bluuebunny/crossref_metadata_2025 huggingface dataset:
(P1-84) Application of an Indian Public Health Standard for Evaluation of Community Health Centers of Rajasthan, India
Authors: Sinha T.P. , Anamika  , Bhoi S.
Published: May 2011

Background

Community Health Centers (CHCs) constitute the secondary level of health in India. However, these centers are fulfilling the tasks entrusted to them only to a limited extent. In order to provide quality care in these CHCs, Indian Public Health Standards (IPHS) are being prescribed to provide optimal expert care to the community and to maintain an acceptable standard of quality of care. These standards would help to monitor and improve the functioning of the CHCs.

Objectives

The aim of this study is to apply the IPHS for evaluation of the CHCs of Rajasthan.

Methods

A cross-sectional observational study was conducted during August to October 2010. Four CHCs of Rajasthan were visited and data were collected in a pre-designed Performa. The quality of services provided in the selected CHCs as per the IPHS norms was assessed.

Result

All the four CHCs were rendering the assured services of the outpatient department, 24-hour general emergency services, new born care, normal delivery, and referral (transport). All CHCs had full-time physicians, but only three (75%) had surgeons and obstetricians, two (50%) CHCs had pediatricians. One (25%) had anesthetists and one (25%) had a program manager. There was a blood storage facility at one (25%) CHC. Nursing staff were adequate. Basic laboratory facilities were available in all CHCs.

Conclusions

The present study revealed important deficiencies as per IPHS norms in the studied CHCs so that adequate measures can be taken to improve the healthcare facility.
(P1-96) Social Context of Natural Disaster
Authors: Maltais D.
Published: May 2011

Social context of natural disaster Danielle Maltais, Ph.D., Simon Gauthier, M.Sc. University of Québec in Chicoutimi (UQAC), Social Sciences Department, Social Work Teaching Unit, 555 Boulevard de l'Université, Chicoutimi, Québec, Canada, G7H 2B1, danielle_maltais@uqac.ca During the last few years, several countries in North America as well as in Europe or Asia were exposed to catastrophes that can be described as macrosocial catastrophes since a large number of people were affected. The death of an important number of people during the Katrina hurricane, the 2003 summer heat wave in Europe and the 2004 tsunami in Indonesia unfortunately showed that several countries and communities, even the most developed, are very badly prepared, in the event of a natural disaster, to protect and help its citizens and more specifically vulnerable people such as the old or the poor as well as lonely or sick people, those with reduced mobility or living in unsuitable housing conditions. Natural disasters are never completely quite so because of the frequency of the disasters as well as their human, community and social consequences and the extent of the subsequent material damage. They can be regarded as the result of human factors related to the deployment of ill advised activities for the environment (hasty urbanization and industrialization, deforestation, construction in zones at risk, etc), socio-economic conflicts (wars, political conflicts, displacement of segments of the population in environments at risk) or unequal distribution of economic, social and cultural resources between individuals, communities and countries. In social work, when we examine the causes and consequences of disasters on people's health and social activities, it is important to consider the notion of individual and social vulnerability of the people as well as the concepts of human adaptation to stress and impact strength. This communication will mainly make it possible to place the consequences of natural disasters in their social context and discuss the repercussions of this concept of reality on workers training and guiding.
(P1-98) Psychological Aspects of the Disaster Victim Identification (DVI)
Authors: Vymetal S. , Kvasnickova M.
Published: May 2011

The process of identification of disaster and mass casualties' victims (Disaster Victim Identification - DVI) impose requirements on the interdisciplinary cooperation of experts in many professions. When working with survivors and witnesses, it is necessary to maintain general ethical principles and follow the guidelines of optimal crisis communication with the affected people. The important thing is not to cause further secondary trauma. It is therefore necessary to understand the normal reactions of the human psyche in extreme stress and psychosocial needs of the people in stressful situations. Also members of DVI teams deserve adequate psychosocial support during and after the completion of difficult tasks. It is likely that these workers are psychologically resistant to extreme stress comparing to the general population but they are also increasingly exposed. To maintain work performance and life satisfaction is the possibility to use a specific psychological support very important. Keywords: acute stress reaction (ASR), DVI teams, disaster victim identification, crisis communication, survivors, crisis and disaster psychology, psychosocial crisis management, psychosocial care, posttraumatic stress disorder (PTSD).
(P1-99) Comparative Descriptive Analysis of Post-Disaster Psychological Interventions
Authors: Cheung E.Y.L. , Chan E.Y.Y. , Lee S.H.
Published: May 2011

Introduction

Disaster could greatly affect physical, psychological and social health of people affected. However, current crisis intervention protocols after natural or man-made disasters often overlook the psychosocial impact of crisis on victims. In its executive board meeting in 2005, WHO has called for action in implementing programs that can repair the psychological damage of war, conflict and natural disasters. Currently there are three main post-disaster psychological interventions available in the field: Critical Incidence Stress Management developed by Mitchell and Everly in 1980's; Psychological First Aid developed by the National Child Traumatic Stress Network and National Center for PTSD after millennium; and Mental Health First Aid developed by the Kitchener and Jorm after millennium.

Methods

A comparative descriptive analysis among the three different interventions was performed. Specific objectives, target populations, content, training duration, empirical evidence, instructor training and various adaptations were compared. Public health implications for implementation in disaster settings are discussed.

Results

The study is among the first that provided a detail comparison among the different protocols available in the field. More importantly it discussed the empirical evidence that support the use of the specific protocols at different scenarios. Implication the results of the study could be used as a guidance for choosing psychological interventions immediately post-disasters by emergency responders, public health practitioners and academic researchers.
(A-309) Flood Disaster Averted: Red River Resilience
Authors: Mclean A.J. , Shultz J.M.
Published: May 2011

Flood Disaster Averted: Red River Resilience It is estimated that floods make up 40% of all natural disasters and that the majority of natural disaster deaths are attributable to these events. The vast majority of literature on mental health and disaster revolves around response and recovery after the event. Mitigation of flooding can have a tremendous impact on health, including the prevention of common physical ailments including diarrhea, hepatitis, typhoid, tetanus, malnutrition, dermatologic conditions, orthopedic injuries, etc… It can also reduce mental health difficulties including stress, anxiety, depression, PTSD and other disorders. Psychosocial reactions to trauma are recognized to be among the most long-term and debilitating outcomes of disasters. This presentation describes a community's successful efforts to prevent a major flood disaster in the midst of a changing risk landscape. The authors focus on factors contributing to the resilience of a community in the upper Midwest of the United States in responding to the threat of a catastrophic natural disaster. In addition, the presentation includes the building blocks for successful integration of mental health presence through all phases of disaster: mitigation, preparedness, response and recovery. Andrew J. McLean, MD Medical Director, Department of Human Services, State of North Dakota. 2624 9th Ave. SW, Fargo, ND 58103 ajmclean@nd.gov, amclean@medicine.nodak.edu James M. Shultz, MS PhD. Director, Center for Disaster & Extreme Event Preparedness (DEEP Center) University of Miami Miller School of Medicine, Clinical Research Building 1120 NW 14 St., Miami, FL 33160, USA and Partner, High-Alert International, Orlando, FL, USA 305-219-9011 jamesmichaelshultz@gmail.com. jshultz1@med.miami.edu. jshultz@high-alert.com.
(P1-106) Scarce Resources Planning Summit for Pediatric Critical Care and Transport Stakeholders
Authors: Reynolds S. , Weber E.K. , Severin P.J.
Published: May 2011

There are six children's hospitals in Chicago, Illinois and the surrounding region. These hospitals often have bed limitations due to high censuses in daily operations. The Pediatric Committee of the Chicago Healthcare System Coalition for Preparedness and Response had provided two conferences in pediatric emergency preparedness in Spring 2010 that identified a need to examine scarce critical care resources in the region. A “Pediatric Critical Care and Transport Stakeholder's Summit” was convened in April 2010. This meeting brought together the Pediatric Critical Care Medical and Nursing Directors along with Transport Team representatives from major hospitals to identify the key issues related to pediatric emergency preparedness and scarce resources. The four-hour Summit, was held in a Conference Center, away from any hospital or clinical setting, was organized into seven sections: (1) Welcome & Introductions; (2) Issues Identification; (3) Scenario Introduction; (4) Specific Issues Indentification; (5) Prioritization of Specific Issues; (6) Development of Action Steps; and (7) Moving Forward. A Facilitator with specific knowledge of hospital-based preparedness led the Summit process. He utilized a pediatric scenario to engage the participants in discussion, interaction, and planning. Action steps, with statements of need and specific action items were developed, based on the following prioritized issues: (1) lack of pediatric training and experience for front line personnel; (2) alternate care sites/bed capacity/surge planning; (3) ethical issues; (4) transport; (5) credentialing/pediatric specialist availability; (6) incident command/community integration; (7) pediatric supplies and equipment; (8) patient indentification; (9) financial tracking/reimbursement; and (10) Crisis Standards of Care/Crisis Operation Standards Moving forward, the participants of the Summit will reconvene into small workgroups to develop plans and training for the areas specified above. In May, 2011 a statewide exercise utilizing the special population of children will occur to test these plans.
(P1-107) Paediatric Emergencies
Authors: Doshi D.
Published: May 2011

Paediatric asthma is a frequent presentation to Emergency departments. Early intervention may prevent progression of the acute phase to a severe or life threatening stage. Magnesium is a wonder molecule that has repeatedly undergone vigorous trials. Magnesium is used by intravenous and nebulized route in many guidelines across the world. Heliox keeps coming in and falling out of favour with conflicting literature reviews. Its simplicity of use makes it an effective tool in the treatment of exacerbations of asthma. Aminophylline is one of the earliest bronchodilator that has heaps of adverse effects. This presentations begins with a world tour of major guidelines with a special focus on Magnesium, Aminophylline and Heliox followed by an in depth literature search. Current literature and metanalysis for all the three drugs for pulmonary function test, hospitalisation and adverse effects are graphically illustrated. Based on the evidence so far, a guideline is proposed for the use of the above three drugs for Paediatric asthma.
(P2-2) Suicide Attack Response Considerations for First Responders
Authors: Foerster C.R. , Mohr J.A. , Patrick J.E. , Richman A.
Published: May 2011

Introduction

All first responders must be prepared to respond to suicide attacks. Staging safe and effective responses to these incidents requires knowledge of a number of unique considerations.

Methods

The research presented in this presentation used reviews of open source information along with site visits to multiple suicide bombing sites in Israel and the United Kingdom to determine the important considerations for first responders responding to suicide attacks. What is presented is not a specific standard operating procedure but rather a common framework that can help to facilitate a coordinated and effective response from all agencies involved.

Results

Civilians and private security guards can play an important role in detecting the planning and execution of suicide attacks and sometimes even in their interdiction in the imminent attack phase. The suspicions of civilians must be taken seriously and citizens should be encouraged to report these suspicions immediately. The first responding emergency services personnel must be able to effectively begin their agency's response to the attack while maintaining a strong situational awareness. Also on scene, strong frontline commanders are needed to work together to lead a coordinated response. Interagency communication and using a scaled response is of increased importance at these incidents when first responders could be targeted by the secondary attacks or an initial threat that has not yet been neutralized. First responders can take the initial steps to promote the return to normalcy that is important after terrorist attacks. In the aftermath of attacks, efforts should be made to establish a collective knowledge within the emergency services community to share lessons learned in the response.

Conclusion

The results of this research can help local agencies plan for suicide attack response and also provides a strong foundation for future research to further investigate responses to the varying types of suicide attacks around the world.
(P2-5) Pre- and in-Hospital Time Delays in Acute Stroke Management in Estonia
Authors: Gross-Paju K. , Adlas R. , Sorro U.
Published: May 2011

Background

Short intervals between stroke onset and thrombolysis determine the efficacy of this procedure. Guidelines for stroke management were introduced in 2005 in the West-Tallinn Stroke Centre and in 2008 in the Tallinn Emergency Medical Services. Since 2006, annual joint stroke meetings of pre- and in-hospital staff have been held. These meetings included analysis of time delays of thrombolyzed patients.

Objective

The aim of the study was to analyze changes in time delays in acute stroke management and adherence to treatment guidelines.

Methods

Pre- and in-hospital data of all consecutive ischemic stroke patients who received intravenous thrombolytic therapy were recorded prospectively at the Stroke Centre. Data from the implementation period of thrombolysis (2005–2008 i.e., 1st period) were compared to recent data from 2009 to 01 September 2010 (2nd period). The data from all stroke patients presenting to ambulance services were analyzed separately from 01 September 2009 to 01 September 2010. Recorded procedures were compared to current treatment guidelines.

Results

A total of 115 patients received thrombolysis at the Stroke Centre. The Alarm Centre assigned the correct priority (C, lights and sirens) for 31% of thrombolyzed patients during the 1st period, and for 80% during the 2nd period. The mean time ambulance personnel spent at the home was 20 minutes during both periods. In-hospital door-to-needle time was < 60 minutes in 11% of patients during the 1st period, and in 56% during the 2nd period. Ambulance personnel treated 1,094 stroke patients during the study. All procedures were performed and documented correctly in 10% of visits. The most frequent deviation from guidelines was under-reported values of blood glucose. In 44.7% of patients, an ECG was performed, which is not required by guidelines.

Conclusions

Acute stroke management improved significantly. Adherence to recently developed stroke guidelines in the ambulance services must be improved.
(P2-10) Emergency Medical Services Workers' Willingness to Work during Pandemic Influenza
Authors: Klein I. , Balicer R. , Aharonson-Daniel L. , Jaffe E.
Published: May 2011

Background

Emergency medicine services (EMS) will play a key role in any response to a flu epidemic. In order to devise an effective preparedness plan for coping with pandemic, it is necessary to comprehend the factors affecting the willingness of EMS workers to respond during an outbreak.

Aims

This study aims to: (1) examine the willingness of the workers of Israeli EMS (Magen David Adom (MDA)) to come to work during a pandemic flu; and (2) identify the factors that will increase the willingness of workers to come to work and the obstacles that will keep them from working during a flu pandemic.

Methods

Between November 2009 and January 2010, a representative sample of MDA workers in Israel were given questionnaires asking about their knowledge and attitudes in regard to pandemic flu, and concerning factors that may influence their willingness to come to work. Data analysis included descriptive statistics, central and dispersion measures, analyzes of variance, and an exploratory factor analysis.

Results

The study population included 365 people (290 men and 75 women), with 84% aged 20–49 years. Of the respondents, 92% expressed willingness to come to work during a flu pandemic, even if they were asked and not obligated to report to work. An increase in willingness to come to work was found to be associated with the significance of the role of the workers, the guidance that they receive from the organization, their trust in the system, their knowledge, and their feeling of being protected.

Conclusion

Workers' perception of the significance of their role and their trust in the system were found to be central factors in determining workers willingness to come to work during a time of an emergency.
(P2-12) Emergency Medical Procedures Provided by Paramedics in Prehospital Sudden Cardiac Arrest — Analysis of the Example of District Siedlce (Poland)
Authors: Pilip S. , Celiński D. , Wiśniewski R. , Binkowska A. , Michalak G.
Published: May 2011

Introduction

The organization of the medical emergency system in Poland has been revised substantially since 2007. Rescuers were able to perform certain life-saving procedures and to administrate some drugs without doctor's order.

Aim

The efficiency of advanced life support (ALS) performed by emergency medical service with paramedics (without doctor) was assessed for cases of cardiac arrest (CA) in prehospital conditions. It was correlated with quantity of basic life support (BLS) procedures undertaken by casual witnesses and with the knowledge of automated external defibrillation (AED) in people without medical training.

Method

Forty-eight cases of CA were analyzed, which took place in District Siedlce in the first three quarters of 2009. Data were collected retrospectively, from medical reports. Advanced life support procedures adhering to the guidelines of the European Resuscitation Council were investigated in terms of pharmaco-and electrotherapy. Additionally, the study of the knowledge of AED was conducted through a survey, in which 103 randomly selected persons without medical training took part.

Results

Adrenaline and amiodarone were given by paramedics correctly in 94% of patients. Defibrillation was performed in all patients with documented ventricular fibrillation or pulseless ventricular tachycardia valid values of energy. Cardiopulmonary resuscitation was successful in 33% of the cases. At the scene of the accident BLS was performed before the arrival of ambulance in only 7% of cases. Of the respondents, 41% (non-medic) could use the AED safely, but only 13% of them knew the guidelines for using defibrillators.

Conclusions

Paramedics were properly implementing ALS procedures for prehospital CA. The percent of effective cardiopulmonary resuscitations may improve the early implementation of BLS, including the use of AED. It is necessary to educate people without medical training in this field.
(P2-18) ICU Surge Capacity in Australian Major Trauma Centres
Authors: Rigby O.M.
Published: May 2011

Introduction

Mass casualty incidents (MCIs), requiring Trauma critical care, are increasingly likely. The ability to scale operations up i.e. ‘surge capacity’, is vital for ensuring scarce resources are used efficiently. The number of intensive care unit (ICU) beds is one of the key resources and indicators of a hospital's capacity and thus a vital area to target when assessing a systems ability to surge its Trauma ICU capabilities.

Objective

The study attempted to assess whether ICU facilities at major hospitals in large Australian cities would be able to respond to an event on the magnitude of the Madrid tragedy. This is the first report to measure Australia's major hospitals intensive care trauma surge capacity using Madrid as a standard.

Methods

In this prospective, cross-sectional analysis, we conducted a survey of major urban ICU trauma centres in the 8 state and Territory Capital cities of Australia. 14 Trauma Centre ICU's were targeted. The study was composed of two parts, A & B. Part A of the study consisted of an online survey, Part B, consisted of a follow-up telephone questionnaire. Full Ethics approval was sought and obtained.

Results

There were 8 replies to the survey giving a 57% participation rate. At the time of this snap-shot survey the total number of Physically available ICU beds throughout the 8 Level I trauma centres was 52.5. All hospitals had at least 3 spare beds. This ranged from 3 to 10 beds. After accounting for the flux in beds post admissions & discharges there was a 21% increase in bed availability, which was further increased by a magnitude of 28% to an average of 10.125 beds, if all elective surgical procedures were cancelled. When using the Madrid ICU surge (29 new ICU patients) as a gold standard against which to compare, it was found the largest trauma ICU in Australia could have managed 62% of this surge. On average the 8 trauma centres would have handled only 34.75% of the Madrid ICU surge.

Conclusions

In the event of a major traumatic disaster on the scale of the Madrid atrocity, few if any of Australia's major trauma centres have the capacity to cope with the requisite surge. More research and novel ways of addressing this challenge are needed.
(P2-19) A Modular Portable Emergency Department Expansion Setup, Experience during the H1N1 Pandemic
Authors: Little C.M. , Evans B. , Yaron M.
Published: May 2011

The recent H1N1 pandemic presented severe challenges to many emergency departments (ED). At our institution it caused overcapacity issues with increasing length of stay and increasing patients leaving before treatment. The emergency department space at the hospital was already fully used including hallway beds. Other clinical space could not be taken for ED expansion, as it was also all maximally used.

Methods

Portable mobile ED expansion modules were developed consisting of ED supply carts, pharmacy items and a wireless ED information system (EDIS) integrated with computers on wheels. This EDIS provided internet access from anywhere in the hospital, enabling access to clinical databases, order entry for testing, medications and discharge instructions, providing full operability of ED functions. This complete assembly can be stored in a small storage area. The H1N1 pandemic allowed for practical testing of this system. This system was deployed to a nearby hospital clinic that closed at 5 pm. The expansion module operated from 6pm to 10pm staffed with two providers. Data was compared between days when the surge clinic was in operation and days it was not. Data was collected on patients seen and left without being seen rates.

Results

During the trial period of 9 days, 1323 patients were seen in the ED and 112 were seen in the modular clinic setting, representing 8.5% of the total ED volume. No technical problems were noted and the system worked as designed. We observed increased satisfaction from both staff and patients. No reduction in the number of patients leaving without treatment was noted in either group (5/day).

Conclusion

A modular portable ED expansion setup is practical and may increase ED capacity at times of maximal patient volumes. These materials are easily storable and build surge capacity for other events.
(P2-22) Proposed Model for Cellular Medical Record in Emergency Medicine
Authors: Friedman N. , Goldberg A.
Published: May 2011

Introduction

In a hypothetical situation, an emergency services team is launched to treat a man who collapsed in the street. The team finds John Doe's mobile phone, and within seconds retrieves the required clinical parameters from his Mobile Medical Record (MMR), thus, providing a life-saving treatment suited to his personal health condition. This study seeks to determine if the necessary clinical parameters, required at emergency situations have ever been examined in order to best match both emergency situations and cellular technology.

Objective

To characterize the clinical parameters that make up an MMR in the context of saving lives, and to propose a model for an MMR in emergency medicine.

Methods

The essential emergency medicine clinical parameters in the context of life-saving treatments were characterized through interviews with prehospital and hospital experts in emergency medicine. The results were analyzed with the help of a cellular multimedia expert in order to best incorporate the clinical parameters into cellular phones as MMRs.

Conclusion

Emergency medicine teams chose individual and specific clinical parameters in a certain order of appearance from the general medical record that should assembly, in their opinion, an emergency medicine MMR. A MMR was chosen by the emergency medicine treatment teams as one of their preferred communication methods. The MMR model, if applied correctly, will provide the emergency medicine treatment teams an available, reliable, homogeneous database of real time clinical parameters adapted to life-saving conditions. The MMR model represents a conceptual revolution of taking the medical record from the caregiver and transferring it to the patient, which can be constantly at hand at any given time or place in their mobile phones.
(P2-25) Evaluation of the Apache III Grading System in Predicting the Prognosis and Mortality of Patients Admitted to Emergency Room, in Need of Intensive Care Unit Admission
Authors: Hatamabadi H. , Darbandsar P. , Abdalvand A. , Kariman H. , Arhamidolatabadi A.
Published: May 2011

Objectives

Many of critically ill patients are being cared for prolonged periods in ED just because of limited number of ICU beds and utilize of ED as the entry point to the health care system. The aim of this study is evaluation efficiency of APACHE III scoring system in predicting mortality rate of the mentioned patients.

Materials and Methods

This cross-sectional, observational, analytic study was performed in one year period. A hundred patients remaining in ED and necessitating ICU hospitalizing were enrolled by the convenience type of non-probability sampling. Then, the APACHE III scores, predicted and observed mortality rates were calculated using of information obtained from patients' files, interview with the patients' family and performing required physical exams and lab tests.

Results

In the assessment of 100 patients, men group were 56% (56) and women group 44% (44). The age of patients and the ED lengths of stay were 66.07 ± 19.92 years and 5.11 ± 3.79 days respectively. The average (± SD) of APACHE III score of the enrolled patients was 58.89 ± 18.24 and the predicted mortality rate calculated 32.73%; while, the total of observed mortality rate was 55%. The average (± SD) of APACHE III score of survivors and non-survivors were 48.63 ± 16.35 and 67.63 ± 14.84 respectively. So, there was a significant deference (p < 0.001). Also, there was a significant deference in the ED lengths of stay between survivors and non-survivors (3.20 ± 1.34 and 6.57 ± 4.40 respectively, p < 0.001).

Conclusion

In our study, APACHE III score and ED lengths of stay were higher versus other studies in Iran and other countries; which show more critical patients presenting to our hospital and limited ICU beds versus patients. This study results nevertheless there was significant difference between predicted and observed mortality rates, the APACHE III scoring system is applicable to evaluating care, treatment and prognosis of ED patients, as is used in ICU.
(P2-31) The Situation of the Development of Disaster Medical Assistant Team in Japan
Authors: Morino K. , Kondo H. , Otomo Y. , Honma M. , Nakayama S. , Koido Y. , Henmi H.
Published: May 2011

Background

After the Great Hanshin-Awaji Earthquake, the disaster countermeasures concerning medical care in Japan changed drastically. In 2005, the Japanese government began to develop a domestic, rapid, medical response system called Disaster Medical Assistance Team (DMAT) for the purpose of rapid medical correspondence in the acute phase. As of 12 July 2010, 393 institutions and 734 teams (3,700 persons) were trained. A DMAT is important not only to the response to large disasters such as earthquakes, but also the response to local disasters. It is important to establish the DMAT system of each prefecture and district.

Methods

The DMAT system at the local level was described at the 15th World Congress on Disaster and Emergency Medicine. During the present Congress, the development and activities of the DMAT system over the past three years will be reported.

Results and Conclusion

Eight local districts in the DMAT system have been developed, and progress has been made in the fields of policy, operative plans, and agreement among each province. The system of inter-prefecture mutual aid must be built upon in the near future.
(P2-38) Operational Response to a Gastroenteritis Outbreak in the Emergency Department
Authors: Lam E.G. , Tajutdin N.B. , Soh C.K.K.
Published: May 2011

Mass gatherings can be disruptive to the daily operations of any emergency department (ED). These events usually are spontaneous and sudden. Therefore, operational processes must be effective and concise when dealing with a sudden surge. This study examines the Tan Tock Seng Hospital (TTSH) ED response process to a gastroenteritis (GE) outbreak. Prompt identification and establishment of a casualty holding and treatment area ensured smooth operational capacity, which allowed these patients to be segregated from the mainstream ED crowd and more specific care to be rendered. Entrance and exit points of the designated area were established with controlled access to prevent cross-contamination with the mainstream patient load. Patients with GE who presented with acute symptoms required immediate assessment and intervention, placing stress on existing personnel. Hence, adequate personnel was an important factor that could not be disregarded. Staff burnout was a plausible issue that was recognized from the start and attempts were made to prevent burnout by creating an encouraging work environment and allowing frequent relieving of duties. Communicating the event to relevant departments ensured that the ED was adequately supported during the GE outbreak, both administratively and logistically. This was a reflection of the established communication channels. Leadership also had an essential and crucial role to play as the nursing and medical leaders had to be decisive, delegate roles and give concise instructions during the chaotic situation. The availability and access to ample logistical supplies saves on precious time, which allowed more focus on patients. In summary, procedures and protocols, together with staff preparedness, enhances an ED operational capability of effectively responding to mass gatherings.
(P2-51) Being Injured in a Cold Environment
Authors: Aléx J. , Saveman B.
Published: May 2011

Background

Prehospital patients, irrespective of diseases or trauma, might experience discomfort due to a cold environment and are at risk for decreasing body temperature which can increase morbidity and mortality. Research concerning experiences of being injured in a cold environment is scarce.

Objective

The aim of this study was to explore the patients' descriptions of being injured in a cold environment.

Methods

Twenty persons who have been injured in a cold environment during wintertime in the north of Sweden were interviewed; 14 of them were treated with active heat supply. They waited on snow or ice for an ambulance between 8 minutes and 4 hours and 10 minutes. The interviews were performed face-to-face and telephone interviews were used when the participants lived far away. The interviews had a storytelling run-up and the participants were asked to narrate the injury event, from just before the event until arrival at the emergency department. The interviews were transcribed verbatim and analyzed by content.

Results

In the preliminary results three themes were formulated: (1) waiting for an ambulance; (2) being cared for; and (3) reflecting on changes in life after the traumatic event. The cold environment influenced the experience of being injured in a negative way. More suffering from the cold than from pain of the injury was described. Those who were treated with active heat experienced it in a positive way.

Conclusions

Discomfort from cold became the largest problem independent of their injury classification. Active heat should be used in prehospital care to reduce the negative experiences from cold.
(P2-61) Hiccups with Chapman/Carberra Sign And left Bundle Branch Block in Anterior Wall Myocardial Infarction
Authors: Mishra D. , Koli D.T.
Published: May 2011

Patients with myocardial infarction can present to the Emergency Department with atypical symptoms. A 60-year-old male presented with a fever for two days and ongoing hiccups he had experienced for four hours. He also had experienced an episode of vomiting. An electrocardiograph revealed ascending limbs of the S-waves in leads V3/V4, notching > 0.05 seconds in the ascending limbs of the R-waves in leads I, aVL, V6, and the presence of a left bundle branch block.
(P2-62) An Infrequent Case of Orthopedic Emergencies – Open Dorsal Dislocation of the Proximal Interphalangeal (PIP) Joint Dislocation
Authors: Bayir A. , Kaldirim U. , Ardic S. , Eyi Y.E. , Arziman I. , Durusu M.
Published: May 2011

Introduction

Reducible open dorsal dislocation of the single finger's PIP joint is an infrequent case of orthopedic emergencies. The severity of this injury may be underestimated. These injuries are associated with long-term complications such as synovitis, stiffness, degenerative arthrosis, septic arthritis, and loss of the digit if suboptimally treated.

Case

A 90-year-old male came to the emergency department with an open dorsal PIP dislocation due to a fall on his right hand. There was a transverse skin laceration just proximal to the PIP flexion crease of his small and ring fingers. The condyles of his small finger's proximal phalanx protruded through the wound. X-rays showed a dorsal dislocation of the PIP joint without fracture. There was no neurovascular injury determined. The proximal phalanx was hyperextended slightly with gentle axial traction. After irrigation, the skin wound was closed primarily without repair of damaged structures, and systemic antibiotherapy was performed for a week. The PIP joint was immobilized for three weeks by applying the splint dorsally with the joint in 20 degrees of flexion. Active range of motion exercises were then implemented, and the patient regained full digital flexion with only a 10 degree loss of extension within eight weeks.

Discussion

Forced hyperextension with axial compression causes a dorsal dislocation of the PIP joint. Dorsal PIP dislocations are more common than volar IP dislocation. Open dorsal dislocation of the PIP joint is an infrequent case of orthopedic emergencies. Such injuries can be treated safely in the emergency department by closed reduction and extensor splinting until a definite treatment plan is made by an orthopedic hand surgeon. The complications must be taken into consideration. Early active motion leads to significantly superior results in the range of motion than static splinting, because prolonged immobilization may result in flexion contracture.
(P2-65) Perception of Emergency Care Providers Toward the Implementation of an Electronic Medical Record System in the Emergency Department of a Level-1 Trauma Center
Authors: Chauhan S. , Bhoi S. , Sinha D.T. , Rodha M. , Adhikari G. , Sharma G. , Sharma K. , Kumar R.
Published: May 2011

Background

Manual documentation has an inherent problem of improper communication, manipulation, and validity. An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital. EMRs tend to be a part of a local, stand-alone, health information system that allows for storage and retrieval.

Objectives

The objective of this study was to assess the perception of emergency care providers toward the implementation of an EMR System in the emergency department of a Level-1 Trauma Center.

Methods

A qualitative survey was conducted among consenting doctors and nurses in the emergency department of the All India Institute of Medical Sciences February to October 2010. Data were collected from a sample of 22—eight doctors and 14 nurses. The collection tool was a structured, closed-ended questionnaire of 12 questions based on usability, applicability, and security, of EMR. A Likert scale (LS) was used (1 = worst, 4 = best). Surveys were done on Day 20, Day 45, and after nine months of implementation of. Responses of emergency care providers were compiled and analyzed using SPSS version 16.

Results

Three surveys consisted of 22 participants in each survey. The survey domain of usability improved on Survey 3 (LS = 2.57), Survey 2 (LS = 2.46), Survey 1 (LS = 2.24). Application of EMR improved from Survey 1 to Survey 3. The data regarding perception of security concerns such as manipulation of data, transparency, and accountability were comparable among Survey 1, Survey 2, and Survey 3. Initial satisfaction was strongly associated with perception of usefulness of data mining for research purposes.

Conclusions

Satisfaction with an EMR system at its implementation generally persisted through the first year of use. Implementation plans must include positive reinforcement regarding EMR among emergency care providers.
(P2-69) Diagnosis and Management of Bile Leaks After Blunt Liver Injury by Dicct
Authors: Mitsusada M.
Published: May 2011

Background

Although bile leaks are emerging as frequent complications of non-operative management of liver injury, the best method to use to diagnose intrahepatic biliary injury (IHBI) has not been established.

Methods

Fifteen patients with a blunt liver injury admitted to the hospital during a two-year period, were diagnosed by computed tomography as having a grade 3–4 injury, and underwent DIC-MDCT intended to diagnose IHBI in its early stages. These 15 patients included 11 with a grade 4 (Group A: five patients who underwent TAE; Group B: six patients who did not undergo TAE) and four with a grade 3.

Results

In Group A, all of the patients were found to have some signs of IHBI in DIC-CT. Of these patients, two were found to have extrahepatic leakage and underwent local drainage; one also underwent ENBD. Three patients were not found to have extrahepatic leakage even though they had signs of IHBI; these three underwent conservative therapy with no other care, and had a satisfactory course. In Group B, only one patient was found to have IHBI. However, all of the patients, including those not found to have signs of IHBI in DIC-CT, recovered. Patients with grade 3 did not have signs of IHBI. Compared to Group B, Group A had a high Injury Severity Scale Score of 38.5 ± 11.2, and a higher incidence of IHBI.

Conclusions

DIC-MDCT may, in cases of severe liver injury that might require TAE, help to diagnose IHBI in its early stages, and help to determine if additional treatment is needed based on the site and extent of the injury and whether extrahepatic bile leakage is present.
(P2-74) Does Implementation of Protocols Improve the Red Area Disposition Time of Emergency Department at a Level-1 Trauma Center?
Authors: Kumar R. , Shyamla K. , Bhoi S. , Sinha T.P. , Chauhan S. , Adhikari G. , Sharma G.
Published: May 2011

Background

Acute care addresses immediate resuscitation and early disposition to definitive care. Delay in final disposition from the emergency department (ED) affects outcomes in terms of morbidity and mortality. An audit was performed to assess the impact of protocols on red area disposition time.

Methods

An audit of red (resuscitation) area disposition time was performed among patients with compromised airway, breathing, and circulation. The red area disposition time was defined as the time from ED arrival to red area disposition. Pre-protocol data from nursing report books were reviewed for ED to operating room (OR), ED to intensive care unit (ICU), and overall disposition time between September 2007 and January 2008. Similar outcomes were documented after implementation of protocols during February to December 2008.

Results

In the pre-protocol period, 992 red area patients were enrolled out of 10,000 ED visits. Out of which 527 (53.1%) were shifted to the OR and 222 (22.3%) to ICU. The average ED disposition time was 3.5 hours (range 2–5). Similarly, 1797 red area patients were enrolled in the post-protocol period out of 25,928. Of these, 453 (25.2%) patients were shifted to the OR, and 423 (23.7%) were shifted to the ICU. The average ED disposition time was 1.5 hours (range 10 minutes–3 hours).

Conclusions

Implementation of protocols improves the red area disposition time of the ED. Auditing is an important tool to address patient safety issues.
(P2-75) Emergency Medicine Begins with General Practitioners in Nepal
Authors: Maharjan R.K.
Published: May 2011

Introduction

Emergency medicine (EM) is a long-awaited specialty to be established in Nepal, although it has been practiced for a long time starting with hospitals in Nepal. Currently, almost all hospital emergency departments in Nepal are run under general practitioners (GPs) as emergency consultants (emergency physicians) and medical officers work as 24-hour duty doctors.

Methods

This was a five-year observational study (2006–2010) after the Department of General Practice joined with MD in Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.

Results

There are no academically trained MD physicians working in Nepal according to the Nepal Medical Council's Registered Doctors, however, there are Nepalese doctors trained and working in EM in foreign countries. There is a demand of training those GPs interested in EM in a Fellowship/MPhil/MD program. There is a need for developing curriculum of EM for the Fellowship/MPhil/MD or for a different level of training collaborating with universities abroad. There is no ideal prehospital EM/emergency medical services capable of ambulance services. There must be a national code for mobilization and it must be under an umbrella of a governmental Department of GP and EM. Development of infrastructure for the EM department in every hospital in different parts of country is also a challenging task. Standards must be developed for EM and the EMS according to the need of the country. All known and unknown challenges can be addressed by coordinating with international support.
(P2-76) Mortality Pattern in the Emergency Department in Tribhuvan University Teaching Hospital, Kathmandu, Nepal
Authors: Maharjan R.K.
Published: May 2011

Introduction

The emergency department (ED) deals with serious diseases, trauma, and terminal stage cases. The mortality pattern of cases in the ED must be assessed for future planning and development.

Objectives

The aim of this study is to evaluate the pattern of the mortality cases in ED.

Methods

Retrospective mortality data were collected and analyzed during April to September 2010 from the Tribhuvan University Teaching Hospital.

Results

There were 81 mortality records found during the study period. The mortality rate among the ED cases was 36 per 10,000 (0.36%). Sixteen (19.75%) were dead upon arrival to the ED. Among the remaining 65 mortality cases, 30 (46.2%) were male and 35 (53.8%) female. The ages ranged from 1 to 80 years; the mean age for males was 43.8 years and 55.0 years for females. The mean time duration from when the patient was bought to the ED to death was 6.7 hours. The primary causes of mortality were hypovolumic with hemorrhagic shock (10, 15.5%), aspiration pneumonitis (9, 13.8%), cardiopulmonary arrest (8, 12.4%), sepsis and septic shock (7, 10.8%), severe head injury (6, 9.3%), acute exacerbations of chronic obstructive pulmonary disease (6, 9.3%), hemorrhagic cerebrovascular accident (3, 4.7%), hepatic encephalopathy (3, 4.7%), cardiogenic shock (2, 3%), chronic renal failure (2, 3%), dyselectrolytemia (2, 3%), anaphylaxis (1, 1.5%), acute respiratory distress syndrome (1, 1.5%), meningoencepahalitis (1, 1.5%), acute myocardial infarction (1, 1.5%), OP poisoning (1, 1.5%), pulmonary edema (1, 1.5%), and severe pneumonia (1, 1.5%).

Conclusions

The mortality in the ED is due to the high rate of severe and serious cases that arrive at late stages of disease. It also is accounted with severe trauma cases despite vigorous treatment at the ED. The rate also is increased by “Brought Dead” cases which could be reduced with proper emergency medical services.
(P2-77) The Unique Role of Emergency Medical Services (EMS) in an Earthquake – A Community Based Approach
Authors: Jaffe E. , Ben-zvi S.
Published: May 2011

Introduction

Timely actions can facilitate the efficacy of Emergency Medical Services (EMS) response in disaster by understanding the scale of event and shifting of traditional tasks. A simple scaling system of earthquakes/disasters by ABC is proposed: Level A treated by the local EMS. One or more Multi Casualty Incident's (MCI) in a defined geographical area that can easily be Level B hours, by reinforcement of regional and national aid coordinated by automatic autonomic response. An earthquake/disaster where the EMS and medical community can complete their task within 48 Level C - An earthquake/disaster that even joint national forces cannot eliminate within 48 hours.

Methods

Information from medical systems around the world was gathered to help develop strategies to minimize the weaknesses whilst achieving the objectives of the EMS via adapting to shifting conditions.

Results

EMS goal is to provide treatment to those in need of urgent medical care and arrange for timely transfer of the patient to definitive care. EMS are not qualified or equipped to delay victims in the field for hours or days. However, many patients in earthquakes do not require definitive treatment or have an immediate lifethreatening.

Conclusion

By scaling the event by the ABC - a timely coordinated autonomic regional / national response can begin immediately. An area defined as level A will automatically back-up a level B/C area, in an event that the standard communication and activation systems collapse. Moreover, a clear shift in EMS roles will take place in a level B or C events. Available-Hours Busy-48-Hours Catastrophe-weeks Types of Levels area for delaying evacuation. Prioritizing, sorting and sending patients that require immediate attention to definitive care whilst considering availability of destination facilities and transportation resources. Patients that do not require immediate attention or cannot be saved shall await evacuation.