bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct and large-eddy simulations of internal tide generation at a near-critical slope
Authors: GAYEN BISHAKHDATTA , SARKAR SUTANU
Published: May 2011

A numerical study is performed to investigate nonlinear processes during internal wave generation by the oscillation of a background barotropic tide over a sloping bottom. The focus is on the near-critical case where the slope angle is equal to the natural internal wave propagation angle and, consequently, there is a resonant wave response that leads to an intense boundary flow. The resonant wave undergoes both convective and shear instabilities that lead to turbulence with a broad range of scales over the entire slope. A thermal bore is found during upslope flow. Spectra of the baroclinic velocity, both inside the boundary layer and in the external region with free wave propagation, exhibit discrete peaks at the fundamental tidal frequency, higher harmonics of the fundamental, subharmonics and inter-harmonics in addition to a significant continuous part. The internal wave flux and its distribution between the fundamental and harmonics is obtained. Turbulence statistics in the boundary layer including turbulent kinetic energy and dissipation rate are quantified. The slope length is varied with the smaller lengths examined by direct numerical simulation (DNS) and the larger with large-eddy simulation (LES). The peak value of the near-bottom velocity increases with the length of the critical region of the topography. The scaling law that is observed to link the near-bottom peak velocity to slope length is explained by an analytical boundary-layer solution that incorporates an empirically obtained turbulent viscosity. The slope length is also found to have a strong impact on quantities such as the wave energy flux, wave energy spectra, turbulent kinetic energy, turbulent production and turbulent dissipation.
How heat transfer efficiencies in turbulent thermal convection depend on internal flow modes
Authors: XIA KE-QING
Published: May 2011

How internal flow states can influence the global transport properties in a turbulent system has always been an intriguing question. Weiss & Ahlers (J. Fluid Mech., this issue, vol. 676, 2011, pp. 5–40) have provided an example by measuring the instantaneous Nusselt number in turbulent Rayleigh-Bénard convection and correlating it to the different modes of large-scale flow.
The King of the Batavians: Remarks onTab. Vindol. III, 628
Authors: Cuff David B.
Published: May 2011

Tab.Vindol.III, 628 is a letter of an auxiliary decurion ofcohors VIIII Batavorumthat begins with the greeting‘Masclus Ceriali regi suo’. A.R. Birley tentatively suggested that the title held a literal force, while Bowman and Thomas interpreted the word as meaning ‘patron’ on the basis ofOLDs.v. 8 and a parallel withP. Mich.8.472 =CEL147, a letter, also from a military context, from‘Claudius Tiberianus Longino Prisco domin[o] et regi suo’. This article examines the Batavian and military contexts of these interpretations alongside other epigraphic examples ofrexas ‘patron’.
Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers
Authors: Macdonald Marilyn , Lang Ariella , MacDonald Jo-Anne
Published: May 2011

Le but de cette conception qualitative et interprétative était d’examiner les perspectives des chercheurs, des pourvoyeurs de soins de santé et et des décideurs aux sujets des risques principaux, des préoccupations et des problèmes émergents rattachées à la sécurité de soins à domicile qui informerait une ligne d’enquête de recherche. La sécurité, tel qu’elle s’applique spécifiquement à ce context des soins à domicile, n’a pas encore été définie. Par conséquent, afin de profiter de diverses parties prenantes sur les questions de securité relatives aux soins à domicile est nécessaire afin d’informer les orientations stratégiques pour la recherche future. Afin de commencer à tracer un programme de recherche, une analyse en trois parties de l’environnement a été realisée: (a) une étude pilote avec les bénéficiaires et les fournisseurs de soins à domicile; (b) des entretiens avec des informateurs clés, les chercheurs, les fournisseurs de soins de santé, et les décideurs; et (c) une revue de la littérature dans trois domaines thématiques. Seulement les résultats des entrevues des informateurs clés sont présentés ici.
À mots couverts: le regard des aînés et des soignants sur la communication quotidienne et ses manifestations d’âgisme implicite
Authors: Lagacé Martine , Medouar Fouad , Loock Joséphine , Davignon André
Published: May 2011

The aim of this exploratory study was to better understand interpersonal communication between frail elders and caregivers in the context of long-term care giving. In addition, in light of the Communication Accommodation Theory, the goal was to determine the extent to which communication can be a transmitter of ageism, particularly of implicit ageism. A total of 26 semi-structured interviews were conducted among elders and caregivers of a Quebec long-term care facility. Results suggest a close convergence between the perception of seniors and caregivers in regards to a quasi total absence of daily communication and moreover, in regards to the highly instrumental nature of this same communication. Finally, results of the content analysis also suggest that implicit ageism is indeed reflected in interpersonal communication between frail elders and caregivers.
Becoming Old as a ‘Pharmaceutical Person’: Negotiation of Health and Medicines among Ethnoculturally Diverse Older Adults
Authors: Ballantyne Peri J. , Mirza Raza M. , Austin Zubin , Boon Heather S. , Fisher Judith E.
Published: May 2011

Parce que la prescription et l’utilisation des médicaments sont devenus un aspect normatif des soins de santé pour les personnes âgées, nous cherchons à comprendre comment les individus gérer l’utilisation des médicaments d’ordonnance dans le contexte du vieillissement. Nous soutenons que, pour ceux qui sont ambulatoires, l’utilisation de médicaments est susceptible d’être influencée par des considérations ethno-culturelles en matière de la santé et des expériences avec d’autres approches aux soins de santé. En conséquence, nous avons méné une étude qualitative, avec des entrevues en profondeur, sur un échantillon diversifié de personnes âgées afin d’identifier leurs perceptions et utilisations de médicaments. Nos conclusions dépeignent les personne âgées comme des agents actifs – qui s’appuient sur une vie d’expérience et de connaissances – qui prennent la responsabilité de l’adhésion (our non-adhésion) aux médicaments et leurs effets liés sur leur propre corps. Nous représentons la personne âgée comme une « personne pharmaceutique » dont les expériences du vieillissement sont inextricablement liée à la négociation des soins de santé dépendent sur les médicaments.
(A1) The May 12, 2008 Wenchuan Earthquake: A Primer on China's Emergency Responses and Recovery Planning
Authors: Svirchev L. , Li Y. , Yan L. , He C. , Lin M.B.
Published: May 2011

Background

This presentation summarizes our ongoing hybrid sociological-geological field research into the May 12, 2008 Wenchuan earthquake. In this extreme geo-disaster, mortality was 69,226, with 274,643 injuries, and 17,923 missing. The human toll was accompanied by significant destruction of the natural environment and the economy, estimated at US$ 176 billion. A 300 km long surface rupture occurred in the Longmen Mountains along its margin with the Sichuan Basin.

Discussion

This disaster was caused by the relationships among (1) towns built in on or in proximity to fault lines, (2) the low earthquake-resistance of residences, schools and hospitals, and other buildings, and (3) the concentration of population distributed along rivers lying below steep-sloped mountains. Mortality and devastation were compounded by post-earthquake landslides. The Chinese central government started a national-level response within 2 hours, upgrading it to the highest national emergency level within 10 hours. Most lives were saved by local people. Military rescue units were activated within minutes of the earthquake, and regional militia, local and provincial units such as the Sichuan Seismological Bureau self-activated immediately. By day-two, 20,000 rescue and engineering soldiers had been deployed. Over 15 large medical treatment, epidemic prevention, and psychological intervention teams responded and more than 10 million volunteers took part in relief activities. In spite of mobilization of the nation's resources, emergency relief was frustrated by formidable obstacles such as cloud cover, a destroyed ground transportation network, loss of communication, and continued geo-hazards in the form of landslide-dammed rivers which threatened large downstream urban centers. Expert national planning for recovery began five days post-earthquake; the plan was promulgated by national law in September, 2008. By the second anniversary of the Wenchuan earthquake, most school and residential construction was completed in earthquake-resistant areas.
(A14) Psychosocial Support Services in Disasters - Indian Experiences
Authors: Sekar K.
Published: May 2011

India with 1.08 billion populations is vulnerable to earthquake (56%), floods (8%), cyclones (12%) and droughts (28%) every year. It is further compounded with refugees, riots, epidemic and endemic situations. Disaster psychosocial support and mental health services has consistently grown and standardized over the past three decades in India. The initial experiments' started in 1981 with a circus tragedy and documentation of prolonged grief reaction. In the Bhopal gas tragedy (1984) mental health services were integrated through primary care doctors. The Marathwada earthquake (1991) involved primary health care personnel in provision of mental health care to the survivors. The Orissa super cyclone (1999) saw the emergence of psychosocial support to the community using local resources like community level workers who were survivors by themselves. The feasibility study involving 40 such workers was expanded to a pilot model with 400 workers in the Gujarat earthquake (2001) and later to the level of a District model in the Gujarat riots (2002). These developments paved way for the State model when Tsunami struck the eastern coast of India affecting three States and two Union Territories in India. The experiences and experiments led to the development of standardized capacity building tools and intervention kits with level and limits of care being addressed. The Indian experiences has seen a striding change from psychiatry paradigm to public health model, to the development of a standardized psychosocial support models involving community at large. The lesson learnt has been helpful in developing the National Guidelines on Psychosocial Support and Mental Health Services by the National Disaster Management Authority of India. These service models could be adapted to the developing South East Asian countries where there is a paucity of trained professionals to attend the needs of the survivors.
(A15) Trauma Signature Analysis: Evidence-Based Guidance for Disaster Mental Health Response
Authors: Shultz J.M. , Neria Y. , Espinel Z. , Kelly F.
Published: May 2011

Introduction

The first decade of the 2000s has advanced the field of mental health and psychosocial support (MHPSS) in disasters by providing expert consensus guidance. Nevertheless, MHPSS response to major disasters is frequently uncoordinated and rarely based on scientific evidence. Moreover, MHPSS response is not customized to the unique constellation of stressors and psychological risk factors that distinguish each disaster event. To address this lack of science and specificity, we have developed trauma signature (TSIG) analysis.

Methods

TSIG analysis consists of the following steps. Risk factors for disaster-related psychological distress and psychopathology (e.g., PTSD, depression) are continuously documented, updated, and refined. When disaster strikes, situation reports (sitreps) are issued in the early aftermath. We examine initial sitreps to determine the presence and intensity of evidence-based risk factors, subsumed under the headings of exposure to hazards, loss, and change. We estimate the size of the affected population. We rapidly create an initial TSIG and translate findings into actionable guidance regarding probable MHPSS needs for services and personnel.

Results

We have constructed TSIGs for prominent 2010 disasters: Haiti earthquake, Deepwater Horizon oil spill, and Pakistan monsoonal flooding. Psychological risk factor profiles contrast sharply across these three salient events. Regarding exposure to hazards, numbers of persons experiencing physical injury and perceiving threat to life are highly divergent. Losses differ dramatically when quantified in terms of deaths, numbers bereaved, homes and livelihoods lost, and economic toll. The degree of lifestyle and societal change, including displacement, lack of survival needs, lack of security, and interpersonal violence, also differentiates the psychological impact of these disparate events.

Conclusion

TSIG analysis can be used to provide rapid post-impact/pre-deployment MHPSS response guidance based on risk factor assessment. Using TSIG analysis, MHPSS response can be tailored and timed to the defining features of the disaster event.
(A21) Injury Patterns of Blast Type Antipersonnel Land Mine Victims
Authors: Dassanayake L. , Karunarathne A. , Munidasa D.
Published: May 2011

Anti-personnel land mines are deployed in many regions of conflict around the world. A large number of civilians and militants are affected regularly due to the blasts of such mines. Once set, they remain as silent concealed killers for decades and challenge the safety of the civilians even during the times of peace. A descriptive study was carried out at the Anuradhapura Teaching Hospital during a six month period starting in July 2007. The total number of anti-personal land mine injuries admitted during this period was 89. In all cases, the body part primarily in contact with the mine had been a lower limb. Except for few occasions, extensive soft tissue damage associated with compound fractures necessitated some form of an amputation for those limbs in primary contact with the blast mines. Closed fractures of the calcareous, talus, and the tarsal bones were seen in two cases. Nearly two thirds of the patients sustained either soft tissue or bone injuries to the opposite lower limb. Twelve percent of the victims had compound fractures on the opposite tibia and fibula. Injuries to external genitalia were seen in 8% of the cases. Upper limb injuries were not rare and predominantly found on the contra lateral upper limb (17%). The majority of them were soft tissue injuries. Chest wall injuries were seen among 2% of the cases. Superficial facial injuries were seen among 7% of the cases. In one occasion a gingival injury was detected. Seven percent of the victims developed deterioration in level of consciousness. None of them clinically showed any external physical trauma to the head. In some instances, the Glasgow Coma Scale (GCS) was ranked as 7 in which tracheal intubation and ventilation were needed. It was evident in this study that the majority of the affected patients sustained severe injuries in both lower limbs in contrast to some of the previous available studies.
(A22) Impact of Karachi Terrorist Bombing on an Emergency Department of a Tertiary Care Hospital
Authors: Waseem H. , Shahbaz S. , Razzak J.
Published: May 2011

Objectives

The objective of this study was to collect epidemiological injury data on patients presenting to the emergency department of a tertiary care hospital after the bombing on 29 December 2009.

Methods

This was a retrospective review of the medical records of the victims that were brought to a tertiary care hospital. Bombing victims were described as requiring acute care due to the direct effect of the bombing.

Results

The results are derived from a sample size of 198 bomb blast victims, most of which were first transported to government hospitals by private cars rather than ambulances. After the government announced free treatment, there was a wave of patients, among which, most were stable and already had received some form of treatment. Approximately 5–6 patients who had life-threatening injuries were brought directly to the tertiary care facility and needed surgical intervention. The lack of security in the emergency department could have lead to another terrorist activity. There were no procedures done in the field as there is lack of emergency medical services training in Pakistan, but in the hospital most of the interventions included intravenous (IV) lines, wound care, and laceration repair. The most common treatments included the administration of IV fluids, antibiotics, and analgesia. Radiographs of specific sites and trauma series were used to rule out bone injuries. There was lack of documentation in most of the medical charts.

Conclusions

The emergency department was overwhelmed with the number of patients that it received. Therefore, an updated disaster plan and regular disaster drills are required. Rapid and accurate triage could minimize mortality among bombing survivors significantly. The majority of patients were discharged home.
(A24) An Disaster Education Framework to Bridge Natural Disaster Medical Response and Primary Care Development in Developing Countries
Authors: Chan E.Y.Y. , Wong S.Y. , Griffiths S.M. , Graham C.A.
Published: May 2011

Introduction

Natural disasters cannot be prevented but their human impact can be mitigated. Effective medical and public health mitigation and responses require multidisciplinary efforts and appropriate training. Whilst Asia is currently ranked as the most natural disaster prone area globally, limited disaster medical and public health response training opportunities are available in the region. Our paper reports efforts to identify the training gaps and ways to fill them to prepare frontline practitioners and academic researchers in disaster and medical humanitarian emergency relief efforts in Asia.

Methods

Grounded on the disciplinary principles of academic training in public health, emergency & disaster medicine and primary care, our paper reviews the current disaster related academic training offered in these disciplines and maps out the training and knowledge gaps in disaster mitigation and response for frontline practitioners and academic researchers. We suggest ways to fill such gaps.

Results

A two-dimensional (clinical versus non-clinical), three-tier education training framework (Entrant level, Continuous medical education needs and Expertise level) is developed. Experiences and key training needs in Asia are highlighted.

Conclusion

The proposed framework identifies areas for comprehensive training for medical and public health practitioners who are interested to engage in medical disaster relief. The proposed framework also aims to strengthen mitigation and response capacities in health systems.
(A32) Emergency Preparedness in Louisiana Nursing Programs – Response Roles, Impacts, and Competencies
Authors: Andress K.
Published: May 2011

Introduction

Nurses are leaders and primary health responder/providers in natural, anthropic and technological disasters. Preparation and education for nursing emergency and disaster response should begin before nursing program graduation and before disaster events occur. In Louisiana, 17 federally-declared disaster declarations were experienced from 2000 – 2009, ranging from the Space Shuttle “Columbia” to Hurricane “Katrina”. This presentation overviews Louisiana nursing programs' disaster preparedness and operational planning as demonstrated to Louisiana's Schools of Nursing Aligned for Emergency Responsiveness (SAFER) Conference, New Orleans, 2010. Co-sponsored by Dillard University, Division of Nursing, New Orleans, and Northwestern State University, College of Nursing, Shreveport, the invitational conference brought expert nurse and physician preparedness speakers from federal, state and local venues to review disaster planning, experiences, needs, and nurse preparedness competencies with nurse faculty leadership.

Methods

A multiple choice survey was developed, trialed and emailed to 42 Louisiana Nursing Programs. Programs surveyed included Associate degree, Bachelors and Graduate-level providers for Registered Nurses as well as Vocational Technical programs for the Licensed Practical Nurse. National Planning Scenario threat priorities; impacts of federally declared disasters on Louisiana nursing programs; nursing program roles in disaster; and awareness of nurse emergency preparedness competencies were queried.

Results

34 of 42 surveys were returned. 20 were complete. Nursing programs were located state-wide and found in 7 of 9 Louisiana regions. Surveyed programs offered a Bachelors degree (45%); Graduate degree (35%); Associate degree (35%) and vocational or Licensed Practical Nursing (35%).

Conclusions

The majority of Louisiana nursing programs and their health communities have been impacted by federally declared disasters. Coordinated efforts to improve nursing program preparedness education, roles and responsibility are warranted as vulnerability increases.
(A39) Civil-Military Collaboration in Trauma Training
Authors: Lundberg L. , Ortenwall P.
Published: May 2011

In the present Swedish military medical organisation all medical personnel, including surgeons, have to be recruited from civilian hospitals. Even if there are many civilian surgeons well qualified to perform trauma surgery, the injury patterns seen in e.g. Afghanistan are quite different compared to what is generally seen in trauma patients arriving to the ED at a civilian hospital. In order to upgrade the major trauma skills of the civilian surgeons recruited to and trained for participating in international missions, the (extended) military version of the Definitive Surgical Trauma Care (DSTC) Course has been implemented. DSTC is given with the intention not to duplicate ATLS, nor to provide an in depth course in surgery, but rather to teach those techniques particularly applicable to the patient who requires surgery and intensive care for major trauma, in a setting where such care is not commonly practised or even necessarily available. The course, made up by a mix of lectures, case discussions and skill stations has been given at the Swedish Armed Forces Centre for Defence Medicine in Gothenburg since 2007. It has gradually evolved to incorporate also anaesthesiologists and nursing staff into an integrated team. The faculty during these courses has been made up by a mix of international and Swedish instructors. Course candidates have primarily been military health staff, but vacant slots have been offered clinicians working in civilian hospitals in the western part of Sweden. During the last course in September 2010 17/20 (85%) of the physicians and 13/17 (76%) of the nurses rated the course as very beneficial or indispensible. The Swedish Armed Forces Centre for Defence Medicine will continue to run the military version of the DSTC course. Due to a certain over-capacity, course participation can be offered the civilian health care system.
(A40) Military and Civilians in Australian Disaster Medical Assistance Teams
Authors: Robertson A.G. , Weeramanthri T.S.
Published: May 2011

The Australian Government first started to deploy civilian medical teams internationally in the aftermath of the 2004 Tsunami to Banda Aceh, the Maldives, and Sri Lanka. Historically, Australia had relied upon the Australian Defence Force (ADF) to provide overseas medical assistance, but, in this instance, the volunteers deployed were civilian staff, predominantly from tertiary hospital environments. Civilian Australian Medical Assistance Teams (AUSMATs), particularly in Banda Aceh, interacted closely with the ADF after the tsunami and have had a close liaison with the ADF in subsequent disasters, particularly where ADF assistance was required for aeromedical evacuation of patients. This has included assistance after the 2005 Bali bombing, the 2009 Ashmore Reef explosion, the 2009 Samoa tsunami, and the 2010 Pakistan floods. In the latter, Australia deployed a joint military-civilian medical taskforce to provide care to the affected people in Kot Addu in central Pakistan. Having had extensive experience in both military and civilian disaster responses, the authors in this presentation will look at the lessons that can be shared between civilian and military teams in the Australian context. The military brings particular proficiency in command and control, information gathering, security, communications, general logistics, aeromedical evacuation and living in the field. The civilian AUSMATs bring specialized medical expertise, experience in operating in small teams in a range of disaster conditions, health logistics, surveillance, and public health measures in a disaster setting. Learning how to blend these skill sets will be critical in ensuring effective and collaborative international deployments in the future.
(A42) Developement of Slovene Military Medical Unit
Authors: Strahovnik A.
Published: May 2011

Discussion

During the past 12 years we have been developing our military medical unit through collaboration between the public health system and military system. We found that one system could not work separate without another. Experts from public health system are incorporated into the military structure which provides efficient technical support and logistics. Through such a system we can cooperate in international projects.
(A43) Are Injuries due to Terrorism and War Similar? A Comparison of Civilians and Soldiers
Authors: Peleg K.
Published: May 2011

Objective

The objective of this study was to compare injuries and hospital utilization and outcomes from terror and war for civilians and soldiers.

Background

Injuries from terrorism and war are not necessarily comparable, especially among civilians and soldiers. For example, civilians have less direct exposure to conflict and are unprepared for injury, whereas soldiers are psychologically and physically prepared for combat on battlefields that often are far from trauma centers. Evidence-based studies distinguishing and characterizing differences in injuries according to conflict type and population group are lacking.

Methods

A retrospective study was performed using hospitalization data from the Israel National Trauma Registry (10/2000–12/2006).

Results

Terrorism and war accounted for trauma hospitalizations among 1,784 civilians and 802 soldiers. Most civilians (93%) were injured in terrorism and transferred to trauma centers by land, whereas soldiers were transferred by land and air. Critical injuries and injuries to multiple body regions were more likely due to terrorism than war. Soldiers tended to present with less severe injuries from war than from terrorism. Rates of first admission to orthopedic surgery were greater for all casualties with the exception of civilians injured in terrorism who were equally likely to be admitted to the intensive care unit. In-hospital mortality was higher among terrorism (7%) than war (2%) casualties, and particularly among civilians.

Conclusions

This study provides evidence that substantial differences exist in injury characteristics and hospital resources required to treat civilians and soldiers injured in terrorism and war.
(A46) Health Volunteers during the MT. MERAPI ERUPTION: What did Nursing Students Learn?
Authors: Rochmawati E.
Published: May 2011

Background

Undergraduate nursing students are expected to be responsive and competency, particularly during a disaster. Working as health volunteers is one strategy to develop these skills. However, little research has investigated the experiences of nursing students working as health volunteers during a disaster.

Objectives

This study aimed to investigate undergraduate nursing student perceptions and experiences of being health volunteer during the Mt. Merapi eruption.

Methods: A non-experimental, descriptive design was used. A sampling of 25 undergraduate nurse students who worked as health volunteers during the Mt. Merapi eruption completed a self-administered questionnaire. The questionnaire consisted open- and closed-ended questions, and was used to measure students' self awareness and what they have learned. Additional questions were asked to prioritize attributes required to be health volunteers. Data were aggregated and analyzed using a simple, descriptive analysis.

Results

Undergraduate nursing students had internal motivation of being health volunteers during disaster. Findings of this study illustrated benefits, future impact of being health volunteer, and required attributes of being good health volunteers.

Conclusions

Students' perceptions and experiences during disasters underscores important factors in the promotion of disaster management competency in nursing education.
(A48) The Role of Nurse Leader and Humanitarian: Disaster Planning, Management, and Evaluation
Authors: Mcglown J.
Published: May 2011

In the blink of an eye, a disaster caused by either natural or man-made hazard can change the sociocultural, psychological, physiological, and geopolitical integrity of all those that are directly and indirectly impacted. Disasters occur in every part of the world and are nondiscriminatory. Nurses, as the largest group of healthcare providers worldwide, are and should be at the center of disaster planning, management, and evaluation. Nurses are there when prevention is needed, during the crisis, and when the cameras and media are gone and the real work of recovery begins. Nurses remain there when the evaluation of the response, in its broadest sense, occurs and when recommendations must be made for applicable modification prior to the next disaster, as nurses are aware there will be more on the way somewhere in the world. As the second largest nursing organization in the world, the Honor Society of Nursing, Sigma Theta Tau International (STTI), has committed to being a leader in improving the health of the world's citizens. This leadership extends to being at the forefront of disaster planning, management, and evaluation. Through its member's use of knowledge, research, scholarship, service, and learning, STTI has created an environment in which they will impact the shaping of how nurses plan for, respond to, and evaluate disasters globally. This presentation will highlight the expertise that STTI has in the area of disaster planning, management, and evaluation, as well as the work that leaders are conducting to make an impact on the world during times of such crises. Discussion also will center on how STTI is continuing to provide leadership, education, service, and research opportunities in the area of disaster planning, management, and evaluation that can be applied throughout the world.
(A51) Facilitating Disaster Nursing Research in Oceania Region
Authors: Plummer V.M. , Telepo T. , Suryanto S.
Published: May 2011

“Facilitating disaster nursing research in Oceania Region” Natural disasters in the Oceania region and surrounds include for example earthquakes, volcanic eruptions (Rabaul, PNG, 1994, Merapi, Indonesia 2006), tsunamis, floods,(Indian Ocean 2004) fires, drought (Australia, 2009) and also pest plaques and pandemics which affected the broader international community. Between 1980 and 2008, there were 380 disaster events reported in the Oceania region in which 4,450 people died. That is approximately 154 deaths and 668,786 people affected at a cost of approximately $US 889 million per year. However despite this significant number of deaths and injuries, there is limited reporting on the nursing experience during such disasters or the impact of nursing on communities during response and recovery. This is due to the prioritised clinical focus of nursing resources of most countries during these events. A network of authors and researchers is being established in the area to support the reporting of nursing research in developing countries such as Papua New Guinea, Fiji, the Solomon Islands, Vanuatu, and Indonesia where nurses receive little post basic education, have limited opportunities to review the evidence for practice in disaster and emergency nursing, yet are regularly required to support the multidisciplinary disaster health team without essential support from the nursing research community. The network is essentially web-based and consists of a translational research approach via a network grid of researchers in response to a disaster event. Researchers from neighboring countries not clinically involved in the event respond by discovering and accessing data, analysing and reporting through a portal that enables timely reporting for discussion, publication, e-learning and dissemination of contemporary disaster nursing practices. This paper will report on the development of the network and its nexus with the WADEM Nursing Research Committee.
(A60) Collection of Disaster Information in the Emergency Phase: An NGO View
Authors: Takada Y. , Ukai T.
Published: May 2011

Background

In a disaster, the most important information for those in the international disaster response community is that about the exact place and scale. However, problems with communication networks and the complexity of the disaster information can make collection difficult. The United Nations Office for the Coordination of Humanitarian Affairs provides information about the situation in the affected country on its websites; Virtual On-Site Operations Coordination Center (V-OSOCC), One Response (OR) and Relief Web (RW). The positive and negative characteristics of these websites are discussed from the viewpoint of a medical non-governmental organization (NGO).

Results

V-OSOCC is a platform for disaster response personnel in around the world. Disaster coordination information is shared interactively on a mimic board. This information is sent in E-mails and SMS in real time. OR is a collaborative interagency website, designed to enhance coordination of humanitarian responses within the cluster approach. Public documents such as situation and assessment reports, maps, meeting schedules, and contact lists can be viewed. RW provides a wide range of information, not only about disasters but also about humanitarian emergencies. However, this website does not provide information such as contact lists for direct use in relief work.

Discussion

These websites are considered from the viewpoint of a medical NGO. V-OSOCC can share information related to urban search and rescue in real time, but there is no coordination of medical teams. Thus, each medical team has to participate in health cluster meetings on site. OR is more convenient than V-OSOCC for health cluster members because it provides more detail, with updated situation and assessment reports and meeting schedules. However, such reports do not show needs at the community level. RW is suitable for institutions such as libraries, which generally collect academic information.

Conclusion

The websites discussed here are useful for collecting disaster information; however, they do not have information about community-level needs. Therefore, needs assessment has to be undertaken within affected communities.
(A67) Empowerment Model for Community Disaster (EMCD)
Authors: Farchi M.U. , Shahar E.
Published: May 2011

The earthquake in Haiti and its consequences highlighted the need to enhance knowledge and skills for community intervention in situations of disaster and acute trauma. The large number of homeless people concentrated in enormous refugee camps has made such an investigation possible. In the lecture, we will present a model for empowerment intervention with victims of community disasters. The model is based on analyses of three cases in which psychosocial interventions were conducted by the investigators: the Tsunami in Sri Lanka, work at refugee camps in Georgia, and the earthquake in Haiti. Principles of the Model The more extensive the casualties are, the less relevant individual intervention will be. Entering an unfamiliar culture requires collaborative professional work with local residents. Intervention in a large-scale disaster needs to be based on an interdisciplinary perspective in terms of planning, preparation, and implementation. It is assumed that the intervention will be short-term, and a specific length of time is allocated for therapeutic agents to provide assistance. This approach was adopted in light of the limited resources at our disposal, and in an attempt to minimize dependence in the relationships between the therapeutic agents and the victims. An attempt is made to enhance efficacy for effective coping with changing needs that emerge in the wake of the disaster. An attempt is made to prevent CPTSD, which can inhibit the functioning of the community residents. We will present these principles and describe how they were implemented in community intervention at two refugee camps in Haiti following the earthquake there, and at a refugee camp in Georgia.
(A68) 7 Options for Evolving the Concept of Disaster Health
Authors: Allen A. , Shultz J.M. , Espinel Z.
Published: May 2011

Introduction

The World Association for Disaster and Emergency Medicine (WADEM) has been the primary innovator and incubator for the concept of disaster health. This presentation puts forth 7 options for consideration for evolving the concept of disaster health.

Discussion

(1) Promote disaster health from an adjective to a noun phrase. Disaster health has been a modifier for too long, tucked into expressions such as disaster health management or disaster health education. It is time for disaster health to emerge in its own right. (2) Elevate disaster health from a discipline to an endpoint, a defined and desired outcome. (3) Liberate disaster health from the confines of medicine and health care. Disaster health originated there, but is much more expansive. One of the distinctions of disaster health is its multidisciplinary nature. (4) Fully integrate the mental health and psychological dimension of disaster health. WADEM has been at the forefront, championing psychosocial issues in disasters, yet to date, this dimension of disaster health has been underdeveloped and underappreciated. (5) Consider the parallels inherent in optimizing disaster health for both disaster responders and disaster survivors. Also consider using plain language to create a common set of strategies for achieving disaster health that is equally applicable for responders and survivors. (6) Consider disaster health applied at the community level in a manner that subsumes community health, resilience, and disaster resistance. (7) Give disaster health its own framework. Clear and comprehensive WADEM-driven frameworks now exist for disaster health education, for example. Disaster health needs a framework that is simple, supple, and explanatory.

Conclusion

WADEM has promulgated disaster health as a vital, pivotal concept. The 7 options presented here have come from our own engagement with this concept. They are, in fact, defining features of our SAFETY FUNCTION ACTION framework for disaster health.
(A79) Where Do Ed Patients Come From?
Authors: Rego J. , Fitzgerald G. , Toloo S.
Published: May 2011

A lack of access to primary care services, decreasing numbers of general practitioners (GPs) and free of charge visits have been cited as factors contributing to the rising demand on emergency departments. This study aims to investigate the sources of patients' referrals to emergency departments and track changes in the source of referral over a six-year period in Queensland. Data from Queensland Emergency Departments Information Systems were analyzed based on records from 21 hospitals for the periods 2003–04 to 2008–09. The emergency department data were compared with publicly available data on GPs services and patients attendance rates. In Queensland, the majority of patients are self-referred and a 6.6% growth between 2003–04 and 2008–09 (84.4% to 90% respectively) has been observed. The number of referrals made by GPs, hospitals and community services decreased by 29.4%, 40%, 42% respectively during the six-year period. The full-time workload equivalent GPs per 100,000 people increased by 4.5% and the number of GP attendances measured per capita rose by 4% (4.25 to 4.42). An examination of changes in the triage category of self-referred patients revealed an increase in triage category 1-3 by 60%, 36.2%, and 14.4% respectively. The number of self-referred patients in triage categories 4–5 decreased by 10.5% and 21.9% respectively. The results of this analysis reveal that although the number of services provided by GPs increased, the amount of referrals decreased, and the proportion of self-referred patients to emergency departments rose during the six-year period. In addition, a growth in urgent triage categories (1–3) has been observed, with a decline in the number of non-urgent categories (4–5) among patients who came directly to emergency departments. Understanding the reasons behind this situation is crucial for appropriate demand management. Possible explanations will be sought and presented based on patients' responses to an emergency department users' questionnaire.
(A84) Video Documentation as a Supplemental Teaching Tool for Multi-Focused Emergency Management Exercises
Authors: Tedeschi C. , Hilmi L.M.
Published: May 2011

Introduction

Emergency management education and large-scale disaster drills help to increase local capacity for dealing with a multitude of hazards. Video recordings of disaster drills offer participants with little exposure to fundamental emergency management principles an introduction to important topics and scenarios. Such resources allow ongoing training and education, thus maximizing the investment required to mount a large-scale exercise.

Methods

During emergency management exercises in Mumbai, India between 2008 and 2010, video recordings of prior exercises were used to augment training for clinicians, administrators and public health practitioners. During the exercises, videos depicting scenario-based disaster drills were produced for use as teaching and evaluation tools focused on pre-hospital care, trauma life support, and hospital operations. Videos are distributed digitally and online, extending the teaching impact of multi-day courses and serving as a benchmark for future exercises.

Results

During the 2010 exercise in Mumbai, approximately eight hours of video footage were recorded by professional producers, and by participants in the evaluation and monitoring track of the course. That footage was added to a library from exercises in Ahmedabad and Mumbai, India, in 2007 and 2008. Video was used as a tool for immediate feedback on participant performance as well as the foundation for ongoing instruction. Videos allowed students to be sensitized to important issues prior to taking part in a drill, and to participate in the post-drill evaluation process.

Conclusion

Video documents of disaster management exercises serve as a valuable addition to an ongoing program of emergency management education and preparedness. Short video pieces increase the effectiveness of a teaching program by providing re-usable, easily accessible, and setting-specific teaching tools.
(A104) Simulation in Disaster and Emergency Medicine
Authors: Khalifa G.E.A.
Published: May 2011

Simulation

An activity or situation that produces conditions which are not real, but have the appearance of being real, used especially for testing something. Longman Dictionary of Contemporary English. Simulation has evolved over the centuries but has not been applied to medicine until the 20th century with the introduction of virtual reality and computers. Prior to the 20th century simulation took the forms of physical models and cadavers. With the introduction of flight simulation there was an effort to move similar approaches into medicine. This was pushed by the demands of minimally invasive surgery and the introduction of robotics in surgery. In the 21st century in addition to cognitive task analysis tools we are beginning to see the migration of advanced intelligence tools to simulation. We are just at the beginning of how we will use adversarial reasoning in the medical environment and in high risk time constrained situations like Emergency Medicine. The practitioner of emergency medicine is at high risk for errors because of multiple factors including high decision density, high levels of diagnostic uncertainty, high patient acuity, and frequent distractions. Some authors have suggested that instructing physicians in “cognitive forcing strategies” or “metacognition” will help reduce the amount of cognitive error in medical practice. It has been said ‘‘[There is an] ethical obligation to make all efforts to expose health professionals to clinical challenges that can be reasonably well simulated prior to allowing them to encounter and be responsible for similar real-life challenges.’' TYPES OF SIMULATION • Verbal • Tactile • Visual • Situational • Environmental TYPES OF SIMULATION TRAINING • Standardized patients (role play) • Basic models (partial task trainers) • Simple level • Higher level • Mannequins • Low fidelity • High fidelity • Virtual patients • Screen-based; computer-based • COMBINATIONS • Augmented sp encounters with technology • Crises management HUMAN PATIENT SIMULATION • Realistic • Suitable for all levels • Safe • Wide variety of training programs • Expensive ADVANTAGES OF SIMULATION • Patients are never at risk • Serious but infrequent events, in predictable times and places • Errors can be allowed to occur, and play-out • Rehearsal, repetition, mastery • Crisis management simulation, planning • Reduces institutional liability • Increases operational confidence • Produces rapid results • Allows team training • Increases institutional prestige The use of high fidelity simulations to train multidisciplinary teams in critical environments is well established.
(A114) Disaster Medical Services System in Hyogo Prefecture from the Lessons of the Great Hanshin-Awaji Earthquake
Authors: Nakayama S. , Kozawa S. , Ukai T.
Published: May 2011

Purpose

To examine how did Hyogo prefecture renovate disaster medical services system from the lessons of the Great Hanshin -Awaji Earthquake.

Method

Countermeasures after the experience of the Earthquake were 1. Establishment of disaster-related medical information network which was introduced to each of various institutions to collect and disseminate medical information at the time of disaster. 2. Designation of sixteen hospitals as Disaster Medical Centers, which were expected to play leading role in disaster management,and to receive many patients at a time of disasters. 3. Construction of Hyogo Emergency Medical Center which was designated as a main Disaster Medical Center to train medical staffs, to operate the Emergency Medical Information Control Center.

Results

We have several training courses for medical staffs. The most important training course is the DMAT (Disaster Medical Assistant Team)training course. DMAT trainigs held at two main Disaster Medical Centers, east National Disaster Medical Center, west Hyogo Emergency Medical Center. More than three hundreds teams have been cultivated now. We experienced five disasters in Hyogo prefecture in these seven years. 2 were natural disasters by the typhoon. 3 were a collision of the ship, the collision of the truck, train derailments each. A big JR train accident occurred in Amagasaki city of Hyogo on April 25,2005. Hyogo Emergency Medical Center worked as the emergency information control center, dispatched doctor attended ambulance, performed on-site triage and first aid, dispatched second team by helicopter, received four severe cases by helicopters, dispatched third team in the evening and provided confined space medicine, and took initiative of surveillance study of the casualties.

Conclusion

Disaster medical services system from the lessons of the Earthqukake functioned at the time of the JR Train accident.