevier, Scopus, and Proquest databases. Of 37,762 articles, 17 articles were included in this review, covering 18 mass-gathering events; 14 were multiple-day events.
ResultsAcross all events, the patient presentation rate (PPR) ranged from 0.13 to 20.8 patients per 1,000 attendees and the transfer to hospital rate (TTHR) ranged from 0.01 to 10.2 ambulance transports per 1,000 attendees. In four out of the seven studies, having on-site providers was associated with a lower rate of ambulance transports. The highest frequencies of noncommunicable presentations were headaches, abdominal complaints, and abrasions/lacerations. Most presentations were minor. Emergent cases requiring hospitalization (such as acute myocardial infarction) were rare.
ConclusionsThe rate of noncommunicable health issues varies across events and very serious emergencies are rare.
. ,Alquthami AH .Pines JM A Systematic Review of Noncommunicable Health Issues in Mass Gatherings . Prehosp Disaster Med.2014 ;29 (2 ):1 -9
Case Report
High-fidelity Human Patient Simulators Compared with Human Actors in an Unannounced Mass-Casualty Exercise
- Christian M. Schulz, Matthias Skrzypczak, Stefan Raith, Dominik Hinzmann, Veronika Krautheim, Fabian Heuser, Valentin Mayer, Christoph Kreuzer, Meike Himsl, Michael Holl, Christina Lipp, Eberhard F. Kochs, Klaus J. Wagner
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- 20 March 2014, pp. 176-182
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High-fidelity simulators (HFSs) have been shown to prompt critical actions at a level equal to that of trained human actors (HAs) and increase perceived realism in intrahospital mass-casualty incident (MCI) exercises. For unannounced prehospital MCI exercises, however, no data are available about the feasibility of incorporating HFSs. This case report describes the integration of HFSs in such an unannounced prehospital MCI drill with HAs and provides data about the differences concerning triage, treatment, and transport of HFSs and HAs with identical injury patterns. For this purpose, 75 actors and four high-fidelity simulators were subdivided into nine groups defined by a specific injury pattern. Four HFSs and six HAs comprised a group suffering from traumatic brain injury and blunt abdominal trauma. Triage results, times for transport, and number of diagnostic and therapeutic tasks were recorded. Means were compared by t test or one-way ANOVA.
Triage times and results did not differ between actors and simulators. The number of diagnostic (1.25, SD = 0.5 in simulators vs 3.5, SD = 1.05 in HAs; P = .010) and therapeutic tasks (2.0, SD = 1.6 in simulators vs 4.8, SD = 0.4 in HAs; P = .019) were significantly lower in simulators. Due to difficulties in treating and evacuating the casualties from the site of the accident in a timely manner, all simulators died. Possible causal factors and strategies are discussed, with the aim of increasing the utility of simulators in emergency medicine training.
. ,Schulz CM ,Skrzypczak M ,Raith S ,Hinzmann D ,Krautheim V ,Heuser F ,Mayer V ,Kreuzer C ,Himsl M ,Holl M ,Lipp C ,Kochs EF .Wagner KJ High-fidelity Human Patient Simulators Compared with Human Actors in an Unannounced Mass-Casualty Exercise . Prehosp Disaster Med.2014 ;29 (2 ):1 -7
Special Report
The Need for a Systematic Approach to Disaster Psychosocial Response: A Suggested Competency Framework
- Robin S. Cox, Taryn Danford
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- 17 March 2014, pp. 183-189
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Competency models attempt to define what makes expert performers “experts.” Successful disaster psychosocial planning and the institutionalizing of psychosocial response within emergency management require clearly-defined skill sets. This necessitates anticipating both the short- and long-term psychosocial implications of a disaster or health emergency (ie, pandemic) by developing effective and sustained working relationships among psychosocial providers, programs, and other planning partners. The following article outlines recommended competencies for psychosocial responders to enable communities and organizations to prepare for and effectively manage a disaster response.
Competency-based models are founded on observable performance or behavioral indicators, attitudes, traits, or personalities related to effective performance in a specific role or job. After analyzing the literature regarding competency-based frameworks, a proposed competency framework that details 13 competency domains is suggested. Each domain describes a series of competencies and suggests behavioral indicators for each competency and, where relevant, associated training expectations. These domains have been organized under three distinct categories or types of competencies: general competency domains; disaster psychosocial intervention competency domains; and disaster psychosocial program leadership and coordination competency domains.
Competencies do not replace job descriptions nor should they be confused with performance assessments. What they can do is update and revise job descriptions; orient existing and new employees to their disaster/emergency roles and responsibilities; target training needs; provide the basis for ongoing self-assessment by agencies and individuals as they evaluate their readiness to respond; and provide a job- or role-relevant basis for performance appraisal dimensions or standards and review discussions.
Using a modular approach to psychosocial planning, service providers can improve their response capacity by utilizing differences in levels of expertise and training. The competencies outlined in this paper can thus be used to standardize expectations about levels of psychosocial support interventions. In addition this approach provides an adaptable framework that can be adjusted for various contexts.
. ,Cox RS .Danford T The Need for a Systematic Approach to Disaster Psychosocial Response: A Suggested Competency Framework . Prehosp Disaster Med.2014 ;29 (2 ):1 -7
Brief Report
Dextrose 10% in the Treatment of Out-of-Hospital Hypoglycemia
- Matthew V. Kiefer, H. Gene Hern, Harrison J. Alter, Joseph B. Barger
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- 15 April 2014, pp. 190-194
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Introduction
Prehospital first responders historically have treated hypoglycemia in the field with an IV bolus of 50 mL of 50% dextrose solution (D50). The California Contra Costa County Emergency Medical Services (EMS) system recently adopted a protocol of IV 10% dextrose solution (D10), due to frequent shortages and relatively high cost of D50. The feasibility, safety, and efficacy of this approach are reported using the experience of this EMS system.
MethodsOver the course of 18 weeks, paramedics treated 239 hypoglycemic patients with D10 and recorded patient demographics and clinical outcomes. Of these, 203 patients were treated with 100 mL of D10 initially upon EMS arrival, and full data on response to treatment was available on 164 of the 203 patients. The 164 patients’ capillary glucose response to initial infusion of 100 mL of D10 was calculated and a linear regression line fit between elapsed time and difference between initial and repeat glucose values. Feasibility, safety, and the need for repeat glucose infusions were examined.
ResultsThe study cohort included 102 men and 62 women with a median age of 68 years. The median initial field blood glucose was 38 mg/dL, with a subsequent blood glucose median of 98 mg/dL. The median time to second glucose testing was eight minutes after beginning the 100 mL D10 infusion. Of 164 patients, 29 (18%) required an additional dose of IV D10 solution due to persistent or recurrent hypoglycemia, and one patient required a third dose. There were no reported adverse events or deaths related to D10 administration. Linear regression analysis of elapsed time and difference between initial and repeat glucose values showed near-zero correlation.
ConclusionsIn addition to practical reasons of cost and availability, theoretical risks of using 50 mL of D50 in the out-of-hospital setting include extravasation injury, direct toxic effects of hypertonic dextrose, and potential neurotoxic effects of hyperglycemia. The results of one local EMS system over an 18-week period demonstrate the feasibility, safety, and efficacy of using 100 mL of D10 as an alternative. Additionally, the linear regression line of repeat glucose measurements suggests that there may be little or no short-term decay in blood glucose values after D10 administration.
,Kiefer MV ,Hern HG ,Alter HJ .Barger JB Dextrose 10% in the Treatment of Out-of-Hospital Hypoglycemia . Prehosp Disaster Med.2014 ;29 (2 ):1 -5 .
Medical and Psychosocial Needs of Olympic and Pan American Athletes after the 2010 Earthquake in Haiti: An Opportunity to Promote Resilience Through Sports Medicine and Public Diplomacy
- Eugene S. Yim, Robert D. Macy, Gregory Ciottone
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- Published online by Cambridge University Press:
- 10 April 2014, pp. 195-199
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Introduction
On January 12, 2010, a magnitude 7.0 earthquake devastated Haiti. Data regarding the prevalence of medical and psychosocial needs after the earthquake is scarce, complicating informed targeting of aid. The effects of the earthquake on athletes, as they differ from the general population, are especially unclear. The Center for Disaster Resilience (Boston, Massachusetts USA) and the Disaster Medicine Section at Harvard Medical School (Boston, Massachusetts USA) have partnered with Child in Hand to care for athletes training for the Pan American and Olympic games in Haiti, as well as for children from the general population. This report presents preliminary epidemiologic data illustrating the burden of medical and psychosocial needs of Haitian athletes and the general population after the earthquake of 2010.
MethodsThe study was a cross-sectional, comparative study conducted a year after the earthquake. The study group comprised 104 athletes, aged 12-18 years, enrolled from the National Sports Center in Haiti. The control group (N = 104) from the general population was age- and gender-matched from orphanages and schools in and around Port-au-Prince, Haiti. Medical teams assessed illness based on history and physicals. Psychosocial teams utilized the Child Psychosocial Distress Screener (CPDS). Two-proportion z tests and two-sample t tests were used to compare the proportions of medical illnesses, mean CPDS scores, and proportion of CPDS scores indicating treatment.
ResultsThe most prevalent medical condition in athletes was musculoskeletal pain, which was more common than in controls (49% versus 2.9%). All other medical conditions were more common in the controls than athletes: abdominal pain (28.8% versus 4.8%); headache (22.1% versus 5.8%); fever (15.4% versus 1%); and malnutrition (18.3% versus 1.9%). In contrast, there was no significant difference in mean psychosocial scores and the proportion of scores indicating treatment between athletes and controls.
ConclusionElite athletes in Haiti have a low prevalence of most medical conditions after the disaster, suggesting that they may be protected from risk factors affecting the general population. However, athletes have a higher prevalence of musculoskeletal ailments and were not protected from psychosocial distress. This presents an opportunity for sports medicine physicians and mental health providers to engage in efforts to rebuild Haiti on an individual level by providing targeted care to athletes, and on a larger scale, by supporting international sports competition, which enhances human capital and facilitates public diplomacy.
,Yim ES ,Macy RD .Ciottone G Medical and Psychosocial Needs of Olympic and Pan American Athletes after the 2010 Earthquake in Haiti: An Opportunity to Promote Resilience Through Sports Medicine and Public Diplomacy . Prehosp Disaster Med.2014 ;29 (3 ):1 -5 .
Use of Point-of-Care Lactate in the Prehospital Aeromedical Environment
- Marie Mullen, Gianluca Cerri, Ryan Murray, Angela Talbot, Alexandra Sanseverino, Peter McCahill, Virginia Mangolds, Jesse Volturo, Chad Darling, Marc Restuccia
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- Published online by Cambridge University Press:
- 19 March 2014, pp. 200-203
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Introduction
Lactate measurement has been used to identify critical medical illness and initiate early treatment strategies. The prehospital environment offers an opportunity for very early identification of critical illness and commencement of care.
HypothesisThe investigators hypothesized that point-of-care lactate measurement in the prehospital aeromedical environment would: (1) identify medical patients with high mortality; (2) influence fluid, transfusion, and intubation; and (3) increase early central venous catheter (CVC) placement.
MethodsCritically ill, medical, nontrauma patients who were transported from September 2007 through February 2009 by University of Massachusetts (UMass) Memorial LifeFlight, a university-based emergency medical helicopter service, were eligible for enrollment. Patients were prospectively randomized to receive a fingerstick whole-blood lactate measurement on an alternate-day schedule. Flight crews were not blinded to results. Flight crews were asked to inform the receiving attending physician of the results. The primary endpoint was the ability of a high, prehospital lactate value [> 4 millimoles per liter (mmol/L)] to identify mortality. Secondary endpoints included differences in post-transport fluid, transfusion, and intubation, and decrease in time to central venous catheter (CVC) placement. Categorical variables were compared between groups by Fisher's Exact Test, and continuous variables were compared by t-test.
ResultsPatients (N = 59) were well matched for age, gender, and acuity. In the lactate cohort (n = 20), mean lactate was 7 mmol/L [Standard error of the mean, SEM = 1]. Initial analysis revealed that prehospital lactate levels of ≥4 mmol/L did show a trend toward higher mortality with an odds ratio of 2.1 (95% CI, 0.3-13.8). Secondary endpoints did not show a statistically significant change in management between the lactate and non lactate groups. There was a trend toward decreased time to post-transport CVC in the non lactate faction.
ConclusionPrehospital aeromedical point-of-care lactate measurement levels ≥4 mmol/L may help stratify mortality. Further investigation is needed, as this is a small, limited study. The initial analysis did not find a significant change in post-transport management.
. ,Mullen M ,Cerri G ,Murray R ,Talbot A ,Sanseverino A ,McCahill P ,Mangolds V ,Volturo J ,Darling C .Restuccia M Use of Point-of-Care Lactate in the Prehospital Aeromedical Environment . Prehosp Disaster Med.2014 ;29 (1 ):1 -4
Reliability of Telecommunications Systems Following a Major Disaster: Survey of Secondary and Tertiary Emergency Institutions in Miyagi Prefecture During the Acute Phase of the 2011 Great East Japan Earthquake
- Daisuke Kudo, Hajime Furukawa, Atsuhiro Nakagawa, Yoshiko Abe, Toshikatsu Washio, Tatsuhiko Arafune, Dai Sato, Satoshi Yamanouchi, Sae Ochi, Teiji Tominaga, Shigeki Kushimoto
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- Published online by Cambridge University Press:
- 21 February 2014, pp. 204-208
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Introduction
Telecommunication systems are important for sharing information among health institutions to successfully provide medical response following disasters.
Hypothesis/ProblemThe aim of this study was to clarify the problems associated with telecommunication systems in the acute phase of the Great East Japan Earthquake (March 11, 2011).
MethodsAll 72 of the secondary and tertiary emergency hospitals in Miyagi Prefecture were surveyed to evaluate the telecommunication systems in use during the 2011 Great Japan Earthquake, including satellite mobile phones, multi-channel access (MCA) wireless systems, mobile phones, Personal Handy-phone Systems (PHS), fixed-line phones, and the Internet. Hospitals were asked whether the telecommunication systems functioned correctly during the first four days after the earthquake, and, if not, to identify the cause of the malfunction. Each telecommunication system was considered to function correctly if the hospital staff could communicate at least once in every three calls.
ResultsValid responses were received from 53 hospitals (73.6%). Satellite mobile phones functioned correctly at the highest proportion of the equipped hospitals, 71.4%, even on Day 0. The MCA wireless system functioned correctly at the second highest proportion of the equipped hospitals. The systems functioned correctly at 72.0% on Day 0 and at 64.0% during Day 1 through Day 3. The main cause of malfunction of the MCA wireless systems was damage to the base station or communication lines (66.7%). Ordinary (personal or general communication systems) mobile phones did not function correctly at any hospital until Day 2, and PHS, fixed-line phones, and the Internet did not function correctly at any area hospitals that were severely damaged by the tsunami. Even in mildly damaged areas, these systems functioned correctly at <40% of the hospitals during the first three days. The main causes of malfunction were a lack of electricity (mobile phones, 25.6%; the Internet, 54.8%) and damage to the base stations or communication lines (the Internet, 38.1%; mobile phones, 56.4%).
ConclusionResults suggest that satellite mobile phones and MCA wireless systems are relatively reliable and ordinary systems are less reliable in the acute period of a major disaster. It is important to distribute reliable disaster communication equipment to hospitals and plan for situations in which hospital telecommunications systems do not function.
. ,Kudo D ,Furukawa H ,Nakagawa A ,Abe Y ,Washio T ,Arafune T ,Sato D ,Yamanouchi S ,Ochi S ,Tominaga T .Kushimoto S Reliability of Telecommunications Systems Following a Major Disaster: Survey of Secondary and Tertiary Emergency Institutions in Miyagi Prefecture During the Acute Phase of the 2011 Great East Japan Earthquake . Prehosp Disaster Med.2014 ;29 (1 ):1 -5
Case Report
Early Diagnosis and Treatment of a Posttraumatic Pseudoaneurysm/Dissection of the Innominate Artery
- Fernando Azarcon, Melhelm Ghaleb
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- Published online by Cambridge University Press:
- 04 February 2014, pp. 209-211
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A 25-year-old male developed a traumatic intimo-medial dissection and saccular pseudoaneurysm at the origin of the innominate artery following a motorcycle accident. On physical examination there was no perceivable trauma to the chest. In addition, there were no clinical symptoms that suggested this serious injury. The patient was managed with successful stent-graft placement on an elective basis.
. ,Azarcon F .Ghaleb M Early Diagnosis and Treatment of a Posttraumatic Pseudoaneurysm/Dissection of the Innominate Artery . Prehosp Disaster Med.2014 ;29 (1 ):1 -3
Use of a Gum Elastic Bougie in a Penetrating Neck Trauma
- Yann Daniel, Stanislas de Regloix, Eric Kaiser
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- 28 February 2014, pp. 212-213
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The case of a patient with a zone II penetrating neck injury who was intubated successfully utilizing the gum elastic bougie (GEB) is reported. He presented at a forward operational base in Afghanistan with a shrapnel wound in his neck as well as a cough and hoarseness. There were two wounds on each side of his laryngeal cartilages. The patient's breathing rate gradually increased and labored inhalation developed while the aeromedical evacuation was delayed for tactical reasons. Subcutaneous emphysema and edema concealed the anatomical landmarks, making a cricothyrotomy unsafe, and no fiber optic devices were available on site. Intratracheal intubation was decided upon by the doctors involved. Because of the anticipated difficultly of intubation, the GEB was used from the outset. During direct laryngoscopy, edema, blood, and mucus concealed the anatomic reliefs of the larynx. The glottis was not visible. On the second attempt, “clicks” were clearly perceived and the tube was railroaded over the bougie. Finally, the patient was evacuated to an Afghan military hospital.
In this report, the benefit-risk balance for the use of the GEB in penetrating neck trauma is discussed. Although the use of the GEB cannot be recommended in all cases of penetrating neck injury, it should be considered as an option. This technique is not without risk, but in very remote settings or hostile environments, especially when cricothyrotomy is not possible, it can be lifesaving.
. ,Daniel Y ,de Regloix S .Kaiser E Use of a Gum Elastic Bougie in a Penetrating Neck Trauma . Prehosp Disaster Med.2014 ;29 (2 ):1 -2
School Interventions After the Joplin Tornado
- Robert K. Kanter, David Abramson
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- Published online by Cambridge University Press:
- 21 March 2014, pp. 214-217
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Background/Objective
To qualitatively describe interventions by schools to meet children's needs after the May 2011 Joplin, Missouri tornado.
MethodsQualitative exploratory study conducted six months after the tornado. Key informant interviews with school staff (teachers, psychologists, guidance counselor, nurse, principal), public health official, and physicians.
ReportAfter the tornado, school staff immediately worked to contact every enrolled child to provide assistance and coordinate recovery services. Despite severe damage to half of the city's schools, the decision was made to reopen schools at the earliest possible time to provide a safe, reassuring environment and additional services. An expanded summer school session emphasized child safety and emotional wellbeing. The 2011-2012 school year began on time, less than three months after the disaster, using temporary facilities. Displaced children were bused to their usual schools regardless of their new temporary residence locations. In just-in-time training sessions, teachers developed strategies to support students and staff experiencing anxiety or depression. Certified counselors conducted school-based, small-group counseling for students. Selective referrals were made to community mental health providers for children with greatest needs.
ConclusionsEvidence from Joplin adds to a small body of empirical experience demonstrating the important contribution of schools to postdisaster community recovery. Despite timely and proactive services, many families and children struggled after the tornado. Improvements in the effectiveness of postdisaster interventions at schools will follow from future scientific evidence on optimal approaches.
. ,Kanter RK .Abramson D School Interventions After the Joplin Tornado . Prehosp Disaster Med.2014 ;29 (2 ):1 -4
Conference Reports
Report and Session Summary from the 18th World Congress on Disaster and Emergency Medicine: May 28 to May 31, 2013 Manchester, UK
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- Published online by Cambridge University Press:
- 10 February 2014, pp. 218-220
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This section of Prehospital and Disaster Medicine (PDM) presents a report and summary of a session at the 18th World Congress on Disaster and Emergency Medicine (WCDEM) held in Manchester, UK in May of 2013. Additional reports and summaries were published in PDM (Volume 28, No. 6). Abstracts of Congress oral and poster presentations were published in May, 2013 as a supplement to PDM (Volume 28, Supplement 1).
Report and session summary from the 18th World Congress on Disaster and Emergency Medicine. Prehosp Disaster Med. 2014:29(1):1-3.
Front Cover (OFC, IFC) and matter
PDM volume 29 issue 2 Cover and Front matter
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- Published online by Cambridge University Press:
- 25 April 2014, pp. f1-f8
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