Editorial
Assessing the Accuracy of Survey Research
- Samuel J. Stratton
-
- Published online by Cambridge University Press:
- 08 May 2015, pp. 225-226
-
- Article
-
- You have access Access
- HTML
- Export citation
Disastrous Events and Political Failures
- Jeffrey Levett
-
- Published online by Cambridge University Press:
- 17 April 2015, pp. 227-228
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Response to the Ebola crisis (ongoing event) has been less than efficient. It has been monitored less than adequately by the international community and has been coordinated poorly in the USA. The event is used as a platform to examine deficiencies in public health infrastructure, the limits of its political and financial support, and how political outcomes can be affected. The need to tease out the political determinants implicit in policy failure and disaster management is argued in this Editorial. Failures mentioned include in the Balkans and in Greece with ongoing austerity. Comments on the real heroes of Ebola on the ground in Africa and the need for a charismatic role for political leaders in public health are also included.
.Levett J Disastrous Events and Political Failures . Prehosp Disaster Med.2015 ;30 (3 ):1 2.
Original Research
Declaration of a State of Emergency in Trinidad and Tobago: Effect on the Trauma Admissions at the National Referral Trauma Centre
- Michael J. Ramdass, Shamir O. Cawich, Suresh Pooran, David Milne, Earnest Ali, Vijay Naraynsingh
-
- Published online by Cambridge University Press:
- 18 March 2015, pp. 229-232
-
- Article
- Export citation
-
Objective
To determine the effect of a State of Emergency (SOE) on penetrating injuries at the main trauma center in Trinidad and Tobago.
MethodsEmergency room registers were accessed in order to identify all patients treated for penetrating injuries from July 1, 2010 through December 30, 2012. This study period was chosen to include injuries one year before and one year after the SOE that spanned from August 21, 2011 to December 5, 2011. Data were analyzed using SPSS version 19 and a P value <.05 was considered statistically significant.
ResultsThere were 1,067 patients treated for penetrating injuries. There were significantly more injuries from gunshots compared to stab wounds (64.7% vs 35.3%; P<.001), and this pattern was maintained during the SOE (54.7% vs 45.3%; P=.37). There was a significant fall in mean monthly admissions for penetrating trauma during the SOE when compared to the 12-month period before its imposition (17.7, SD=4.0 vs 38.9, SD=12.3; CI, 5.6-36.8; P=.0108). One year later, mean monthly admissions for penetrating trauma were similar to those during the SOE (22.7, SD=2.1 vs 17.6, SD=4.0; CI, -2.3-12.3; P=.1295). The incidence of gunshot wounds remained low and stab wounds increased.
ConclusionThis study has demonstrated that there was a reduction in the incidence of penetrating trauma at the national trauma center after the SOE, with a shift from gunshot to stab wounds.
,Ramdass MJ ,Cawich SO ,Pooran S ,Milne D ,Ali E Naraynsingh V. Declaration of a State of Emergency in Trinidad and Tobago: Effect on the Trauma Admissions at the National Referral Trauma Centre . Prehosp Disaster Med.2015 ;30 (3 ):1 4.
Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making
- Karen A. Ricci, Anne R. Griffin, Kevin C. Heslin, Derrick Kranke, Aram Dobalian
-
- Published online by Cambridge University Press:
- 18 March 2015, pp. 233-238
-
- Article
- Export citation
-
Problem
Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System’s (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012.
MethodsSemi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event.
ResultsThe most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City’s (NYC’s) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city’s order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit.
ConclusionsResults suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.
,Ricci KA ,Griffin AR ,Heslin KC ,Kranke D .Dobalian A Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making . Prehosp Disaster Med2015 ;30 (3 ):1 -6
Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service
- James S. Lee, Domhnall O’Dochartaigh, Mark MacKenzie, Darren Hudson, Stephanie Couperthwaite, Cristina Villa-Roel, Brian H. Rowe
-
- Published online by Cambridge University Press:
- 27 February 2015, pp. 239-243
-
- Article
- Export citation
-
Introduction
Non-invasive positive pressure ventilation (NIPPV) is used to treat severe acute respiratory distress. Prehospital NIPPV has been associated with a reduction in both in-hospital mortality and the need for invasive ventilation.
Hypothesis/ProblemThe authors of this study examined factors associated with NIPPV failure and evaluated the impact of NIPPV on scene times in a critical care helicopter Emergency Medical Service (HEMS). Non-invasive positive pressure ventilation failure was defined as the need for airway intervention or alternative means of ventilatory support.
MethodsA retrospective chart review of consecutive patients where NIPPV was completed in a critical care HEMS was conducted. Factors associated with NIPPV failure in univariate analyses and from published literature were included in a multivariable, logistic regression model.
ResultsFrom a total of 44 patients, NIPPV failed in 14 (32%); a Glasgow Coma Scale (GCS) <15 at HEMS arrival was associated independently with NIPPV failure (adjusted odds ratio 13.9; 95% CI, 2.4-80.3; P=.003). Mean scene times were significantly longer in patients who failed NIPPV when compared with patients in whom NIPPV was successful (95 minutes vs 51 minutes; 39.4 minutes longer; 95% CI, 16.2-62.5; P=.001).
ConclusionPatients with a decreased level of consciousness were more likely to fail NIPPV. Furthermore, patients who failed NIPPV had significantly longer scene times. The benefits of NIPPV should be balanced against risks of long scene times by HEMS providers. Knowing risk factors of NIPPV failure could assist HEMS providers to make the safest decision for patients on whether to initiate NIPPV or proceed directly to endotracheal intubation prior to transport.
,Lee JS ,O’Dochartaigh D ,MacKenzie M ,Hudson D ,Couperthwaite S ,Villa-Roel C .Rowe BH Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service . Prehosp Disaster Med2015 ;30 (2 ):1 –5
An Educational Measure to Significantly Increase Critical Knowledge Regarding Interfacility Patient Transfers
- Torben K. Becker, James F. Skiba, Cemal B. Sozener
-
- Published online by Cambridge University Press:
- 19 March 2015, pp. 244-248
-
- Article
- Export citation
-
Background
Patient transfers among medical facilities are high-risk situations. Despite this, there is very little training of physicians regarding the medical and legal aspects of transport medicine.
ObjectivesTo examine the effects of a one hour, educational intervention on Emergency Medicine (EM) residents’ and Critical Care (CC) fellows’ knowledge regarding the medical and legal aspects of interfacility patient transfers.
MethodsPrior to the intervention, physician knowledge regarding 12 key concepts in patient transfer was assessed using a pre-test instrument. A one hour, interactive, educational session followed immediately thereafter. Following the intervention, a post-intervention test was given between two and four weeks after delivery. Participants were also asked to describe any prior transportation-medicine-related education, their opinions as they relate to the relevance of the topic, and their comfort levels with patient transfers before and after the intervention.
ResultsOnly a minority of participants had received any formal training in patient transfers prior to the intervention, despite dealing with patient transfers on a frequent, often daily, basis. Both groups improved in several categories on the post-intervention test. They reported improved comfort levels with the medicolegal aspects of interfacility patient transfers after the intervention and felt well-prepared to manage transfers in their daily practice.
ConclusionA one hour, educational intervention objectively increased EM and CC physician trainees’ understanding of some of the medicolegal aspects of interfacility patient transfers. The study demonstrated a lack of previous training on this important topic and improved levels of comfort with transfers after study participation.
,Becker TK ,Skiba JF .Sozener CB An Educational Measure to Significantly Increase Critical Knowledge Regarding Interfacility Patient Transfers . Prehosp Disaster Med.2015 ;30 (3 ):1 -5
Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis
- Brian M. Clemency, Christopher T. Tanski, Michael Rosenberg, Paul R. May, Joseph D. Consiglio, Heather A. Lindstrom
-
- Published online by Cambridge University Press:
- 10 April 2015, pp. 249-253
-
- Article
- Export citation
-
Introduction
Needle thoracostomy is the prehospital treatment for tension pneumothorax. Sufficient catheter length is necessary for procedural success. The authors of this study determined minimum catheter length needed for procedural success on a percentile basis.
MethodsA meta-analysis of existing studies was conducted. A Medline search was performed using the search terms: needle decompression, needle thoracentesis, chest decompression, pneumothorax decompression, needle thoracostomy, and tension pneumothorax. Studies were included if they published a sample size, mean chest wall thickness, and a standard deviation or confidence interval. A PubMed search was performed in a similar fashion. Sample size, mean chest wall thickness, and standard deviation were found or calculated for each study. Data were combined to create a pooled dataset. Normal distribution of data was assumed. Procedural success was defined as catheter length being equal to or greater than the chest wall thickness.
ResultsThe Medline and PubMed searches yielded 773 unique studies; all study abstracts were reviewed for possible inclusion. Eighteen papers were identified for full manuscript review. Thirteen studies met all inclusion criteria and were included in the analysis. Pooled sample statistics were: n=2,558; mean=4.19 cm; and SD=1.37 cm. Minimum catheter length needed for success at the 95th percentile for chest wall size was found to be 6.44 cm.
DiscussionA catheter of at least 6.44 cm in length would be required to ensure that 95% of the patients in this pooled sample would have penetration of the pleural space at the site of needle decompression, and therefore, a successful procedure. These findings represent Level III evidence.
,Clemency BM ,Tanski CT ,Rosenberg M ,May PR ,Consiglio JD .Lindstrom HA Sufficient Catheter Length for Pneumothorax Needle Decompression: A Meta-Analysis . Prehosp Disaster Med.2015 ;30 (3 ):1 5
Survey of UK Health Care First Responders’ Knowledge of Personal Protective Equipment Requirements
- Jan Schumacher, Alexandra R. Bond, Valentine Woodham, Anna Buckingham, Francesca Garnham, Andrea Brinker
-
- Published online by Cambridge University Press:
- 22 April 2015, pp. 254-258
-
- Article
- Export citation
-
Introduction
An adequate level of personal protective equipment (PPE) is necessary when treating patients with highly infectious diseases or those contaminated with hazardous substances.
MethodsFollowing National Institute for Health Research’s Research Centre (London, United Kingdom) approval, the authors of this study conducted a survey of specialist registrars’ knowledge of the respiratory and skin protection requirements needed during a resuscitation scenario with Advanced Life Support. Participant responses were compared to UK national recommendations and to a previous survey in 2009.
ResultsA total of 98 specialist registrars (in Anesthesiology, n=51; in Emergency Medicine (EM), n=21; and in Intensive Care Medicine (ICM) n=26) completed hand-delivered surveys. The best knowledge of PPE requirements (76%) was found for severe acute respiratory syndrome (SARS), with less knowledge about PPE requirements for anthrax, plague, Ebola virus disease (EVD), and smallpox (60%). The results show limited knowledge of PPE requirements (20%-30%) for various chemical warfare agents. Personal protective equipment knowledge regarding treatment of sarin-contaminated casualties was over-rated by 80%, and for patients with EVD, it was over-rated by up to 67% of participants.
ConclusionThe results of the tested cohort indicate that current knowledge regarding PPE for chemical warfare agents remains very limited.
,Schumacher J ,Bond AR ,Woodham V ,Buckingham A ,Garnham F .Brinker A Survey of UK Health Care First Responders’ Knowledge of Personal Protective Equipment Requirements . Prehosp Disaster Med.2015 ;30 (3 ):1 5
Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE: A Preliminary High-fidelity Mannequin Study
- Sara J. Aberle, Benjamin J. Sandefur, Kharmene L. Sunga, Ronna L. Campbell, Christine M. Lohse, Henrique Alecastro Puls, Sarah Laudon, Matthew D. Sztajnkrycer
-
- Published online by Cambridge University Press:
- 11 May 2015, pp. 259-263
-
- Article
- Export citation
-
Introduction
Management of contaminated patients in the decontamination corridor requires the use of hazardous material (HazMat) personal protective equipment (PPE). Previous studies have demonstrated that HazMat PPE may increase the difficulty of airway management. This study compared the efficiency of video laryngoscopy (VL) with traditional direct laryngoscopy (DL) during endotracheal intubation (ETI) while wearing HazMat PPE.
MethodsPost-graduate year (PGY) 1-3 Emergency Medicine residents were randomized to VL or DL while wearing encapsulating PPE. Video laryngoscopy was performed using the GlideScope Cobalt AVL video laryngoscope. The primary outcome measure was time to successful ETI in a high-fidelity simulation mannequin. Three time points were utilized in the analysis: Time 0 (blade at lips), Time 1 (blade removed from lips after endotracheal tube placement), and Time 2 (bag valve mask [BVM] attached to endotracheal tube). Secondary outcome measures were perceived ease of use and feasibility of VL and DL ETI modalities.
ResultsTwenty-one of 23 (91.3%) eligible residents participated. Mean time to ETI was 10.0 seconds (SD=5.3 seconds) in the DL group and 7.8 seconds (SD=3.0 seconds) in the VL group (P=.081). Mean times from blade insertion until BVM attachment were 17.4 seconds (SD=6.0 seconds) and 15.6 seconds (SD=4.6 seconds), respectively (P=.30). There were no unsuccessful intubation attempts. Seventeen out of 20 participants (85.0%) perceived VL to be easier to use when performing ETI in PPE. Twelve out of 20 participants (60%) perceived DL to be more feasible in an actual HazMat scenario.
ConclusionThe time to successful ETI was not significantly different between VL and DL. Video laryngoscopy had a greater perceived ease of use, but DL was perceived to be more feasible for use in actual HazMat situations. These findings suggest that both DL and VL are reasonable modalities for use in HazMat situations, and the choice of modality could be based on the clinical situation and provider experience.
,Aberle SJ ,Sandefur BJ ,Sunga KL ,Campbell RL ,Lohse CM ,Alecastro Puls H ,Laudon S .Sztajnkrycer MD Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE: A Preliminary High-fidelity Mannequin Study . Prehosp Disaster Med.2015 ;30 (3 ):1 –5 .
Humanitarian Assistance and Accountability: What Are We Really Talking About?
- Y.S. Andrew Tan, Johan von Schreeb
-
- Published online by Cambridge University Press:
- 18 March 2015, pp. 264-270
-
- Article
- Export citation
-
Background
In the past two decades, there has been a worldwide increase in the number of disasters, as well as the number of people affected, along with the number of foreign medical teams (FMTs) deployed to provide assistance. However, in the wake of the 2010 Haiti earthquake, multiple reports and anecdotes questioned the actual, positive contribution of such FMTs and even the intentions behind these aid efforts. This brought on a renewed interest in the humanitarian community towards accountability. Between 2000 and 2012, the number of “Quality and Accountability” initiatives and instruments more than tripled from 42 to 147. Yet, to date, there is no single accepted definition of accountability in the humanitarian context.
AimThe aim of this report was to explore and assess how accountability in the humanitarian context is used and/or defined in the literature.
MethodsThe electronic database PubMed and a predefined list of grey literature comprising 46 organizations were searched for articles that discussed or provided a definition of accountability in the humanitarian context. The definitions found in these articles were analyzed qualitatively using a framework analysis method based on principles of grounded theory as well as using a summative content analysis method.
ResultsA total of 85 articles were reviewed in-depth. Fifteen organizations had formal definitions of accountability or explained what it meant to them. Accountability was generally seen in two paradigms: as a “process” or as a “goal.” A total of 16 different concepts were identified amongst the definitions. Accountability to aid recipients had four main themes: empowering aid recipients, being in an optimal position to do the greatest good, meeting expectations, and being liable. The concepts of “enforcement/enforceability” under the last theme of “being liable” received the least mention.
ConclusionThe concept of accountability is defined poorly in many humanitarian organizations. Humanitarian providers often refer to different concepts when talking about accountability in general. The lack of a common understanding is contributed by the semantic and practical complexities of the term. The lack of emphasis on “enforcement/enforceability” is noteworthy. Other aspects of accountability, such as its “measurability” and by whom, similarly lack a common understanding and community-wide consensus. To what extent these vague definitions of accountability affect agencies’ work in the field remains to be documented.
,Tan YSA .von Schreeb J Humanitarian Assistance and Accountability: What Are We Really Talking About? Prehosp Disaster Med.2015 ;30 (3 ):1 7
Mass-gathering Medicine: Risks and Patient Presentations at a 2-Day Electronic Dance Music Event
- Adam Lund, Sheila A. Turris
-
- Published online by Cambridge University Press:
- 14 April 2015, pp. 271-278
-
- Article
- Export citation
-
Introduction
Music festivals, including electronic dance music events (EDMEs), increasingly are common in Canada and internationally. Part of a US $4.5 billion industry annually, the target audience is youth and young adults aged 15-25 years. Little is known about the impact of these events on local emergency departments (EDs).
MethodsDrawing on prospective data over a 2-day EDME, the authors of this study employed mixed methods to describe the case mix and prospectively compared patient presentation rate (PPR) and ambulance transfer rate (ATR) between a first aid (FA) only and a higher level of care (HLC) model.
ResultsThere were 20,301 ticketed attendees. Seventy patient encounters were recorded over two days. The average age was 19.1 years. Roughly 69% were female (n=48/70). Forty-six percent of those seen in the main medical area were under the age of 19 years (n=32/70). The average length of stay in the main medical area was 70.8 minutes. The overall PPR was 4.09 per 1,000 attendees. The ATR with FA only would have been 1.98; ATR with HLC model was 0.52. The presence of an on-site HLC team had a significant positive effect on avoiding ambulance transfers.
DiscussionTwenty-nine ambulance transfers and ED visits were avoided by the presence of an on-site HLC medical team. Reduction of impact to the public health care system was substantial.
ConclusionsElectronic dance music events have predictable risks and patient presentations, and appropriate on-site health care resources may reduce significantly the impact on the prehospital and emergency health resources in the host community.
,Lund A .Turris SA Mass-gathering Medicine: Risks and Patient Presentations at a 2-Day Electronic Dance Music Event . Prehosp Disaster Med.2015 ;30 (3 ):1 8
Special Report
Modeling Evacuation of a Hospital without Electric Power
- Eric D. Vugrin, Stephen J. Verzi, Patrick D. Finley, Mark A. Turnquist, Anne R. Griffin, Karen A. Ricci, Tamar Wyte-Lake
-
- Published online by Cambridge University Press:
- 14 April 2015, pp. 279-287
-
- Article
- Export citation
-
Hospital evacuations that occur during, or as a result of, infrastructure outages are complicated and demanding. Loss of infrastructure services can initiate a chain of events with corresponding management challenges. This report describes a modeling case study of the 2001 evacuation of the Memorial Hermann Hospital in Houston, Texas (USA). The study uses a model designed to track such cascading events following loss of infrastructure services and to identify the staff, resources, and operational adaptations required to sustain patient care and/or conduct an evacuation. The model is based on the assumption that a hospital’s primary mission is to provide necessary medical care to all of its patients, even when critical infrastructure services to the hospital and surrounding areas are disrupted. Model logic evaluates the hospital’s ability to provide an adequate level of care for all of its patients throughout a period of disruption. If hospital resources are insufficient to provide such care, the model recommends an evacuation. Model features also provide information to support evacuation and resource allocation decisions for optimizing care over the entire population of patients. This report documents the application of the model to a scenario designed to resemble the 2001 evacuation of the Memorial Hermann Hospital, demonstrating the model’s ability to recreate the timeline of an actual evacuation. The model is also applied to scenarios demonstrating how its output can inform evacuation planning activities and timing.
,Vugrin ED ,Verzi SJ ,Finley PD ,Turnquist MA ,Griffin AR ,Ricci KA .Wyte-Lake T Modeling Evacuation of a Hospital without Electric Power . Prehosp Disaster Med.2015 ;30 (3 ):1 -9
Self-care Decontamination within a Chemical Exposure Mass-casualty Incident
- Raymond G. Monteith, Laurie D. R. Pearce
-
- Published online by Cambridge University Press:
- 27 April 2015, pp. 288-296
-
- Article
- Export citation
-
Growing awareness and concern for the increasing frequency of incidents involving hazardous materials (HazMat) across a broad spectrum of contaminants from chemical, biological, radiological, and nuclear (CBRN) sources indicates a clear need to refine the capability to respond successfully to mass-casualty contamination incidents. Best results for decontamination from a chemical agent will be achieved if done within minutes following exposure, and delays in decontamination will increase the length of time a casualty is in contact with the contaminate. The findings presented in this report indicate that casualties involved in a HazMat/CBRN mass-casualty incident (MCI) in a typical community would not receive sufficient on-scene care because of operational delays that are integral to a standard HazMat/CBRN first response. This delay in response will mean that casualty care will shift away from the incident scene into already over-tasked health care facilities as casualties seek aid on their own. The self-care decontamination protocols recommended here present a viable option to ensure decontamination is completed in the field, at the incident scene, and that casualties are cared for more quickly and less traumatically than they would be otherwise. Introducing self-care decontamination procedures as a standard first response within the response community will improve the level of care significantly and provide essential, self-care decontamination to casualties. The process involves three distinct stages which should not be delayed; these are summarized by the acronym MADE: Move/Assist, Disrobe/Decontaminate, Evaluate/Evacuate.
,Monteith RG .Pearce LDR Self-care Decontamination within a Chemical Exposure Mass-casualty Incident . Prehosp Disaster Med.2015 ;30 (3 ):1 –9 .
Comprehensive Review
Exertional Heat Illness: Emerging Concepts and Advances in Prehospital Care
- Riana R. Pryor, Ronald N. Roth, Joe Suyama, David Hostler
-
- Published online by Cambridge University Press:
- 10 April 2015, pp. 297-305
-
- Article
- Export citation
-
Exertional heat illness is a classification of disease with clinical presentations that are not always diagnosed easily. Exertional heat stroke is a significant cause of death in competitive sports, and the increasing popularity of marathons races and ultra-endurance competitions will make treating many heat illnesses more common for Emergency Medical Services (EMS) providers. Although evidence is available primarily from case series and healthy volunteer studies, the consensus for treating exertional heat illness, coupled with altered mental status, is whole body rapid cooling. Cold or ice water immersion remains the most effective treatment to achieve this goal. External thermometry is unreliable in the context of heat stress and direct internal temperature measurement by rectal or esophageal probes must be used when diagnosing heat illness and during cooling. With rapid recognition and implementation of effective cooling, most patients suffering from exertional heat stroke will recover quickly and can be discharged home with instructions to rest and to avoid heat stress and exercise for a minimum of 48 hours; although, further research pertaining to return to activity is warranted.
,Pryor RR ,Roth RN ,Suyama J .Hostler D Exertional Heat Illness: Emerging Concepts and Advances in Prehospital Care . Prehosp Disaster Med.2015 ;30 (3 ):1 9 .
Child Debriefing: A Review of the Evidence Base
- Betty Pfefferbaum, Anne K. Jacobs, Pascal Nitiéma, George S. Everly, Jr.
-
- Published online by Cambridge University Press:
- 14 April 2015, pp. 306-315
-
- Article
- Export citation
-
Introduction
Debriefing, a controversial crisis intervention delivered in the early aftermath of a disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base.
MethodsA systematic search of selected bibliographic databases (EBM Reviews, EMBASE, ERIC, Medline, Ovid, PILOTS, PubMed, and PsycINFO) was conducted in the spring of 2014 using search terms related to psychological debriefing. The search was limited to English language sources and studies of youth, aged 0 to 18 years. No time limit was placed on date of publication. The search yielded 713 references. Titles and abstracts were reviewed to select publications describing scientific studies and clinical reports. Reference sections of these publications, and of other literature known to the authors that was not generated by the search, were used to locate additional materials. Review of these materials generated 187 publications for more thorough examination; this assessment yielded a total of 91 references on debriefing in children and adolescents. Only 15 publications on debriefing in children and adolescents described empirical studies. Due to a lack of statistical analysis of effectiveness data with youth, and some articles describing the same study, only seven empirical studies described in nine papers were identified for analysis for this review. These studies were evaluated using criteria for assessment of methodological rigor in debriefing studies.
ResultsChildren and adolescents included in the seven empirical debriefing studies were survivors of motor-vehicle accidents, a maritime disaster, hostage taking, war, or peer suicides. The nine papers describing the seven studies were characterized by inconsistency in describing the interventions and populations and by a lack of information on intervention fidelity. Few of the studies used randomized design or blinded assessment. The results described in the reviewed studies were mixed in regard to debriefing’s effect on posttraumatic stress, depression, anxiety, and other outcomes. Even in studies in which debriefing appeared promising, the research was compromised by potentially confounding interventions.
ConclusionThe results highlight the small empirical evidence base for drawing conclusions about the use of debriefing with children and adolescents, and they call for further dialogue regarding challenges in evaluating debriefing and other crisis interventions in children.
,Pfefferbaum B ,Jacobs AK ,Nitiéma P Everly GS Jr. Child Debriefing: A Review of the Evidence Base . Prehosp Disaster Med.2015 ;30 (3 ):1 10 .
Case Report
Maxillofacial Gunshot Wounds
- Olga Maurin, Stanislas de Régloix, Stéphane Dubourdieu, Hugues Lefort, Stéphane Boizat, Benoit Houze, Jennifer Culoma, Guillaume Burlaton, Jean-Pierre Tourtier
-
- Published online by Cambridge University Press:
- 14 April 2015, pp. 316-319
-
- Article
- Export citation
-
The majority of maxillofacial gunshot wounds are caused by suicide attempts. Young men are affected most often. When the lower one-third of the face is involved, airway patency (1.6% of the cases) and hemorrhage control (1.9% of the cases) are the two most urgent complications to monitor and prevent. Spinal fractures are observed with 10% of maxillary injuries and in 20% of orbital injuries. Actions to treat the facial gunshot victim need to be performed, keeping in mind spine immobilization until radiographic imaging is complete and any required spinal stabilization accomplished. Patients should be transported to a trauma center equipped to deal with maxillofacial and neurosurgery because 40% require emergency surgery. The mortality rate of maxillofacial injuries shortly after arrival at a hospital varies from 2.8% to 11.0%. Complications such as hemiparesis or cranial nerve paralysis occur in 20% of survivors. This case has been reported on a victim of four gunshot injuries. One of the gunshots was to the left mandibular ramus and became lodged in the C4 vertebral bone.
,Maurin O ,de Régloix S ,Dubourdieu S ,Lefort H ,Boizat S ,Houze B ,Culoma J ,Burlaton G .Tourtier JP Maxillofacial Gunshot Wounds . Prehosp Disaster Med.2015 ;30 (3 ):1 4 .
Special Report
Recent Advances in Medical Device Triage Technologies for Chemical, Biological, Radiological, and Nuclear Events
- Krystal Lansdowne, Christopher G. Scully, Loriano Galeotti, Suzanne Schwartz, David Marcozzi, David G. Strauss
-
- Published online by Cambridge University Press:
- 14 April 2015, pp. 320-323
-
- Article
- Export citation
-
In 2010, the US Food and Drug Administration (Silver Spring, Maryland USA) created the Medical Countermeasures Initiative with the mission of development and promoting medical countermeasures that would be needed to protect the nation from identified, high‐priority chemical, biological, radiological, or nuclear (CBRN) threats and emerging infectious diseases. The aim of this review was to promote regulatory science research of medical devices and to analyze how the devices can be employed in different CBRN scenarios. Triage in CBRN scenarios presents unique challenges for first responders because the effects of CBRN agents and the clinical presentations of casualties at each triage stage can vary. The uniqueness of a CBRN event can render standard patient monitoring medical device and conventional triage algorithms ineffective. Despite the challenges, there have been recent advances in CBRN triage technology that include: novel technologies; mobile medical applications (“medical apps”) for CBRN disasters; electronic triage tags, such as eTriage; diagnostic field devices, such as the Joint Biological Agent Identification System; and decision support systems, such as the Chemical Hazards Emergency Medical Management Intelligent Syndromes Tool (CHEMM-IST). Further research and medical device validation can help to advance prehospital triage technology for CBRN events.
,Lansdowne K ,Scully CG ,Galeotti L ,Schwartz S ,Marcozzi D .Strauss DG Recent Advances in Medical Device Triage Technologies for Chemical, Biological, Radiological, and Nuclear Events . Prehosp Disaster Med.2015 ;30 (3 ):1 -4
Front Cover (OFC, IFC) and matter
PDM volume 30 issue 3 Cover and Front matter
-
- Published online by Cambridge University Press:
- 01 June 2015, pp. f1-f8
-
- Article
-
- You have access Access
- Export citation
Back Cover (OBC, IBC) and matter
PDM volume 30 issue 3 Cover and Back matter
-
- Published online by Cambridge University Press:
- 01 June 2015, pp. b1-b5
-
- Article
-
- You have access Access
- Export citation