bluuebunny/crossref_metadata_2025 huggingface dataset:
Caring for the Vulnerable Geriatric Individual in a Disaster
Authors: Mace Sharon , Doyle Connie
Published: May 2019

Introduction:

The elderly have the highest rates of morbidity/mortality in a disaster and are therefore the most vulnerable. 50% of deaths in Hurricane Katrina were ≥75 years old. In the California wildfires, most deaths were people in their 70s and 80s living in areas with unreliable communication services (without cell phone service, etc.), and were uninformed of the disaster or unable and/or unwilling to evacuate. Issues include social isolation and limited technology skills (may not receive messages).

Methods:

A review of the literature and after action reports from multiple disasters.

Results:

Augmented services are needed for persons with decreased mobility (impaired access to transportation and shelters); impaired senses; dependence on devices/technology, comorbidities requiring medications/equipment/oxygen, special feedings, sanitary/hygiene needs increased susceptibility to environmental extremes (heat, cold), inability to do ADLs (need for caregivers), increased susceptibility and increased morbidity/mortality with infections, illnesses, trauma; exacerbation of underlying conditions/illnesses when in crowded transportation vehicles and shelters. Additional stress may precipitate or exacerbate coping skills especially in those with dementia, delirium, or mental health illnesses.

Discussion:

Recommendations include the following:

1.

Communications: messages in various forms: closed captioning, TTY deaf phones, use of family, friends, neighbors, officials for notification in addition to mass communication notices, house-to-house notification.

2.

Medical: Medical/Special Needs Shelters to provide medical care (dialysis, etc.), cache of common medications (diabetic and BP medications) and devices (BP monitoring, glucometers), oxygen, wound care supplies, potable and non-potable water, special diets/formulas, feeding tubes, catheter care, diapers and other hygiene supplies.

3.

Independence: Health care professionals to assist with medical and psychiatric needs. Caregivers to assist with ADLs.

4. Supervision: Those with dementia, delirium, mental health conditions may need supervision.

5. Transportation: Need for ambulances, wheelchair vans, specially equipped buses/vans in addition to “usual” school buses/vans with access to water, food, and sanitation if traveling long distances.
Challenges in Dealing with Supervised and Institutionalized Populations in a Disaster
Authors: Mace Sharon , Doyle Connie
Published: May 2019

Introduction:

Those residing in supervised facilities including nursing homes, mental health facilities, group homes, and penal institutions for health, legal, or security reasons present unique challenges in a disaster.

Methods:

A review of the literature and after action reports on supervised and institutionalized populations in disasters.

Results:

Recommendations for supervised, institutionalized populations in a disaster include: (1.) preplanned agreements for specialized transportation if needed; (2.) reciprocal agreements between similar facilities (nursing home with another nursing home, prison with other prison, dialysis centers, etc.) for resource sharing; (3.) arrangements for sharing and emergency privileging of personnel in institutions that are not their primary workplace; (4.) just-in-time training for appropriate volunteers; and (5.) accommodations for family members if personnel are to be available during a disaster.

Individuals in some institutions need a personalized disaster plan with pertinent data: next of kin with contact information, medical records, care providers and care plan to accompany a mobilized individual. Long-term care and housing may be needed if the institution is nonfunctional. Dealing with medical and behavioral issues is secondary to the disaster. Chronic issues must be considered as well.

Discussion: Caring for specialized, institutional individuals is complex and difficult. Comprehensive pre-disaster planning can mitigate the effects of the disaster.
Chemical and Radiation Training for Public Health and Nursing Students: An Under-Utilized Disaster Response Demographic
Authors: Atti Sukhi , Kiernan Emily , Layer Mark , Sahin Aynur , Alotiabi Shaikhah , Als uk aiti Waleed , Shuk Sydney , Lindros Kayla , Giberson Tyler , Kazzi Ziad
Published: May 2019

Introduction:

Public health (PH) and nursing students are an underutilized demographic in disaster response. Knowledge of the disaster response phase may enhance student understanding of preparedness, and provide response capabilities.

Aim:

A single four-hour simulation-based training session, with toxicologists as instructors, can effectively improve PH and nursing student knowledge and skills in chemical and radiation response, despite minimal prior experience.

Methods:

A convenience sample was used to test PH and nursing students in a response training program. An introductory lecture and simulation training reviewed: mass casualty care, triage, personal protective equipment, decontamination, and chemical and radiation exposure toxidromes. An examination was administered pre-training, and then post-training, to evaluate relevant training, knowledge, risk perception, and comfort in response capabilities to chemical and radiation incidents.

Results:

Forty-two students attended the course; 39 were included in the study. Seventy-two percent (n=28) of participants had no prior disaster training. Overall, there were significant differences between the pre-test and post-test scores for all students [95% CI: 5.4 (4.7-6.1); p<0.0001, paired t-test]; maximum score 15/15. Comparing scores of nursing and PH students, despite statistical difference in pre-test scores (median, IQR: 9.0 (7.5-10±2.0); 7.0 (5.7-9.0) respectively; p=0.048, Mann Whitney U-test), there were no statistical differences in post-test scores (median, IQR: 14.0 (13.0-14.0); 13.0 (12.0-14.0), respectively, Mann Whitney U-test). All students recognized nerve agent toxidrome and performed SALT triage after the training (p <0.0001, McNemar test). Subjectively, participant comfort level in responding to a chemical or radiological incident improved (p <0.0001, McNemar test). Individual risk perception for chemical or radiological disasters did not improve after training.

Discussion:

Improvement of knowledge and comfort was demonstrated, irrespective of previous experience. Simulation-based training of chemical and radiation disaster preparedness, led by medical toxicologists, is an effective means of educating PH and nursing students, with minimal prior fluency.
Collaborative Relationships for Mass Gathering Events
Authors: Jones Tracie
Published: May 2019

Introduction:

Electronic Dance Music events (EDMs) are complex mass gatherings and given published rates of illnesses, injuries, and hospitalizations, these events can place an additional burden on local health care services. Accordingly, during the planning process for EDMs many stakeholders are involved; however, local hospitals, a key part of the medical safety plan, are often excluded. In this case report, it is posited that the involvement of local hospital(s) and the resulting integration of on-site and acute-care service provision during an event, ultimately reduces the burden placed on local hospitals.

Methods:

Case report; synthesis of published literature.

Results:

A 25,000 person per day, two-day mass gathering EDM event trialed a model of collaborative planning with a local community hospital. Planning included the identification of a hospital liaison, pre-event teleconferences between event staff, contracted and public medical response teams, emergency management teams, harm reduction practitioners, public health, and hospital personnel. Throughout the collaborative planning process, vital information was shared in order to optimize patient continuity of care and streamline the transition of care from site medical response to an acute care setting. Outcomes included the prevention of unnecessary transfers to the hospital; however, those patients who required transfer had their initial treatment started prior to leaving the venue. Further, collaborative planning also contributed to improved bidirectional data sharing to better understand the impact on the local hospital of the event, including transfers from the onsite medical team as well as transports from the community and self-presentations for care.

Discussion:

The collaboration of onsite medical and hospital teams improved the delivery of essential medical care to the patrons of the event and added a layer to the safety planning process essential to mass gathering events.
Concerns for Small Hospitals in Rationalising Trauma Services: How Do We Ensure Enhanced Patient Services in Rural Areas?
Authors: Molloy Michael , Kelly Paul , Ciottone Gregory R
Published: May 2019

Introduction:

Trauma bypass has been introduced successfully worldwide with sustained reductions in mortality/morbidity. Analyzing structure, process, and outcome individually and collectively in systems has been found to focus improvement efforts in the audit cycle. The second Irish report on Major Trauma Audit (MTA) was published in December 2017. The median age of trauma patients in Ireland was 59, indicating an aging trauma population. 28% of patients required secondary transfer to complete their care. The mortality rate for 2016 was only 4%.

Aim:

To determine the ability of a road-based EMS system to bring patients from areas of Wexford County to proposed receiving centers within 60-90 minutes.

Methods:

Analysis took population centers in Wexford County, used Google Maps to estimate travel times at 3pm on a weekday, and proposed new trauma units and centers in Dublin, Cork, and Waterford.

Results:

In Wexford County urban centers, >95% of patients will not reach a trauma unit in less than 60 minutes with current prehospital medical service capabilities. This even excludes response/on-scene time by prehospital practitioners in land-based EMS vehicles.

Discussion:

The proposed introduction of trauma bypass systems in Ireland should not disenfranchise patients with respect to the standards they are currently receiving. Gap analysis suggests considerable work is required within the ambulance service to increase critical skill levels of paramedics to support critical patients in the golden hour of their transfer. An increase in vehicles/resources will be required to ensure adequate staffing to meet Health Information and Quality Authority (HIQA) targets of 8 and 19 minutes for response acuity, and for longer durations of transport allied to dynamic resource deployment model as used by National Emergency Operations Centre (NEOC). Unintended consequences of system changes will need to be monitored carefully to avoid further adversely impacting recruitment of staff to bypassed Model 3 hospitals.
Culturally Sensitive Disaster Nursing Focusing on Pacific Rim Island Countries: First Report on Japanese Public Health Nurses
Authors: Marutani Miki , Harada Nahoko , Uebayashi Mihoko , Anzai Yukiko , Takase Kanae , Okuda Hiroko
Published: May 2019

Introduction:

Providing culturally sensitive disaster nursing is essential to enhance survivors’ resilience, especially in Pacific Rim island countries, which are home to 80% of the disaster victims of the world. Until now, most studies have focused on immigrant culture or language, and few have explored the idea of disaster nursing adjusted to the affected area’s culture.

Aim:

The study explores public health nurses’ (PHNs) tacit knowledge regarding culturally sensitive disaster nursing focusing on the Pacific Rim island countries. This first report is the result of the study that clarified how Japanese PHNs, as relief nurses, considered the local culture to provide care to survivors in Japan.

Methods:

Study participants were nine PHNs from seven prefectures, who provided care to survivors of natural disasters that occurred in 2011–2017 in Japan. Semi-structured interviews were conducted with questions such as, “Which culture did you consider while providing care to survivors in each disaster phase?” Data were analyzed qualitatively and inductively and were sorted according to the four disaster phases. The study was approved by the ethical committee at the National Institution of Public Health.

Results:

In the acute phase, PHNs utilized close relationships between local residents and health care providers to collect information. They balanced local habits and the prevention of secondary health damage in the subacute phase; for example, balancing sanitation habits and prevention of contaminations. Additionally, they, as strangers to the community, played a role in alleviating tensions between residents under stress. During the recovery phase, they strengthened survivors’ attachment to the area.

Discussion:

PHNs dispatched from the outside of the affected areas must be culturally malleable to adjust their practice to the local context. Being strangers in an affected area can be advantageous if they utilize their position effectively.
Description of Disaster Forms Usage in Health Cluster in Lombok and Palu Earthquake
Authors: Ariani Madelina , Donna Bella
Published: May 2019

Introduction:

The effort of medical and health services distribution requires data. However, the data and information were ignored in an emergency situation. For improving the distribution of data and information, the Center of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada (UGM) developed forms based on Health Crisis Response Guideline by Ministry of Health 2016 and the World Health Organization (WHO).

Aim:

Describing the implementation and development of forms based on Lombok and Central Sulawesi earthquake in 2018 for health cluster.

Methods:

The form contains (1) a volunteer registration form; (2) a monitoring potential outbreak disease form; (3) health problem in health cluster daily report form; (4) a chronological situation form. This will be implemented in health policymaking by the Sulawesi district health office (DHO) and will be regularly analyzed in every week.

Results:

North Lombok DHO, Central Sulawesi health office, and volunteers accepted these forms well. Periodically volunteers had reported their activity to DHO. All these reports contain many health indicators including environmental health. Reproductive health and health promotion. Implementation of this form in the other type of disaster in Indonesia is suggested.

Discussion:

First, these forms are important to attach to the guideline of health crisis response in order to be accessed by all DHO. Second, all forms are printed documents. It needs to develop into data input and analysis applications.
Development of an E-Learning Platform For EMTs In Ghana
Authors: Bonney Joseph , Namburete Ana I. L. , Dagadu Sesinam , Quao Nana Serwaa , Osei-Ampofo Maxwell , Awariyah Dominic , Cobbold Sonia
Published: May 2019

Introduction:

The continuous development of the knowledge and skill of the emergency medical technicians (EMTs) in Ghana is important for the success of the pre-hospital system. Due to distance and time constraints, an online e-learning platform is a good way to educate the Emergency Medicine Technicians in Ghana.

Aim:

The study looked at the feasibility of developing a distant learning module for the training and continuous medical education of EMTs.

Methods:

EMTs in the Ashanti Region were randomly selected to be part of the study. They received online lectures and notes that were accessible by their mobile phones. They all received a test at the end of each model. The study measured their willingness to participate, average attendance for each model, and the scores for each model test. The study also measured the overall feasibility of the distant learning program.

Results:

The study developed a training course comprised of 7 modules: trauma and surgical emergencies, obstetric emergencies, pediatric emergencies, disaster management, medical emergencies, basic ultrasound, and medical research. Tests and quizzes were electronically sent to EMTs over the course of the research period, with an average test score of 70.14% (low: 35%, high: 95%) for the cohort. Feedback from participants showed gains in knowledge and skill delivery. The average attendance for all model was 56.6% ranging from 47.37%-63.16% for the models. Challenges for attendance included internet access, heavy duties, and other personal reasons. The post-training interview showed 100% willingness to participate in future online programs with the most common reasons stated as low cost, ease of attendance for models, and reduced expense.

Discussion:

The study concluded that online, distant learning models can be used in Ghana for training and continuous medical education for EMTs. It is an easy and cost-effective model compared to a face-to-face model.
Development of Trauma and Disaster Response in Togo, Africa
Authors: Benin-Goren Odeda , Aviran Nimrod , Adler Iris , Zlotnik Oran , Baratz Yossi
Published: May 2019

Introduction:

The project was provided under the auspice and support of the Israel Agency for International Development Cooperation (MASHAV) at the Ministry of Foreign Affairs (MFA). Togo, one of the smallest and least developed countries in West Africa, has a population of ~7.9 million. About 65% of its population lives in rural areas. Due to the lack of medical resources, Togo suffers from health problems including those related to trauma and mass events. In May 2017, a trauma and disaster team came to Togo to train the medical team in the new trauma unit, donated and built by the MFA. The unit was built in the Atakpame Regional Hospital (ARH), located 160km north of the capital, Lomé. ARH serves one million inhabitants, mostly from rural areas.

Methods:

The training included lectures, simulations, drills, case studies, bedside teaching, and operation of medical technologies.

Results:

Following the training, it was recommended to continue the program and to move forward with advanced training. Following the team’s recommendations, MASHAV decided to expand the program and to provide a multilateral project to Togo and ten other West African countries within five months after the first training ended. Twenty participants (mostly senior doctors) were chosen from ten Western African countries and brought to Lomé. The participants joined a two-day Trauma and Disaster Preparedness seminar. Following the seminar, they were moved to Atakpame to join the local team and the facilitators, to visit the trauma unit, and to learn about it as a model for trauma care that can be modified to the capabilities of the local facility.

Discussion:

Lessons learned and recommendations from those two projects were brought to the MFA that will try to develop more training and cooperation models to help and establish better trauma care and disaster response, supported by the Israeli team.
Disaster Education and Drills in Turkey: Do We Prepare Ourselves for Unexpected Disasters?
Authors: Ülker Volkan , Erdoğan Özcan
Published: May 2019

Introduction:

Turkey is vulnerable to many natural hazards, including earthquakes, landslides, floods, and terrorist attacks. The 7.1 magnitude Marmara Earthquake in 1999 resulted in over 18,000 deaths and estimated losses of over $28 billion. The country’s largest city, Istanbul, is located on the North Anatolian Fault and thus highly prone to earthquakes. It is estimated more than half of the population in the country are potentially seismically vulnerable. This vulnerability makes us ready for disasters. Turkey has advanced disaster risk management through initiating reforms to better manage and reduce disaster risk and strengthening institutions.

Aim:

To overcome institutional fragmentation, the government established the Disaster and Emergency Management Presidency (AFAD) in 2009.

Methods:

Assess the 2015 government adopted Turkey National Disaster Response Plan to guide all disaster and emergency response.

Results:

In the last six years, Turkey has become one of the world’s largest refugee-hosting countries. As of 2018, approximately 3.5 million Syrians under temporary protection have largely been integrated into cities, towns, and villages that stressing the infrastructure and increasing potential risk exposure. This situation makes us recognize disaster protection preparedness. We have many public and civil institutions to prepare society for unexpected situations. The main institution is the Disaster and Emergency Management Presidency. AFAD has many projects for youth, school children and all age groups of society. The second organization is the Red Crescent organization of Turkey. The other organizations are mainly National Medical Rescue Teams (UMKE), some university disaster clubs, and civil institutions like Beşir NGOs.

Discussion:

These institutions give main disaster confidence education, main CBRN education, main fire-fighting education, camping life educations, orienteering, mobile oven, and kitchen facilities and drills. We have to raise awareness of the community about preparedness to disasters. We have to share lessons with the whole population for reducing social and economic loss.
Disaster Medical Management of Pediatric and Perinatal Disaster Medical Liaison (PPDML) for Children and Pregnant Women in Osaka, Japan
Authors: Arimoto Hideki , Furuya Shinsuke , Yamashita Kimiko , Tanaka Kazuharu , Maruyama Tomoko , Takeuchi Muneyuki , Wada Kazuko , Ogita Kazuhide , Misaki Miho , Fuke Akihiro , Rinka Hiroshi
Published: May 2019

Introduction:

Children are a vulnerable population in disasters. However, there were few pediatricians, neonatologists, and obstetricians in the Japan Disaster Medical Assistance Team (DMAT), so disaster medical headquarters had limited knowledge to solve these problems. Pediatric and perinatal disaster liaison coordinators were trained to improve disaster medical management for children and pregnant women since the 2016 Kumamoto earthquake.

Aim:

To analyze and report the activity of PPDML during these years in Osaka, Japan.

Methods:

The records of PPDML in major disasters and disaster drills from 2017 to 2018 were reviewed.

Results:

The DMAT had disaster drills twice a year in Osaka, and PPDML participated in the drill for the first time in July 2017. In the drill, PPDML coordinated the pediatric and perinatal issues with DMAT and Japan Ground Self-Defense Force (JGSDF) in disaster headquarters. In June 20184. months after the drill, PPDML participated for the second time in February 2018 when the North Osaka Earthquake occurred. PPDML coordinated transport of 22 children and babies with congenital heart disease from the damaged National Cerebral and Cardiovascular Center Hospital. The operation was finished within 5 hours after requested transportation.

Discussion:

To protect children and pregnant women, cooperation between the disaster medical network and the pediatric and perinatal network is absolutely important for any phase in disaster. Because PPDML had attended in disaster drills before, the experience could make PPDML achieve good performance in a real disaster in North Osaka Earthquake. It can be concluded that cooperation between disaster medical network and PPDML is very useful to manage the disaster issues for children and pregnant women, and the most important thing is to cooperate not only in disaster but also in ordinary days.
Discovering Best Practice Establishing Evacuation Centers for Vulnerable Populations: Findings from Australia and Japan
Authors: Kako Mayumi , Steenkamp Malinda , Ryan Benjamin , Arbon Paul , Takada Yosuke
Published: May 2019

Introduction:

Potentially vulnerable population groups in disasters include the elderly and frail, people who are isolated, and those with chronic diseases, including mental health conditions or mobility issues. The disasters such as the Queensland flood and Great East Japan Disaster in 2011, affected regions of Australia and Japan. This study is followed by two pilot studies in both countries after the disasters. While both countries have different evacuation center procedures for evacuees, the issues regarding the role and responsibility across governments involving planning, setup, and management of evacuation centers demonstrate similarities and differences.

Aim:

This paper will report the preliminary findings of a pilot study undertaken with local government officials and humanitarian agencies in Australia and Japan concerning their involvement in planning for, setting up, and managing evacuation centers for vulnerable populations in recent natural disasters. The objective is to illuminate the similarities and differences that officials and agencies faced, and to highlight the resolutions and lessons learned in the preparation of evacuation centers through this event.

Methods:

This is the final stage of the study. After completing an analysis of both phases, a comparative framework to highlight similarities and differences was developed.

Results:

Each government’s role in relation to the establishment of evacuation centers is legally defined in both countries. However, the degree of involvement and communication with non-governmental organizations from the planning cycle to the recovery cycle demonstrates different expectations across governments.

Discussion:

While the role of governments is clearly established in both countries based on the legal frameworks, the planning, set-up, and management of evacuation center differs.
The Effect of Emergency Department Expansion on Emergency Department Patient Flow
Authors: Kim Min Joung , Park Joon Min
Published: May 2019

Introduction:

Overcrowding in the emergency department (ED) has been a global problem for a long time, but it is still not resolved.

Aim:

To determine if an ED expansion would be effective in resolving overcrowding.

Methods:

This was a retrospective study comparing two 10-month periods before (September 2015 to June 2016) and after (September 2017 to June 2018) the ED expansion in an urban tertiary hospital. The existing ED consisted of 45 beds in the adult area and eight beds in the pediatric area. After the construction, the number of beds was not increased, but a fast track area was newly established in the adult area, and a 25-bed ward for emergency hospitalized patients was opened.

Results:

The number of patients visiting the ED increased from 77,078 to 87,927. The proportion of patients who returned home without treatment significantly decreased from 11.5% to 0.9% (p<0.001). The number of adult patients increased from 40,814 to 60,720, but the number of patients who could be treated on the bed decreased (22,166 (54.3%) vs. 17,776 (29.3%), p<0.001). The number of pediatric patients was similar in both periods. Median ED length of stay (LOS) of total patients increased from 193.0 min to 205.8 min (p<0.001). Of the 18,900 hospitalized patients during post-period, 1,255 (6.64%) were admitted to the emergency ward, and the boarding (from admission decision to hospitalization) time of the admitted patients decreased from 239.2 min in the pre-period to 190.9 min in the post-period by 38.3 min. However, more time was required for admission decision in the post-period (216.8 vs. 253.3, p<0.001).

Discussion:

The ED expansion allowed more patients to be treated, and the emergency ward reduced boarding times of admitted patients. However, due to the increase in the number of patients, the time required for medical treatment increased.
The Experience of a Mass Casualty Incident Call in a Tertiary Hospital after the 2018 Hualien Earthquake
Authors: Cheng Hsing Chia , Niu Kuang Yu , Ho Ming Han
Published: May 2019

Introduction:

After a 6.0 magnitude earthquake struck Hualien on February 6, 2018, over one hundred and fifty patients crammed into the emergency department of a nearby tertiary hospital within two hours. The mass casualty incident (MCI) call was activated, and over 300 related personnel responded to the call and engaged with the MCI management.

Aim:

This research aimed to analyze the practice of an MCI call and to form the strategies to improve its efficiency and effectiveness.

Methods:

The research was conducted in a tertiary hospital in Hualien, Taiwan. Questionnaires regarding the practice of the MCI call were sent out to the healthcare providers in the emergency department who responded to that MCI operation.

Results:

Thirty-seven responders in the emergency department were involved in this study. 78% had participated in training courses for hospital incident command system (HICS) or MCI management before this event. On arrival at the emergency department, 69.4% of the responders were aware of the check-in station and received a clear task assignment and briefing. During the operation, 25.7% reported the lack of confidence carrying out the assigned tasks and 54.1% of the participants experienced great stress (stress score over 7 out of 10).

Discussion:

MCI is an uncommon event for hospital management. It is universally challenging owing to its unpredictable and time-sensitive nature. Furthermore, the administration could be further complicated by the associated disasters. Despite regular exercises and drills, there are still a significant number of participants experiencing stress and confusion during the operation. The chaotic situation may further compromise the performance of the participants. This study showed that optimizing task briefing and on-site directions may improve the performance of the MCI participants.
Health Care Provision during a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery
Authors: Johnston Amy , Wadham Jasmine , Polong-Brown Josea , Aitken Michael , Ranse Jamie , Hutton Alison , Richards Brent , Crilly Julia
Published: May 2019

Introduction:

During mass gatherings, such as marathons, the provision of timely access to health care services is required for the mass gathering population as well as the local community. However, effective provision of health care during sporting mass gatherings is not well understood.

Aim:

To describe the structures and processes developed for an emergency team to operate an in-event acute health care facility during one of the largest mass sporting participation events in the southern hemisphere, the Gold Coast marathon.

Methods:

A pragmatic qualitative methodology was used to describe the structures and processes required to operate an in-event acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with Emergency Department (ED) clinical staff working during the two-day event was undertaken in 2016.

Results:

Structural elements that underpinned the in-event health care facility included: physical spaces such as the clinical zones in the marathon health tent, tent access, and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms. Critical processes included: clear communication pathways, interprofessional care coordination, and engagement involving shared knowledge of and access to resources. Distinct but overlapping clinical scope between nurses and doctors was also noted as important for timely care provision and appropriate case management. Staff outlined many perceived benefits and opportunities of in-event health care delivery including ED avoidance and disaster training.

Discussion:

This in-event model of emergency care delivery enabled acute out-of-hospital health care to be delivered in a portable and transportable facility. Clinical staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
HESPER SW: A Web-Based Tool to Assess Needs
Authors: Hugelius Karin , Semrau Maya , Holmefur Marie
Published: May 2019

Introduction:

The Humanitarian Emergency Settings Perceived Needs Scale (HESPER) evaluates experienced needs among disaster-affected populations and has been frequently used in both humanitarian emergencies and research. Today, the use of this tool is increasing among people affected by crises and emergencies. Web-based methods have shown to reduce several methodological and practical challenges in disaster health research.

Aim:

This project aims to develop and evaluate HESPER SW (a self-administered, web-based version of the HESPER scale).

Methods:

Alternative reliability and test-retest validity of HESPER SW were evaluated using different analytic statistical methods.

Results:

The first analysis suggests that HEPSER SW is a reliable and valid instrument which is easy to use and that it reduces several methodological and practical challenges in disaster health research.

Discussion:

HESPER SW can be used both for humanitarian and research purposes and offers a quick, self-administered, web-based, and scientifically robust way to investigate experienced needs in populations affected by disasters or humanitarian crises.
The Human Disaster and the Urgency of the Intersetorial Join Between Public Social Policies: Lives that are Lost and Stories that Repeat Themselves
Authors: Bellini Maria Isabel Barros , Marques Nadianna
Published: May 2019

Introduction:

The human disaster is a permanent challenge for the Brazilian government because the difficulties faced are related to the lack of interface between public policies, resulting in fragile analyses of risk and non-prevention, being that annually several Brazilian lives are lost in disasters that continue to happen.

Aim:

The article is the result of research and presents the analyses of health policy, actions, and programs developed to anticipate the fire victims of the Nightclub Kiss concert hall that took place in 2013 (Santa Maria, Brazil). The objective was to investigate and analyze the disasters and human disasters, especially the fire of Nightclub Kiss when 242 young people died. Causes and determinants were analyzed in order to subsidize public policies, in particular, the health policy.

Methods:

A qualitative case study supported by the critical dialectic method with semi-structured interviews, focus group, documentary analysis, and bibliographic review.

Results:

The experiences accumulated throughout history show that disaster situations require public policies to be able to act readily, resolve, and pay attention to the needs of the population involved. Disasters are increasingly recurrent episodes and generate deep social consequences that mark human life. Managing a human disaster remains a challenge for the health policy in Brazil. The difficulties faced are related to the lack of interface with other public policies. The urgency to incorporate intervention/action strategies into health plans is important. Implementation of prevention and training programs, and adopting strategies and protocols for the whole network of attention is critical.

Discussion:

It is important to emphasize the importance of broadening the theoretical definitions by overcoming the divergences of the concepts adopted between the theoretical and operational field, by elaborating a review of the Brazilian legislation in order to broaden and contemplate the needs of different people.
Human Factor and Disasters: Possible Equations
Authors: Bellini Maria Isabel Barros , da Silva Ines Amaro , Gershenson Beatriz , Correa Michele Cardoso
Published: May 2019

Introduction:

This research starts from the assumption that work accidents, in addition to fortuitous or individual phenomena, imply social and organizational factors, and highlights the social character of the production of the accident at work. For this reason, this study investigates the living conditions and the ways of workers in the oil and gas industry in Brazil.

Aim:

To analyze the human factors in the relationship with work accidents on oil platforms from the social dimensions.

Methods:

It is qualitative research and it has as instruments of collection the focal group and individual interviews with workers and managers of the platforms, participant observation, and documentary analysis.

Results:

The research is still being carried out, but some reflections are possible so far: accidents at work depend on the direct or indirect relationship of workers with the work process itself, the modalities of production of work, and management of work. Possible causes underlying the accident are the quality of life and the conceptions of health and safety. Associated with it are social constructs and the multifactorial causes of occupational accidents including the relations between acts and unsafe conditions.

Discussion:

The increase in outsourcing and the decrease in training quality, as well as the prioritization of production, targets the detriment of meeting safety criteria. There is a need to reassess labor management, safety policies, and outsourcing processes. Lack of awareness of the proper use of safety equipment and the organization of the work environment are major causes of work-related accidents. The human factor focuses on the individual, group, organizational, and social dimensions in complex interactions. The identification of social processes between working groups in empirical reality, the influence of elements of culture, organizational management, and their impacts on relations and on safe work performance allows an understanding of social risks.
Immunization Readiness of a Deploying Emergency Medical Team
Authors: Morrow Melanie , Sekulich Hollie , Trewin Abigail , Archer Peter
Published: May 2019

Introduction:

It is a requirement for a World Health Organization verified Emergency Medical Team (EMT) that all members be immunized against common diseases in the deploying region. Most jurisdictions use private suppliers such as travel doctors for immunization services. When a deployment is announced, members are nominated by their jurisdiction under the condition they are fully immunized. It is up to the individual to monitor their immunization status.

Aim:

To determine how many members nominated for deployment were fully immunized.

Methods:

Nominated members sent their completed vaccination record to a central location for assessment of their immunization status. The following data were recorded: vaccination status, last-minute booster doses required, and the number of emails sent by the assessor in processing the records. The number of phone calls made and received were not recorded.

Results:

To complete the skills matrix for a field hospital containing an emergency department and operating theater (an EMT type 2), 61 members were nominated. At the time of assessment, 32 (52%) were fully immunized, requiring no further booster doses (vaccinations or serology tests). Three members were removed from the deployment as they were not fully immunized. Last-minute booster doses were required by 27 (44%) members, with a total of 74 booster doses administered (range 0-5). 19 of the booster doses administered were immunizations required to work in any health facility in Australia. The most common vaccines requiring booster doses were rabies (n=21) and typhoid (n=15). 58 emails were sent over a period of 5 days to 24 members to clarify vaccination status.

Discussion:

This deployment highlighted a gap in members’ perception of their immunization status, leading to delays in deployment readiness for the team. A new electronic system where vaccine status tracking occurs in real time should address this issue.
Impact Scale for the Continuity of Care in Contingency Management Situations - Operationalization of the Crisis Standards of Care
Authors: Geene Roel , van der Torn Pieter , den Hartog Dennis
Published: May 2019

Introduction:

A common language is needed to compare the impacts of incidents, crises, and disasters among health care coalition members, such as emergency medical services, general practitioners, and hospitals. A generic impact scale was developed, based on the Crisis Standards of Care, and was put to the test during the 2017 and 2018 winter/flu-seasons.

Aim:

To define an impact scale for the quantitative assessment of the hospital response to incidents, crises, and disasters.

Methods:

An impact scale has to be generally applicable to be useful in the context of a health care coalition. It should be applicable to all hazards and all parties in proactive and reactive, real-time settings. In addition, the scale should be easy to understand and score and should be independent of the various information systems in use. The Crisis Standards of Care were chosen as basis and were operationalized in a seven-point Likert-scale for expert-based scoring: “No impact,” “Buffer capacity needed,” “Buffer capacity sufficient,” “Unusual adaptations to care needed,” “Unusual adaptations sufficient,” “Disturbance of continuity of care inevitable without external assistance,” and “Disturbance of continuity of care inevitable.”

Results:

During the 2017 and 2018 winter/flu-seasons, crisis managers of ten hospitals scored the scale almost daily for three months. This served as a regional monitor and created the possibility to distribute patients and resources more evenly over the hospitals and with the care sector.

Discussion:

The impact scale improved communication and mutual understanding between hospitals and with other health care organizations, and is expected to have helped in maintaining the continuity of care during the 2017 and 2018 winter/flu-seasons. More research is needed on the reliability of the response. Nevertheless, the scale has since become an integral part of the regional contingency planning.
Inter-Authority and Cross-Border Cooperation Using the Tetra Digital Radio Network
Authors: Silfvast Tom , Pekkonen Tomi
Published: May 2019

Introduction:

The Tetra digital radio network enables a secure and encrypted environment for verbal and minimal data (SDS, Unit Alert) communication. In Finland (population 5.6 million), the technology has been in use since 2002, and the network currently has close to 40,000 end-users representing several authorities including emergency medical services and health care, police, fire and rescue services, Border Guard, Customs, and defense forces. The national dispatch authority uses the network to dispatch and communicate with EMS, police, and rescue services, and inter-authority talk groups have been designed to enable direct communication between each or all actors as needed. On a daily basis, the network transmits more than 7.5 million messages and 150,000 verbal contacts. The system has proved to be extremely stable during mass casualty incidents needing simultaneous actions by hundreds of individuals representing several authorities. Finland, Sweden, and Norway have common borders in the north, which EMS units routinely cross on a daily basis responding to urgent missions. Both Sweden and Norway have nationally implemented the Tetra communication network, but are using different operators.

Methods:

The need to facilitate communication between Tetra end-users in the Nordic countries using each other’s networks resulted in an inter-system-interface (ISI) solution enabling network roaming. Between Finland and Norway, the mechanism was launched late in 2017 and is being implemented between Finland and Sweden in 2018.

Results:

Pending configuration of necessary talk groups, the system will be functional and in use in 2019.

Discussion:

Based on agreements on cross-border emergency assistance between Nordic countries in mass-casualty and other major incidents, the countries have developed national capacities to deploy response teams to neighbor countries for on-scene assistance and medical evacuation. Planning of necessary talk groups is in progress, and practical testing will be performed during the Barents rescue exercise hosted by Sweden in 2019.
Measuring the Masses: Guidelines for Publication of Case Reports on Mass Gatherings
Authors: Turris Sheila , Rabb Haddon , Callaghan Christopher , Munn Matthew Brendan , Ranse Jamie , Lund Adam , Chasmar Elizabeth
Published: May 2019

Introduction:

The science supporting event medicine is growing rapidly. In order to improve the ability of researchers to access event data and improve the quality of publishing mass gathering cases, it would be of benefit to standardize event reports to permit the comparison of similar events across local and national boundaries. These data would support the development of practice standards across settings.

Aim:

The authors propose the creation of a publication guideline to support authors seeking to publish in this field.

Method: Derivation study via analysis of published case reports using the Delphi process.

Results:

Data elements were inconsistently reported within published case reports. Categories of variables included: event demographics (descriptors of date, time, genre, activity, risks), attendance and population demographics, data related to climate and weather conditions, composition and deployment of an onsite medical team, highest level of care available onsite, patient demographics, patient presentations and measures of impact on the local health care system such as transfer to hospital rates. Of note, there was a high incidence of “missing” variables that would be of central interest to researchers.

Discussion:

Approaches to standardizing the collection and reporting of data are often discussed in the health care literature. The benefits of consistent, structured data collection are well understood. In the context of mass gathering event case reporting, the time is ripe for the introduction of a guideline (with accompanying guidance notes and dictionary). The proposed guideline requires the input of subject matter experts (in progress) to enhances its relevance and uptake. This work is timely as there is ongoing work on improving an international event medicine registry. If the evolution of both proceeds in lockstep, there is a good chance that access to a rigorous data set will become a reality.
Medical Activity Training using SDF Ship at Wide Area Disaster
Authors: Mimura Seiji
Published: May 2019

Introduction:

We have repeatedly trained to use the SDF ship as a temporary medical facility during acute disasters. The Maritime Self Defense Force has various types of ships: supply ship (Oumei type), transport ship (Osumi type), and escort ship (hinge type, whip type) which has a large hangar and a treatable medical compartment.

Methods:

The points of training are collaboration between the SDF and the commander’s line of medical personnel, construction of a method of contact with the outside, construction of contact method inside the ship, kind of patient, medical contents, use of medical zone, method of transporting to the ship, method of transporting to the outside of the ship, positioning of the ship in the afflicted area, etc.

Results:

Assuming the Nankai Trough Earthquake, the activities of SDF vessels in coastal areas are affected by the extent to which the functions of medical institutions in inland areas are kept, how transportation methods can be secured, and how many injured people there are.

Discussion:

As a result of the examination thus far, the range of activities of SDF vessels is limited. The function of the ship is considered to be offshore SCU, hospital evacuation support, etc. Tight collaboration and training with the SDF are necessary in the future.