bluuebunny/crossref_metadata_2025 huggingface dataset:
(A54) EU Project: European Guideline for Target Group Oriented Psychosocial Aftercare-Implementation
Authors: Vymetal S. , Bering R. , Diestler A. , Rooze M. , Schedlich C. , Zurek G. , Orengo F.
Published: May 2011

Although most victims of disasters recover on their own, a minority of survivors, uniformed services, and relatives develop long-term disaster related psychic disorders such as Posttraumatic Stress Disorder (PTSD). Especially this subgroup should receive timely and appropriate psychosocial help. In many EU countries is offered post-disaster psychosocial care by a variety of caregivers (i.e. professionals and volunteers, NGOs, church or commercial organizations). Therefore, European standardization of providing post-disaster psychosocial support is currently required. The presentation describes the project supported by the European Commission and named European Guideline for Target Group Oriented Psychosocial Aftercare – Implementation (EUTOPA-IP), supported by the European Commission. EUTOPA-IP has integrated two materials: German “Target Group Intervention Programme” and Dutch “Multidisciplinary guideline”, also with the experiences of experts in the area of psychosocial support from the EU countries. Main target is to develop a guideline for the uniformed services on the basis of the Multidisciplinary guideline for early psychosocial interventions, the adaptation of the Target group Oriented Intervention Program (TGIP) to the International Classification of Functioning, Disability and Health (ICF) and preparation and implementation of training program for various professional groups. The project aims at standardization of psychosocial aftercare in case of disasters as well as at the development of European network based on current findings in psychotraumatology. Early screening, supportive context, early preventive and curative psychosocial interventions, management of interventions, implications for the clinical field and future research are topics discussed in the project. Project consortium:

– City of Cologne (Germany)

– Centre of Psychotraumatology (Germany)

– Impact (The Netherlands)

– Spanish Society for Psychotraumatology and Traumatic Stress (Spain)

– Charles University in Prague (Czech Republic)

– Capital City of Dusseldorf, Department of Public Health (Germany).
(A71) Prospective Evaluation of “Focused Assessment with Sonography for Trauma” Done by Emergency Physicians, and its Comparative Analysis with Radiologist's Performance
Authors: Sinha T.P. , Bhoi S. , Kumar S. , Bhasin A. , Rodha M.
Published: May 2011

Objective

The objective of this study was to determine the accuracy of emergency physicians in detecting free fluid in the abdomen when compared to radiologists during w primary survey of trauma victims by focused assessment with sonography for trauma (FAST) scan in the emergency department.

Methods

This prospective study was performed during a primary survey of the resuscitation of non-consecutive patients in the resuscitation bay. The study subjects included emergency physicians (EP) [one emergency medicine (EM) consultant, two EM residents, one orthopedic resident, and one surgical resident] who underwent training at a three-day workshop on emergency sonography and performed 10 supervised positive and negative scans for free fluid. The FAST scans were performed by the EPs and then by the radiology resident (RR). Both were blinded to each other's sonography findings. Computed tomography (CT) scan and laparatomy findings were used as gold standard. Results were compared between both groups. Intra-observer variability among EPs and level of agreement between EPs and RRs were assessed.

Results

One hundred fifty scans performed by EPs and RRs were analyzed. The mean age of the patients was 28 [1–70] years. Out of 24 true positive patients, 18 underwent CT scan, and exploratory laparatomy was done in six patients. Intra-observer performance variation ranged from 87–97%. The sensitivity of FAST performed by EP and RR was 100%. The specificity of FAST by EPs was 95.4% vs. 98.4% by RRs. The level of agreement was 100%.

Conclusions

This study proves that FAST scan performed by EPs who are trained in short course of ultrasonography can be reliable and accurate when compared to a qualified radiologist.
(A80) Nationwide Study to Improve Door-to-Balloon Times in Patients with Acute St Elevation Myocardial Infarction Requiring Primary Percutaneous Coronary Intervention Using Prehospital ECG Transmission
Authors: Ong M.E. , Wong A.S. , Teo S.G. , Seet C.M. , Lim B.L. , Foo D.C. , Lai S.M. , Ong S.H. , Lee F.C. , Chan K.P. , Anantharaman V. , Chua T.S. , Pek P.P. , Li H.H.
Published: May 2011

Objective

To reduce nationwide door-to-balloon times (DTB) in patients presenting with acute ST-elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI), by adoption of pre-hospital wireless 12-lead electrocardiogram (ECG) transmission by Singapore's national ambulance service.

Methods

A phased, prospective, before-after, interventional study of all patients who presented to the national ambulance service with the diagnosis of STEMI. In the ‘Before’ phase, chest pain patients only received 12-lead ECGs on arrival at the Emergency Departments (ED), where diagnosis of STEMI could be made. In the ‘After’ phase, 12-lead ECGs were performed in the field by ambulance crews and transmitted while en-route to the hospitals. Diagnoses of STEMI was made by on-duty emergency physicians (EP) prior to patients' arrival and PCI activated. Data was collected from ambulance run sheets, ECG transmission logs, EDs and cardiology units.

Results

451 eligible patients from “Before” and 214 patients from “After” phase were included in the analysis. Median DTB time was 88 minutes in the “Before” and 52 minutes in the “After” phase (p = 0.0001). During office hours, median DTB times for ‘Before’ and ‘After’ phases were 84 minutes and 47 minutes, respectively (p = 0.0001). After office hours, median DTB times for ‘Before’ and ‘After’ phases were 95 minutes and 54 minutes, respectively (p = 0.0001). There were 11 false positive activations in “Before” phase and one in the “After” phase.

Conclusion

Pre-hospital ECG transmission resulted in significant reduction of DTB time; this effect occurred regardless of whether patients presented to the ED before or after office hours. No increase in false activations was found in the “After” phase. Pre-hospital ECG transmission should be adopted as “standard of care” for all STEMI cases meeting the criteria for PCI.
(A100) Building Local Resilience and Competencies in Remote Haitian Communities
Authors: Gore R. , Bloem C.M. , Arquilla B. , Roblin P.
Published: May 2011

Injury and trauma are major causes of premature deaths worldwide. At present, Haiti does not have an existing emergency medical system. Basic first responders training was developed for lay people and medical professionals in rural Haiti.

Methods

The training was conducted in Terrier Rouge, Haiti. Participants included medical professionals, laborers, health professionals, teachers, students, and truck drivers from six towns in northeastern Haiti. A three-day training course taught by U.S. board certified emergency medicine physicians was instituted. Basic life support (BLS), first aid, and BLS/first aid instructors courses were taught based on the American and Canadian Heart Associations curriculum. The BLS/first aid instructors course was limited to health professionals, whereas the first aid course was open to all members of the community. The program included the development of local teaching tools and manuals translated to local languages. Twelve newly trained local Haitian instructors assisted in the final day of training.

Results

The course was well received by participants. A total of 54 people completed the BLS course, 67 completed the first aid course, and 12 participants completed the BLS/first aid instructors course. Ninty-five program participants completed the end of course survey. Forty-four of the participants were male, 49 were female, and 2 did not answer. Forty-one participants had no prior BLS/first aid training or exposure. The ages of participants ranged from 13 to 52 years. The course participants included two physicians, 22 students, eight nursing students, seven nurses, 20 teachers, 12 health workers, five drivers, and 14 laborers. Of those surveyed, 92 stated they would recommend this course to a friend. Eighty-eight participants stated that hands on learning helped them better learn the course material.

Conclusion

This sustainable, locally controlled training model increased local skill level for basic first responders in rural Haiti.
(A101) Gender Difference of the Damage in Haiti Earthquake Disaster
Authors: Hata M. , Tanaka J. , Yamahata Y. , Okuchi K.
Published: May 2011

An earthquake struck Haiti on 12 January 2010. More than 200,000 people were killed and more than 300,000 people were injured in this earthquake. The Japanese government dispatched the Japan Disaster Relief Medical Team (JDR-MT) to Haiti on 16 January. This is the report of the medical activities of JDR-MT in Haiti. The JDR-MT consisted of 27 members, including four medical doctors, seven nurses, one pharmacist, one radiologist, one medical technologist, two emergency medical technicians, and 11 logisticians. The JDR-MT was equipped with medicines for 1,000 patients, a portable x-ray system, and ultrasound diagnostic equipment. The JDR-MT performed relief activities at Leogane City, which was 40km west of the capital of Port-au-Prince, and was the first medical team that entered the Leogane area after the earthquake. The JDR-MT treated 534 patients for eight days. The male-female ratio of total patients was 180/354, and the male-female ratio of 242 injured cases treated by the JDR-MT was 80/162. Among the patients treated by the JDR-MT, 100 were diagnosed as bone fractures with the portable x-ray system. There were 17 cases of open bone fractures and 15 cases of pelvic fractures. The male-female ratios were 28/72, 4/13, and 1/14 respectively. The total number of female patients was approximately double compared with the number of male patients in this experience. The proportion of female patients was much higher in the cases of severe injury, such as open bone fractures and pelvic fractures.
(A109) Health Workforce and Disaster Preparedness of Rural Hospitals
Authors: Siegloff L. , Cusack L. , Arbon P. , Hutton A. , Mayner L.
Published: May 2011

Following the devastating March 2009 Victorian bushfire disaster in rural areas of Australia, authorities reviewed strategies designed to protect communities during periods of extreme fire risk. New policy and regulation were introduced and designed to ensure that small rural communities were protected and prepared to confront a wildfire emergency during days of extreme heat or bushfire risk weather. As a result on days of declared ‘catastrophic’ bushfire weather conditions government agencies in South Australia have implemented a policy for schools (including pre-schools) to be temporarily closed. On these days community members are advised to evacuate early to safe regional centres, and to limit travel on country roads. The WADEM Guidelines for Disaster Evaluation and Research demonstrate that Basic Societal Functions (BSFs), such as education, health, transport and others, are interconnected and interdependent. For example in small rural communities in South Australia people may have a number of important roles including being parents, volunteers of emergency services while also being employed as staff of local hospitals. This project reviewed the impact of school closures and other protective measures on the availability of the rural nursing workforce and on rural hospitals. Rural hospitals in Australia are staffed, on average, by 2–8 nurses, service very small communities and are separated by great distances. As a result, small changes in the absentee rate for nurses can have a significant impact on the operation of these hospitals. This paper will argue that policy changes in other sectors, such as education, can impact on societal activities such as childcare, volunteer emergency service work, and hospital staffing, in ways that may not be anticipated unless the impact on all Basic Societal Functions are considered by policymakers.
(A110) A Survey of Health Professions Students Attitudes towards and Knowledge of Emergency Preparedness
Authors: Markenson D. , Reilly M.
Published: May 2011

Introduction

The possibility of natural disasters and public health emergencies coupled with the possibility of terrorism support the need to incorporate emergency preparedness into the curricula for every health professional school. Methods: A survey methodology was employed to assess both attitudes towards and knowledge of emergency preparedness amongst health professions students which included the schools of medicine, nursing, dentistry and public health. The survey was piloted to graduating students and then administered prior to institution of a emergency preparedness curriculum and then repeated as an annual survey.

Results

The survey found that 51.8% had been present at a disaster as non-responder while only 12.1% had ever been present as a responder. With regard to baseline class room exposure over 50% reported no exposure to such key concepts as incident command, triage, all-hazards planning, surge and aspects of terrorism. In addition at baseline most students felt they had no competency in emergency preparedness. As an example only 10% of students felt competent with personal protective equipment. While exposure both as a responder and student was low, 82.5% of students felt that emergency preparedness should be a mandatory topic in their education. Lastly, with a minimal curriculum change students showed statistically significant increases on knowledge testing.

Conclusions

While exposure was low for emergency preparedness topics and most did not recognize how information they had been taught might be applicable to emergency preparedness, there was a strong desire for additional training. In addition simple curricular adjustments can lead to significant improvements in knowledge.
(A111) Role, Resources, and Clinical and Educational Backgrounds of Nurses Who Participated in the Prehospital Response to the 2009 Bushfires in Victoria, Australia
Authors: Ranse J. , Lenson S.
Published: May 2011

The bushfires of February 2009 in Victoria, Australia resulted in the deaths of 173 people and caused injuries to 414. Furthermore, > 2,030 houses and 3,500 structures were destroyed. The role and experience of nurses in this environment are not well understood, and little is known about the clinical and education background of nurses in this setting. This presentation will provide an overview of the bushfires and report on two research projects. The aims of these projects were to explore participant demographics and various aspects of nursing activities in the prehospital environment. These projects used volunteer nursing members of St John Ambulance Australia who responded to the Victorian fires. The first project used a retrospective, descriptive postal survey, and the second was descriptive and exploratory, using semi-structured interviews as a means of data collection. The survey highlighted that nurses had varying clinical and educational backgrounds. Males were overrepresented when compared to the national average of nurses. Most participants had taken disaster-related education, however, this varied in type and duration. Similarly, most had participated in training or mock disasters; however this usually was not related to bushfire emergencies. The qualitative findings identified two main themes having expansive roles and being prepared. These highlighted that nurses maintained a variety of roles, such as clinicians, emotional supporters, coordinators and problem solvers, and they were well prepared for these roles. This research provided insight into the characteristics and level of preparedness of nurses who responded to the 2009 Victorian bushfires in the prehospital environment. Additionally, it highlights the need for more structured education and training for nurse that is aligned with their role and deployment environment.
(A119) Ethical Issues in the Review and Conduct of Research during Active Conflicts: Reflections from Darfur, West Sudan
Authors: Hussein G.M.A.
Published: May 2011

A crisis has been evolving in the region of Darfur following an armed conflict between rebel groups and the assumingly government-supported militia in 2003. It has attracted international attention and intervention where 13 UN agencies and around 100 national and international non-governmental organizations have been serving the affected populations. Research as methodological means of data collection is crucial to timely assessment of the affected populations' needs before humanitarian interventions, raising fund to fulfil these needs, and to assess the effects of the humanitarian aids that have been delivered. However, the factors of (1) insecurity; (2) limited resources; (3) vulnerability of the population; and (4) the potential cultural and moral differences among researchers and the surveyed populations make the research process methodologically and ethically challenging. The aim of this paper is to present the effects of these factors on the ethical review and implementation of research, with emphasis on the issues of benefit-risk analysis, conflict of interests, and informed consent. A practical framework for the ethical review that responds to the need of timely provision of information as well as promoting the adherence to the international ethical principles also will be provided.
(A122) Using Focused Operations Management Tools to Analyze and Alleviate Emergency Department Overcrowding
Authors: Schwartz D. , Ronen B. , Pliskin J.S. , Goldberg A.
Published: May 2011

Introduction

Emergency department overcrowding plagues departments worldwide with grave implications on patient comfort and care quality. Many standard approaches have been introduced without widespread success. A new approach is required. Focused Operations Management (FM) integrates novel managerial theories and practical tools into a systematic approach to complex systems, promoting insight and improving performance. It has allowed systems in the industry and service sectors to radically improve throughput and quality with no or little additional cost. The implementation of the FM in the emergency department setting to alleviate overcrowding has never been attempted, and it could revolutionize emergency department operations management.

Methods

Emergency department patient flow data affecting factors and outcomes from a large tertiary medical center, exclusively utilizing electronic patient records, will be collected. Root causes and influencing variables of emergency department overcrowding will be mapped and analyzed using FM tools. Later, alleviating measures will be developed and evaluated. During phase two, data will be collected from two additional emergency departments, measuring the impact of implementation of FM operational changes on emergency department flow parameters such as length of stay, wait times, clinical outcomes, and patient and staff satisfaction.

Results

Data collection and analysis of phase one of the study will be completed by March 2011 and presented at the conference. The authors speculate that the FM tools will allow better understanding of the root causes and affecting variables of emergency department overcrowding and help plan and later implement efficient interventions.

Discussion

The implementation of the novel management strategies of FM has revolutionized operations in many industries and services, helping them to drastically improve performance. The emergency department is a perfect candidate for the use of these tools, due to the overwhelming current operational difficulties (with overcrowding as a prominent symptom) and its complex high volume and high acuity patient flow.
(A109) Systematic Literature Review on Pediatric Sleep Disturbance Management Post-Disaster: Implications of Post-Disaster Pediatric Clinical Management in Developing Countries
Authors: Chan E.Y.Y. , Koo S.D.
Published: May 2011

Introduction

Sleep disturbances are common symptoms during the immediate and long-term aftermath of exposure of traumatic events. While stress affects sleep in all age groups, due to differences in physiological, psychological, and socio-behavorial risk factors, the clinical management of pediatric patients with sleep disturbances post-disaster might be different. This study aims to systematically review scientific literature on the clinical management of pediatric sleep disturbances post-disaster and its clinical implication in developing countries. Methods: A keyword-based, systematic review was conducted for scientific publication in academic and disaster literature databases (Medline, PUBMED, Academic Search Premier, Google Scholar, ELDIS, PsycINFO, PILOTS and RELIEFWEB) until October 2010. Abstracts of all the hits were inspected to remove non-relevant articles, and all relevant articles were reviewed and scored by two reviewers to determine relevancy before being included in the final study database. Quality, relevance, and applicability of the reported literature were examined critically with the EBM level of evidence and EPPHPPQ (2003) assessment tool.

Results and Discussion

The literature disproportionally emphasized the clinical effects and psychological impacts of traumatic events on pediatric patients, and most reported studies were reported as a subset within PTSD study literature. Management of younger children, gender differences, clinical effectiveness of cross-disciplinary management modalities, and experiences in middle- and low-income countries were extremely limited. While principles of sleep hygiene and clinical guidelines for management of adult sleep disturbance are available, the application of clinical effectiveness and appropriateness of these guidelines in pediatric population must be examined further.

Conclusion and Implications

Currently, there is limited literature on the acute management of pediatric sleep disturbances post-disaster in developing countries. Evidence-based studies are needed to identify the appropriate clinical approaches to support the pediatric population with sleep disturbances post-disaster.
(A130) Advantages of Apparatus of External Fixation in Severe Injuries of Extremities in Children
Authors: Karabenyuk A. , Levitskiy A.
Published: May 2011

Purpose

To study advantages of external fixation in severe injuries of extremities in children.

Material and Method

305 children at the age from 3 to 17 years with polytrauma (ISS > 18) were studied. From them skeletal injuries took place in 198 patients, cranioskeletal trauma - 125, multiple bone fractures - 56, bone fractures + visceral trauma - 24. 44 children had open bone fractures or fractures accompained with vast defects of soft tissues. Operative interventions in polytrauma are divided into urgent, elective and delayded. Urgent intervention (according to vital indications) are conducted together with anti-shock therapy in massive blood losses (injury of spleen, liver), crushing of lungs, cardiac tamponade, intracranial compression. Elective interventions are prformed after stabilization of patient's state and after bringing him out of shock.

Results

Sets for external fixation were used in acute period of trauma, in early and late posttraumatic period. Tipe of sets depended on character of injury and followed steps of treatment. Indications for external fixation in acute period and catabolic phase of traumatic disease were: 1. multiple fragmental fractures, 2. defects of bones, 3. vast defects of soft tissues, 4. long bone fractures accompained with severe brain trauma. Indications for external fixation in late period were mulunion, in postpond – ununion, deformations and shortening of extremities.

Conclusion

The usage of external fixation was an effective approach in treatment of children with severe complicated injuries of extremities. Advantages of external fixation in conditions of polytrauma were undiscutable: management in force effects, absence of secondary dislocations, good conditions for debridment and follow restorative treatment, mobility of patients.
(A131) Surgical Help to Children in Disasters and Wars
Authors: Roshal L.
Published: May 2011

Purpose

To describe results of experience in providing surgical aid to children in technological and natural disasters in various countries of the world: Haiti, Algeria, Armenia, Afganistan (three times), Georgia, Egypt, Russia, Indonesia (twice), Iran, Pakistan, India, Japan, Gaza strip, Chechnya, and Yugoslavia.

Materials and Methods

The Russian specialized team consisting of highly qualified pediatric specialists (traumatologists, neurosurgeons, plastic surgeons, specialists in wound treatment, anaesthesiologists-reanimatologists and others if necessary) work at local hospitals in the disaster zone. All of them work as volunteers. The most serious pediatric victims were concentrated in one or two regional hospitals. The volunteer specialists work on a twenty-four hour basis together with local doctors. Every day they examine patients, control wound bandaging, and perform surgeries. For long tubular bone fractures metalosteosynthesis is used. Modern techniques are used for Crush syndrome and for extended and purulent wounds (water-based ointments, early autoplasty). Currently, the main difficulty in many cases is primary treatment of extensive wounds with their complete closure and the many indications for amputations. Conservative and sparing techniques are not often used.

Conclusions

Pediatric victims in technologic and natural disasters must be helped by pediatric specialists. Our experience in the countries to which we have responded have revealed that there are not enough local specialists who can provide highly professional aid to children. There is no known coordinating structure in the world to efficiently organize specialized pediatric help to children in disasters and wars.
(A135) Preliminary Results of Post-Flooding Impacts on Rural Elderly in Hainan Province, China
Authors: Chan E.Y.Y. , Lin C.L.Y. , Lee P.P.Y. , Zheng I. , Cheung E.Y.L. , Lam S.C.
Published: May 2011

Background

Limited information is available on the health outcomes of the rural older population in developing countries is affected by disasters. In October 2010, Hainan Province experienced severe flooding following heavy rains. Nearly four million people were affected and many had undergone resettlement. This study investigated the impacts of the flooding on people living in the disaster-affected rural communities. The findings were compared with baseline information collected in 2010 about health issues in rural villages in Hainan. Health outcome comparisons also were made between ethnic groups (Han versus Li).

Methods

A two-stage cluster-sampling, cross-sectional post-disaster study was conducted. The entire Hainan Island was categorized into ranks of different severity in rainfall amount and associated damage in October (most severe, intermediate, least severe). The county with the most rainfall and the most severe ranking and the one with least rainfall and the least severe ranking were identified. In each county, one Han and one Li village were chosen by using a computer-generated random number, so four villages were sampled in total. More than 100 individuals ≥ 50 years of age were interviewed by face-to-face survey. Data on disaster-related injuries, socio-demographic information, non-communicable disease, lifestyle, and mental health were collected.

Results

Findings indicated the severity of impact was associated with self-reported health outcomes of older population. Gender and ethnic differences were found in reported health outcomes. Predictors of adverse post-disaster health outcomes in older populations in rural communities were identified.

Conclusions

The results demonstrated significant differences in the impacts of flooding in rural populations. Targeted services and interventions should be planned to address the disparity and meet the physical and mental health needs post-disaster.
(A140) An Analysis of National Survey on Disaster Drill by Emergency Medical Centers in Korea
Authors: Wang S.J.
Published: May 2011

Introduction

Disaster drills have been performed officially for disaster medical preparedness by wide regional emergency medical centers in Korea. Government evaluates these disaster drills every year, but this evaluation is performed based on administrative aspect not disaster medical aspect. Also there are insufficient number of research on disaster drill not on disaster itself, especially national level. So these disaster medical drills were analyzed and reevaluated.

Methods

Disaster drills performed by wide regional emergency medical centers in Korea were evaluated and analyzed from August 2006 to July 2008. Disaster drill planning, performance, kinds of disaster drill, contents of drill and resources of drill were collected and analyzed in medical aspect based on the disaster drill report and additional compensation of incomplete data by direct contact with the participating institutions. The appropriateness and evaluation results referred to the guideline of National Emergency Medical Center of Korea.

Results

All the wild regional emergency medical centers had their own disaster drill planning and resource application planning for drills and real disasters. Most of disaster drill planning were appropriate, but disaster facility was the weakest point in the planning. Types of disasters in disaster drills were fire and structural collapse(44.4%), special disaster(13.7%), natural disaster(1.7%). Average duration of disaster drills were 6.12 hours and 1.26 days. Real field drill rate was 80.3%. Sixty five percent of drills were connected to multiple institutions or organizations other than hospitals. Number of participating persons from wide regional emergency medical centers were 21 on average.

Conclusions

Medical situation on disaster drills is that there are various levels and kinds of disaster drills done by wide regional emergency medical centers, so the quality and quantity should be enforced in low level centers. It is recommended that international situation or database can be extracted based on this research.
(A141) Hospital Preparedness for a Large Scale Biological Drill
Authors: Benin-Goren O. , Miller E. , Dalla I.
Published: May 2011

Background

During the past four years large scale biological exercises took place in several districts of the state of Israel. The drills included hospitals, Health Maintenance Organizations (HMOs), Emergency Medical Services (EMS), public health district offices and interface agencies such as Israel Defense Forces (IDF) Home Front Command (HFC).

Discussion and Observations

On January 2010 a comprehensive biological exercise was conducted in Tel Aviv. Tel Aviv Sourasky Medical Center (TASMC) together with the agencies mentioned above practiced the hospital competing with Exceptional Biological Event. New elements, which had never been inspected before, were evaluated in this drill:

•

Activating of a triage point at the hospital gate.

•

Opening a special registration point.

•

Staff protection from biological agents.

•

Activating a separate Emergency Department (ED) for bio- threat.

•

Detection and Containment ward.

•

Protected elevators and passageways

•

Interface agencies in and out the hospital.

Designated physicians, nurses and paramedical team, that practiced other events in the past, needed to be trained and practiced in order to be ready for a biological event. Wards that usually did not participate in such drills, needed to take part in this particular drill, while the routine work continued. This paper presents the hospital preparation for the drill, the methodology of training and preparedness, as well as the outcome of the drill.
(A142) Simulated Evacuation of Three Critical Hospital Departments: A Comparison
Authors: Dhondt E.L. , Lauwaert D. , Hendrickx C.
Published: May 2011

Background

According to the Belgian Hospital Disaster Planning Act, all hospitals are required to have written disaster plans and to routinely conduct annual disaster drills. In 2010, three neighboring hospitals organized independently from each other an evacuation exercise of a critical care department (CCD): two university hospitals of a Dialysis Center and a One-day Surgery Clinic respectively and the military hospital of a Burn Unit.

Aim

To compare these CCD's evacuation plans and drills and the overall hospital emergency incident response and command system.

Methods and Results

Conducting an evacuation exercise in a CCD, moving vulnerable highly dependent people towards an alternative shelter site is challenging, causing an important burden to ongoing medical specialist care, working staff and critical infrastructure. In all three CCD, it was decided to conduct a simulated evacuation exercise following an internal fire, thereby deploying fashioned simulated patients and visitors but bringing into action the regular attending medical, nursing and logistic staff. In each hospital a multidisciplinary design team was launched, consisting of the hospitals disaster preparedness coordinator, the EMS-staff, external emergency incident management and operational engineering experts. The appointed objectives for evaluation were the knowledge of the regular evacuation drills, especially the clearance of an intensive care or an operating room; access to evacuation routes; visibility of safety guidelines; need of specific evacuation equipment for the movement of patients; mission and tasks of the hospital's first response team and the medical incident manager; communication and information flow and the establishment of the hospital's coordination committee.

Conclusion

1. Simulated hospital evacuation exercises increased the hospital emergency preparedness, awareness and response to disasters within the hospital, in particular in a CCD, otherwise difficult to assess. 2. All three CCD experienced the same challenges and identified similar flaws. 3. A hospital disaster exercise manual might be of valuable help.
(A154) A Comprehensive Thrombolysis Service for Patients with Acute Ischemic Stroke Administered Prehospital and in an Emergency Department in Northern Taiwan
Authors: Chen Y. , Chen C. , Chiang C. , Peng G. , Tzeng R. , Huang H. , Huang C. , Wu W. , Hsiung K. , Liu H.
Published: May 2011

Background

Golden time of thrombolysis therapy in acute ischemic stroke is only three hours. Emergency medical services transport and hospital prenotification were not been strengthened in Taiwan.

Aims

In order to elevate the medical quality of acute ischemic stroke, we developed a Quality Control Circle (QCC) focused on a comprehensive thrombolysis service for patients with acute ischemic stroke administered pre-hospital and in an emergency department.

Methods

QCC activities contained early recognition of acute stroke by EMT, hospital prenotification, early emergency management, activate the stroke team, shorten the time to CT scan and report, and early thromobolytic therapy. There were three policy groups via quality method analysis which these methods aimed to improve the efficiency and quality of management process focused on acute ischemic stroke.

Results

Group 1: After the implementation of QCC, the number of times of pre-hospital notification was six in Mar. 2010, achieve the expected standard. Group 2: Responses were received from 160 people for the pretest and 145 people for the posttest. In the pretest and posttest analysis, significant improvement in the attitudes of the physician group (p < 0.001) and general behavior (p < 0.001) were disclosed. The case-based educational module of acute stroke was better than the traditional oral lecture especially in the nursing group (p < 0.001). Group 3: The rate of administering thrombolytic therapy/total ischemic stroke increased from 3.1% to 10.5 % (from Mar to Apr, 2010) after running the organized service. These activities reached the goal of expected standard (5%). All above groups were set up into standardization. The thrombolytic rate in effect maintainence was still around 5% eight months later.

Conclusion

Setting up and running a organized thrombolysis service for patients with acute ischemic stroke prehospital and in the emergency department can be a good method to increase the rate of administration of thrombolytic therapy.
(A155) Acute Myocardial Infarction with Upper Gastrointestinal Bleeding
Authors: Tandon S. , Bordoloi P. , Kole T.
Published: May 2011

Objective

To report a rare case of Acute Myocardial Infarction (AMI) along with Upper Gastrointestinal bleeding (UGIB).

Presentation and Intervention

A 58 year old male with history of black coloured stools was admitted in ER for chest pain and coffee ground emesis. ECG showed an acute inferior wall MI. After doing the necessary interventions, patient was inserted with a nasogastric tube and started on medications in the Emergency for UGIB followed by immediate endoscopy. Endoscopy confirmed presence of multiple superficial Ulcers in the stomach along with Esophagitis.

Conclusion

We support Esophagogastroduodenoscopy (EGD) prior to cardiac catheterisation in patients with AMI associated with overt Upper GI Bleed. This results in fewer complications as compared with direct catheterization
(A156) Performance Indicators: Technical, Physical and Mental Readiness
Authors: Mcdonald J.M.
Published: May 2011

The purpose of this presentation is to report the results from a series of standardized exercises administered to experienced, disaster-emergency-responders on their “operational readiness.” Based on original research with Olympic athletes, these results include: a frontline-perspective of challenges in a disaster; a quantitative definition of “readiness;” and the creation of related performance indicators. A growing body of literature has drawn attention to the significance of mental-readiness skills in attaining peak performance in challenging situations. For example, we know that top-level athletes have particularly well-honed mental-readiness skills and that this fact has often separated those who win a gold medal from those who do not. In recent years, this research has been extended to other occupations, including the field of surgery, policing, and now disaster-emergency-response, and similar results were found. For example, in the study entitled “Gold Medal Policing: Mental Readiness and Performance Excellence” (McDonald, 2006), peak-performing police officers demonstrated excellent technical and physical skills but excelled in mental readiness skills. Traditionally, the focus of most core-competencies has been on the technical and physical skills necessary to perform the duties. Given what we now know about the significance of mental-readiness skills, we can specifically develop and formally recognize these skills. That is, in addition to seeking the technical and physical skills required of a job, particular emphasis is places on refining the mental skills that ultimately makes the difference between satisfactory performance and peak performance. The goal of any field-training, is to produce a competent, independent, functioning frontline-responder. Such a responder will demonstrate concrete, observable “performance indicators.” Current research on peak performers has been integrated into developing comprehensive performance indicators. This outcome can benefit the recruitment, selection, training and evaluation of professions seeking to enter into the unique world of disaster emergency medicine.
(A157) Interprofessional Education as a Vehicle to Instill Teamwork Mentality for Disaster Preparedness and Response in Healthcare Professional Students
Authors: Mackintosh S. , Mcclure D.
Published: May 2011

There is a crucial need for teamwork in disaster management. Gaps in collaborative efforts resulted in significant loss of life and property during recent disasters. Such losses could have been minimized with enhanced teamwork. Unfortunately, the current US healthcare system fosters a fractured structure where health professions work in isolated silos. While coordinated disaster management has done much to overcome this, the silo mentality still inhibits maximal achievement toward the four phases of emergency and disaster preparedness and response. Since 2007, Western University of Health Sciences (Western U) has embarked upon an initiative focusing upon the concept of patient-centered, collaborative care in students from the beginning of the clinical education process. The intent of the program is to instill in all students non-technical competencies that promote teamwork such as communication, collaboration, and understanding scope of practice. The long term vision is to develop a three phase program (case based, team training and clinical experience) that will take the student through an awareness level to an application level of the competencies. The second phase of the program utilizes the TeamSTEPPS® training to instill these competencies in students. The application and assessment of the teaching points will be through community and patient safety exercises that include topics such as disaster preparedness and response. In conjunction with the TeamSTEPPS® training, the students from the nine professional programs (DO, PA, PT, PharmD, Graduate Nursing, Vet Med, Dental, Podiatry, and Optometry) will also be exposed to principles and practices of disaster response. By intensifying teamwork principles as the basis of disaster preparedness, the response pool for disaster response will be amplified, and future healthcare practitioners will be more aware of teamwork strategies necessary in a disaster setting. The intent of this presentation is to introduce this academic model including early outcome data.
(A158) Preventing Disasters: Public Health Vulnerability Reduction as a Sustainable Adaptation to Climate Change
Authors: Keim M.
Published: May 2011

Background

Global warming is predicted to increase the number and severity of extreme weather events. (IPCC 2007) But we can lessen the effects of these disasters. “Critically important will be factors that directly shape the health of populations such as education, health care, public health prevention and infrastructure.” (IPCC 2007) A comprehensive approach to disaster risk reduction (DRR) has been proposed for climate change adaptation. (Thomalla 2006) DRR is cost-effective. One dollar invested in DRR can save $2-10 in disaster response and recovery costs. (Mechler 2005) Disasters occur as a result of the combination of population exposure to a hazard; the conditions of vulnerability that are present; and insufficient capacity to reduce or cope with the potential negative consequences.

Discussion

By reducing human vulnerability to disasters, we can lessen—and at times even prevent—their impact. Vulnerability may be lessened by: 1) reducing human exposures to the hazard by a reduction of human vulnerability, 2) lessening human susceptibility to the hazard, and 3) building resilience to the impact of the hazard. (Keim 2008) Public health disasters are prevented when populations are protected from exposure to the hazard. Public awareness and education can be used to promote a “culture of prevention” and to encourage local prevention activities. Public health disasters may also be mitigated through both structural and social measures undertaken to limit a health hazard's adverse impact. (IPCC 2007) Community-level public health can play an important part in lessening human vulnerability to climate-related disasters through promotion of “healthy people, healthy homes and healthy, disaster resilience communities.” (Srinivasan 2003)
(A162) Preparing Plans! Helping First Responders Prepare the Population
Authors: Simon-Agolory K.M. , Watkins K.Z.
Published: May 2011

It is common knowledge that having an individual or family disaster plan is vital for saving lives and property before, during and after a disaster. First responders have the daunting task of helping many people during a disaster. It would make their jobs easier if people had disaster plans before a disaster. However, for a variety of reasons, few people have a disaster plan. People often do not develop disaster plans due to the time required to devise a plan, a lack of knowledge of the benefits of having a plan, or the effort required for the primarily manual process of developing a disaster plan. Wilberforce University has designed a solution called Wilberforce's Information Library Boosting Emergency Recovery (WILBER) which is a customized, online tool to quickly and automatically generate disaster plans to help save lives and property as well as mitigate the impacts of a potential disaster. WILBER utilizes an interdisciplinary approach to automatically generate a basic disaster preparedness plan. The system addresses a wide range of disasters but focuses on floods, earthquakes and technological disasters such as terrorism and nuclear disasters. WILBER automatically processes locally relevant data intelligently and combines mathematical analysis; distributed computing; individual and business risk management; current and historical information from a comprehensive Geographical Information Systems (GIS) that includes imagery, infrastructure, demographic, and environmental data; and wireless sensors for real time condition assessment. Not planning for a disaster only increases the potential magnitude of a disaster. WILBER allows citizens to quickly establish immediate procedures in the event of an emergency which in turn can lessen the burden on first responders and reduces the likelihood of loss of life. This research is funded by the Department of Energy's National Nuclear Security Administration and conducted by the Wilberforce University Disaster Recovery Center in Wilberforce, Ohio, USA.
(A72a) Development of Emergency Medical System in High Speed Train and Station
Authors: Wang S.J. , Byun H.J.
Published: May 2011

Introduction

High speed train is defined as train which can run at the speed of more than 200Km/h and Korean version of high speed train (Korean Train Express: KTX) runs at 300Km/h on average. Because of high speed, safety is the most important issue of high speed train, so the early detection of technical error and operational safety have been emphasized. But the research about emergency medical system for patients occurring in the high speed train and stations is insufficient. So author analyzed the project on development of emergency medical system for cardiac arrest in the high speed train and stations.

Methods

The project on development of emergency medical system for cardiac arrest in the high speed train and stations was analyzed retrospectively and the real situation was confirmed by interviewing the staffs and visiting the high speed train and stations. The education on both basic life support and PAD (public access defibrillation) for staff of the high speed train and stations was analyzed. Simulation was perfomred for adequate distribution and arrangement of AEDs (automatic external defibrillators) in the high speed train and stations.

Results

The education on both basic life support and PAD (public access defibrillation) for staff of the high speed train and stations was performed to 1323 persons from October 2008 to June 2009. Total 51 AEDs were arranged in 6 stations and 87 AEDs were arranged in the high speed train. One AEDs were arranged for successive 6 passenger car in a train. Public education by repeated video playing in the high speed train was started.

Conclusions

The emergency medical system for cardiac arrest in the high speed train and stations was developed by training staffs and arranging AEDs initially. The next step will be developing the disaster medical system in the high speed train.