Editorial
The Revised International Guidelines for Ethical Health-Related Human Research
- Samuel J. Stratton
-
- Published online by Cambridge University Press:
- 28 September 2017, pp. 471-472
-
- Article
-
- You have access Access
- HTML
- Export citation
Original Research
Categorization and Analysis of Disaster Health Publications: An Inventory
- Marvin L. Birnbaum, Sowmya Adibhatla, Olivia Dudek, Jessica Ramsel-Miller
-
- Published online by Cambridge University Press:
- 31 May 2017, pp. 473-482
-
- Article
- Export citation
-
Disaster Medicine is a relatively new discipline. Understanding of the current status of its science is needed in order to develop a roadmap for the direction and structure of future studies that will contribute to building the science of the health aspects of disasters (HADs). The objective of this study was to examine the existing, peer-reviewed literature relevant to the HADs to determine the status of the currently available literature underlying the science of the HADs. A total of 709 consecutive, peer-reviewed articles published from 2009-2014 in two disaster-health-related medical journals, Prehospital and Disaster Medicine (PDM) and Disaster Medicine and Public Health Preparedness (DMPHP), were examined. Of these, 495 were disaster-related (PDM, 248; DMPHP, 247). Three major categories defined these disaster-related research articles: (1) Epidemiological studies comprised 50.5%; (2) Interventional, 20.3%; and (3) Syntheses, 26.9%. Interventional studies were sub-categorized into: (a) Relief Responses, 23.0%; (b) Recovery Responses, 2.0%; or (c) Risk-Reduction Interventions, 75.0%. Basically, the inventories were consistent within the two journals. Reported indicators of outcomes related to the responses were constrained to achievement indicators (numbers accomplished). Syntheses articles were sub-categorized into: (a) Literature Reviews, 17.6%; (b) Opinions, 25.2%; (c) Models, 24.4%; (d) Frameworks, 6.9%; (e) Guidelines, 13.0%; (f) Tools, 3.0%; (g) Protocols, Policies, or Criteria, 2.3%; or (h) Conference Summaries, 7.6%. Trend analyses indicated that the relative proportions of articles in each category and sub-category remained relatively constant over the five years. No randomized controlled trials (RTCs), non-randomized, comparative controlled trials (CCTs), or systematic reviews were published in these journals during the period examined. Each article also was examined qualitatively for objectives, study type, content, language, and structure. There was no common structure used for any category or sub-categories. In addition, the terminology used was inconsistent and often confusing. This categorization process should be applied to other peer-reviewed journals that publish research related to HADs. As evidenced in the current study, the evidence base for HADs is far from robust and is disorganized, making the development of scientific evidence on which to base best practices difficult. A stronger evidence base is needed to develop the science associated with the HADs. This will require a common structure and terminology to facilitate comparisons. Greater depth of reporting is needed in order to render the Epidemiological studies more useful in mitigating the negative health impacts of hazard-related events. Interventional studies must be structured and include outcomes, impacts, benefits, and costs with robust indicators. The outcomes and impacts of Risk-Reduction Interventions will require the evaluation of changes in the epidemiology documented in future events or exercises.
Birnbaum ML Adibhatla S Dudek O Ramsel-Miller J Categorization and Analysis of Disaster Health Publications: An Inventory . Prehosp Disaster Med.2017 ;32 (5 ):473 –482
Are Dutch Hospitals Prepared for Chemical, Biological, or Radionuclear Incidents? A Survey Study
- Luc J.M. Mortelmans, Menno I. Gaakeer, Greet Dieltiens, Kurt Anseeuw, Marc B. Sabbe
-
- Published online by Cambridge University Press:
- 08 May 2017, pp. 483-491
-
- Article
- Export citation
-
Introduction
Being one of Europe’s most densely populated countries, and having multiple nuclear installations, a heavy petrochemical industry, and terrorist targets, the Netherlands is at-risk for chemical, biological, or radionuclear (CBRN) incidents. Recent world and continental events show that this threat is real and that authorities may be underprepared.
HypothesisThe hypothesis of this study is that Dutch hospitals are underprepared to deal with these incidents.
MethodsA descriptive, cross-sectional study was performed. All 93 Dutch hospitals with an emergency department (ED) were sent a link to an online survey on different aspects of CBRN preparedness. Besides specific hospital information, information was obtained on the hospital’s disaster planning; risk perception; and availability of decontamination units, personal protective equipment (PPE), antidotes, radiation detection, infectiologists, isolation measures, and staff training.
ResultsResponse rate was 67%. Sixty-two percent of participating hospitals were estimated to be at-risk for CBRN incidents. Only 40% had decontamination facilities and 32% had appropriate PPE available for triage and decontamination teams. Atropine was available in high doses in all hospitals, but specific antidotes that could be used for treating victims of CBRN incidents, such as hydroxycobolamine, thiosulphate, Prussian blue, Diethylenetriaminepentaacetic acid (DTPA), or pralidoxime, were less frequently available (74%, 65%, 18%, 14%, and 42%, respectively). Six percent of hospitals had radioactive detection equipment with an alarm function and 22.5% had a nuclear specialist available 24/7 in case of disasters. Infectiologists were continuously available in 60% of the hospitals. Collective isolation facilities were present in 15% of the hospitals.
Conclusion:There is a serious lack of hospital preparedness for CBRN incidents in The Netherlands.
,Mortelmans LJM ,Gaakeer MI ,Dieltiens G ,Anseeuw K .Sabbe MB Are Dutch Hospitals Prepared for Chemical, Biological, or Radionuclear Incidents? A Survey Study . Prehosp Disaster Med.2017 ;32 (5 ):483 –491 .
Basic Disaster Life Support (BDLS) Training Improves First Responder Confidence to Face Mass-Casualty Incidents in Thailand
- Deborah A. Kuhls, Paul J. Chestovich, Phillip Coule, Dale M. Carrison, Charleston M. Chua, Nopadol Wora-Urai, Tavatchai Kanchanarin
-
- Published online by Cambridge University Press:
- 13 June 2017, pp. 492-500
-
- Article
- Export citation
-
Background
Medical response to mass-casualty incidents (MCIs) requires specialized training and preparation. Basic Disaster Life Support (BDLS) is a course designed to prepare health care workers for a MCI. The purpose of this study was to evaluate the confidence of health care professionals in Thailand to face a MCI after participating in a BDLS course.
MethodsBasic Disaster Life Support was taught to health care professionals in Thailand in July 2008. Demographics and medical experience were recorded, and participants rated their confidence before and after the course using a five-point Likert scale in 11 pertinent MCI categories. Survey results were compiled and compared with P<.05 statistically significant.
ResultsA total of 162 health care professionals completed the BDLS course and surveys, including 78 physicians, 70 nurses, and 14 other health care professionals. Combined confidence increased among all participants (2.1 to 3.8; +1.7; P<.001). Each occupation scored confidence increases in each measured area (P<.001). Nurses had significantly lower pre-course confidence but greater confidence increase, while physicians had higher pre-course confidence but lower confidence increase. Active duty military also had lower pre-course confidence with significantly greater confidence increases, while previous disaster courses or experience increased pre-course confidence but lower increase in confidence. Age and work experience did not influence confidence.
ConclusionBasic Disaster Life Support significantly improves confidence to respond to MCI situations, but nurses and active duty military benefit the most from the course. Future courses should focus on these groups to prepare for MCIs.
Kuhls DA Chestovich PJ Coule P Carrison DM Chua CM Wora-Urai N Kanchanarin T Basic Disaster Life Support (BDLS) Training Improves First Responder Confidence to Face Mass-Casualty Incidents in Thailand . Prehosp Disaster Med.2017 ;32 (5 ):492 –500
Disaster Metrics: A Comprehensive Framework for Disaster Evaluation Typologies
- Diana F. Wong, Caroline Spencer, Lee Boyd, Frederick M. Burkle, Jr., Frank Archer
-
- Published online by Cambridge University Press:
- 08 May 2017, pp. 501-514
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Introduction
The frequency of disasters is increasing around the world with more people being at risk. There is a moral imperative to improve the way in which disaster evaluations are undertaken and reported with the aim of reducing preventable mortality and morbidity in future events. Disasters are complex events and undertaking disaster evaluations is a specialized area of study at an international level.
Hypothesis/ProblemWhile some frameworks have been developed to support consistent disaster research and evaluation, they lack validation, consistent terminology, and standards for reporting across the different phases of a disaster. There is yet to be an agreed, comprehensive framework to structure disaster evaluation typologies.
The aim of this paper is to outline an evolving comprehensive framework for disaster evaluation typologies. It is anticipated that this new framework will facilitate an agreement on identifying, structuring, and relating the various evaluations found in the disaster setting with a view to better understand the process, outcomes, and impacts of the effectiveness and efficiency of interventions.
MethodsResearch was undertaken in two phases: (1) a scoping literature review (peer-reviewed and “grey literature”) was undertaken to identify current evaluation frameworks and typologies used in the disaster setting; and (2) a structure was developed that included the range of typologies identified in Phase One and suggests possible relationships in the disaster setting.
ResultsNo core, unifying framework to structure disaster evaluation and research was identified in the literature. The authors propose a “Comprehensive Framework for Disaster Evaluation Typologies” that identifies, structures, and suggests relationships for the various typologies detected.
ConclusionThe proposed Comprehensive Framework for Disaster Evaluation Typologies outlines the different typologies of disaster evaluations that were identified in this study and brings them together into a single framework. This unique, unifying framework has relevance at an international level and is expected to benefit the disaster, humanitarian, and development sectors. The next step is to undertake a validation process that will include international leaders with experience in evaluation, in general, and disasters specifically. This work promotes an environment for constructive dialogue on evaluations in the disaster setting to strengthen the evidence base for interventions across the disaster spectrum. It remains a work in progress.
,Wong DF ,Spencer C ,Boyd L ,Burkle FM Jr. .Archer F Disaster Metrics: A Comprehensive Framework for Disaster Evaluation Typologies . Prehosp Disaster Med.2017 ;32 (5 ):501 –514 .
Survey of Preventable Disaster Deaths at Medical Institutions in Areas Affected by the Great East Japan Earthquake: Retrospective Survey of Medical Institutions in Miyagi Prefecture
- Satoshi Yamanouchi, Hiroyuki Sasaki, Hisayoshi Kondo, Tomohiko Mase, Yasuhiro Otomo, Yuichi Koido, Shigeki Kushimoto
-
- Published online by Cambridge University Press:
- 09 May 2017, pp. 515-522
-
- Article
- Export citation
-
Introduction
In 2015, the authors reported the results of a preliminary investigation of preventable disaster deaths (PDDs) at medical institutions in areas affected by the Great East Japan Earthquake (2011). This initial survey considered only disaster base hospitals (DBHs) and hospitals that had experienced at least 20 patient deaths in Miyagi Prefecture (Japan); therefore, hospitals that experienced fewer than 20 patient deaths were not investigated. This was an additional study to the previous survey to better reflect PDD at hospitals across the entire prefecture.
MethodOf the 147 hospitals in Miyagi Prefecture, the 14 DBHs and 82 non-DBHs that agreed to participate were included in an on-site survey. A database was created based on the medical records of 1,243 patient deaths that occurred between March 11, 2011 and April 1, 2011, followed by determination of their status as PDDs.
ResultsA total of 125 cases of PDD were identified among the patients surveyed. The rate of PDD was significantly higher at coastal hospitals than inland hospitals (17.3% versus 6.3%; P<.001). Preventable disaster deaths in non-DBHs were most numerous in facilities with few general beds, especially among patients hospitalized before the disaster in hospitals with fewer than 100 beds. Categorized by area, the most frequent causes of PDD were: insufficient medical resources, disrupted lifelines, delayed medical intervention, and deteriorated environmental conditions in homes and emergency shelters in coastal areas; and were delayed medical intervention and disrupted lifelines in inland areas. Categorized by hospital function, the most frequent causes were: delayed medical intervention, deteriorated environmental conditions in homes and emergency shelters, and insufficient medical resources at DBHs; while those at non-DBHs were disrupted lifelines, insufficient medical resources, delayed medical intervention, and lack of capacity for transport within the area.
Conclusion:Preventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake occurred mainly at coastal hospitals with insufficient medical resources, disrupted lifelines, delayed medical intervention, and deteriorated environmental conditions in homes and emergency shelters constituting the main contributing factors. Preventing PDD, in addition to strengthening organizational support and functional enhancement of DBHs, calls for the development of business continuity plans (BCPs) for medical facilities in directly affected areas, including non-DBHs.
,Yamanouchi S ,Sasaki H ,Kondo H ,Mase T ,Otomo Y ,Koido Y .Kushimoto S Survey of Preventable Disaster Deaths at Medical Institutions in Areas Affected by the Great East Japan Earthquake: Retrospective Survey of Medical Institutions in Miyagi Prefecture . Prehosp Disaster Med.2017 ;32 (5 ):515 –522 .
When is a Cardiac Arrest Non-Cardiac?
- Ryan M. Carter, David C. Cone
-
- Published online by Cambridge University Press:
- 02 May 2017, pp. 523-527
-
- Article
- Export citation
-
Introduction
While the overall survival rate for out-of-hospital cardiac arrest (OHCA) is low, ranging from 5%-10%, several characteristics have been shown to decrease mortality, such as presence of bystander cardiopulmonary resuscitation (CPR), witnessed vs unwitnessed events, and favorable initial rhythm (VF/VT). More recently, studies have shown that modified CPR algorithms, such as chest-compression only or cardio-cerebral resuscitation, can further increase survival rates in OHCA. Most of these studies have included only OHCA patients with “presumed cardiac etiology,” on the assumption that airway management is of lesser impact than chest compressions in these patients. However, prehospital personnel often lack objective and consistent criteria to assess whether an OHCA is of cardiac or non-cardiac etiology.
Hypothesis/ProblemThe relative proportions of cardiac vs non-cardiac etiology in published data sets of OHCA in the peer-reviewed literature were examined in order to assess the variability of prehospital clinical etiology assessment.
MethodsA Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA) search was performed using the subject headings “OHCA” and “Emergency Medical Services” (EMS). Studies were included if they reported prevalence of cardiac etiology among OHCA in the entire patient sample, or in all arms of a comparison study. Studies that either did not report etiology of OHCA, or that excluded all cardiac or non-cardiac etiologies prior to reporting clinical data, were excluded.
ResultsTwenty-four studies were identified, containing 27 datasets of OHCA which reported the prevalence of presumed cardiac vs non-cardiac etiology. These 27 datasets were drawn from 15 different countries. The prevalence of cardiac etiology among OHCA ranged from 50% to 91%. No obvious patterns were found regarding database size, year of publication, or global region (continent) of origin.
Conclusions:There exists significant variation in published rates of cardiac etiology among OHCAs. While some of this variation likely reflects different actual rates of cardiac etiologies in the sampled populations, varying definitions of cardiac etiology among prehospital personnel or varying implementation of existing definitions may also play a role. Different proportions of cardiac vs non-cardiac etiology of OHCA in a sample could result in entirely different interpretations of data. A more specific consensus definition of cardiac etiology than that which currently exists in the Utstein template may provide better guidance to prehospital personnel and EMS researchers in the future.
Carter RM Cone DC When is a Cardiac Arrest Non-Cardiac? Prehosp Disaster Med.2017 ;32 (5 ):523 –527 .
On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions
- Julia Tärnqvist, Erik Dahlén, Gabriella Norberg, Carl Magnusson, Johan Herlitz, Anneli Strömsöe, Christer Axelsson, Magnus Andersson Hagiwara
-
- Published online by Cambridge University Press:
- 08 May 2017, pp. 528-535
-
- Article
- Export citation
-
Introduction
The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group.
ProblemThere is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis.
MethodPatients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records.
ResultsIn all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years.
The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent).
Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate.
Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate.
Conclusion:Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate.
,Tärnqvist J ,Dahlén E ,Norberg G ,Magnusson C ,Herlitz J ,Strömsöe A ,Axelsson C .Andersson Hagiwara M On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions . Prehosp Disaster Med.2017 ;32 (5 ):528 –535 .
Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit
- Domhnall O’Dochartaigh, Matthew Douma, Chris Alexiu, Shell Ryan, Mark MacKenzie
-
- Published online by Cambridge University Press:
- 03 May 2017, pp. 536-540
-
- Article
- Export citation
-
Introduction
Prehospital ultrasound (PHUS) assessments by physicians and non-physicians are performed on medical and trauma patients with increasing frequency. Prehospital ultrasound has been shown to be of benefit by supporting interventions.
ProblemWhich patients may benefit from PHUS has not been clearly identified.
MethodsA multi-variable logistic regression analysis was performed on a previously created retrospective dataset of five years of physician- and non-physician-performed ultrasound scans in a Canadian critical care Helicopter Emergency Medical Service (HEMS). For separate medical and trauma patient groups, the a-priori outcome assessed was patient characteristics associated with the outcome variable of “PHUS-supported intervention.”
ResultsBoth models were assessed (Likelihood Ratio, Score, and Wald) as a good fit. For medical patients, the characteristics of heart rate (HR) and shock index (SI) were found to be most significant for an intervention being supported by PHUS. An extremely low HR was found to be the most significant (OR=15.86 [95% confidence interval (CI), 1.46-171.73]; P=.02). The higher the SI, the more likely that an intervention was supported by PHUS (SI 0.9 to<1.3: OR=9.15 [95% CI, 1.36-61.69]; P=.02; and SI 1.3+: OR=8.37 [95% CI, 0.69-101.66]; P=.09). For trauma patients, the characteristics of Prehospital Index (PHI) and SI were found to be most significant for PHUS support. The greatest effect was PHI, where increasing ORs were seen with increasing PHI (PHI 14-19: OR=13.36 [95% CI, 1.92-92.81]; P=.008; and PHI 20-24: OR=53.10 [95% CI, 4.83-583.86]; P=.001). Shock index was found to be similar, though, with lower impact and significance (SI 0.9 to<1.3: OR=9.11 [95% CI, 1.31-63.32]; P=.025; and SI 1.3+: OR=35.75 [95% CI, 2.51-509.81]; P=.008).
Conclusions:In a critical care HEMS, markers of higher patient acuity in both medical and trauma patients were associated with occurrences when an intervention was supported by PHUS. Prospective study with in-hospital follow-up is required to confirm these hypothesis-generating results.
,O’Dochartaigh D ,Douma M ,Alexiu C ,Ryan S .MacKenzie M Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit . Prehosp Disaster Med.2017 ;32 (5 ):536 –540 .
Clinical Information Transfer between EMS Staff and Emergency Medicine Assistants during Handover of Trauma Patients
- Seyedeh Almas Fahim Yegane, Ali Shahrami, Hamid Reza Hatamabadi, Seyed-Mostafa Hosseini-Zijoud
-
- Published online by Cambridge University Press:
- 13 June 2017, pp. 541-547
-
- Article
- Export citation
-
Introduction
Clinical handover by Emergency Medical Services (EMS) staff, as the first people who have contact with trauma patients, in the emergency department (ED), is very important. Therefore, effective communication to transfer clinical information about patients in a concise, rational, clear, and time-bound manner is essential. In Iran, the transfer of necessary information in clinical handover in EDs was carried out orally and without following standard instructions. This study aimed to audit the current clinical handover according to the Identify, Situation, Background, Assessment, and Recommendation (ISBAR) tool and survey the effect of training the ISBAR tool to Emergency Medicine Assistants (EMAs) and EMS staff on improvement of the clinical handover of patients to the ED.
MethodsThis is a clinical audit study in three phases in Imam Hossein Hospital (Tehran, Iran) during 2016. In the first phase, the clinical handover between EMS staff and EMAs for 178 trauma patients admitted to the ED using ISBAR was audited and information was recorded. In the second phase, the correct approach of clinical handover according to the ISBAR tool was taught to EMS staff and EMAs using pamphlets and lectures. In the third phase, again, the clinical handover between EMS staff and EMAs for 168 trauma patients admitted to the ED was audited using the ISBAR tool and information was recorded. At the end, clinical audit assessment indicators of handover were evaluated before and after training.
ResultsClinical audit of the current situation in the ED showed that the clinical handover process does not follow standard ISBAR (0.0%). However, after training, 65.3% of clinical handover processes were performed in accordance with ISBAR. In the current study, there was an increase in all parameters of the ISBAR tool after training, most of which increased significantly compared to the first phase of the study (before the intervention).
ConclusionsFindings demonstrate that patient handover in the ED did not initially follow the ISBAR standard guideline. After providing education as pamphlets and lectures to EMS staff and EMAs, a high percentage of patient handovers were conducted in accordance with the ISBAR instructions.
,Fahim Yegane SA ,Shahrami A ,Hatamabadi HR .Hosseini-Zijoud SM Clinical Information Transfer between EMS Staff and Emergency Medicine Assistants during Handover of Trauma Patients . Prehosp Disaster Med.2017 ;32 (5 ):541 –547 .
Fatalities from Firearm-Related Injuries in Selected Governorates of Iraq, 2010-2013
- Maximilian P. Nerlander, Eva Leidman, Ahmed Hassan, Abdul-Salam Saleh Sultan, Syed Jaffar Hussain, Lauren B. Browne, Oleg O. Bilukha
-
- Published online by Cambridge University Press:
- 18 May 2017, pp. 548-555
-
- Article
- Export citation
-
Background
In Iraq, where Islamic State of Iraq and Syria (ISIS) and other groups have contributed to escalating violence in recent years, understanding the epidemiology of intentional firearm-related fatalities is essential for public health action.
MethodsThe Iraqi Ministry of Health (MoH; Baghdad, Iraq) compiles surveillance of fatal injuries in eight of Iraq’s 18 governorates (Baghdad, Al-Anbar, Basrah, Erbil, Kerbala, Maysan, Ninevah, and Al-Sulaimaniya). Information is collected from coroner’s reports and interviews with family members. Analysis was performed on intentional firearm-related injuries, excluding injuries from intentional self-harm or negligent discharges, that occurred during 2010-2013, a subset of all fatal injuries, and compared to previously published explosive-related fatalities.
ResultsOverall, the dataset included 7,985 firearm-related fatalities. Yearly fatalities were: 2010=1,706; 2011=1,642; 2012=1,662; and 2013=2,975. Among fatalities, 86.0% were men and 13.7% women; 83.4% were adults and 6.2% children <18 years of age. Where age and sex were both known, men aged 20-39 years accounted for 56.3% of fatalities. Three “high-burden” governorates had the highest fatality rate per 100,000 population—Baghdad (12.9), Ninevah (17.0), and Al-Anbar (14.6)—accounting for 85.9% of fatalities recorded in the eight governorates. Most fatalities occurred in the street (56.3%), followed by workplace (12.2%), home (11.3%), and farm/countryside (8.4%). Comparing the ratio of firearm-related fatalities to explosives-related fatalities revealed an overall ratio of 2.8:1. The ratio in Baghdad more than doubled from 2.9 in 2010 to 6.1 in 2013; the highest ratios were seen outside the high-burden governorates.
ConclusionsFirearm-related fatalities remained relatively stable throughout 2010-2012, and almost doubled in 2013, correlating with increased ISIS activity. Three governorates contributed the majority of fatalities and experienced the highest fatality rates; these saw high levels of conflict. Firearm-related fatalities disproportionately affected younger men, who historically are over-represented as victims and perpetrators of violence. More than one-half of fatalities occurred in the street, indicating this as a common environment for conflict involving firearms. Firearms appear to account for more fatalities in Iraq than explosives and largely accounted for escalating violence in Baghdad during the study period. The high ratio observed outside the high-burden governorates is reflective of very low numbers of explosives-related fatalities; thus, violence in these governorates is likely non-conflict-related. These observations provide valuable public health information for targeted intervention to prevent violence.
,Nerlander MP ,Leidman E ,Hassan A ,Sultan ASS ,Hussain SJ ,Browne LB .Bilukha OO Fatalities from Firearm-Related Injuries in Selected Governorates of Iraq, 2010-2013 . Prehosp Disaster Med.2017 ;32 (5 ):548 –555 .
An Assessment of Climate Change Impacts on Los Angeles (California USA) Hospitals, Wildfires Highest Priority
- Sabrina A. Adelaine, Mizuki Sato, Yufang Jin, Hilary Godwin
-
- Published online by Cambridge University Press:
- 13 June 2017, pp. 556-562
-
- Article
- Export citation
-
Introduction
Although many studies have delineated the variety and magnitude of impacts that climate change is likely to have on health, very little is known about how well hospitals are poised to respond to these impacts.
Hypothesis/ProblemThe hypothesis is that most modern hospitals in urban areas in the United States need to augment their current disaster planning to include climate-related impacts.
MethodsUsing Los Angeles County (California USA) as a case study, historical data for emergency department (ED) visits and projections for extreme-heat events were used to determine how much climate change is likely to increase ED visits by mid-century for each hospital. In addition, historical data about the location of wildfires in Los Angeles County and projections for increased frequency of both wildfires and flooding related to sea-level rise were used to identify which area hospitals will have an increased risk of climate-related wildfires or flooding at mid-century.
ResultsOnly a small fraction of the total number of predicted ED visits at mid-century would likely to be due to climate change. By contrast, a significant portion of hospitals in Los Angeles County are in close proximity to very high fire hazard severity zones (VHFHSZs) and would be at greater risk to wildfire impacts as a result of climate change by mid-century. One hospital in Los Angeles County was anticipated to be at greater risk due to flooding by mid-century as a result of climate-related sea-level rise.
ConclusionThis analysis suggests that several Los Angeles County hospitals should focus their climate-change-related planning on building resiliency to wildfires.
,Adelaine SA ,Sato M ,Jin Y .Godwin H An Assessment of Climate Change Impacts on Los Angeles (California USA) Hospitals, Wildfires Highest Priority . Prehosp Disaster Med.2017 ;32 (5 ):556 –562 .
Mass-Gathering Medical Care in Electronic Dance Music Festivals
- Kathleen M. FitzGibbon, Jose V. Nable, Benjamin Ayd, Benjamin J. Lawner, Angela C. Comer, Richard Lichenstein, Matthew J. Levy, Kevin G. Seaman, Ian Bussey
-
- Published online by Cambridge University Press:
- 19 June 2017, pp. 563-567
-
- Article
- Export citation
-
Introduction
Electronic dance music (EDM) festivals represent a unique subset of mass-gathering events with limited guidance through literature or legislation to guide mass-gathering medical care at these events.
Hypothesis/ProblemElectronic dance music festivals pose unique challenges with increased patient encounters and heightened patient acuity under-estimated by current validated casualty predication models.
MethodsThis was a retrospective review of three separate EDM festivals with analysis of patient encounters and patient transport rates. Data obtained were inserted into the predictive Arbon and Hartman models to determine estimated patient presentation rate and patient transport rates.
ResultsThe Arbon model under-predicted the number of patient encounters and the number of patient transports for all three festivals, while the Hartman model under-predicted the number of patient encounters at one festival and over-predicted the number of encounters at the other two festivals. The Hartman model over-predicted patient transport rates for two of the three festivals.
ConclusionElectronic dance music festivals often involve distinct challenges and current predictive models are inaccurate for planning these events. The formation of a cohesive incident action plan will assist in addressing these challenges and lead to the collection of more uniform data metrics.
,FitzGibbon KM ,Nable JV ,Ayd B ,Lawner BJ ,Comer AC ,Lichenstein R ,Levy MJ ,Seaman KG .Bussey I Mass-Gathering Medical Care in Electronic Dance Music Festivals . Prehosp Disaster Med.2017 ;32 (5 ):563 –567 .
Comprehensive Review
No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters
- Dell D. Saulnier, Kim Brolin Ribacke, Johan von Schreeb
-
- Published online by Cambridge University Press:
- 13 June 2017, pp. 568-579
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Introduction
How the burden of disease varies during different phases after floods and after storms is essential in order to guide a medical response, but it has not been well-described. The objective of this review was to elucidate the health problems following flood and storm disasters.
MethodsA literature search of the databases Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); Cinahl (EBSCO Information Services; Ipswich, Massachusetts USA); Global Health (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science Core Collection (Thomson Reuters; New York, New York USA); Embase (Elsevier; Amsterdam, Netherlands); and PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA) was conducted in June 2015 for English-language research articles on morbidity or mortality and flood or storm disasters. Articles on mental health, interventions, and rescue or health care workers were excluded. Data were extracted from articles that met the eligibility criteria and analyzed by narrative synthesis.
ResultsThe review included 113 studies. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections all increased after storms. Gastrointestinal infections were more frequent after floods. Leptospirosis and diabetes-related complications increased after both. The majority of changes occurred within four weeks of floods or storms.
ConclusionHealth changes differently after floods and after storms. There is a lack of data on the health effects of floods alone, long-term changes in health, and the strength of the association between disasters and health problems. This review highlights areas of consideration for medical response and the need for high-quality, systematic research in this area.
,Saulnier DD ,Brolin Ribacke K .von Schreeb J No Calm After the Storm: A Systematic Review of Human Health Following Flood and Storm Disasters . Prehosp Disaster Med.2017 ;32 (5 ):568 –579 .
Brief Report
Assessing Coagulation by Rotational Thromboelastometry (ROTEM) in Rivaroxaban-Anticoagulated Blood Using Hemostatic Agents
- Jonathan Bar, Alexa David, Tarek Khader, Mary Mulcare, Christopher Tedeschi
-
- Published online by Cambridge University Press:
- 19 June 2017, pp. 580-587
-
- Article
- Export citation
-
Introduction
The use of direct oral anticoagulants (DOACs) such as rivaroxaban (Xarelto) is increasingly common. However, therapies for reversing anticoagulation in the event of hemorrhage are limited. This study investigates the ability of hemostatic agents to improve the coagulation of rivaroxaban-anticoagulated blood, as measured by rotational thromboelastometry (ROTEM).
Hypothesis/ProblemIf a chitosan-based hemostatic agent (Celox), which works independently of the clotting cascade, is applied to rivaroxaban-anticoagulated blood, it should improve coagulation by decreasing clotting time (CT), decreasing clot formation time (CFT), and increasing maximum clot firmness (MCF). If a kaolin-based hemostatic agent (QuikClot Combat Gauze), which works primarily by augmenting the clotting cascade upstream of factor Xa (FXa), is applied to rivaroxaban-anticoagulated blood, it will not be effective at improving coagulation.
MethodsPatients (age >18 years; non-pregnant) on rivaroxaban, presenting to the emergency department (ED) at two large, university-based medical centers, were recruited. Subjects (n=8) had blood drawn and analyzed using ROTEM with and without the presence of a kaolin-based and a chitosan-based hemostatic agent. The percentage of patients whose ROTEM parameters responded to the hemostatic agent and percent changes in coagulation parameters were calculated.
ResultsData points analyzed included: CT, CFT, and MCF. Of the samples treated with a kaolin-based hemostatic agent, seven (87.5%) showed reductions in CT, eight (100.0%) showed reductions in CFT, and six (75.0%) showed increases in MCF. The average percent change in CT, CFT, and MCF for all patients was 32.5% (Standard Deviation [SD]: 286; Range:-75.3 to 740.7%); -66.0% (SD:14.4; Range: -91.4 to -44.1%); and 4.70% (SD: 6.10; Range: -4.8 to 15.1%), respectively. The corresponding median percent changes were -68.1%, -64.0%, and 5.2%. Of samples treated with a chitosan-based agent, six (75.0%) showed reductions in CT, three (37.5%) showed reductions in CFT, and five (62.5%) showed increases in MCF. The average percent changes for CT, CFT, and MCF for all patients were 165.0% (SD: 629; Range:-96.9 to 1718.5%); 139.0% (SD: 174; Range: -83.3 to 348.0%); and -8.38% (SD: 32.7; Range:-88.7 to 10.4%), respectively. The corresponding median percent changes were -53.7%, 141.8%, and 3.0%.
ConclusionsRotational thromboelastometry detects changes in coagulation parameters caused by hemostatics applied to rivaroxaban-anticoagulated blood. These changes trended in the direction towards improved coagulability, suggesting that kaolin-based and chitosan-based hemostatics may be effective at improving coagulation in these patients.
,Bar J ,David A ,Khader T ,Mulcare M .Tedeschi C Assessing Coagulation by Rotational Thromboelastometry (ROTEM) in Rivaroxaban-Anticoagulated Blood Using Hemostatic Agents . Prehosp Disaster Med.2017 ;32 (5 ):580 –587 .
Front Cover (OFC, IFC) and matter
PDM volume 32 issue 5 Cover and Front matter
-
- Published online by Cambridge University Press:
- 28 September 2017, pp. f1-f7
-
- Article
-
- You have access Access
- Export citation
Back Cover (OBC, IBC) and matter
PDM volume 32 issue 5 Cover and Back matter
-
- Published online by Cambridge University Press:
- 28 September 2017, pp. b1-b3
-
- Article
-
- You have access Access
- Export citation