bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of a Novel Electronic Patient Care Record System at Mass Gathering Events by St. John Ambulance Victoria
Authors: Gao Crystal , Lim Zheng Jie , Freestone Brendan , Austin Kristy , McManus Rob
Published: May 2019

Introduction:

The growing number of mass gathering events (MGEs) in Victoria has seen an increase in demand for event health services and the need for real-time reporting of medical incidents at these events.

Aim:

Since 2016, St. John Ambulance Victoria has introduced an electronic patient care record (ePCR) system with the aim of improving patient care and satisfaction. It appears that this ePCR system is the first of its kind to be trialed at MGEs by a volunteer organization.

Methods:

A qualitative study was conducted to determine strengths and limitations of the ePCR system by compiling results of surveys and interviews and through anonymous feedback from volunteers and patrons (event organizers, patients). This study is ongoing.

Results:

It was found that the use of ePCR:

1.

Allowed for collection of relevant data to assist in future planning of MGEs

2.

Aids the overall coordination of first aid delivery at MGEs

-

faster relaying of patient information to event commanders

-

reduction of paperwork

-

improved ability to locate first aid crews using GPS tracking

3.

Received positive feedback from first aiders, event organizers, and patrons

4.

Was deemed easy-to-use (4/5), acceptable (4.3/5), and helpful (4.1/5) by our members

Discussion:

These experiences demonstrate that ePCR is well-received, easy to use, and leads to improved patient satisfaction and treatment outcomes at MGEs. Furthermore, the ability to collect and analyze real-time data such as GPS location tracking, incidence heat maps, and patient demographics facilitate future event planning and resource allocation at MGEs. It is acknowledged that this study is preliminary, and the trialed use of an ePCR system has been limited to metropolitan areas and MGEs with <1 million patrons. The intent is to continue this study and explore the use of ePCRs at larger MGEs and events in rural or regional areas.
Hemorrhage-control Tourniquets: How Intuitive are They?
Authors: Ochs Nicole , Sexton Martha , McKenzie Nicole , Rega Paul , Ziehr Jonathon , Parquette Brent , Fink Brian
Published: May 2019

Introduction:

According to the Federal Bureau of Investigation (FBI), there were fifty active shooter incidents in 2016 and 2017. In the first five months of 2018, there have been 23 school shootings where someone was injured or killed. Hemorrhage-control tourniquets have proven their life-saving capability in the military and civilian EMS. Now, they are being advocated for use by civilians – the true “first responders.” Since Combat Application Tourniquets (CATs) are strap-and-windlass devices, the question remains whether a naïve population can intuitively apply them efficaciously.

Aim:

To determine the efficacy (speed, correct placement) of a CAT by an interprofessional group of healthcare students naïve to tourniquet hemorrhage control.

Methods:

Consenting students attempted to apply a CAT to a standardized patient with a simulated hemorrhaging brachial artery. No instruction was given except for the directions included in the package. Timing began upon removal of the tourniquet from the package and ended when the participants stated they completed their attempt. Errors in application were documented. Afterward, students received education and an opportunity to properly re-apply the tourniquet. The completion times of the students were compared to ten emergency medical technicians (EMT-P), serving as subject matter experts. Errors in application were categorized.

Results:

50 students from the following professions participated: Medicine, Nursing, Public Health, and Respiratory Therapy. The mean time of tourniquet application was 96.16 seconds (range: 25.12-226.31). This was statistically different from the EMT-Ps’ time of 42.83 seconds (range: 23.89-82.94). Additionally, only five (10%) placed the tourniquet correctly. Errors included improper location and windlass misuse or non-use. The instructions were frequently critiqued for being difficult to read and containing confusing graphics.

Discussion:

Provision of commercial tourniquets in public access areas must be accompanied by civilian education and the creation of CAT instructions that are simplistic, comprehensible, and suitably graphic.
Hunger in Latin America: What Can We Do?
Authors: Ponte Silvana Dal , Menezes Daniel
Published: May 2019

Introduction:

Hunger is a global problem and has increased in recent years. In Latin America, hunger continues in high numbers. Although the level of hunger is relatively low compared to other regions, this increase in Latin America is mainly explained by the economic slowdown in South America. Also, climate changes are already weakening the production of the main crops in tropical and temperate regions.

Aim:

Report the numbers of hunger in Latin America.

Methods:

A cross-sectional study with reports of the World Health Organization’s hunger figures, September 2018.

Results:

The number of hungry people in the world has increased for the third consecutive year and affects 821 million people, according to a report released by UN agencies. This corresponds to one in nine people in the world. In Brazil, the figures indicate that more than 5.2 million people spent a day or more without consuming food by 2017, which corresponds to 2.5% of the population. In Latin America and the Caribbean, hunger has also increased and affects some 39 million people.

Discussion:

Hunger is a catastrophic problem in Latin America. Involving professionals in food and nutrition to try to reduce these numbers appears to be a good strategy because just as the doctor treats the disease, the involvement of other specialists to address the cause of the problem can bring long-term benefits. A social project for this purpose that mobilizes chefs and nutritionists is in progress in Brazil.
The Social Determinants of Health in Disaster Risk Reduction
Authors: Cuthbertson Joseph , Archer Frank , Rodriguez-llanes Jose , Robertson Andrew
Published: May 2019

Introduction:

The rationale for undertaking this study was to investigate how characteristics of population health relate to and impact disaster risk, resilience, vulnerability, impact, and recovery. The multi-disciplinary environment that contextualizes disaster practice can influence determinants of health. Robust health determinants, or lack thereof, may influence the outcomes of disaster events affecting an individual or a community.

Aim:

To investigate how the social determinants of health inform community perceptions of disaster risk.

Methods:

Community perception of disaster risk in reference to the social determinants of health was assessed in this study. Individual interviews with participants from a community were conducted, all of whom were permanent community residents. Thematic analysis was conducted using narrative inquiry to gather firsthand insights on their perceptions of how characteristics of population health relate to and impact an individual’s disaster risk.

Results:

Analysis demonstrated commonality between interviewees in perceptions of the influence of the social determinants of health on individual disaster risk by determinant type. Interviewees sensed a strong correlation between low community connection and disaster risk vulnerability. Specific populations thought to have low community connection were perceived to be socially isolated, resulting in low knowledge or awareness of the surrounding disaster risks, or how to prepare and respond to disasters. In addition, they had reduced access to communication and support in time of need.

Discussion:

The importance of a strong social community connection was a feature of this research. Further research on how health determinants can enable disaster risk awareness and disaster risk communication is warranted.
Assessing the Efficacy of a One-day Structured Induction Program in Orienting Clinical Staff to a Novel Prehospital Medical Deployment Model
Authors: Gao Crystal , Jie Lim Zheng , Yeh Sabrina , Santinon Scott , De Haas Scott , Austin Kristy
Published: May 2019

Introduction:

St. John Ambulance Victoria provides first aid and medical services at a variety of mass gathering events (MGEs) throughout Victoria. Volunteer healthcare professionals and students (termed “volunteers”) form Medical Assistance Teams (MAT) at these MGEs. MAT deployments manage a variety of patient presentations which include critically ill patients. This reduces high acuity patient transfers to the hospital and, where possible, avoid ambulance and hospital utilization.

Aim:

To determine the effectiveness of interdisciplinary prehospital simulation workshops in preparing volunteers for MAT deployment at MGEs.

Methods:

A one-day, simulation-based training session within the MAT environment was implemented to introduce volunteers to the management of various scenarios faced at MGEs. All volunteers were provided an orientation to the equipment and setting up MAT deployments at MGEs. Volunteers then participated in interdisciplinary group-based scenarios such as cardiac arrest management, drug intoxication, spinal injuries, agitated patients, and airway management. To determine the effectiveness of this training session, volunteers were invited to participate in a post-training survey, comprising of Likert scores and open-ended responses.

Results:

Seventeen volunteers attended the training session with 10 (58.8%) completing the post-training survey. Volunteers were satisfied with environment familiarization in the MAT (Average 4.47/5.00) and found the simulation-based training helpful (Average 3.67/4.00). The induction overall was well-received (4.60/5.00) with volunteers feeling more confident in being deployed at MGEs (4.20/5.00).

Discussion:

The results of the simulation-based training session were positive with volunteers receptive to the need for a training day prior to MAT deployment at MGEs. The simulation session enables volunteers to be comfortable with working in MAT and managing a diverse range of patients at MGEs. This session is likely to improve interdisciplinary communication and teamwork in the MAT. Future research is aimed at following these volunteers after several MAT deployments to improve the training session for future participants.
Blockchain Technology for Disaster and Refugee Relief Operations
Authors: McIsaac Joseph , Brulle Joseph , Burg John , Tarnacki Gregory , Sullivan Christian , Wassel Rick
Published: May 2019

Introduction:

Blockchain is a distributed ledger technology for storing and transmitting information (value) that is secure, verifiable, and auditable. Two specific use-case opportunities exist, identity management and payment systems.

Aim:

A secure and auditable solution for disaster refugee support.

Methods:

Gap analysis, literature search, and synthesis using existing technologies.

Results:

Strategy foundation: A blockchain identity management system that utilizes the Hyperledger Fabric framework; identification on a large scale, in a distributed model that provides immutable record capabilities to prevent fraud, with the ability to incorporate biometrics and DNA; deploy applications that will provide supply-chain capabilities; cryptocurrency for recipients and other relief functions for refugees/disaster victims; components such as consensus, membership services, and Smart Contracts; cloud-based, with redundancies in multiple vendors and additional complex government cloud requirements/certifications, leveraging NIST 800–53 by utilizing a hybrid public permissions architecture.

Discussion:

There are an estimated 68 million refugees worldwide at any time. Valid identification is needed by most refugees to qualify for government or international donor relief. That identification is crucial in getting refugees and victims access to the aid supply chain. Blockchain stores data on a large number of computer nodes connected over the Internet. Each node contains an identical copy that is time-stamped and protected by a cryptographic technique called hashing, and control is decentralized. This blockchain strategy will revolutionize the way the government manages the $30 billion in foreign aid to refugees. It will build upon the identities established to deploy applications that will provide supply-chain capabilities, cryptocurrency for recipients, and other relief functions for refugees/disaster victims. Stakeholders beyond government will also benefit tremendously. The distributed nature of our application will provide visibility to NGOs, nonprofits, host nation stakeholders, and other relief organizations. A single system that provides information to everyone involved will almost instantaneously change the face of relief.
Construction of an Operational Protocol for Multiple Victims and Disasters in Southern Brazil
Authors: Mara Marin Sandra , Bender Jean , Bezerra Cabral Danielle
Published: May 2019

Introduction:

Unpredictable events, such as disasters, can change the organizational configuration of health facilities. In a situation of multiple victims, this scenario modifies the flow of care to adapt to the reality that is there. In addition, emergency and emergency units provide immediate care to maintain and preserve the lives of these victims, making it a challenge for all health professionals.

Aim:

To construct an Operational Protocol for nursing care with multiple victims and disasters in a Hospital Emergency and Emergency Service.

Methods:

We used a descriptive study with a qualitative approach using the Focal Group technique (GF). The participants included nursing staff and residents who work in the emergency and emergency unit in a hospital in the south of Brazil. The topics from the GF discussion were analyzed by the scientific content of Minayo (2013).

Results:

The operational assistance protocol for multiple victims and disasters was planned with a redistribution of materials, equipment, human resources of the service, and physical restructuring of the service and other units with the construction of a flow chart to meet the proposed demand.

Discussion:

In the study, we observed the importance of discussing and planning proposals for care with multiple victims. In addition, the interest of the participants was fundamental to the success of this protocol. This protocol serves as an incentive for nursing professionals and academics for future research that evaluates the effectiveness of using nursing competencies to assist multiple victims in emergency and disaster situations.
Core Curriculum for Event Medical Leaders
Authors: Lund Adam , Munn Matthew Brendan , Ranse Jamie , Turris Sheila
Published: May 2019

Introduction:

The literature on mass gatherings has expanded over the last decade. However, no readily accessible curriculum exists to prepare and support event medical leaders. Such a curriculum has the potential to align event medical professionals on improving event safety, standardizing emergency response, and reducing community impacts.

Methods:

We organized collaborative expert focus groups on the proposed “core curriculum” and “electives.”

Results:

Key features of a mass gathering medical curriculum include operations-focused, evidence-informed, best-known practices offered via low barrier, modular, flexible formats with interactive options, and a multi-national focus.

Core content proposed:

Background (Definitions, Context, Risk, Legalities)

Event Medical Planning - “The Seven Steps” - (1.) Assessment and Environmental Scan - Event Emergency Action Plan, (2.) Human Resources, (3.) Equipment/Supplies, (4.) Infrastructure/Logistics, (5.) Transportation (To, On, From), (6.)

Communication (Pre, During, Post), and (7.) Administration/Medical Direction

Event After-Action Reporting

Case-based Activities

Electives mirror Core outline and serve as expanded case-studies of specific event categories. Initially proposed electives include:

Concerts/Music Festivals

Running Events

Cycling Events

Multi-Sport Events

Obstacle Adventure Courses

Staged Wilderness Courses

Amateur Games

Political Gatherings & Orations

Religious Gatherings & Pilgrimages

Community Gatherings (e.g., Parades, Fireworks, etc.)

Discussion:

Complex team learning to standardize real-world approaches has been accomplished in other medical domains (e.g., ACLS, AHLS, ATLS, PALS, etc.). A course for event medicine should not re-teach medical content (i.e. first aid, paramedicine, nursing, medicine); it should make available a commonly understood, systematic approach to planning, execution, and post-event evaluation vis a vis health services at events. A ‘train the trainer’ model will be required, with business operations support for sustainable course delivery. The author team seeks community feedback at WCDEM 2019 in creating ‘the ACLS’ of Event Medicine.
Current Status of the Japanese Disaster Medical Record
Authors: Chishima Kayako , Toyokuni Yoshiki , Hisayoshi Kondo , Koido Yuichi , Kubo Tatsuhiko
Published: May 2019

Introduction:

There was no common medical record used in disasters in Japan. At the 2011 Great East Japan Earthquake, medical teams used their own medical records instead of a unified format and operational rules. As a result, confusion occurred at the clinical practice site. The Joint Committee on Medical Records proposed a standard format of disaster medical records in February 2015. The Ministry of Health, Labor, and Welfare has issued the notification of states’ use of a standardized medical record for disaster in 2017. It was confirmed that standardized disaster medical records were used by each organization in the 2018 Western Japan torrential rain disaster and the Hokkaido Iburi Eastern Earthquake, but the actual condition of those records was not clarified.

Methods:

We sent a questionnaire to the local governments where the medical team worked in 2018 Western Japan torrential rain disaster and the Hokkaido Iburi Eastern Earthquake. In the questionnaire, we asked about the operation and management of standardized disaster medical records at the time of the disaster and also questioned future management methods.

Results:

There was no use of other medical records. Standardized medical records were used in all records. All records were managed and operated by the disaster medical headquarters responsible for health care and welfare. Standardized disaster medical records were recorded on paper. Evacuees included patients who moved from shelter to shelter or to temporary housing to get better living conditions. That created difficulties transferring records since it was recorded on paper and stored in medical headquarters. Some returning patients were checked by several medical teams, resulting in the creation of several medical records of the same patient’s condition. Future improvements and management of the recording process and record-keeping are required.
Developing an Educational Strategy for Delivering an E-learning Disaster Medicine Course for Undergraduate Students in US Medical Schools
Authors: Molloy Michael , Power Edmond , Ciottone Gregory R.
Published: May 2019

Introduction:

Disaster Medicine (DM) is a discipline arising from the marriage of emergency medicine and disaster management. The importance of DM has recently increased, with current wildfire situations throughout the world being examples of mass scale disasters with significant human morbidity and mortality. DM deals with preparedness, mitigation, response, recovery, and prevention of disasters (1).

Aim:

To develop an educational strategy and reusable format for delivering undergraduate DM courses online. Man-made, weather-related, humanitarian, and technological disasters occur all around the globe annually, yet the majority of medical schools do not have an undergraduate DM program. This project developed an online course structure accessible to medical schools and students throughout the world.

Methods:

Learning theories and models of learning were used to construct a course layout that encouraged students to be active learners, developed long-term retention strategies, and facilitated assessment for and of learning. This was accomplished through innovative educational modalities, including novel apps and external online resources. The course focuses heavily on outcome-based education with an emphasis on the development of applicable skills. Each lecture is divided into a series of learning objectives to allow students to master concepts sequentially, followed by questions to make use of the “testing effect” (2).

Results:

Focused review of current medical education literature reveals that students learn best when given short, outcome-focused “mini-lectures” followed by low-stakes assessment and feedback.

Discussion:

Medical schools without trained DM staff now have access to expert online material developed by educationalists with a focus on skills and knowledge retention.
Development and Challenges of Japan DMORT (Disaster Mortuary Operational Response Team) Association
Authors: Kuboyama Kazutoishi , Kurokawa Kayoko , Murakami Noriko , Nagasaki Yasushi , Ukai Takashi , Yamazaki Tatsue , Yoshinaga Kazumasa
Published: May 2019

Introduction:

In 2006, Japan DMORT was established by physicians, nurses, forensic pathologists, social workers, and a journalist (inspired by a major train crash in the previous year) to provide mental support to disaster victims’ families who had not received care. However, disaster victims’ identification and care of the families were monopolized by police in Japan. Also, our ‘study group’ status confused people who were affected by disasters.

Aim:

To describe the development and future challenges of our association.

Methods:

We developed our policy to focus on mental support through various activities such as the 11 closed seminars with disaster victims’ families, 21 training courses for disaster responders, and several workshops in medical or nursing conferences. In the Christchurch Earthquake, NZ (2011), with young Japanese casualties in a collapsed building, our core member reported the needs of families’ mental support, which showed the validity of our policy.

Results:

In the Great East Japan Earthquake (2011), we distributed mental health care manuals for disaster responders. In the landslides in Izu Oshima Island (2013), 3 members supported victims’ families through the town office. In the Kumamoto Earthquake (2016), two members made grief work on families of 17 victims at the prefectural police academy. These activities convinced the police of the need for medical/mental support and ourselves of the necessity for legal status. In 2017, we reorganized our association into an incorporated society. We also became official members of crime/disaster victims support liaison councils of two prefectures among 47 in Japan. In 2018, official agreements were made with the Hyogo prefectural police. But in the Heavy Rains and Flooding of July and in the Hokkaido Eastern Iburi Earthquake of September, the local police did not agree to accept us.

Discussion:

Official collaboration with police is essential nationwide in Japan. Further relief activities are expected.
Development and Initial Validation of a Stochastic Discrete Event Simulation to Assess Disaster Preparedness
Authors: Cronqvist Mattias Lantz , Jonson Carl-Oscar , Prytz Erik
Published: May 2019

Introduction:

Assessing disaster preparedness in a given region is a complex problem. Current methods are often resource-intensive and may lack generalizability beyond a specific scenario. Computer-based stochastic simulations may be an additional method but would require systems that are valid, flexible, and easy to use. Emergo Train System (ETS) is an analog simulation system used for disaster preparedness assessments.

Aim:

To digitalize the ETS model and develop stochastic simulation software for improved disaster preparedness assessments.

Methods:

A simulation software was developed in C#. The simulation model was based on ETS. Preliminary verification and validation (V&V) tests were performed, including unit and integration testing, trace validation, and a comparison to a prior analog ETS disaster preparedness assessment exercise.

Results:

The software contains medically validated patients from ETS and is capable of automatically running disaster scenarios with stochastic variations in the injury panorama, available resources, geographical location, and other variables. It consists of two main programs: an editor where scenarios can be constructed and a simulation system to evaluate the outcome. Initial V&V testing showed that the software is reliable and internally consistent. The comparison to the analog exercise showed a general high agreement in terms of patient outcome. The analog exercise featured a train derailment with 397 injured, of which 45 patients suffered preventable death. In comparison, the computer simulation ran 100 iterations of the same scenario and indicated that a median of 41 patients (IQR 31 to 44) would suffer a preventable death.

Discussion:

Stochastic simulation methods can be a powerful complement to traditional capability assessments methods. The developed simulation software can be used for both assessing emergency preparedness with some validity and as a complement to analog capability assessment exercises, both as input and to validate results. Future work includes comparing the simulation to real disaster outcomes.
Disaster Preparedness Technician = Striking Cost Savings
Authors: Dexter Jasmine , Morrow Melanie , Fogarty Kelly , Trewin Abigail
Published: May 2019

Introduction:

The workplace holds a rapidly deployable, self-sufficient field hospital including a medicine cache valued at $80,000. The cache is rotated through the affiliated hospital pharmacy when they have less than 12 months to their expiry. Rotations are done regularly due to the short expiry dates of stock coming from suppliers. A senior pharmacy technician is employed two days per week at a cost of $13,024.80 per annum to manage this cache.

Aim:

To demonstrate the associated cost savings of employing a pharmacy technician to manage a medication cache.

Methods:

Every month, the technician extracts items with less than a year expiry from the stock control system and compares these dates with that of the stock held in the pharmacy. All items with a better expiry date are rotated as long as there is sufficient turnover to ensure use before its expiry. Automatic recording occurs of items rotated, items discarded, and their costs are used as key performance indicators (KPI).

Results:

Over a 12 month period, $52,803 worth of stock was rotated. On average, 48 lines and 7,619 individual items were rotated monthly with a value of $4,061.83 (range $0-$8,820 per month). During this period, there were 2 months where no rotations occurred due to staff changeover and annual leave. 10 lines of medicines at a value of $4,041 were discarded over this time period. The two main reasons for discarding were that the medicine was not a pharmacy item or was not used in a large enough quantity to allow rotation.

Discussion:

The equivalent of four times the technician’s wage was saved over 12 months. This illustrates striking cost savings gained by efficient, timely rotations and the cost benefits of employing a technician.
Does Medical Presence Decrease the Perceived Risk of Substance-Related Harm at Music Festivals?
Authors: Munn Matthew Brendan , White Melissa Sydney , Hutton Alison , Turris Sheila , Tabb Haddon , Lund Adam , Ranse Jamie
Published: May 2019

Introduction:

The use of recreational substances is a contributor to the risk of morbidity and mortality at music festivals. One of the aims of onsite medical services is to mitigate substance-related harms. It is known that attendees’ perceptions of risk can shape their planned substance use; however, it is unclear how attendees perceive the presence of onsite medical services in evaluating the risk associated with substance use at music festivals.

Methods:

A questionnaire was administered to a random sample of attendees entering a multi-day electronic dance music festival.

Results:

There were 630 attendees approached and 587 attendees completed the 19 item questionnaire. Many confirmed their intent to use alcohol (48%, n=280), cannabis (78%, n=453), and recreational substances other than alcohol and cannabis (93%, n=541) while attending the festival. The majority (60%, n=343) stated they would still have attended the event if there were no onsite medical services available. Some attendees agreed that the absence of medical services would have reduced their intended use of alcohol (30%, n=174) and recreational substances other than alcohol and cannabis (46%, n=266).

Discussion:

In the context of a music festival, plans for recreational substance use appear to be substantially altered by attendees’ knowledge about the presence or absence of onsite medical services. This contradicts our initial hypothesis that medical services are independent of planned substance use and serve solely to reduce any associated harms. Additional exploration and characterization of this phenomenon at various events would further clarify the understanding of perceived risks surrounding substance use and the presence of onsite medical services.
The Effects of Current Cold Chain Management Equipment in Controlling the Temperature of Pharmaceutical Stores in an Australian Defence Force Exercise Environment
Authors: Daly Liz
Published: May 2019

Aim:

The purpose of this pilot study was to analyze the current cold chain storage methods of Class 8 stores, specifically thermolabile medications and temperature sensitive diagnostics, dressings, and fluids, for the Australian Army in a training area within Australia. This research was designed to identify deficiencies in current storage methods, including the inability to maintain the recommended storage temperature of pharmaceutical stores in accordance with the Therapeutic Goods Administration, as well as foster communication between key stakeholders, including the Royal Australian Army Medical Corps and the Department of Defence Joint Health Command, and to develop a cold chain protocol specific for the Australian Defence Force.

Methods:

This pilot study identified the common occurrence of breaches in a specific climate and recommends that current mission essential equipment be replaced. It also discusses the need for clearly defined guidelines with accountability of the stakeholders to ensure that the provision of health support to all Australian Defence Force personnel is in accordance with civilian standards.

Results:

This pilot study identified that the carried thermolabile medications and temperature sensitive diagnostics, dressings, and fluids were commonly exposed to temperatures outside the range recommended by the manufacturers. These findings related mainly to the storage equipment for Class 8 stores used by the Army. As a result, it is recommended that such equipment is replaced so that the cold chain storage meets the Therapeutic Goods Administration Guidelines to ensure that health support to Australian Defence Force Personnel in the field is in accordance with the standard of care expected at a civilian health facility.

Discussion:

This pilot study has enabled the Australian Defence Force to qualify and quantify the temperature exposure of the medications and stores and engage with key stakeholders to trial and apply new technologies and processes for the management of the cold chain.
The Efficacy of Blood Lactate on Predicting the Prognosis of Patients with Multiple Trauma
Authors: Hao Di
Published: May 2019

Introduction:

Because of the rapid progress of multiple trauma patients, the early mortality rate is high. Therefore, early assessment of the severity and prognosis of multiple injuries is crucial for timely treatment and improvement of prognosis. So we need to find parameters related to mortality and severity of multiple trauma.

Aim:

To find out parameters related to mortality and severity of multiple trauma.

Methods:

This was a single center, trauma registry based, observational cohort study. Data were collected from consecutive patients with multiple trauma who presented to the emergency department of a tertiary referral hospital between April 2015 and December 2016. The main outcomes studied were 28-day in-hospital mortality, 24-hours mortality, emergency operation rate, and ICU admission rate.

Results:

444 patients were eventually included in the study, including 337 males (75.9%) and 107 females (24.1%). The 28-day survival group consisted of 381 patients (85.8%) and the death group accounted for the other 14.2%. Multivariate logistic regression analysis showed that heart rate, peripheral oxygen saturation, lactic acid, partial pressure of carbon dioxide, plasma albumin, hematocrit, and Glasgow score were independent risk factors for 28-day mortality. The area under the ROC curve (AUC) of the above indicators was 0.669, 0.547, 0.868, 0.512, 0.740, 0.627, and 0.815, and the AUC value of lactate was the maximum.

Discussion:

When the body suffers from severe trauma, it loses a lot of blood and reduces the circulating blood volume, which leads to absolutely insufficient hemoglobin content and hypoxia of tissue cells. The plasma lactate content increases at this time. Therefore, lactate can be used as an important prognostic parameter for patients with multiple trauma. In addition, we can use lactate to revise the existing trauma score to enhance its effectiveness.
Establishment of Research Model on the Correlation Between Psychological Stress Intensity and Personality in Nursing Students Under Different Pressure Sources
Authors: lei xu , Xiwen Liu
Published: May 2019

Introduction:

In recent years, sudden disasters are occurring frequently, resulting in inestimable casualties and losses. Hence, knowing what personality traits are suitable for stressful works is of vital importance for selecting applicable nurses for disaster relief operation, and helping the nursing students to have a clearer career orientation when choosing the specialty direction. Stress response is divided into psychological response and physiological response. This study focused on the process of physiological response and evaluated the psychological stress intensity through monitoring physiological indexes related to the autonomic nervous system during the stress process.

Method: The experimental subjects were 16 nursing students. In the monitoring experiment, three kinds of pressures were set, including time limitation, threat assessment, and task- interference. The physiological indexes under the resting state of the experimental subjects were recorded as the resting period group (RT). Then, the nursing students performed the operation without setting the pressure condition, called the baseline period group (BL). The experimenter would record all important time nodes. The physiological indexes recorded under the three pressures were the time stress group (TS), the assessment stress group (AS), and the task-interference stress group (INS).

Results:

There was no statistically significant difference in heart rate and skin temperature between RT and BL, but there was a statistically significant difference in skin resistance. The heart rate and skin temperature in the stress phase were significantly higher than those in RT and BL. According to the analysis of HRV, the difference between RT and BL has no statistical significance.

Discussion:

Models can eliminate the interference of the operation itself to the recording of physiological signals. The time-stress condition caused a more psychological-stress response in nursing students than assessment and task interference. The pressure source was set up effectively and the stress model was established successfully.
Evidence for Residual Immunity to Smallpox After Vaccination
Authors: Kunasekaran Mohana , Chen Xin , Costantino Valentina , Chughtai Abrar , MacIntyre Raina
Published: May 2019

Introduction:

Smallpox has been eradicated, but advances in synthetic biology have increased the risk of its re-emergence. Residual immunity in individuals who were previously vaccinated may mitigate the impact of an outbreak, but there is a high degree of uncertainty regarding the duration and degree of residual immunity.

Methods:

A systematic literature review using the PRISMA criteria was conducted to quantify the duration and extent of residual immunity to smallpox after vaccination. 29 papers related to quantifying residual immunity to smallpox after vaccination were identified.

Results:

Duration of protection of >20 years was consistently shown in the 16 retrospective cross-sectional studies, while the lowest estimated duration of protection was 11.7 years among the modeling studies. Childhood vaccination conferred longer duration of protection than vaccination in adulthood. Multiple vaccinations did not appear to improve immunity. Most studies suggest a longer duration of residual immunity (at least 20 years) than assumed in smallpox guidelines. Estimates from modeling studies were less but still greater than the 3-10 years suggested by the WHO Committee on International Quarantine or US CDC guidelines. These recommendations were probably based on observations and studies conducted while smallpox was endemic. The cut-off values for pre-existing antibody levels of >1:20 and >1:32 reported during the period of endemic smallpox circulation may not be relevant to the contemporary population but have been used as a threshold for identifying people with residual immunity in post-eradication era studies.

Discussion:

Of the total antibodies produced in response to smallpox vaccination, neutralizing antibodies have shown to contribute significantly to immunological memory. Although the mechanism of immunological memory and boosting is unclear, revaccination is likely to result in a more robust response. There is a need to improve the evidence base for estimates on residual immunity to better inform planning and preparedness for re-emergent smallpox.
The Experience of Using Informational Systems to Improve the ACLS Process Optimization in the Emergency Department
Authors: Lai Pei Fang , Zhou Ying Fang , Chen Pin Shou
Published: May 2019

Introduction:

The best first-aid treatment for cardiac arrest patients is Advanced Cardiac Life Support (ACLS) to not only hope to save lives but to also leave minimal sequelae. The American Heart Association (AHA) published updated ACLS guidelines for care in 2015 emphasizing the concept of teamwork in resuscitation. However, the actual use of ACLS is not easy due to stress and unfamiliarity with the process.

Aim:

Therefore, we want to use the information technology to assist the medical team to implement the ACLS process. This information system can help us to save time and labor, as well as increase precision. In addition to this, data analysis is more convenient, which facilitates the management and supervision of resuscitation quality.

Methods:

An information system was developed using responsive web design (RWD) website. It can be used on a variety of devices, such as desktops, tablets, or mobile phones, and can be updated simultaneously. The system requires non-synchronous operation to be used in a wireless network environment. When the information system is in operation, the medical personnel can perform the resuscitation actions according to voice prompts, which can periodically remind staff to check rhythm, give correct medication dose, and identify whether defibrillation shock is needed. At the same time, the entire process can be recorded instantly. After the file is uploaded, the medical records are complete at the same time.

Results:

After 3 months, the satisfaction of medical staff reached 80.3%, the rate of return of spontaneous circulation (ROSC) of OHCA cases elevated to 45% from 15%, and discharge without neurological sequelae elevated to 33% from 27.4%.

Discussion:

All hospital staff can use this system to assist in the correct implementation of advanced CPR. It improves the quality of resuscitation and reduces the burden on clinical and writing medical records of medical staff.
First Aid Management of Hypothermia and Cold Injuries
Authors: Christiansen Rowena
Published: May 2019

Introduction:

Best practice first aid management of accidental hypothermia and cold injuries in the prehospital setting is relevant for disaster management in cold environments as well as for wilderness and expedition medicine, and space medicine. In the Australasian context, guidance is currently taken from the Australian Resuscitation Council (“ARC”) Guidelines dealing with these issues.

Aim:

To review and update the recommendations of the ARC Guideline 9.3.3 Hypothermia: First-Aid Management (February 2009) and ARC Guideline 9.3.6 Cold Injury (March 2000).

Method: The review is being undertaken through a combination of a focused literature review and expert opinion. Through the author’s membership of the International Commission for Alpine Rescue (“ICAR”) Alpine Emergency Medicine Commission, two northern-hemisphere experts on hypothermia have reviewed the guidelines and provided commentary and recommendations.

Results:

Much of the literature around accidental hypothermia and cold injuries (including frostbite, frostnip, and chilblains), relies on expert opinion and case studies. There are relatively few randomized controlled trials, and these are often confined to the laboratory setting. As a result, there is a heavier reliance on expert opinion than in any other areas of medicine.

Discussion:

This presentation will summarize the current best practice recommendations for the first aid management of accidental hypothermia and cold injuries through combining the existing ARC Guidelines with key advances identified through the literature review, and the key management recommendations stemming from expert opinion. This will provide attendees with a cohesive set of clinical practice recommendations which can be used in the field.
Health Needs Assessment in Disasters by Emergency Medical Teams in the ASEAN Region
Authors: Takada Yosuke , Keeratipongpaiboon Kanin ,   ARCH Project Expert Team
Published: May 2019

Introduction:

Japan International Cooperation Agency has started the project for strengthening the ASEAN regional capacity on disaster health management (ARCH Project) since 2016. This project conducted the start-up regional collaboration drill in ASEAN. All participants from ASEAN countries realized the need for a standardized assessment tool. Several UN agencies and international organizations launched assessment tools, but there is no standard assessment tool.

Aim:

To develop an integrated rapid health needs assessment (HNA) tool in the ASEAN region. This paper reports the development process of the HNA tool.

Methods:

The project established the project working group (PWG) to developing some tools. PWG consisted of the expert team, project team, Japanese Advisory group and twenty delegates from ten ASEAN member states. PWG established the cycle of the developing process of the HNA tool.

Results:

We created a health needs assessment form and a summary form. The assessment form consists of (1) Informant information, (2) Site information, (3) Overall situation of the site, (4) Public health, (5) Health facility damage. The summary form consists of (1) Informant information, (2) Site information, (3) Critical areas for support, (4) Situation of the site.

Discussion:

Frequently, the public health emergency operation center in an affected country is not able to obtain the critical information of an affected area in the acute phase of disasters. This HNA tool would be used in the acute phase by the Emergency Medical Teams (EMTs) because the EMT has mobility and workforce for assisting the affected country. We have agreed on the usage of the assessment form as a kind of an “interview guide”. The purpose of this assessment form is to assess a disaster situation. The next step will be to provide more opportunities for the ASEAN member states to use and learn more about this HNA form.
The Incidence of Post-Traumatic Stress Disorder Among Healthcare Providers After the 2018 Taiwan Hualien Earthquake
Authors: Nieh Jen-Hao , Lai Pei-Fang , Niu Kuang-Yu
Published: May 2019

Introduction:

On February 6, 2018, a magnitude 6.2 earthquake struck Hualien, Taiwan. Over 150 patients crammed into the emergency department of nearby hospitals within two hours. Mass casualty incident (MCI) management was activated. During the recovery phase, little attention was paid to the mental health of hospital staff.

Aim:

To analyze the prevalence of post-traumatic stress disorder (PTSD) among healthcare providers (HCPs) and explore the possible risk factors.

Methods:

63 HCPs in the emergency department of the single tertiary hospital near the epicenter were included. The Chinese version of the Davidson Trauma Scale (DTS-C) was used to evaluate the prevalence of PTSD. Questionnaires were sent to explore the possible contributing factors.

Results:

The average age of the HCPs was 32.7 years (30.3 years for nurses; 40.4 years for physicians). The prevalence of PTSD was 3.2% eight months after the incident. The mean DTS-C score was 8.9/136. Nurses had a higher score than physicians (10.8 and 4.7). HCPs with 6-10 years working experience had the highest score (14.2), while those with less than 3 years experience had the lowest (4.8).

Discussion:

We found HCPs had a lower prevalence of PTSD compared with earthquake survivors (Chou 2007), and physicians had longer working years and lower DTS-C scores. The professional training may help HCPs going through psychological impacts during the disaster. HCPs with 6-10 years of experience in the emergency department were found to have a higher risk of developing PTSD. Most of them were taking the responsibility of a team leader during the MCI, which may cause significant stress to these staff. Adequate training regarding MCI management could help to relieve tension and frustration, hoping to prevent the development of PTSD. Based on our study, PTSD among HCPs is an ignored issue, and we should follow-up HCPs’ psychological condition in the future.