bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Implementation of First Hospital-Based Epidemic Outbreak Management Plan: Lessons Learned from Nepal
Authors: Shrestha Ashis , Khouli Michael , Bajracharya Sumana , House Rose , Mugele Joshua
Published: May 2019

Introduction:

Patan Hospital, located in Kathmandu Valley, Nepal is a 400-bed hospital that has a long history of responding to natural disasters. Hospital personnel have worked with the Ministry of Health (MOH) and the World Health Organization (WHO) to develop standardized disaster response plans that were implemented in multiple hospital systems after the earthquake of 2015. These plans focused primarily on traumatic events but did not account for epidemics despite the prevalence of infectious diseases in Nepal.

Aim:

To develop and test a robust epidemic/pandemic response plan at Patan Hospital in Kathmandu that would be generalizable to other hospitals nationwide.

Methods:

Using the existing disaster plan in conjunction with public health and disaster medicine experts,we developed an epidemic response plan focusing on communication and coordination (between the hospital and MOH, among hospital administration and staff), logistics and supplies including personal protective equipment (PPE), and personnel and hospital incident command (IC) training. After development, we tested the plan using a high-fidelity, real-time simulation across the entire hospital and the hospital IC using actors and in conjunction with the MOH and WHO. We adjusted the plan based on lessons learned from this exercise.

Results:

Lessons learned from the high-fidelity simulation included the following: uncovering patient flow issues to avoid contamination/infection; layout issues with the isolation area, specifically accounting for donning/doffing of PPE; more sustained duration of response compared to a natural disaster with implications for staffing and supplies; communication difficulties unique to epidemics; need for national and regional surveillance and inter-facility planning and communication. We adjusted our plan accordingly and created a generalizable plan that can be deployed at an inter-facility and national level.

Discussion:

We learned that this process is feasible in resource-poor hospital systems. Challenges discovered in this process can lead to better national and system-wide preparedness.
Are There Adequate Policies and Programmes in Place to Protect Infants and Young Children During Emergencies?
Authors: Dale Tracey , Hansson Foster
Published: May 2019

Introduction:

In emergencies, infants and young children are disproportionately affected due to specific food and fluid requirements, immature immune system, susceptibility to dehydration, and dependence on others. Provision of safe food and water to infants and young children is critical. However, it is challenging in the emergency context. Specific planning is vital to support infant and young child feeding in emergencies (IYCF-E).

Aim:

To identify the extent to which Australian emergency management plans and guidance account for the needs of infants and young children.

Methods:

An audit of Australian emergency management plans and guidance was conducted as a part of the 2018 World Breastfeeding Trends Initiative assessment of Australian infant feeding policies. All national and state/territory emergency preparedness plans, and a sample of local government area preparedness plans, response plans, and other guidance were identified and searched for content related to the needs of infants and young children. Plans and guidance were searched for content related to the needs of animals as a comparison.

Results:

Vulnerability of infants and young children was commonly noted. However, content related to supporting the specific needs of infants and young children through appropriate IYCF-E was almost totally absent. In some cases, the guidance that did exist was misleading or dangerous. No agency at the federal, state/territory, or local government level was identified as having met the responsibility for ensuring the needs of infants and young children. The absence of any coordinated response for the needs of infants and young children is in stark contrast to consideration of animal needs, which have a delegated authority, plans, and guidance at all levels of government.

Discussion:

Planning for the needs of infants and young children in emergencies in Australia is dangerously inadequate. Action should be taken to ensure that appropriate plans exist at all levels of government.
Development of a Model for Admitting Pediatric Trauma Casualties in the Emergency Department
Authors: Madar Raya Tachlizky , Adini Bruria , Greenberg David , Goldberg Avishay
Published: May 2019

Introduction:

Pediatric trauma is one of the leading causes of child mortality and morbidity and is a major challenge for healthcare systems worldwide. Treatment of pediatric trauma requires special attention according to the unique needs of children, especially in children affected by severe trauma who require life-saving treatments. It is essential to examine the preparedness of Emergency Departments (EDs) for admitting and treating pediatric casualties.

Aim:

To develop a model for admitting and treating pediatric trauma casualties in EDs.

Methods:

Seventeen health professionals were interviewed using a semi-structured qualitative tool. A quantitative questionnaire was distributed among general and pediatric EDs’ medical and nursing staff. Following the qualitative and quantitative findings, another round of interviews was performed to identify constraints, to construct a “Current Reality Tree,” and develop a model for admission and management of pediatric casualties in EDs. The model was validated by the National Council for Trauma and Emergency Medicine.

Results:

Lack of uniformity was found regarding age limit and levels of injury of pediatric patients. Most study participants believe that severe pediatric casualties should be concentrated in designated medical centers and that minor and major pediatric casualties should be treated in pediatric rather that general EDs. Pediatric emergency medicine specialists are preferred as case managers for pediatric casualties. Significant diversity in pediatric-care training was found. Based on qualitative and quantitative findings, a model for the optimal admitting and managing of pediatric casualties was designed.

Discussion:

To provide the best care for pediatric casualties and regulate its key aspects, clear statutory guidelines should be formulated at national and local levels. The model developed in this study considers EDs’ medical teams and policy leaders’ perceptions, and hence its significant contribution. Implementation of the findings and their integration in pediatric trauma care in EDs can significantly improve pediatric emergency medical services.
Lessons Learned from an Obstetrics/Newborn/Neonatal Intensive Care Full-Scale Exercise
Authors: Cooper Arthur , Frogel Michael , Foltin George
Published: May 2019

Introduction:

Children are frequently victims of disasters. However, gaps remain in disaster planning for pediatric patients. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the New York City Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty incidents that involve large numbers of children.

Aim:

On April 26, 2018, the NYCPDC conducted a first full-scale exercise with the New York Fire Department (FDNY) testing evacuation, patient tracking, communications, and emergency response of the obstetrics, newborn, and neonatal units at Staten Island University Hospital North. The goal of the exercise was to evaluate current obstetrics/newborn/neonatal plans and assess the hospital’s ability to evacuate patients.

Methods:

The exercise planning process included a review of existing obstetrics/newborn/neonatal plans, four group planning meetings, specific area meetings, and plan revisions. The exercise incorporated scenario-driven, operations-based activities, which challenged participants to employ the facility’s existing evacuation plans during an emergency.

Results:

The exercise assessed the following: communication, emergency operation plans, evacuation, patient tracking, supplies, and staffing. Internal and external evaluators rated exercise performance on a scale of 1-4. Evaluators completed an exercise evaluation guide based on the Master Scenario Event List.

An After Action Report was written based on the information from the exercise evaluation guides, participant feedback forms, hot wash session, and after-action review meeting. Strengths included the meaningful improvement of plans before the exercise (including the fire department) and the overall meeting of exercise objectives.

Discussion:

Lessons learned included: addressing gaps in effective internal and external communications, adequate supplies of space, staff, and equipment needed for vertical evacuations in addition to providing staging and alternate care sites with sufficient patient care and electrical power resources. The lessons learned are being utilized to improve existing hospital plans to prepare for future full-scale exercise and or real-time events.
Pharmacists Transcend Disaster Health "Silos"
Authors: Watson Kaitlyn E. , Singleton Judith A. , Tippett Vivienne , Nissen Lisa M.
Published: May 2019

Introduction:

Weather-related natural disasters are increasing in frequency and intensity, severely impacting communities. The patient demographic requiring assistance in a disaster is changing from acute traumas to chronic disease exacerbations. Adequate management requires a multidisciplinary healthcare approach. Pharmacists have been recorded in various disaster roles in literature. However, their roles within these disaster health teams are not well-established and do not fully utilize their skill sets.

Aim:

To identify where pharmacists roles are within the four phases of a disaster – prevention, preparedness, response, and recovery (PPRR), and to determine the barriers to pharmacists being better integrated into disaster teams.

Methods:

Semi-structured interviews were conducted with 28 international key stakeholders and pharmacists. Interviews were transcribed and analyzed using both open and axial manual coding, as well as the text-analytics software Leximancer®. The use of these two methods provided triangulation of methods for reliability of results. This research project was covered by QUT ethics approval number 1700000106.

Results:

The themes identified were community, government, "disaster management," "pharmacy," and "barriers and facilitators." The Leximancer® analysis compared the different disaster perspective and experience levels of the participants. The more experienced disaster health professionals who had worked closely with pharmacists believed they were capable of undertaking more roles in a disaster.

Discussion:

Pharmacists have been placed in the logistics "silo" for their role in disaster management supply chain operations. However, pharmacists have the expertise, knowledge, and skills which transcend this "silo" to work across the multiple health roles in disasters. Pharmacists are identified as a critical piece to the puzzle in the disaster management throughout the PPRR cycle. They are capable of undertaking more roles in disasters in addition to the established logistics role. The barriers identified need to be addressed for the better integration of pharmacists into disaster teams.
The Verdict is In: Pharmacists Do Have a Role in Disasters and It is Not Just Logistics
Authors: Watson Kaitlyn E. , Singleton Judith A. , Tippett Vivienne , Nissen Lisa M.
Published: May 2019

Introduction:

The pharmacist’s role in disasters is just as important as in everyday practice. Lack of access to health care services and interruptions to continuity of medication care are the major concerns for chronic disease patients during disasters. Pharmacists’ responsibilities during crises is undefined and their skills and knowledge are underutilized.

Aim:

To convene an expert panel to discuss the role of pharmacists in disasters and the specific roles they could be undertaking in a disaster, prioritizing the roles in order of importance.

Methods:

There were 15 key opinion leaders identified as experts in their knowledge of pharmacists’ roles and the disaster health management field who agreed to participate in the three rounds of surveys. The first round provided the panelists with a list of 46 roles identified from previous research conducted and the literature. The panelists were asked to rank their opinion of pharmacist’s capability of undertaking each role on a 5-point Likert scale and consensus was set at 80%. There were three rounds of surveys with the final round presenting the results for the panel to provide qualitative comments on the results and roles. The roles were broken up into the four phases of disaster management – prevention, preparedness, response, and recovery (PPRR).

Results:

Out of the 46 roles provided to the panelists, consensus was reached on 43 roles with 80% of panelists being in agreement. The experts identified pharmacists had roles across the entire PPRR cycle. The roles included pharmacists being further integrated into disaster teams and managing low-acuity patients requiring chronic disease medications.

Discussion:

This Delphi study begins the process of defining roles for pharmacists in disasters. It can assist policymakers in providing changes to legislative frameworks to allow pharmacists to undertake the roles identified as being beneficial to a community in a disaster.
Health Sector Preparedness During the Eid-al-Fitr Homecoming Across Indonesia in 2017
Authors: Ariani Madelina , Achmad Yurianto , Kamarruzzaman Kamarruzzaman , Agustina Ina , Donna Bella , Wartatmo Hendro
Published: May 2019

Introduction:

Indonesia’s road traffic fatality rate stands at 15.3 per 100,000 people, compared to 17 in the Southeast Asia region. Traffic fatalities are predicted to increase by 50%, becoming the third leading contributor to the global burden of disease by 2020. Indonesian police reported that 575 people died and 2,742 road accidents occurred during Eid-al-Fitr 2015. The problem is increasing rapidly in Indonesia, particularly during Ramadan. Policy makers need to recognize this growing problem as a public health crisis to prevent mass casualty incidents.

Aim:

To assess the health system preparedness with regard to road traffic accidents during 2017 Eid-al-Fitr homecoming in West Java, Central Java, East Java, and Lampung.

Methods:

The project started with an interview and observation followed by stakeholder analysis to assess the level of preparedness. This qualitative and quantitative research was conducted one month prior to Eid-al-Fitr homecoming 2017. The instruments were evaluated for policy, organization, communication, procedure, contingency plan, logistics, facility and human resources, financing, monitoring, evaluation, coordination, and socialization.

Results:

The levels of preparedness were moderate (B) for West Java, East Java, and Lampung, but high (A) for Central Java. Levels of preparedness based on district health office indicators were high for coordination, but low for a contingency plan. Levels of preparedness based on hospitals and primary health care were high for logistics and human resources, but low for a contingency plan and financing.

Discussion:

The findings indicated a moderate level (B) of health sector preparedness. Benchmark information from this research will provide information for further training in contingency planning, particularly for the district health office.
Recent Unprecedented Wildfires in British Columbia, Canada: Progression of a Grassroots Disaster Psychosocial Program
Authors: LeBlanc Jeanne , Kaplan Julie
Published: May 2019

Introduction:

Psychosocial needs related to disaster are increasingly identified as a significant concern for both communities and responders. In response to the needs of travelers suddenly unable to leave Vancouver immediately after 9/11 in the United States, a network for the provision of volunteer mental health response at the time of a disaster was developed through the Provincial government within British Columbia (BC). Starting from less than 20 individuals primarily located within the Vancouver area, Disaster Psychosocial Services (DPS) now encompasses a network of over approximately 200 providers throughout the Province.

Aim:

To showcase a successfully functioning DPS program modeled after a volunteer-based mental health network, the evolution undergone, its present operational framework, and future goals.

Methods:

In response to the observed need for trained psychosocial intervention, we developed a framework for recruitment, education, deployment, and support of a volunteer network of mental health professional and paraprofessional providers.

Results:

This approach has been found to be effective, significantly increasing our volunteer base and opportunities for deployment.

Discussion:

This presentation will detail the grassroots development of BC’s DPS Program as well as the current model in practice. It will provide an overview of how BC’s DPS network of providers was stimulated and managed; issues related to volunteer management, including the selection of volunteers; methods of specialized training; and deployment. Multiple settings in which DPS is now utilized with increasing regularity will be described, including Emergency Operations Centers, Reception Centers, and Town Hall Meetings. Lastly, there will be a focus on the lessons learned, as well as future goals highlighting a focus on culturally-sensitive support, specifically with respect to British Columbia’s indigenous populations for building community resiliency and knowledge across the province.
Responding to Disasters: More Than Economic and Infrastructure Interventions
Authors: Crompton David
Published: May 2019

Introduction:

Natural disasters confront individuals, communities, and governments with the challenge of rebuilding and addressing psychosocial sequelae. With the increasing number of natural disasters, it is pertinent to evaluate the efficacy of interventions and strategies to address the mental health needs of individuals and the community.

Aim:

The presentation will highlight the effectiveness of interventions post-disaster, and continued adverse outcomes five years post-event.

Methods:

An evaluation of literature related to the psychosocial impact of natural disasters, treatment efficacy, and government strategies to confront the social and psychological impact of natural disasters for the period 1983 – 2016 was undertaken.

Results:

Epidemiological studies following natural disasters, despite the use of differing psychological measures, demonstrate significant psychological morbidity – anxiety (7-42%), complicated grief (28-41%), depression (6.5-38%), post-traumatic stress disorder (11-89%), and substance misuse (1.3-24%). Intervention studies post-disaster demonstrate efficacy capability.

Discussion:

The increase in the number and impact of meteorological and hydrological events since the 1980s and the psychological, social, and economic consequences of these events have resulted in the development and implementation of government policies to confirm the immediate and long-term adverse outcomes. The focus is typically on resources and infrastructure redevelopment with less focus on social and mental health interventions, with long-term evaluation of interventions uncommon. The consequence of natural disasters emphasizes the importance of developing strategies to ensure effectively evaluated psychosocial interventions are available across at-risk communities.
Tragedy Meets GME: The Impact of the October 1st Mass Casualty Incident on Academic Attending and Resident Physicians
Authors: Roozendaal Suzanne , Guldner Gregory , Abou-Zaid Hoda , Siegal Jason , Berkeley Ross , Davey Dylan , Allswede Michael
Published: May 2019

Introduction:

On October 1, 2017, a gunman fired on a festival in Las Vegas, Nevada, killing 58 people and wounding over 500. Multiple casualties were received at two nearby hospitals that sponsor residency programs: Sunrise Hospital and Medical Center and University Medical Center.

Aim:

To evaluate the impact of the most lethal mass-shooting event in US history on graduate medical education (GME) at the involved hospitals.

Methods:

Anonymized surveys were sent to 210 physicians at SMC and 110 physicians at UMC. Surveys incorporated 4 validated instruments: The Post Traumatic Growth Inventory (PTGI), The Impact of Events Scale-Revised (IES-R), The Multidimensional Scale of Perceived Social Support (MSPSS), and The Team Cohesion Factor (TCF).

Results:

Sixty-six physicians completed the surveys (38 attendings; 17 residents). 10% of physicians scored in the likely posttraumatic stress disorder (PTSD) range and 15% found themselves avoiding or struggling with managing similar patients, though overall survey response rate was low. The majority of physicians did not believe the event impacted their specific GME activities. No attending physician rated the event as negative in terms of global impact on GME, and 34% rated it as positive. However, 12 of 17 residents rated the event as a hurdle in its GME impact. A regression model predicting the IES-R score demonstrated a trend that those with higher pre-event stress and lower social support reported more adverse impact (p<0.06).

Discussion:

We believe our study is the first to examine the impact of mass casualty traumatic events on graduate medical education. Attendings and residents differ in their global perception of the impact, with attendings viewing it as a positive event and residents as a challenge. Pre-event level of stress and perceived social support predicted the impact of the event and may partially explain these results if residents and attendings vary on these parameters.
From Science to Policy and Practice: A Critical Assessment of Knowledge Management Before, During, and After Environmental Public Health Disasters
Authors: Généreux Mélissa , Lafontaine Marc , Eykelbosh Angela
Published: May 2019

Introduction:

Canada, like many countries, increasingly faces environmental public health (EPH) disasters. Such disasters often require both short- and long-term responses, necessitate evacuation and relocation, cause major environmental impacts, and generate the need for specific knowledge and expertise (chemistry, epidemiology, risk assessment, mental health, etc.).

Aim:

Given the importance of evidence-based, risk-informed decision making, we aimed to critically assess the integration of EPH expertise and research into each phase of disaster risk management in several Canadian and other jurisdictions.

Methods:

In-depth interviews were conducted with 23 leaders in disaster risk management from Canada, United States, United Kingdom, and Australia, and were complemented by other methods (i.e. participant observation, information gathered from participation in scientific events, and document review). Three criteria were explored: governance, knowledge creation and translation, and related needs and barriers. An interview guide was developed based on a standardized toolkit from the World Health Organization. Data were analyzed through a four-step content analysis.

Results:

Six cross-cutting themes emerged from the analysis. These themes are identified as critical factors in successful disaster knowledge management: 1) blending the best of traditional and modern approaches, 2) fostering community engagement; 3) cultivating relationships, 4) investing in preparedness and recovery, 5) putting knowledge into practice, and 6) ensuring sufficient human and financial resources. A wide range of promising knowledge-to-action strategies was also identified, including mentorship programs, communities of practice, advisory groups, systematized learning, and comprehensive repositories of tools and resources.

Discussion:

There is no single roadmap to incorporate EPH knowledge and expertise into disaster risk management. Our findings suggest that beyond structures and plans, it is necessary to cultivate relationships and share responsibility for ensuring the safety, health, and wellbeing of affected communities while respecting the local culture, capacity, and autonomy. Any such considerations should be incorporated into disaster risk management planning.
Preparing for Mass Casualties: Improving Staff Preparedness and Hospital Operations through Multidisciplinary Simulation Training in Disaster Management
Authors: Watkins Nathan , Johnston Amy NB , McNamee Peter , Muter Naomi , Huang Cindy , ling Li Yuet , Samsuddin Amanda , Sweeny Amy
Published: May 2019

Introduction:

World events continue to compel hospitals to have agile and scalable response arrangements for managing natural and instigated disasters. While many hospitals have disaster plans, few exercise these plans or test their staff under realistic scenarios.

Aim:

This study explores changes in perceived preparedness of multidisciplinary hospital-wide teams to manage mass casualty incidents.

Methods:

Two Emergo Train System (ETS) mass casualty exercises involving 80 and 86 “victims,” respectively, were run at two southeast Queensland hospitals: one large teaching hospital and one smaller regional hospital. Pre- and post-exercise surveys were administered, capturing participants’ confidence, skills, and process knowledge anonymously on 5-point Likert scales. A waiver of ethics review was obtained. Changes in individuals’ pre- and post-scores were analyzed using paired t-tests. Open-ended questions and a “hot debrief” occurring immediately post-exercise allowed for capture of improvement ideas.

Results:

Nearly 200 unique healthcare staff (n=193) participated in one exercise. At least one survey was returned by 159 staff (82.4%). Pre- and post- surveys were available for 89 staff; two-thirds (n=59) were nurses or doctors, and 46% overall were emergency department clinicians. Ninety-seven percent reported the exercise was valuable, also recommending additional simulations. Analysis of the 89 matched-pairs showed significant (p<.001) increases in self-confidence, skills, and knowledge (point increases on a five-point Likert scale (95% confidence intervals): 0.8 (0.6-0.9) for confidence and 0.4 (0.2-0.5) for both skills and knowledge. The exercise was critically appraised and a summary of operational learnings was developed. The most common criticism of ETS was its lack of real patients.

Discussion:

Involvement in simulated exercises (e.g. ETS) can increase confidence, knowledge, and skills of staff to manage disasters, with the biggest improvement in confidence. Whilst validating and testing plans, simulations can also uncover opportunities to improve processes and systems.
Exploring the Preparedness of Student Paramedics for the Mental Health Challenges of the Paramedic Profession
Authors: Holmes Lisa
Published: May 2019

Introduction:

The mental health challenges encountered by paramedics have received much attention in recent years. This attention has particularly focused on high rates of stress, depression, anxiety, and post-traumatic stress disorder. This heightened awareness of the high incidence of mental illness, which has at times tragically resulted in the suicide of serving and former paramedics, is stimulating the address of mental health within the paramedic profession. It is now time to call on paramedic educators to prepare student paramedics for the mental health challenges associated with a career in the emergency medical services.

Aim:

To explore the preparedness of student paramedics for the mental health challenges of the paramedic profession and identify the coping strategies used by veteran paramedics to successfully meet these challenges.

Methods:

Twenty semi-structured interviews with veteran paramedics from Australia and New Zealand were conducted.

Results:

Advice from veteran paramedics was comprised of three key themes: support, health, and the profession.

Discussion:

The findings of the study indicate that the preparation of student paramedics for the mental health challenges of the paramedic profession throughout the undergraduate curriculum could be advantageous. The advice offered by veteran paramedics can be included within undergraduate paramedic curricula and delivered by sharing the personal experiences of the veteran paramedics. These experiences are highly credible and sharing them offers an opportunity for veterans to contribute positively to the future of paramedicine. Guidelines for their inclusion in the undergraduate paramedic curriculum should be prepared to facilitate knowledge translation and to encourage the development of conscious coping strategies by student paramedics during their learning phase. Further research is needed to raise awareness in this area, with a specific focus on preparing paramedic students to cope with mental health challenges related to undergraduate degree programs, and how they feel about commencing their career as a paramedic.
Stroke Prehospital Informed Decision-Making Using EEG Recordings (SPIDER)
Authors: Loudon Wayne , Wong Andrew , Finnigan Simon , Tippett Vivienne
Published: May 2019

Introduction:

The acute care of stroke involves the administration of a clot-dissolving drug (thrombolysis) and/or its removal using endovascular clot retrieval. Earlier intervention results in significantly improved patient outcomes. Clinical assessment scores have limitations, and studies have shown that even the most robust scores have a reported false-negative rate of >20% for large vessel occlusive strokes that may be eligible for clot retrieval, while inappropriate bypass may delay delivery of thrombolysis.1 Quantitative Electroencephalography (QEEG) has been shown to have a very high sensitivity and specificity in the identification of acute stroke versus matched controls in an in-hospital setting.(2,3)

Aim:

The SPIDER study commenced in Brisbane, Queensland on September 3, 2018, and is investigating the use of an EEG recorder to gather data on acute stroke patients presenting to a metropolitan ambulance service.

Discussion:

The data collected will guide the development of a simple numerical output reference to guide decision making. The data may aid in identifying large vessel occlusive stroke and patients eligible for endovascular intervention. The QEEG will provide a more accurate and cost-effective tool for the prehospital clinician over other imaging technologies and can guide early destination decisions. This presentation discusses the implementation of a pre-hospital research platform, integration with the clinical dispatch matrix, staff engagement, patient recruitment, and the success of the project so far.
Discovering Best Practice for Establishing Evacuation Centers for Vulnerable Populations: Findings from an Australian Pilot Study
Authors: Kako Mayumi , Steenkamp Malinda , Ryan Benjamin , Arbon Paul , Takada Yosuke
Published: May 2019

Introduction:

Potentially vulnerable population groups in disasters include the elderly and frail, people who are isolated, and those with chronic diseases, including mental health conditions or mobility issues. The 2011 Queensland flood disaster affected central and southeast Queensland, resulting in 2.5 million people being adversely affected. Seventy-two local government areas disaster were activated under the Natural Disaster Relief and Recovery Arrangements, which was more than 99 percent of Queensland. The issues regarding the role and responsibility across governments relating to planning, setup, and management of evacuation centers will be discussed.

Aim:

This paper will report the preliminary findings of a pilot study undertaken with local government officials and humanitarian agencies in Australia concerning their involvement in planning for, setting up, and managing evacuation centers for vulnerable populations in Australia during the Queensland floods in 2011. The objective is to illuminate the challenges officials faced, and the resolutions and lessons learned in the preparation of evacuation centers through this event.

Methods:

The study involved interviews with local government and relevant agencies’ officials who have been involved in establishing evacuation centers for vulnerable populations during the 2011 floods. Six officials were recruited from local government areas affected by the disaster in Queensland, Australia. Semi-structured phone interviews were audio-recorded and thematic analysis was conducted using NVivo software.

Results:

Three core themes emerged: 1) understanding of the importance of preparation, 2) challenging evacuation center environments, and 3) awareness of good governance principles.

Discussion:

This pilot study demonstrated that communication with stakeholders during the preparation period prior to a disaster is essential to best practice for evacuation center management. Understanding and being aware of good governance is also an important element to establish evacuation centers effectively.
Measuring the Health Impact of Natural Disasters – The Attribution Challenge Facing the Medical Community
Authors: Finnigan Gerard A
Published: May 2019

Introduction:

Published reports on health impacts from natural disasters causing injuries, poisonings, infectious disease, chronic illness, and NCDs continue to grow exponentially. Simultaneously, calls for the improvement in scientific rigor to improve causal links, strength of association, and efficacy of interventions are increasing. At the heart of this challenge is demonstrating mortality and morbidity risk across a time continuum, where the health effect is not detected for weeks, months, or years after the disaster event. In some circumstances, the presence and acuity of illness are not apparent until after an insidious or cumulative point has been reached. Notwithstanding medical observations or disaster-attributed morality classification matrices being available for 20 years, natural disaster mortality continues to be measured narrowly, on those confirmed dead (acute physical trauma, drowning, poisoning, or missing). There has been little effort to expand mortality assessment beyond this historical lens. For example, it fails to consider suicide in drought and was not redefined when the Indonesian fires caused the highest mortality in 2015. Tens of thousands of lives were lost from smoke exposure.

Aim:

This study sought to test the progress of two decades of published medical and scientific literature on natural disaster mortality reporting.

Methods:

A retrospective analysis of natural disaster impact reports for the past ten years was performed on three of the world’s largest disaster databases, including CRED, Sigma, and ADRC.

Discussion:

WADEM members must commence a strategic process to expand the recognition of health impacts from natural disasters. Global and domestic advocacy is required for building evidence through improved systematic collection of data and especially reporting patient continuum of care as a minimum standard. Without this leadership, disaster health impacts will continue to be underestimated and emergency health program responses and financial resources will fall short in protecting those most at risk.
Use of Solar Power Production for Point-of-Care Ultrasound: A Comparative Analysis
Authors: Gallien John , Sullivan Ashley
Published: May 2019

Introduction:

Use of Point-of-Care Ultrasound (US) has grown considerably in resource-limited and wilderness environments because of a combination of features, including portability, durability, and safety. However, the optimal method of powering US devices in such environments is not well established.

Aim:

This project has the following aims:

1.

Develop a solar power generation and storage system that maximizes power capacity and minimizes weight while being easily transportable by a single person.

2.

Test the system in a real-world environment to evaluate actual performance relative to stated performance.

3.

Determine the approximate US scan-time where solar systems would outperform pre-charged batteries with respect to weight.

Methods:

We developed multiple solar collecting systems using a combination of polycrystalline, monocrystalline, and thin-film solar arrays paired with different powerbanks and tested them using a variety of US systems. From this, the duration of usage was calculated, which makes the solar power generation system a superior option to pre-charged batteries.

Results:

Lithium-ion energy storage was found to be superior to lead-acid batteries for multiple reasons, most prominently, weight. Several models of US systems were tested revealing that portable US systems consume between 30 to 50 watts. Tri-fold monocrystalline solar panels coupled with lithium-ion powerbanks provided the best combination of weight and transportability. Total weight of the combined solar array, powerbank, and US system is 10 kilograms and easily packs into a backpack carrier. It was found that systems using solar generating capacity become superior to pre-charged powerbanks in regard to weight at approximately 14 hours of scanning time.

Discussion:

While these results are not fully generalizable due to seasonal and geographic variability as well as the type of US system used, use of solar generating capacity to power US systems is optimal for extended durations of use in resource-limited environments.
The 25 Years of Experience Since Inauguration of All-Russian Center for Disaster Medicine “Zaschia” (Protection)
Authors: Kipor Gennady , Baranova N. , Pichugina N. , Goncharov S.
Published: May 2019

Introduction:

Main functions of the Russian Federation in disasters and emergencies are loaded on All-Russian Center for Disaster Medicine of Ministry Health (ARCDM). The principal strategies of the staff are to play leading roles in preparedness, emergency response, evacuation, recovery of health systems, and education.

Methods:

Our presentation includes selection, classification, analysis, and statistics. There about 80 territorial Disaster Medicine Centers working under the leadership of ARCDM. One experience from the Moscow Territory Disaster Medicine Center will be presented.

Results:

At the operational and informational department, there are nine special medical emergency teams (three with helicopters). Time of arrival takes between seven and ten minutes, and transport to the hospital takes about five to seven minutes with 33 landing places for helicopters. The operational and control department uses an early warning system. About 1,300 exercises were organized in these centers and hospitals. We will discuss the examples of medical care delivery to the injured in metro Slaviynskie, Basar park Pobedi, Narofominskay, two major fires, and hurricanes. The mobile field hospital worked in more than 12 countries and in many territories in the Russian Federation over 25 years.

Discussion:

The last year was very difficult due to the Football World Cup, working hard as a collaborating center in emergencies, and working in the framework of a memorandum with China. Preparedness for an international event next May, which includes a field drill with participants from emergency medical teams of Health Ministries of CIS Countries and from State Health of China. We invite others to observe or join this event. Thus, we have some difficulties and problems, but we must increase solidarity and collaboration due to the scale, frequency, and number of losses in emergencies and disasters. Humanity could be able to cope with emergencies if we take into account these issues.
The Advanced Practice Provider in Federal Disaster Medical Response: An American Experience
Authors: Lennon Erin
Published: May 2019

Introduction:

Advanced Practice Providers (APP) are utilized in the United States National Disaster Medical System (NDMS) and consist of Certified Registered Nurse Anesthetists (CRNA), Nurse Practitioners (NP), and Physician Assistants (PA). They fill a critical role as Medical Officers in the Federal Disaster Medical Response on both Disaster Medical Assistance Teams (DMAT), Trauma & Critical Care Teams (TCCT), and United States Public Health Service (USPHS). DMAT teams and components of TCCT and USPHS responded to National Security Special Events, multiple natural disasters over the past two years including prolonged hurricane response in 2017 and 2018. The APPs were heavily utilized in key roles throughout the responses with much success.

Aim:

To explain how APPs are a vital component to US Federal Disaster Medical Response and are able to fill a multitude of roles as Medical Officers.

Method:

We used qualitative data from APPs in the US NDMS system illustrating what roles they filled during recent disaster responses.

Results:

The APPs were key components to the US NDMS response to disasters in the US and US territories by providing direct medical care as APPs, aid in medical evacuation, triage, healthcare administration, and medical infrastructure evaluations.

Discussion:

The APP is essential in the US Federal Disaster Medical Response and future research would be to obtain quantitative data on APPs in the U.S. NDMS. With increasing natural and man-made disasters affecting more people across the world annually, the increasing global population, and expected international health care worker shortages, APPs can be part of the overall solution to Medical Officer shortfalls and other key components in future disaster responses throughout the world. As APPs are not widely utilized worldwide, there will need to be education on what APP training is and how they can be utilized in areas not familiar with their abilities.
Assessing the Impact of a New Emergency Triage System on Head Injury Mortality: Tikur Anbessa Specialized Hospital Emergency Department in Addis Ababa, Ethiopia
Authors: Fantaye helena , Lomencho Amanuel , de vos Pol
Published: May 2019

Introduction:

One of the improvements in Ethiopia’s emergency medical system was the introduction of a five-level Emergency Triage System (ETS) in January 2015 that was piloted in selected Addis Ababa hospitals.

Aim:

To assess the effect of this intervention on the head injury mortality in Tikur Anbessa Specialized Hospital (TASH) Emergency Department (ED).

Methods:

Data were retrospectively collected from all medical records of head injury patients seen in Adult TASH- ED over two 6 months periods, before and after the new Emergency Triage System implementation: 01/04/2014 – 30/09/2014 versus 01/04/2016 – 30/09/2016. An inclusion criterion was age above 13 for the records that could be retrieved. Exclusion criterion was “patient declared dead on arrival.” Mortality and patterns of head injury were compared pre- and post-intervention. Chi-square was used for the analysis using STATA 14.

Results:

A total of 522 Head injury patients were analyzed in the ED in both the pre- 258 and post-264 intervention study periods. Among head injury admission in the ED in both study periods, the highest number of patients were Road Traffic Accident/RTA/ victims, males and young age (<30). Mortality rate among head injury patients decreased from a pre-intervention 44 (17.05%) to post-intervention 27 (10.2%) (OR=0.55 9. 5% CI (0.32, 0.95), p=0.02). The median age of death was 45 years in pre- and 40 years in the post-intervention period, with ages ranging from 13 to 85 and 13 to 96 years, respectively. The proportion of deaths from moderate head injury decreased significantly from 14.0% in pre-intervention to 6.3% in the post-intervention period, respectively (p<0.001).

Discussion:

The Emergency Triage System at TASH-ED has decreased mortality caused by head injury. This could increase life years saved and productivity in a cost-effective and easily achievable way in resource-poor settings.
Assessment of Emergency Medical Rescue Ability of Secondary and Tertiary Hospitals in One City Responding to the Risk of Production and Storage of Hazardous Chemicals
Authors: Hu Xu
Published: May 2019

Introduction:

With the development of the economy and the expansion of the hazardous chemicals industry in one city, it is necessary for the city to establish an evaluation model of emergency medical rescue capability for hazardous chemicals production, storage, and exposure risk.

Aim:

Establish an emergency medical rescue capacity evaluation model for secondary and higher hospitals in a city to deal with exposure risks of hazardous chemicals.

Methods:

1.

Develop an expert consultation form

2.

Develop a survey on the status quo of emergency medical rescue capacity of hospitals in secondary and above hospitals in response to exposure and risk of hazardous chemicals production and storage.

3.

Calculate the weights of the first, second, and third-grade indicators, and establish a comprehensive evaluation model for the rescue capacity assessment of Chengdu hospitals.

Results:

Five levels of first-level indicators were obtained, namely, the weights of the five indicators of “centralized admission ability,” “hospital comprehensive ability,” “emergency management ability,” “material equipment capability,” and “health emergency team” were 0.2884, 0.2219, 0.1938, 0.1507, and 0.1453, respectively.

Discussion:

The establishment of an emergency medical rescue capacity evaluation model for the risk of exposure and storage of hazardous chemicals in secondary and higher hospitals in a city is related to five capabilities, the most important of which is the ability to focus on admission.
Back to the Future: Portable Word Processors and the Electronic Health Record
Authors: Mori Alfredo
Published: May 2019

Introduction:

The Electronic Health Record (EHR) is now the standard means for recording and maintaining medical notes in most emergency departments. The EHR is an independent cause of physician burnout, and maintenance of the EHR may occupy 30 to 50% of clinical time. There are software solutions available, but they are connected to fixed, expensive, distracting, and bright electronically powered computers. Scribes have been successfully trialed, but are also expensive and attached to computers on wheels. Portable digital word processors in the form of the AlphaSmart Neo is a redundant technology designed primarily for children with typing difficulties. It has recently enjoyed a resurgence in popularity among professional writers, journalists, and field researchers for the ultimate distraction-free writing experience. The Alphasmart Neo is cheap, nearly indestructible, intuitive, and requires almost no recharging. It is compatible with all software across Mac OS, Windows, and Linux. Notes are entered by the clinician or scribe, independently of computers, at the bedside, and uploaded to any software via USB cable.

Aim:

To describe the introduction and impact of the AlphaSmart Neo on the EHR in emergency departments across Australia.

Methods:

We will examine the role of the Alphasmart Neo in austere, low power, extreme environments with a demonstration on how to enter, maintain, and transfer an electronic health record independent of any computer or power source.

Discussion:

We believe the AlphaSmart Neo is an ideal, personalized, cheap, effective, and efficient hardware solution to entering notes independent of other software and hardware. It is distraction free at the patient’s bedside, resulting in better notes that the clinician enjoys writing.