bluuebunny/crossref_metadata_2025 huggingface dataset:
(P2-20) Explosion At A Steelwork Plant
Authors: Bortolin M. , Raviolo M. , Vacca R. , Bono D.
Published: May 2011

Introduction

On the night of 06 December 2007, an explosion occurred at a steelworks plant in the city of Turin. The incident involved 10 people. The emergency medical services (EMS 118 Turin) declared a mass-casualty incident (MCI).

Objectives

The aim of this case report is to analyze the response of the EMS 118 Turin to the MCI in order to identify problems or short-comings and improve the service for future responses.

Methods

Information from the dispatch center, medical report of the EMS, and hospitals that received the patients were analyzed.

Results

The emergency call was placed at 01:04 hours, and the MCI was declared closed at 04:40 hours. The disaster, in according to Disaster Severity Scale (DSS), was classified 3. The METHANE message was sent to the dispatch center by the first ambulance 4 minutes after the call. There were 10 patients: seven T1; one T2; and two T3. The dispatch center deployed nine teams, which consisted of five advanced life support (ALS) teams and four basic life support (BLS) teams. All of the casualties were able to walk when they arrived to the medical care. The T1 casualties had burns to > 80% of their body surface area (BSA), the T2 and T1 casualties suffered inhalation of smoke gas. The first casualties were evacuated to the hospital 28 minutes after the call. Four casualties (three T1 and one T3) were transported to the nearest hospital. the other four T1 casualties were transported to four different hospitals of the city. All the T1 casualties died in the next 24 days.

Conclusions

The management of resources during this MCI was suboptimal. The number of ALS teams that responded to the MCI was high considering the number of casualties and the time taken to resolve the incident. The lessons learned from this incident and other cases have permitted the EMS Turin to improve their response plan concerning the use of resources and surge capacity.
(P2-21) Differences in Self-Protective Behavior between Hospital Workers and Community Care Workers in Israel during the Peak of A/H1N1 Pandemic
Authors: Rofe Y. , Bar-Dayan Y.
Published: May 2011

Background

Effective function of the community care system is important during a pandemic. Self-protective behavior might help stop the spread of the disease during a pandemic and prevent system dysfunction because of personnel morbidity.

Objective

To compare the immunization rate and reported self-protective behavior of healthcare workers between hospitals and community care clinics during the peak of the winter A/H1N1 pandemic in Israel.

Methods

A questionnaire was completed by 1,147 healthcare workers in 21 hospitals and 40 primary care clinics in Israel between 26 November 2009 and 10 December 2009 (the peak of the winter A/H1N1 flu outbreak).

Results

The rate of vaccination against A/H1N1 among hospital workers (27.9%) was significantly higher compared with primary care clinics workers (19.3%) (OR = 0.691 (0.821–0.582)).
(P2-23) Attempted and Completed Suicides: A Two-Year Analysis from a German Helicopter Base
Authors: Frank M.D. , Hencke A. , Braun J. , Pyrc J.
Published: May 2011

Introduction

In Germany, emergency physicians in the prehospital rescue system ensure primary care. The rescue helicopter in Dresden covers the city of Dresden (population 517,000), surrounding areas with distances up to 70 km. Typical reasons for alerting the rescue helicopter are heart diseases or injuries during accidents. There also is a high number of patients with attempted or completed suicides. The goal of the study was to analyze cases associated with suicide.

Methods

Data of all emergency transports from the German Air Rescue (DRF-Luftrettung) Helicopter Base Dresden between January 2008 and December 2009 were recorded on a standardized protocol and transferred to a central computer database. Subsequently, all cases were analyzed with special regard to suicides.

Results

There were a total of 3,051 cases during the study period. Fifty-nine cases (1.9%) were related to suicide. The helicopter was on the scene within 10.9 minutes. The mean NACA Score was 4.9. The mean age was 51.6. A total of 52.5% of patients were male. In 15.2% of the cases, the patient called for emergency help; in 37.3%, bystanders contacted authorities. The reason for attempted suicide was unknown in 57.6% of the cases. In 16.9%, it was related to partnership, in 20.3% to health problems, in 5.1% to financial problems. The main method of attempt was the use of medical pills (47.4%). Other frequent methods were strangulation (18.6%), stab wounds and gunshots (8.5%), intoxication (3.4%), or unknown (16.9%). Six patients received cardiopulmonary resuscitation, four reached a Return of Spontaneous Circulation, and 10 patients died.

Discussion

Helicopters often transport suicide victims. This study demonstrates the need for better prevention as well as an improvement of education for emergency physicians working in the prehospital setting.
(P2-26) EMS-Assessed Mass Casualty Incident: A Pilot Surveillance
Authors: Park C.B. , Shin S.D. , Suh G.J. , Park J.O. , Kim C.H.
Published: May 2011

Background Recently the number of disaster and mass casualty incident (MCI) is increasing in Korea, but there have been few administrative reports or technical reports for disaster and MCI. An ad hoc basis data collection method is usually incomplete and outdated. This study was conducted to investigate the new surveillance system composed of EMS based real time survey and medical records based in-depth survey.

Methods

A retrospective review was conducted of the 119 fire department call center database and ambulance running sheets in one metropolitan city. The data on all transported patients with non-medical reasons (fire, rescue and others) between May 2006 and December 2008 was reviewed. We selected all data from the accidents which had more than 2 casualties to exam the feasibility and conducted in-depth surveillance based on medical records.

Results

The total number of accidents was 2,027 with 2,625 patients. The number of accidents which had more than 2 patients was 307 (total 898 patients) and more than 6 patients was 19 (total 176 patients). Among the “MCI” events, 15 cases were traffic accidents (125 patients, 71.0%), 4 cases were fire (51 patients, 29%). Total 142 medical records (80.7%) were reviewed. Admission rate was 32.4% (46 patients) and overall mortality was 3.5% (5 patients).

Conclusion

This nationwide public EMS system could contribute to the establishment of the systematic disaster database.
(P2-29) Educational Model for Pre-Hospital Disaster Management in Haiti and Beyond
Authors: Gore R. , Bloem C. , Elbashir K. , Roblin P. , Ostrovskiy G. , Daphnis J. , Arquilla B.
Published: May 2011

Introduction

There has been increased international awareness and a need to provide accessible and essential emergency preparedness training in developing countries that has resulted in the recognition of new teaching needs and number of new initiatives to meet these needs.

Methods

These teaching methods have been applied in Haiti before and after the 2010 earthquake. They include: - Established a “Train the trainer” model - Established civilian first responder training - Basic Life Support (BLS) and First Aid - Implemented medical training using the Meti Simulator models - Conducted post-training Disaster drill - Conduction of post training assessment - Succession model of training.

Results

A total of 54 people completed a BLS course and 67 completed a First Aid course. 12 participants completed the First Aid and BLS Instructors course. 95 program participants completed an end of course survey. 41 participants had no prior BLS/First Aid training or exposure. The course participants included 2 physicians, 22 students, 8 nursing students, 7 nurses, 20 teachers, 12 health workers, 5 drivers, and 14 laborers. 92 of those surveyed stated they would recommend this course to a friend. 88 participants stated that hands on learning helped them better learn the course material.

Conclusion

This training model has been well received in rural Haiti and can be applied in other developing countries. We would like to standardize training protocols that will serve as a foundation for self-sustaining higher-level emergency, pre-hospital, disaster training and management. This will improve the general quality of health care delivery. Our next pilot of this program will be in other parts of Haiti and in Khartoum, Sudan.
(P2-33) Biosecurity Considerations for Equine Emergency Sheltering
Authors: Mcconnico R.S. , Navarre C.B.
Published: May 2011

Equine emergency shelters have an increased risk of infectious disease occurrences due to increased animal stress levels, excessive co-mingling, inconsistent worker base, and horses arriving from many and varied health management and stabling situations. Biosecurity policies should be in place ahead of time to prevent disease spread and outbreak situations and policies should be effectively conveyed to all shelter personnel. A veterinarian should be involved in the overall health management of an equine emergency shelter including working with public health officials regarding the overall animal and human safety issues associated with effectively managing an equine shelter. The veterinarian should work closely with the shelter manager and both need to be able to apply Incident Command System and National Incident Management Systems applications to maximize disease prevention. Mitigation tactics should include appropriate regular equine health maintenance including current vaccinations against tetanus, Equine Influenza I & II, Equine Herpes virus I & IV, and the encephalitides including Eastern, Western, and West Nile Viruses as part of horse owner emergency preparedness planning. Equine Infectious Anemia (EIA) is a federally regulated equine disease and during disaster situations it is unrealistic to assume that all horses will have a record of a current negative test. EIA testing should be considered a part of the plan for shelter animals depending on risk assessments. Appropriate personal hygiene, particularly hand hygiene, can assist in the prevention of disease transmission. Separate isolation areas are necessary for horses showing clinical signs of infectious disease including fever, nasal discharge, or diarrhea. Equine emergency shelter husbandry plans should include a plan for safe handling of feedstuffs, and water. An effective and implementable biosecurity plan for equine emergency sheltering is a key critical requirement for successful large animal emergency and disaster response outcome.
(P2-36) Evolution of Pet Owner Disaster Preparedness - California Wildfires from 2003 to 2009
Authors: Mcclure D. , Kerr J.
Published: May 2011

California wildfires are expected and they are followed by landslides and floods. A changing culture in traditional responders has co-evolved with a culture of pet owner disaster preparedness in California. This is demonstrated by the documentation of the in California wildfires from 2003–2009. The 2003 wildfires in San Diego County involved a massive relocation of people, small companion animals and over 700 horses. It was a milestone event in allowing co-located human and animal shelters. The intent was for animals to be maintained in adjacent shelters, but the result was humans taking up residence with their animal companions. Pet owners sought to keep their family, including their pets, together. It appeared that pets were providing comfort to their owners. In the same region during 2007, pet owners mobilized rapidly. They were clearly more prepared than they were in 2003. During 2008, a record 1400 fires were burning in California on July 1st. The Santa Barbara Gap Fire mobilized an expert Santa Barbara Equine evacuation team. The human Red Cross evacuation center allowed small animal cohabitation. At the same time, the Butte Lightning Complex fires (37 fires) involved a unique cohort of canine evacuees for an extended duration and requiring unprecedented veterinary volunteers. In 2009, the Santa Barbara Jesusita fire threatened an urban area and evacuation of 35,000 people. It included a vulnerable human population with health disabilities that required ambulance evacuation assistance. Small companion animals were allowed to evacuate in the front cab of the ambulance. Ambulance drivers remarked that they dreaded forcing patients to leave behind their pets and it was a relief to bring the pets along. In summary, the response to repeated California wildfires from 2003 to 2009 has demonstrated an evolving culture of animal disaster preparedness for both traditional responders and companion animal owners.
(P2-37) The Triage and Medical Management of Alcoholized/Intoxicated Patients at the Zurich “Street Parade”, One of the Biggest “Techno Dance Parades” of Europe
Authors: Mueller S.M.
Published: May 2011

Background

Every year, the City of Zurich hosts the “Street Parade”. This is one of the biggest European “techno parade” dance parties attracting way over a half a million mostly young people who party on a 2 km route along the lakeside of the City. Many of these guests drink alcohol and some eventually consume other drugs (e.g., GHB, Ecstasy, LSD). Combinations of these drugs may affect conscience eventually leading to a critical medical condition. Until recently the emergency-posts at the scene, as well as the emergency rooms of the local hospitals have been “flooded” with such patients, leading to obvious logistical problems.

Discussion of Intervention

Over the last years the Ambulance Service of the City of Zurich utilized an unused shelter close to the event scene, where these “intoxicated” mostly young patients were medically supervised and taken care of. The shelter has room for 108 patients. Every patient is first triaged; if a patient suffers from something else than just “intoxication” (e.g., cuts from broken glass) he is sent directly to the hospital for adequate treatment. The patients are then numbered, if needed showered, and receive a bed where they are regularly assessed for pulse, oxygen saturation, blood pressure and GCS by professional personnel. In parallel, if their clothes are dirty, they are washed and dried so the patient will have something clean to dress at the moment of dismissal. The average time of the patients in this shelter is 3 hours 7 minute and the charge is 600 CHF (approx 620 USD). This system has been so helpful for the hospitals, they now supply medical personnel for no cost.

Conclusion

This system of triage and separate medical supervision of “simply” intoxicated patients has been successful in the management of a large number these kind of patients.
(P2-43) Utilizing a Unified Health Command Structure for Mass Gathering Preparedness and Response: Lessons Learned from the 2008 Pacific Arts Festival
Authors: Bouslough D.B. , Lemusu S. , Avegalio F.
Published: May 2011

Background

The Pacific Arts Festival is a mass-gathering event occurring every four years in Oceania. The 10th festival in American Samoa, July 20 to August 2, 2008, brought 2200 performers and 2500 tourists (a 15% population increase) from 27 Pacific nations to the island. Anticipated healthcare concerns included hospital surge (175% in 2004), HIV/STI transmission, imported/communicable diseases, food/water/sanitation-borne illness, interpersonal violence, and healthcare resource utilization.

Objective

To describe the preparedness and response efforts for this mass gathering event by emergency medical services, the hospital, and the department of health.

Methods

A retrospective review of after-action reports, public health and emergency department surveillance records, and key-informant interviews was conducted. Descriptive statistics were used to evaluate data.

Results

A Unified Command structure was utilized for pre-/post-event response. Patient surveillance data was collected daily. During the festival 217 participants (42% female, 58% male, Average age 36) sought medical care. Acute illness (n = 166), injury (n = 39), other (n = 15), routine follow up (n = 9), chronic conditions (n = 6), mental health (n = 1), OB/GYN (n = 1) were complaints addressed. Predominant acute illnesses included headache (n = 49, 23%), respiratory illness (n = 30, 14%), musculoskeletal pain (n = 26, 12%), and gastroenteritis (n = 17, 8%). One fatality occurred among delegates. No public health outbreaks were reported. Visits per healthcare venue demonstrated a decentralization of patient surge from the hospital setting (37.4% venue aid stations, 28.1% delegation medical staff, 24% DOH clinic, 10.6% hospital).

Conclusion

A unified health command structure was effective in responding to this mass gathering event. Surveillance data was rapidly gathered and utilized to direct healthcare resources. Efforts to decentralize healthcare from the hospital were successful. Public health emergencies were avoided.
(P2-45) Impact of Educational Intervention on Knowledge Regarding Disaster Management Among Nurses Working in Nepal
Authors: Mandal G.N.
Published: May 2011

Objectives

The purpose of this study was to find the change in knowledge regarding disaster management among nurses after educational intervention.

Methods

One group pretest and post test design was adopted for the study. The study was carried out in B.P. Koirala Institute of Health Sciences, Nepal. Forty Nurses were selected from emergency, orthopedics, medicine, and surgical ward by using non-probability convenience sampling technique. A self-administered semi-structured questionnaire was used to collect the data. Data was collected before and after the educational intervention. The collected data were analyzed using descriptive statistics (frequency, percentage, mean, standard deviation) and inferential statistics (Chi-square and Z test) were used to identify the difference in knowledge between pre-test and post-test, at 0.05 level of significance.

Results

Study findings revealed that in the pre-test, grand mean of the means of the nurses' knowledge on different aspects of disaster management as a whole was 2.39 with the standard deviation of 0.87. Similarly the grand mean of means of knowledge on different aspects of disaster management was 3.2 with the standard deviation of 0.47 in the post-test. The difference between pre-test and post-test in respondents' knowledge in different aspects of disaster management as a whole was calculated by using “Z” test (p < 0.05) The result showed that the educational intervention was effective in bringing changes in knowledge in all aspects of disaster management.

Conclusions

Study findings revealed that there was significant increase in knowledge in the post-test after the educational intervention. Therefore, it can be concluded that education plays an important role in increasing awareness. It is recommended that awareness programs on disaster management should be carried out periodically as in-service education.
(P2-46) Understanding the Willingness of Australian Emergency Nurses to Respond to a Health Care Disaster
Authors: Ranse J. , Arbon P. , Cusack L. , Shaban R. , Considine J. , Mitchell B. , Woodman R. , Hammad K. , Kako M. , Bahnisch L.
Published: May 2011

Background

Disaster response is an emergency nursing responsibility. Responding to disasters, however, is hazardous as terrorism, pandemics and chemical industrial accidents challenge the safety of nurses and their families. International experience has shown that nurses can become victims of disasters and that fear of contaminating family and friends may prevent nurses from attending work or returning home during a disaster response. An understanding of the factors that enable or disable their disaster preparedness will underpin future disaster policy and planning for Australian and international health care organizations.

Methods

This study examines the willingness of Australian emergency nurses to attend work to respond to a health care disaster, using a 3-phase mixed-method design. Phase 1 was a national online survey, with 451 responses. Phase 2 involved 6 focus groups at 4 hospital sites, with 41 participants and Phase 3 involved in-depth interviews with emergency nurses at different sites, with 11 participants. This presentation will highlight results from the study on the willingness of Australian emergency nurses to respond to a health care disaster.

Results

Preliminary findings indicate that emergency nurses' willingness to respond to health care disasters was dependent on a number of factors, including their out-of-work responsibilities, the changes to their roles and responsibilities at work, their confidence in management and their work team, the information they are given about the disaster, the type of disaster and the degree of risk involved.

Conclusions

The contribution the findings this study will make to disaster planning and preparedness for nursing staff, health planners and administrators will be outlined.
(P2-52) Nurse Educators' Experiences of Conducting Trauma Healing to Reduce Anxiety Among Victims of the MT. Merapi Eruption at Universitas Muhammadiyah Yogyakarta
Authors: Suhariyanto S. , Rochmawati E.
Published: May 2011

Background

The number of victims in various refugee camps who experience anxiety after the Mount Merapi eruption. Various factors that cause this condition include a lack of concern for the early treatment of psychological casualties. Support from health professionals, particularly nurses, is needed to prevent the onset of mild anxiety.

Objectives

The study was carried out in order to help understand the meaning of nurses' experiences of trauma healing to prevent anxiety among the victims of the Mount Merapi eruption.

Method

This was a qualitative research study with a phenomenological approach. In-depth interviews were used to explore participants' experiences conducting trauma healing therapy to the Mount Merapi eruption victims.

Result

The result showed the implementation of trauma healing therapy includes: (1) assessment of emotional responses; (2) physical examination; and (3) psychological assistance. The therapy being implemented includes: (1) five-finger hypnosis therapy; (2) stopped thinking therapy; and (3) progressive relaxation. The impacts of trauma healing included: (1) spirit returning; (2) increased of relaxation; (3) calmness; (4) normal vital signs; and (5) the ability to interact with other refugees. Problems experienced included the large number of refugees, the noisy environment, and a lack of concentration from the nurse when providing therapy.

Conclusion

To solve the problem, nurses are expected to recognize the response required for the victim and apply interventions based on the assessment, data analysis, planning, implementation, and evaluation. Victims of the Mount Merapi eruption are expected to attempt to apply the self-trauma healing.
(P2-53) Investigation of Comprehension of Disaster/Emergency Nursing in Nurse Practitioners in Ningbo Area, China
Authors: Wang X.W. , Xu J. , Shen Y.J.
Published: May 2011

Background

Knowledge of disaster/emergency nursing is essential to nurse practitioners (NP) due to the increasing frequency of disasters. The objective of this study was to identify the knowledge and the response relating D/EN and to investigate whether the reactions vary among NPs in different level hospitals in Ningbo Area, China.

Methods

Pre- and post-test questionnaires were used. A total of 297 NPs in five hospitals (two tertiary hospitals, two secondary hospitals, one primary hospital) were involved in this study. Five lectures were implemented based on disaster/emergency nursing from 8 December 2009 to 14 April 2010.

Results

The mean age of the sample was 31.54 years. Average working experience was 9.57 years. Only 12 participants from the emergency department attended the lecture, yet the lecture was advertised one week in advance. The mean score was 8.88 (pre-test), 12.97 (post-test). Most of the low scores (< 7) on the pre-test were from primary hospitals (43%), while only 0.6% of staff from tertiary hospitals scored that low. A total of 45% of NPs failed to distinguish the contribution of different zones of triage. Nearly 24% of participants considered that the frequency of ALS training should no more than once a month. All participants comprehended the contribution of a triage system after attending lecture, 35% of NPs received perfect scores on the post-test.

Conclusions

Comprehension of disaster/emergency nursing in NPs in Ningbo is deficient. Primary hospital NPs had a lower score than high-level hospitals. Education and training programs associated with disaster/emergency nursing are necessary for NPs.
(P2-58) A Multicasualty Event of Multiple Burn Victims Caused by Spout of Heated Hydrochloric Acid in a Chemical Plant
Authors: Fuke N. , Sato M. , Shiga H. , Yamashita M. , Yokoi T. , Kobayashi Y. , Kobayashi A. , Ikita R.
Published: May 2011

Background

A sudden break-down of a heat-exchanger in vinyl chloride plant resulted in that 141 °C, 23% concentration of hydrochloric acid spouted out over the workers around it. Eight workers suffered and Ichihara City Fire Department was deployed in response to the call 3 minutes after the onset of the incident, 17 vehicles including 5 fire engines, 6 ambulances, and two helicopters. Finally three severely (> 80% of TBSA) burned, two moderately (20–80%) burned, and three slightly (< 20%) burned victims were identified and triaged. One severely burned was transferred at first to the closest tertiary care hospital (TUCMC) which existed within 2.5 km distance by an ambulance and other two and one moderately burned were transferred by helicopters to the neighboring tertiary care hospitals. Another moderately burned one was sent to TUCMC by an ambulance about 30 minutes later than the first one. Three slightly burned victims were sent to a local hospital and treated as an outpatient. This casualty mission was ended by 120 minutes after the call. Two among the three severely burned patients lost their lives but another severe one and two moderately burned were survived. Conclusions: With these considerations, the management of this multiple burn casualty was successful, partly because of small number of the victims and of that the incident occurred in a weekday morning.
(P2-59) Monocular Vision Loss Following Blunt Trauma
Authors: Pustinger P.M. , Paratore D.
Published: May 2011

Blunt trauma is a leading cause of injury in the teenage population. The early detection of injury is the primary goal of emergency medicine in order to maintain an optimal functional capacity. This is of particular importance in the pediatric population. The following is a case presentation of monocular vision loss in a 14-year-old girl as a result of traumatic optic neuropathy. A motor vehicle collision was the cause of injury for this patient. She was an unrestrained rear seat passenger and struck her head on the driver's headrest during a frontal impact. A delayed presentation of over seven hours added to the complexity of this presentation. Further, a non-contrasted computed tomography (CT) scan of the head and orbits was unremarkable except for soft tissue swelling. The child was left with only light perception in the affected eye. This case presentation will illustrate the importance of immediate care, diagnostic studies, proper consultant input, follow-up care, and the natural history of the injury for this most unusual case.
(P2-64) Pattern and Factors Associated with Violent Incidents in the Emergency Department of a Level-1 Trauma Center
Authors: Sharma K. , Bhoi S. , Chauhan S.
Published: May 2011

Background

Violent incidents (VI) in emergency departments (EDs) are under-reported concerns for emergency care providers (ECP). There are limited data from EDs in India.

Objective

This is a study of pattern and factors associated with VIs in the ED of a Level-1 Trauma Center.

Methods

A qualitative survey questionnaire was distributed to 42 ECPs who worked in the ED of the All India Institute of Medical Sciences. Responses of ECPs were compiled and analyzed.

Results

A total of 78.6% of nurses, 19.1% doctors, and 2.4% registration clerks participated in the study. A total of 54.8% were female. A total of 85.7% had five years of work experience in the ED. A total of 59.5% witnessed and experienced verbal abuse; 19.04% witnessed and experienced physical abuse. The remaining experienced and witnessed verbal abuse as well as physical abuse. A total of 57.1% had experienced VI multiple times in last six months. Of these, 88.2% faced the incident between 8 pm and 8 am. The ECP reported the incident to hospital authority's 54.8% of the time, 19.1% reported it to the police, and 14.29% did not report, while 7.1% reported to police and hospital administration. Eighty-five percent experienced insecurity & emotional disturbance. Patient-related factors included intoxication and anxiety. Healthcare system-related factors included delay in investigations, non-availability of beds, overcrowding of ED, and lack of staff. A total of 47.7% of participants felt that there was improper communication between healthcare workers and 40.1% felt that non-availability of senior doctor were the system deficiency factors. A total of 16.6% of ECPs had formal training regarding communication skills, and 11.9% had grief counseling. All respondents felt that steps should be taken to decrease and mitigate the VIs in the ED.

Conclusions

Verbal and physical abuse of emergency care workers is common.
(P2-78) Creating Alternate Care Sites and Community-Based Care Centers for the Delivery of Medical Care During Public Health Emergencies
Authors: Reilly M.
Published: May 2011

Introduction

Developing alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites or community-based care centers which can serve as areas for primary screening and triage or short-term medical treatment can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Additionally, if planned for correctly these facilities can also be used to decant less critical patients from inpatient wards thereby increasing the surge capacity of acute care hospitals.

Methods

A model concept of operations plan for alternate care sites to be used during pandemics and large-scale public health emergencies was developed over a 3 year period, 2007–2010. Subject matter experts were convened and best-practice methods were used to design operational plans, clinical protocols, modified standards of care, and checklists for facilities appropriate to locate such a facility. This model plan was designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting and then ultimately return to their homes for convalescence, following a public health emergency where regional surge capacity had been exceeded.

Results

Over three years of interagency, comprehensive planning, training and review was conducted to create the model alternate care site/community-based care center concept of operations plan. Accomplishments and milestones included: Creating stakeholders, engaging community partners, site selection, staffing issues, detailed medical protocols and clinical pathways, functional role development, equipment and supplies, site security, media and communications plans, designing training programs and conducting drills and exercises.

Conclusion

The key tenets of the concept, planning, operation and demobilization of an alternate care site or community-based care center will be discussed in this session. Participants will learn what has worked based on our planning experience. Lessons learned and best-practices developed in our program will be presented to assist attendees in beginning or continuing the process of creating surge capacity in the out-of-hospital setting, by planning to operate alternate care sites in their local areas.
(P2-78a) Feasibility and Safety of Ultrasonography-Guided Nerve Blocks Performed by Emergency Physicians in the Emergency Department
Authors: Bhoi S. , Sinha T.P. , Rodha M. , Bhasin A.
Published: May 2011

Background

Emergency physicians often encounter patients who require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries like fracture reduction, joint dislocation reduction, wound care, and pain relief. Its complications include airway or circulatory compromise. Ultrasound (US) guided peripheral nerve block is a safe alternative that utilizes minimal amounts of local anesthetic and does not require hemodynamic monitoring or prolonged post-procedure observation.

Objective

The objective of this study is to determine the feasibility and safety of ultrasonography-guided nerve blocks, performed by emergency physicians.

Methods

A prospective study involving 28 patients > 12 years of age presenting to an emergency department (ED) were recruited after informed consent. Ultrasonography-guided nerve blocks were performed by emergency physicians who underwent a minimal training of 10 supervised nerve blocks. Brachial plexus, forearm, and lower-limb nerve blocks were performed as deemed necessary. Verbal analogue scale (VAS) was used to quantify pain, before and five minutes after the procedure. The outcomes for feasibility and safety were the percentage of cases in which no further anesthesia was required, the median reduction in VAS score, median time to completion of procedure and the complication rate noted during the procedure.

Results

All procedures were completed without additional anesthesia. The different nerve blocks performed were brachial plexus (20 cases, 71.4%), forearm (3 cases, 10.7%), femoral (2 cases, 7.1%), combined femoral and sciatic (2 cases, 7.1%) and tibial (1 case, 3.6%). Median reduction in VAS score was 7.0 points (interquartile range 6.0, 8.0; p < 0.001). The median time to completion of nerve blocks was 5 minutes per patient (interquartile range 2 minutes 25 seconds, 10 minutes 0 seconds). There were no immediate complications noted after the procedure.

Conclusions

Emergency physicians with minimal training can perform ultrasonography-guided nerve blocks safely, quickly and without the need for additional anesthesia in the ED.
(P2-82) Developing and Implementing an Emergency Preparedness and Trauma Research Program in a New Level One Trauma Center
Authors: Rives T.E. , Hecht C. , Wallace A. , Gandhi R.
Published: May 2011

Our level one trauma center with a service area covering a population of approximately four-million people treats approximately 80,000 patients per year. In 2010, we anticipate more than 23,000 patients admitted, and to experience more than 850,000 patient encounters within the network. Trauma research is an important component to any level one trauma center, as well as a requirement of the American College of Surgeons/Committee on Trauma (ACS/COT). Our trauma center has recently gained level one designation and began an emergency preparedness research and trauma research (EPR/TR) program in earnest. We are fortunate to have support from executive administrators. Stewardship is a necessary element of our planning, in part because we are a county hospital serving a large uninsured patient population. The following are a few of the necessary steps we took to build an (EPR/TR) department from the beginning, to the point of submitting abstracts, manuscripts, funding grants, and presentations to regional, national, and international conferences, journals, and agencies. Structure the Emergency Preparedness Office to be a component of Trauma Services, allowing a unique opportunity for real-time disaster and mass casualty research. Secure a commitment from senior executives. Secure an experienced researcher, capable of research administration. Ensure the (EPR/TR) director, trauma medical director, trauma services director, and emergency preparedness coordinator can be a cohesive team with complimentary skills. Encourage trauma surgeons to perform research with assistance from the (EPR/TR) Office. Seek federal and foundation funding. Seek alliances with appropriate consortiums and associations. Develop a research relationship with pre-hospital emergency services. The above steps represent only some of the components used to build our (EPR/TR) department. We anticipate the planned expansion of the above steps will take our EPR/TR to the next level and increase extramural funding.
(P2-85) Automatic vs. Manual Bag Valve Resuscitation: An Experimental Bench Test
Authors: L'her E. , Marjanovic N. , Le floch S. , Jaffrelot M.
Published: May 2011

Introduction

Efficiency of resuscitation has been fewly assessed. The aim of our study was to compare standard manual to automatic ventilation using a new device.

Methods

5 categories of healthcare professionals were included (paramedics, nurses, respiratory therapists, senior and junior emergency physicians; n = 10 in each group) and they evaluated 2 different apparatus: manual bag valve (BVM) and automated resuscitator (EasyCPR, Weinman). The experimental bench test consisted in an artificial test lung (ASL5000, IngmarMed), simulating 3 pathological status (COPD, ALI, ASA) and connected to a resuscitation-training manikin for the interface with the mask. Recorded parameters were: tidal volume (Vt), Peak Inspiratory Pressure (PIP), Residual Volume (Vr), overall distension (Vt + Vr), respiratory rate (RR). The ergonomy of the device was assessed at the end of each sequence (1–very uneasy à 5–very easy to use).

Results

Mean Vt reached the goal (400–600 ml) for only 26% [0, 6–45] of the cycles with BVM and 29% [0, 3–80] with the CPR. Within a same pathological status, PIP was higher with BVM (21 ± 17 cmH2O), as compared to CPR (11 ± 3 cmH2O; p < 0.001). Mean RR was 18 ± 6 C/minute with BVM and 10 ± 2 C/minute with CPR. Overall distension was significantly higher with BVM (491 ± 328 ml; up to 1750 ml), as compared to CPR (380 ± 168 ml; p < 0.001). Ergonomy of CPR was considered better for paramedics and nurses (p < 0.05).

Conclusion

BVM resuscitation does not allow reaching the standards in terms of Vt and RR, and may expose to overpressure (gastric distension) and thoracic overinflation. Automatic resuscitation (CPR) may standardize emergency ventilation, allowing a better fit to recommendations and an ergonomy enhancement.
(P2-93) Triage During a Mass Casualty Incident: The 2009 Turkish Airlines Crash in Amsterdam
Authors: Postma I.L.E. , Weel H. , Heetveld M. , Bloemers F. , Bijlsma T. , Goslings J.C.
Published: May 2011

Introduction

Triage is an important aspect of the management of mass-casualty incidents (MCIs). This study evaluates triage after the Turkish Airlines aircraft crash near Amsterdam in 2009. What were the results of triage? What were the injuries of priority 3, and of “walking” casualties? Did the mechanism of trauma have a factor in this mass-casualty triage? How does this affect spinal immobilization rate during transport?

Methods

A retrospective analysis of investigational reports, ambulance forms, and medical charts of survivors of the crash was performed. Outcomes included triage classification, type of injury, Abbreviated Injury Scale (AIS) score, Injury Severity Scale (ISS) score, need for emergency intervention according to the “Baxt criteria”, and spinal immobilization during transport.

Results

There was minimal documentation of prehospital triage. According to the in-hospital triage, 28% of patients were priority 1, 10% had an ISS score ≥ 16, and 3% met the Baxt criteria for emergency intervention. Forty percent were priority 3, 72% had an ISS score ≤ 8, and 63% were discharged from the emergency department. Approximately 83% were over-triaged, and the critical mortality rate was 0%. Nine percent of priority 3 casualties. and 17% of “walking” casualties had serious injuries. Twenty-five percent of all casualties were transported with spinal immobilization; 22% of patients with diagnosed spinal injury were not transported with spinal immobilization.

Conclusions

After the Turkish Airlines crash, documentation of triage was minimal. According to the Baxt criteria, there was a great amount of over-triage. Possible injuries sustained by plane crash survivors that seem minimally harmed (P3) must not be underestimated. Considering spinal immobilization, Not insufficient consideration given the high-energy trauma mechanism.
(P2-99) Russian–Chinese Collaboration for Disaster Risk Reduction
Authors: Kipor G.V. , Goncharov S.F. , Pichugina N.K.
Published: May 2011

The Disaster Medicine Centre “Zaschita” is a coordinating center with the general goal of management and medical relief delivery in response to major emergencies. The Russian Disaster Medicine Service has accumulated a national and international experiences of emergency responses to earthquakes (Columbia 1999, Neftegorsk 1995, Turkey 1999, Iran 2003, Afghanistan 2002, China 2008, etc.). The Health Ministries of the Russian Federation and of Peoples Republic of China have concluded a treaty of collaborative activities in the field of in public health services and disaster medicine. The promotion of cooperation in health sector is based on the key elements of collaboration, which is an a method coping with emergencies. All activities have been discussed during annual meetings, and are planned for participants on the basis of practical field experience and of emergency medical care technologies. These include: (1) mechanisms of trans-boundary field collaboration in management during major disasters; (2) sharing of field experiences for coping with natural disasters; (3) early warning networks and information technologies; (4) staff preparedness programs and postgraduate education; (5) new psycho-physiological technologies for staff selection, training, and conformity of medical teams; (6) coordination and management of international-scale exercises; (7) technology of medical relief provided for injured in major disasters; and (8) lessons learned from technological emergencies. The details of the consequences and issues associated with mutual management will be discussed.
(P2-102) Lessons Learned from Medical Humanitarian Mission During Somalia Civilian War 1992–1994. Moroccan Experience
Authors: Lahsen S.
Published: May 2011

Lessons learned from medical humanitarian mission during Somalia civilian war 1992–1994. Moroccan experience L. Safi. Chirurgical Intensive Unit Mohammed V Military Hospital Hay Riad Rabat Morocco Introduction Natural disasters and civilian war in Africa demonstrate a similar critical need for national preparedness. As one of a team of military physician who went on a medical mission, I would like to share glimpses of our experience and reflect our thought about humanitarian mission.

Objective

To report our experience during medical humanitarian mission.

Background

During Somalia civilian war Morocco deployed level 2 hospital to provide medical and social aid to soma liens during united Nations interventions UNISOM. The specific mission was to provide immediate relief to the affected population of Mogadishu, to minimize loss of life, and to mitigate human suffering. A team of 21 physicians specialists and 40 nurses were deployed in an university campus to provided medical assistance.

Methods

Data were collected from interviews, observations, field notes, memos, and retrospective study of medical statistique.

Results

80% of all patients we examined have infection disease in all fields: dermatology, ophthalmology, ORL, pneumology etc 90% of childs have denutrition Only the emergency surgery was involved.

Discussion and Conclusion

In doing so, the medical team learned many important lessons, including five of particular value to planners of similar relief operations in the future. A successful medical humanitarian mission will depend on accurate and relevant medical intelligence and socio-geographical mapping in advance of deployment.
(P2-103) Haiti Earthquake: Ankara National Medical Rescue Team Field Hospital Experiences
Authors: GÜleÇ M.A. , DemİrkasimoĞlu M. , Ince E. , Özer M. , ÇoŞkun A.
Published: May 2011

An earthquake of 7.6 Richter scale occurred in Port Au Prince which is the capital city of Haiti on 12 January 2010. Turkish Ministry of Health offered support for the people of Haiti by sending its Health Team. In this study, the field hospital services of Turkish Health Team consisting of two groups in 67 days will be reported. Also, further affairs necessary to be done in the future and coordination with other countries will be reported. There are discussions whether there is need for field hospitals or not. With this study, the results of field hospital services were assessed. By contrast with some authorities, it is concluded that field hospital services are beneficial. Finally, UN responsibilities on this issue was discussed.
Automorphismes, graduations et catégories triangulées
Authors: Rouquier Raphaël
Published: May 2011

Nous donnons une construction comme espace de modules du groupe d'automorphisme d'une algèbre de dimension finie analogue à celle du groupe de Picard d'un schéma. Nous en déduisons que la composante connexe de l'identité du groupe des automorphismes extérieurs est invariante par équivalences stables et dérivées. Ceci permet de transférer des graduations entre algèbres et fournit conjecturalement une construction homologique de graduations sur les blocs à défaut abé;lien de groupes finis. Nous donnons des applications au relèvement d'équivalences stables en équivalences dérivées. Nous donnons une version du résultat d'invariance pour les variétés projectives lisses : le produit Pic0 × Aut0 est invariant par équivalences dérivées.
Bullying behaviours among students in Pavia, Italy: prevalence and association with stress and cannabis use
Authors: Martinelli V. , Brondino N. , Rossi S. , Panigati R. , Magnani R. , Cappucciati M. , Vecchia L. , Tinelli S. , Emanuele E. , Politi P.
Published: May 2011

Background.

This study examined the prevalence of students’ reported experiences of bullying and victimization in primary and secondary schools and their association with levels of perceived stress and cannabis use.

Methods.

We consecutively enrolled 407 students attending three secondary schools in Pavia (Italy). Bullying and victimization were measured using the retrospective bullying questionnaire (RQB). The 10-item perceived stress scale (PSS-10) was used to assess the degree to which situations in life were perceived as stressful. Data on demographic characteristics and cannabis use in the previous 6 months were also collected.

Results.

There were 328 victims (80.6%) and 221 bullies (52.1%). The results of the stepwise regression analysis with bullying as the dependent variable were significant with either male sex (R2 = 0.030,p = 0.024) or PSS-10 scores (R2 = 0.056,p = 0.036) in the model. With victimization as the dependent variable, only the PSS-10 scores were retained in the model as an independent predictor variable (R2 = 0.048,p < 0.001).

Conclusions.

The results from this study indicate that the level of perceived stress has an independent association with both bullying and victimization. Further studies are needed to clarify the psychobiological links between stress, cannabis use and bullying behaviours.