Editorial
Access to Essential Medications During Disaster Events
- Samuel J. Stratton
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- Published online by Cambridge University Press:
- 26 September 2016, pp. 579-580
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Guest Editorial
A Survey of Disaster Medical Education in Osteopathic Medical School Curricula
- Steven J. Parrillo, Doran Christensen, Howard S. Teitelbaum, Erik S. Glassman
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- 19 September 2016, pp. 581-582
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,Parrillo SJ ,Christensen D ,Teitelbaum HS .Glassman ES A Survey of Disaster Medical Education in Osteopathic Medical School Curricula . Prehosp Disaster Med.2016 ;31 (6 ):581 –582 .
Original Research
Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study
- Linda H. Banks, Lisa A. Davenport, Meghan H. Hayes, Moriah A. McArthur, Stacey N. Toro, Cameron E. King, Hazel M. Vazirani
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 583-592
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Introduction
In the foothills of the Cumberland Mountains, in central Appalachia (a region that spans 13 states in the US), sits an economically distressed and rural community of the United States. Once a thriving coal-mining area, this region now is reported as one of the hardest places to live in the US. Southeastern Kentucky, located in a remote, rocky, mountainous area surrounded by rivers and valleys and prone to flooding, experienced a major flood in Spring 2013 causing significant damage to homes and critical infrastructure.
PurposeAims of the study were to: (1) identify and better understand the contextual variables compounding the impact of a disaster event that occurred in Spring 2013; (2) identify ways participants managed antecedent circumstances, risk, and protective factors to cope with disaster up to 12 months post-event; and (3) further determine implications for community-focused interventions that may enhance recovery for vulnerable populations to promote greater outcomes of adaptation, wellness, and readiness.
MethodsUsing an ethnographic mixed-methods approach, an inter-collaborative team conducted face-to-face interviews with (N=12) Appalachian residents about their disaster experience, documented observations and visual assessment of need on an observation tool, and used photography depicting structural and environmental conditions. A Health and Emergency Preparedness Assessment Survey Tool was used to collect demographic, health, housing, environment, and disaster readiness assessment data. Community stakeholders facilitated purposeful sampling through coordination of scheduled home visits.
ResultsTriangulation of all data sources provided evidence that the community had unique coping strategies related to faith and spirituality, cultural values and heritage, and social support to manage antecedent circumstances, risk, and protective factors during times of adversity that, in turn, enhanced resilience up to 12 months post-disaster. The community was found to have an innate capacity to persevere and utilize resources to manage and transcend adversity and restore equilibrium, which reflected components of resilience that deserve greater recognition and appreciation.
ConclusionResilience is a foundational concept for disaster science. A model of resilience for the rural Appalachia community was developed to visually depict the encompassing element of community-based interventions that may enhance coping strategies, mitigate risk factors, integrate protective factors, and strengthen access. Community-based interventions are recommended to strengthen resilience, yielding improved outcomes of adaptation, health and wellness, and disaster readiness.
,Banks LH ,Davenport LA ,Hayes MH ,McArthur MA ,Toro SN ,King CE .Vazirani HM Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study . Prehosp Disaster Med.2016 ;31 (6 ):583 –592 .
Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine
- Travis D. Olives, Paul C. Nystrom, Jon B. Cole, Kenneth W. Dodd, Jeffrey D. Ho
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- 19 September 2016, pp. 593-602
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Background
Profound agitation in the prehospital setting confers substantial risk to patients and providers. Optimal chemical sedation in this setting remains unclear.
ObjectiveThe goal of this study was to describe intubation rates among profoundly agitated patients treated with prehospital ketamine and to characterize clinically significant outcomes of a prehospital ketamine protocol.
MethodsThis was a retrospective cohort study of all patients who received prehospital ketamine, per a predefined protocol, for control of profound agitation and who subsequently were transported to an urban Level 1 trauma center from May 1, 2010 through August 31, 2013. Identified records were reviewed for basic ambulance run information, subject characteristics, ketamine dosing, and rate of intubation. Emergency Medical Services (EMS) ambulance run data were matched to hospital-based electronic medical records. Clinically significant outcomes are characterized, including unadjusted and adjusted rates of intubation.
ResultsOverall, ketamine was administered 227 times in the prehospital setting with 135 cases meeting study criteria of use of ketamine for treatment of agitation. Endotracheal intubation was undertaken for 63% (85/135) of patients, including attempted prehospital intubation in four cases. Male gender and late night arrival were associated with intubation in univariate analyses (χ2=12.02; P=.001 and χ2=5.34; P=.021, respectively). Neither ketamine dose, co-administration of additional sedating medications, nor evidence of ethanol (ETOH) or sympathomimetic ingestion was associated with intubation. The association between intubation and both male gender and late night emergency department (ED) arrival persisted in multivariate analysis. Neither higher dose (>5mg/kg) ketamine nor co-administration of midazolam or haloperidol was associated with intubation in logistic regression modeling of the 120 subjects with weights recorded. Two deaths were observed. Post-hoc analysis of intubation rates suggested a high degree of provider-dependent variability.
ConclusionsPrehospital ketamine is associated with a high rate of endotracheal intubation in profoundly agitated patients; however, ketamine dosing is not associated with intubation rate when adjusted for potential confounders. It is likely that factors not included in this analysis, including both provider comfort with post-ketamine patients and anticipated clinical course, play a role in the decision to intubate patients who receive prehospital ketamine.
,Olives TD ,Nystrom PC ,Cole JB ,Dodd KW .Ho JD Intubation of Profoundly Agitated Patients Treated with Prehospital Ketamine . Prehosp Disaster Med.2016 ;31 (6 ):593 –602 .
The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS
- Niels Tangherlini, Julian Villar, John Brown, Robert M. Rodriguez, Clement Yeh, Benjamin T. Friedman, Paul Wada
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 603-607
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Objectives
The San Francisco Fire Department’s (SFFD; San Francisco, California USA) Homeless Outreach and Medical Emergency (HOME) Team is the United States’ first Emergency Medical Services (EMS)-based outreach effort using a specially trained paramedic to redirect frequent users of EMS to other types of services. The effectiveness of this program at reducing repeat use of emergency services during the first seven months of the team’s existence was examined.
MethodsA retrospective analysis of EMS use frequency and demographic characteristics of frequent users was conducted. Clients that used emergency services at least four times per month from March 2004 through May 2005 were contacted for intervention. Patterns for each frequent user before and after intervention were analyzed. Changes in EMS use during the 15-month study interval was the primary outcome measurement.
ResultsA total of 59 clients were included. The target population had a median age of 55.1 years and was 68% male. Additionally, 38.0% of the target population was homeless, 43.4% had no primary care, 88.9% had a substance abuse disorder at time of contact, and 83.0% had a history of psychiatric disorder. The HOME Team undertook 320 distinct contacts with 65 frequent users during the study period. The average EMS use prior to HOME Team contact was 18.72 responses per month (SD=19.40), and after the first contact with the HOME Team, use dropped to 8.61 (SD=10.84), P<.001.
ConclusionFrequent users of EMS suffer from disproportionate comorbidities, particularly substance abuse and psychiatric disorders. This population responds well to the intervention of a specially trained paramedic as measured by EMS usage.
,Tangherlini N ,Villar J ,Brown J ,Rodriguez RM ,Yeh C ,Friedman BT .Wada P The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS . Prehosp Disaster Med.2016 ;31 (6 ):603 –607 .
Prehospital Emergency Medical Services Departure Interval: Does Patient Age Matter?
- Bruno Schnegg, Mathieu Pasquier, Pierre-Nicolas Carron, Bertrand Yersin, Fabrice Dami
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 608-613
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Introduction
The concept of response time with minimal interval is intimately related to the practice of emergency medicine. The factors influencing this time interval are poorly understood.
ProblemIn a process of improvement of response time, the impact of the patient’s age on ambulance departure intervals was investigated.
MethodThis was a 3-year observational study. Departure intervals of ambulances, according to age of patients, were analyzed and a multivariate analysis, according to time of day and suspected medical problem, was performed.
ResultsA total of 44,113 missions were included, 2,417 (5.5%) in the pediatric group. Mean departure delay for the adult group was 152.9 seconds, whereas it was 149.3 seconds for the pediatric group (P =.018).
ConclusionA statistically significant departure interval difference between missions for children and adults was found. The difference, however, probably was not significant from a clinical point of view (four seconds).
,Schnegg B ,Pasquier M ,Carron PN ,Yersin B .Dami F Prehospital Emergency Medical Services Departure Interval: Does Patient Age Matter? Prehosp Disaster Med.2016 ;31 (6 ):608 –613 .
Rwanda’s Model Prehospital Emergency Care Service: A Two-year Review of Patient Demographics and Injury Patterns in Kigali
- Samuel Enumah, John W. Scott, Rebecca Maine, Eric Uwitonze, Jeanne D’Arc Nyinawankusi, Robert Riviello, Jean Claude Byiringiro, Ignace Kabagema, Sudha Jayaraman
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- Published online by Cambridge University Press:
- 22 September 2016, pp. 614-620
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Introduction
Injury is responsible for nearly five million annual deaths worldwide, and nearly 90% of these deaths occur in low- and middle-income countries (LMICs). Reliable clinical data detailing the epidemiology of injury are necessary for improved care delivery, but they are lacking in these regions.
MethodsA retrospective review of the Service d’Aide Medicale Urgente (SAMU; Kigali, Rwanda) prehospital database for patients with traumatic injury-related conditions from December 2012 through November 2014 was conducted. Chi-squared analysis, binomial probability test, and student’s t-test were used, where appropriate, to describe patient demographics, injury patterns, and temporal and geographic trends of injuries.
ResultsIn the two-year period, 3,357 patients were managed by SAMU for traumatic injuries. Males were 76.5% of the study population, and the median age of all injured patients was 29 years (IQR=23-35). The most common causes of injury were road traffic crashes (RTCs; 73.4%), stabbings/cuts (11.1%), and falls (9.4%), and the most common anatomic regions injured were the head (55.7%), lower (45.0%) extremities, and upper (27.0%) extremities. Almost one-fourth of injured patients suffered a fracture (24.9%). The most common mechanism of injury for adults was motorcycle-related RTCs (61.4%), whereas children were more commonly injured as pedestrians (59.8%). Centrally located sectors within Kigali represented common areas for RTCs.
ConclusionsThese data support the call for focused injury prevention strategies, some of which already are underway in Rwanda. Further research on care processes and clinical outcomes for injured patients may help identify avenues for improved care delivery.
,Enumah S ,Scott JW ,Maine R ,Uwitonze E ,Nyinawankusi JD ,Riviello R ,Byiringiro JC ,Kabagema I .Jayaraman S Rwanda’s Model Prehospital Emergency Care Service: A Two-year Review of Patient Demographics and Injury Patterns in Kigali . Prehosp Disaster Med.2016 ;31 (6 ):614 –620 .
Emergency Medical Services Utilization in EMS Priority Conditions in Beirut, Lebanon
- Mazen El Sayed, Hani Tamim, Ahel Al-Hajj Chehadeh, Amin A. Kazzi
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 621-627
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Background
Early activation and use of Emergency Medical Services (EMS) are associated with improved patient outcomes in EMS priority conditions in developed EMS systems. This study describes patterns of EMS use and identifies predictors of EMS utilization in EMS priority conditions in Lebanon
MethodsThis was a cross-sectional study of a random sample of adult patients presenting to the emergency department (ED) of a tertiary care center in Beirut with the following EMS priority conditions: chest pain, major trauma, respiratory distress, cardiac arrest, respiratory arrest, and airway obstruction. Patient/proxy survey (20 questions) and chart review were completed. The responses to survey questions were “disagree,” “neutral,” or “agree” and were scored as one, two, or three with three corresponding to higher likelihood of EMS use. A total scale score ranging from 20 to 60 was created and transformed from 0% to 100%. Data were analyzed based on mode of presentation (EMS vs other).
ResultsAmong the 481 patients enrolled, only 112 (23.3%) used EMS. Mean age for study population was 63.7 years (SD=18.8 years) with 56.5% males. Mean clinical severity score (Emergency Severity Index [ESI]) was 2.5 (SD=0.7) and mean pain score was 3.1 (SD=3.5) at ED presentation. Over one-half (58.8%) needed admission to hospital with 21.8% to an intensive care unit care level and with a mortality rate of 7.3%. Significant associations were found between EMS use and the following variables: severity of illness, degree of pain, familiarity with EMS activation, previous EMS use, perceived EMS benefit, availability of EMS services, trust in EMS response times and treatment, advice from family, and unavailability of immediate private mode of transport (P≤.05). Functional screening, or requiring full assistance (OR=4.77; 95% CI, 1.85-12.29); acute symptoms onset ≤ one hour (OR=2.14; 95% CI, 1.08-4.26); and higher scale scores (OR=2.99; 95% CI, 2.20-4.07) were significant predictors of EMS use. Patients with lower clinical severity (OR=0.53; 95% CI, 0.35-0.81) and those with chest pain (OR=0.05; 95% CI, 0.02-0.12) or respiratory distress (OR=0.15; 95% CI, 0.07-0.31) using cardiac arrest as a reference were less likely to use EMS.
ConclusionEmergency Medical Services use in EMS priority conditions in Lebanon is low. Several predictors of EMS use were identified. Emergency Medical Services initiatives addressing underutilization should result from this proposed assessment of the perspective of the EMS system’s end user.
,El Sayed M ,Tamim H ,Al-Hajj Chehadeh A .Kazzi AA Emergency Medical Services Utilization in EMS Priority Conditions in Beirut, Lebanon . Prehosp Disaster Med.2016 ;31 (6 ):621 –627 .
An Observational Study Using English Syndromic Surveillance Data Collected During the 2012 London Olympics – What did Syndromic Surveillance Show and What Can We Learn for Future Mass-gathering Events?
- Dan Todkill, Helen E. Hughes, Alex J. Elliot, Roger A. Morbey, Obaghe Edeghere, Sally Harcourt, Tom Hughes, Tina Endericks, Brian McCloskey, Mike Catchpole, Sue Ibbotson, Gillian Smith
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 628-634
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Introduction
In preparation for the London 2012 Olympic Games, existing syndromic surveillance systems operating in England were expanded to include daily general practitioner (GP) out-of-hours (OOH) contacts and emergency department (ED) attendances at sentinel sites (the GP OOH and ED syndromic surveillance systems: GPOOHS and EDSSS).
Hypothesis/ProblemThe further development of syndromic surveillance systems in time for the London 2012 Olympic Games provided a unique opportunity to investigate the impact of a large mass-gathering event on public health and health services as monitored in near real-time by syndromic surveillance of GP OOH contacts and ED attendances. This can, in turn, aid the planning of future events.
MethodsThe EDSSS and GPOOHS data for London and England from July 13 to August 26, 2012, and a similar period in 2013, were divided into three distinct time periods: pre-Olympic period (July 13-26, 2012); Olympic period (July 27 to August 12); and post-Olympic period (August 13-26, 2012). Time series of selected syndromic indicators in 2012 and 2013 were plotted, compared, and risk assessed by members of the Real-time Syndromic Surveillance Team (ReSST) in Public Health England (PHE). Student’s t test was used to test any identified changes in pattern of attendance.
ResultsVery few differences were found between years or between the weeks which preceded and followed the Olympics. One significant exception was noted: a statistically significant increase (P value = .0003) in attendances for “chemicals, poisons, and overdoses, including alcohol” and “acute alcohol intoxication” were observed in London EDs coinciding with the timing of the Olympic opening ceremony (9:00 pm July 27, 2012 to 01:00 am July 28, 2012).
ConclusionsSyndromic surveillance was able to provide near to real-time monitoring and could identify hourly changes in patterns of presentation during the London 2012 Olympic Games. Reassurance can be provided to planners of future mass-gathering events that there was no discernible impact in overall attendances to sentinel EDs or GP OOH services in the host country. The increase in attendances for alcohol-related causes during the opening ceremony, however, may provide an opportunity for future public health interventions.
,Todkill D ,Hughes HE ,Elliot AJ ,Morbey RA ,Edeghere O ,Harcourt S ,Hughes T ,Endericks T ,McCloskey B ,Catchpole M ,Ibbotson S .Smith G An Observational Study Using English Syndromic Surveillance Data Collected During the 2012 London Olympics – What did Syndromic Surveillance Show and What Can We Learn for Future Mass-gathering Events? Prehosp Disaster Med.2016 ;31 (6 ):628 –634 .
A Systematic Review of Health Outcomes Among Disaster and Humanitarian Responders
- Stephanie C. Garbern, Laura G. Ebbeling, Susan A. Bartels
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- 19 September 2016, pp. 635-642
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Introduction
Disaster and humanitarian responders are at-risk of experiencing a wide range of physical and psychological health conditions, from minor injuries to chronic mental health problems and fatalities. This article reviews the current literature on the major health outcomes of responders to various disasters and conflicts in order to better inform individuals of the risks and to inform deploying agencies of the health care needs of responders.
MethodsIn March 2014, an EMBASE search was conducted using pre-defined search criteria. Two reviewers screened the resultant 2,849 abstracts and the 66 full-length manuscripts which are included in the review.
ResultsThe majority of research on health outcomes of responders focused on mental health (57 of 66 articles). Posttraumatic stress disorder (PTSD) and depression were the most studied diagnoses with prevalence of PTSD ranging from 0%-34% and depression from 21%-53%. Physical health outcomes were much less well-studied and included a wide range of environmental, infectious, and traumatic conditions such as heat stroke, insect bites, dermatologic, gastrointestinal, and respiratory diseases, as well as burns, fractures, falls, and other traumatic injuries.
ConclusionsThe prevalence of mental health disorders in responders may vary more and be higher than previously suggested. Overall health outcomes of responders are likely poorly monitored and under-reported. Improved surveillance systems and risk mitigation strategies should be employed in all disaster and conflict responses to better protect individual responders.
,Garbern SC ,Ebbeling LG .Bartels SA A Systematic Review of Health Outcomes Among Disaster and Humanitarian Responders . Prehosp Disaster Med.2016 ;31 (6 ):635 –642 .
Comprehensive Reviews
Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US
- Bhakti Hansoti, Dylan S. Kellogg, Sara J. Aberle, Morgan C. Broccoli, Jeffrey Feden, Arthur French, Charles M. Little, Brooks Moore, Joseph Sabato, Jr., Tara Sheets, R. Weinberg, Pat Elmes, Christopher Kang
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 643-647
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Study Objective
This study aimed to review available disaster training options for health care providers, and to provide specific recommendations for developing and delivering a disaster-response-training program for non-disaster-trained emergency physicians, residents, and trainees prior to acute deployment.
MethodsA comprehensive review of the peer-reviewed and grey literature of the existing training options for health care providers was conducted to provide specific recommendations.
ResultsA comprehensive search of the Pubmed, Embase, Web of Science, Scopus, and Cochrane databases was performed to identify publications related to courses for disaster preparedness and response training for health care professionals. This search revealed 7,681 unique titles, of which 53 articles were included in the full review. A total of 384 courses were found through the grey literature search, and many of these were available online for no charge and could be completed in less than six hours. The majority of courses focused on management and disaster planning; few focused on clinical care and acute response.
ConclusionThere is need for a course that is targeted toward emergency physicians and trainees without formal disaster training. This course should be available online and should utilize a mix of educational modalities, including lectures, scenarios, and virtual simulations. An ideal course should focus on disaster preparedness, and the clinical and non-clinical aspects of response, with a focus on an all-hazards approach, including both terrorism-related and environmental disasters.
,Hansoti B ,Kellogg DS ,Aberle SJ ,Broccoli MC ,Feden J ,French A ,Little CM ,Moore B ,Sabato J Jr. ,Sheets T ,Weinberg R ,Elmes P .Kang C Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US . Prehosp Disaster Med.2016 ;31 (6 ):643 –647 .
Women’s Mental Health and Intimate Partner Violence Following Natural Disaster: A Scoping Review
- Sue Anne Bell, Lisa A. Folkerth
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 648-657
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Introduction
Survivors of natural disasters in the United States experience significant health ramifications. Women particularly are vulnerable to both post-disaster posttraumatic stress disorder (PTSD) and depression, and research has documented that these psychopathological sequelae often are correlated with increased incidence of intimate partner violence (IPV). Understanding the link between these health concerns is crucial to informing adequate disaster response and relief efforts for victims of natural disaster.
PurposeThe purpose of this review was to report the results of a scoping review on the specific mental health effects that commonly impact women following natural disasters, and to develop a conceptual framework with which to guide future research.
MethodsA scoping review of mental and physical health effects experienced by women following natural disasters in the United States was conducted. Articles from 2000-2015 were included. Databases examined were PubMed, PsycInfo, Cochrane, JSTOR, Web of Science, and databases available through ProQuest, including ProQuest Research Library.
ResultsA total of 58 articles were selected for inclusion, out of an original 149 that were selected for full-text review. Forty-eight articles, or 82.8%, focused on mental health outcomes. Ten articles, or 17.2%, focused on IPV.
DiscussionCertain mental health outcomes, including PTSD, depression, and other significant mental health concerns, were recurrent issues for women post-disaster. Despite the strong correlation between experience of mental health consequences after disaster and increased risk of domestic violence, studies on the risk and mediating factors are rare. The specific challenges faced by women and the interrelation between negative mental health outcomes and heightened exposure to IPV following disasters require a solid evidence base in order to facilitate the development of effective interventions. Additional research informed by theory on probable health impacts is necessary to improve development/implementation of emergency relief policy.
,Bell SA .Folkerth LA Women’s Mental Health and Intimate Partner Violence Following Natural Disaster: A Scoping Review . Prehosp Disaster Med.2016 ;31 (6 ):648 –657 .
Special Reports
A 3-year Health Care Coalition Experience in Advancing Hospital Evacuation Preparedness
- John J. Lowe, Keith F. Hansen, Kristine K. Sanger, Jannah M. Obaid
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 658-662
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This report outlines a 3-year health care coalition effort to advance and test community capacity for a large-scale hospital evacuation. The multi-year effort utilized a variety workshops, seminars, webinars, tabletops, functional exercises, and culminated with a full-scale exercise testing hospital evacuation. While most hospital evacuation exercises focus on internal movement of patients, this exercise process tested command-level decision making and it tested external partners such as transportation agencies, law enforcement, receiving hospitals, and local emergency management. This process delivered key coalition-building activities and offered a variety of training and exercise opportunities to assist a number of organizations, all at different stages of hospital evacuation planning. The 2012 Hospital Preparedness Program outlined the incorporation of health care coalition activities to transform individual organization preparedness to community-level readiness. This report outlines a health care coalition effort to deliver training and exercises to advance community capacity for a large-scale hospital evacuation.
,Lowe JJ ,Hansen KF ,Sanger KK .Obaid JM A 3-year Health Care Coalition Experience in Advancing Hospital Evacuation Preparedness . Prehosp Disaster Med.2016 ;31 (6 ):658 –662 .
Development and Implementation of a Novel Prehospital Care System in the State of Kerala, India
- Heather A. Brown, Katherine A. Douglass, Shafi Ejas, Venugopalan Poovathumparambil
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- 22 September 2016, pp. 663-666
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Most low- and middle-income countries (LMICs) have struggled to find a system for prehospital care that can provide adequate patient care and geographical coverage while maintaining a feasible price tag. The emergency medical systems of the Western world are not necessarily relevant in developing economic systems, given the lack of strict legislation, the scarcity of resources, and the limited number of trained personnel. Meanwhile, most efforts to provide prehospital care in India have taken the form of adapting Western models to the Indian context with limited success. Described here is a novel approach to prehospital care designed for and implemented in the State of Kerala, India. The Active Network Group of Emergency Life Savers (ANGELS) was launched in 2011 in Calicut City, the third largest city in the Indian State of Kerala. The ANGELS integrated an existing fleet of private and state-owned ambulances into a single network utilizing Global Positioning System (GPS) technology and a single statewide call number. A total of 85 volunteer emergency medical certified technicians (EMCTs) were trained in basic first aid and trauma care principles. Public awareness campaigns accompanied all activities to raise awareness amongst community members. Funding was provided via public-private partnership, aimed to minimize costs to patients for service utilization. Over a two-year period from March 2011 to April 2013, 8,336 calls were recorded, of which 54.8% (4,569) were converted into actual ambulance run sheets. The majority of calls were for medical emergencies and most patients were transported to Medical College Hospital in Calicut. This unique public-private partnership has been responsive to the needs of the population while sustaining low operational costs. This system may provide a relevant template for Emergency Medical Services (EMS) development in other resource-limited settings.
,Brown HA ,Douglass KA ,Ejas S .Poovathumparambil V Development and Implementation of a Novel Prehospital Care System in the State of Kerala, India . Prehosp Disaster Med.2016 ;31 (6 ):663 –666 .
Can Paramedics Safely Refuse Transport of Non-Urgent Patients?
- Alex J. Fraess-Phillips
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 667-674
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Objective
The goal of this search was to review the current literature regarding paramedic triage of primary care patients and the safety of paramedic-initiated non-transport of non-urgent patients.
MethodsA narrative literature review was conducted using the Medline (Medline Industries, Inc.; Mundelein, Illinois USA) database and a manual search of Google Scholar (Google; Mountain View, California USA).
ResultsOnly 11 studies were found investigating paramedic triage and safety of non-transport of non-urgent patients. It was found that triage agreement between paramedic and emergency department staff generally is poor and that paramedics are limited in their abilities to predict the ultimate admission location of their patients. However, these triage decisions and admission predictions are much more accurate when the patient’s condition is the result of trauma and when the patient requires critical care services. Furthermore, the literature provides very limited support for the safety of paramedic triage in the refusal of non-urgent patient transport, especially without physician oversight. Though many non-transported patients are satisfied with the quality of non-urgent treatment that they receive from paramedics, the rates of under-triage and subsequent hospitalization reported in the literature are too high to suggest that this practice can be adopted widely.
ConclusionThere is insufficient evidence to suggest that non-urgent patients can safely be refused transport based on paramedic triage alone. Further attempts to implement paramedic-initiated non-transport of non-urgent patients should be approached with careful triage protocol development, paramedic training, and pilot studies. Future primary research and systematic reviews also are required to build on the currently limited literature.
.Fraess-Phillips AJ Can Paramedics Safely Refuse Transport of Non-Urgent Patients? Prehosp Disaster Med.2016 ;31 (6 ):667 –674 .
Brief Reports
Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments
- Olindi Wijesekera, Amanda Reed, Parker S. Chastain, Shauna Biggs, Elizabeth G. Clark, Tamorish Kole, Anoop T. Chakrapani, Nandy Ashish, Prasad Rajhans, Alan H. Breaud, Gabrielle A. Jacquet
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 675-679
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Introduction
Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.
MethodsA retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.
ResultsA range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.
ConclusionsNeurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.
,Wijesekera O ,Reed A ,Chastain PS ,Biggs S ,Clark EG ,Kole T ,Chakrapani AT ,Ashish N ,Rajhans P ,Breaud AH .Jacquet GA Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments . Prehosp Disaster Med.2016 ;31 (6 ):675 –679 .
Review of the International Council of Nurses (ICN) Framework of Disaster Nursing Competencies
- Alison Hutton, Tener Goodwin Veenema, Kristine Gebbie
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- Published online by Cambridge University Press:
- 20 September 2016, pp. 680-683
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The International Council of Nurses (ICN; Geneva, Switzerland) and the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) joined together in 2014 to review the use of the ICN Framework of Disaster Nursing Competencies. The existing ICN Framework (version 1.10; dated 2009) formed the starting point for this review. The key target audiences for this process were members of the disaster nursing community concerned with pre-service education for professional nursing and the continuing education of practicing professional nurses. To minimize risk in the disaster nursing practice, competencies have been identified as the foundation of evidence-based practice and standard development. A Steering Committee was established by the WADEM Nursing Section to discuss how to initiate a review of the ICN Framework of Disaster Nursing Competencies. The Steering Committee then worked via email to develop a survey to send out to disaster/emergency groups that may have nurse members who work/respond in disasters. Thirty-five invitations were sent out with 20 responses (57%) received. Ninety-five percent of respondents knew of the ICN Framework of Disaster Nursing Competencies, with the majority accessing these competencies via the Internet. The majority of those who responded said that they make use of the ICN Framework of Disaster Nursing Competencies with the most common use being for educational purposes. Education was done at a local, national, and international level. The competencies were held in high esteem and valued by these organizations as the cornerstone of their disaster education, and also were used for the continued professional development of disaster nursing. However, respondents stated that five years on from their development, the competencies also should include the psychosocial elements of nurses caring for themselves and their colleagues. Additionally, further studies should explore if there are other areas related to the disaster nursing practice (in addition to psychosocial concerns) that may be missing or not fully developed. Finally, the authors of this report recommend that future research explore how the ICN Framework of Disaster Nursing Competencies do or do not assist in maintaining best practices in this field and improve outcomes for victims of disaster.
,Hutton A ,Veenema TG .Gebbie K Review of the International Council of Nurses (ICN) Framework of Disaster Nursing Competencies . Prehosp Disaster Med.2016 ;31 (6 ):680 –683 .
Case Report
Thoracic Spine Fracture in a Survivor of Out-of-Hospital Cardiac Arrest with Mechanical CPR
- Robert Trevor Marshall, Hemang Kotecha, Takuyo Chiba, Joseph Tennyson
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- Published online by Cambridge University Press:
- 19 September 2016, pp. 684-686
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This is a report of a thoracic vertebral fracture in a 79-year-old male survivor of out-of-hospital cardiac arrest with chest compressions provided by a LUCAS 2 (Physio-Control Inc.; Lund Sweden) device. This is the first such report in the literature of a vertebral fracture being noted in a survivor of cardiac arrest where an automated compression device was used.
,Marshall RT ,Kotecha H ,Chiba T .Tennyson J Thoracic Spine Fracture in a Survivor of Out-of-Hospital Cardiac Arrest with Mechanical CPR . Prehosp Disaster Med.2016 ;31 (6 ):684 –686 .
Letter to the Editor
Mass-gathering Medicine: Risks and Patient Presentations at a 2-day Electronic Dance Music Event - Year Two
- Sheila A. Turris, Michael Camporese, Samuel J. Gutman, Adam Lund
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- Published online by Cambridge University Press:
- 20 September 2016, pp. 687-688
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,Turris SA ,Camporese M ,Gutman SJ .Lund A Mass-gathering Medicine: Risks and Patient Presentations at a 2-day Electronic Dance Music Event - Year Two . Prehosp Disaster Med.2016 ;31 (6 ):687 –688 .
Front Cover (OFC, IFC) and matter
PDM volume 31 issue 6 Cover and Front matter
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- 21 November 2016, pp. f1-f8
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