bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety of endomyocardial biopsy in children
Authors: Cowley Collin G. , Lozier John S. , Orsmond Garth S. , Shaddy Robert E.
Published: May 2019

Endomyocardial biopsy in children remains important in the evaluation of cardiomyopathy, myocarditis, and rejection following cardiac transplantation. We sought to evaluate the morbidity associated with endomyocardial biopsy on the basis of a large experience from a single institution.

We reviewed records of all endomyocardial biopsies performed at our institution. Complications were defined as adverse events resulting from the biopsy requiring intervention or additional observation. We also reviewed the most recent echocardiogram from all the patients for the presence and severity of tricuspid valvar regurgitation.

Between November 1986 and April 2002, we performed 1051 endomyocardial biopsies in 135 patients ranging in age from 9 days to 18 years. The internal jugular vein was the site of vascular access in 68% of the procedures. There were 10 acute procedural complications requiring intervention or additional observation. Severe tricuspid regurgitation developed in two patients who had undergone multiple biopsies after cardiac transplantation, one of whom underwent subsequent replacement of the tricuspid valve. There were no deaths or cardiac perforations. The total incidence of morbidity was 1.1%. No demographic or procedural factors were identified to be predictive of complications.

In experienced hands, therefore, endomyocardial biopsy can be safely performed in children with very low morbidity.
Characterization and treatment of systemic venous to pulmonary venous collaterals seen after the Fontan operation
Authors: Sugiyama Hisashi , Yoo Shi-Joon , Williams William , Benson Lee N.
Published: May 2019

Objectives: To determine the anatomical characteristics of systemic venous collaterals formed after the Fontan operation, and the efficacy of a transcatheter strategy for management. Methods: We reviewed retrospectively the data from cardiac catherization of 50 persistently cyanotic patients after the Fontan operation. Results: A total of 54 transcatheter interventions were performed, at a mean age of 6.3 ± 3.5 years, a mean interval of 2.7 ± 2.9 years from completion of the Fontan circulation. Of 38 patients who had fenestration of the baffle at the time of surgery, 25 had patency of the fenestration, and 24 had the fenestration occluded with a device at the time of interventional treatment for associated venous collaterals. We identified a total of 68 systemic venous collateral channels, of which 36 (53%) were supracardiac, 12 (18%) cardiac, and 20 (29%) infracardiac in origin. The most common site of origin was the brachiocephalic vein (44%), followed by the left phrenic vein (25%). A longer time from surgery, at 3.3 ± 3.4 years, was associated with the identification of collaterals having a diameter larger than 4 mm (p < 0.01). The mean pulmonary arterial pressure was higher in those with larger compared to those with smaller collaterals (13.3 ± 2.8 versus 11.1 ± 2.0 mmHg, p < 0.01). Coils were used for occlusion of 61 vessels, and a Rashkind™ occluder for the remaining 7. After exclusion of the patients undergoing simultaneous closure of their fenestration, systemic saturation of oxygen increased from 89 ± 6% to 95 ± 3% (p < 0.01). Conclusion: Venous collateral channels are common in patients suffering progressive cyanosis in the setting of the Fontan circulation. The collaterals increase in size with time, and are associated with higher pulmonary arterial pressures. Transcatheter treatment is feasible, and results in resolution of cyanosis. Only continuing follow-up will show whether further collateralization occurs in time.
Coronary arterial compression treated by stenting after replacement of the mitral valve in a child
Authors: Assaqqat Mervat A. , Hassan Walid , Siblini Ghassan
Published: May 2019

We describe the clinical history of a nine years old girl with Shone's syndrome. She underwent balloon angioplasty of the aortic coarctation in infancy, and later developed severe sub-aortic stenosis and moderate mitral valvar stenosis. The mitral valve was therefore replaced with a mechanical prosthesis, and the sub-aortic shelf was resected. Immediately after the operation, she developed signs of myocardial ischemia. Coronary angiography showed compression of the middle part of the circumflex artery by the mechanical prosthesis, the obstructed segment being successfully dilated using a coronary arterial stent.
Mortality in Nursing Home Evacuations in the United States from 1995-2017
Authors: Mace Sharon , Caicedo Daniel , Sharma Aishwarya
Published: May 2019

Introduction:

There are an estimated 15,600 nursing homes with a total of 1.4 million residents in the United States. The number of residents will continue to increase due to the aging population, and the associated morbidities will make it difficult to evacuate them safely.

Aim:

This study is the first of its kind to provide an analysis of the number of nursing home deaths caused by external and internal events following evacuations.

Methods:

Information from the databases Lexis Nexis and PubMed were compiled and limited to news articles from 1995-2017. The gathered information included the reason for evacuation, injuries, deaths, and locations within the United States.

Results:

From 1995 to 2017, there was a total of 51 evacuations and 141 deaths in nursing homes. 27 (53%) evacuations were due to external events which resulted in a combined 121 (86%) deaths, and 24 (47%) evacuations were due to internal events which resulted in a combined 20 (14%) deaths. Hurricanes were responsible for the majority of deaths during evacuations, followed by fires and floods. The number of evacuations and deaths increased the greatest between 2005 to 2008.

Discussion:

External events have the greatest impact on loss of life. Internal disasters are about equal in the number of incidents, however, external events have a much greater mortality rate. Exact numbers on injuries, morbidity, and mortality are difficult to ascertain, but it appears to be related to natural disasters. In view of the increasing likelihood of natural disasters related to global warming, a drastic improvement of standard evacuation procedures of long-term nursing homes is critical to decreasing mortality of nursing home residents. There also needs to be a nationally standardized method of reporting evacuations in order to better analyze data on nursing homes.
Surgical Procedures Performed by Emergency Medical Teams in Sudden-Onset Disasters: A Systematic Review
Authors: Coventry Charles , Holland Andrew , Vaska Ashish , Ivers Rebecca , Read David
Published: May 2019

Aim:

To describe the types of surgical procedures performed by emergency medical teams (EMTs) with general surgical capability in the aftermath of sudden-onset disasters (SODs) in low- and middle-income countries (LMICs).

Methods:

A search of electronic databases (PubMed, MEDLINE, and EMBASE) was carried out to identify articles published between 1990 and 2018 that describe the type of surgical procedures performed by EMTs in the impact and post-impact phases a SOD. Further relevant articles were obtained by hand-searching reference lists.

Results:

16 articles met the inclusion criteria. Articles reporting on EMTs from a number of different countries and responding to a variety of disasters were included. There was a high prevalence of procedures for extremity soft tissue injuries (46.8%) and fractures (28.3%). However, a significant number of genitourinary/obstetric procedures were also reported.

Discussion:

Knowledge of the types of surgical procedures most frequently performed by EMTs may help further determine the necessary prerequisite surgical skills required for the recruitment of surgeons for EMTs. Experience in basic plastic, orthopedic, urological, and obstetric surgery would seem desirable for surgeons and surgical teams wishing to participate in an EMT.
August 24th, 2016 Central Italy Earthquake - Validation of “Modified Utstein Template for Hospital Disaster Response Reporting,” A New Tool for Reporting Hospital’s Reaction to Disasters
Authors: Paganini Matteo , Ragazzoni Luca , Rossitto Fabio , Vecchiato Aurora , Bonfini Rita , Mucciante Maria Vittoria , Nisii Alessandra , Corte Francesco Della , Ingrassia Pier Luigi
Published: May 2019

Introduction:

After Action Reports analyze events and recommend actions to facilitate preparedness and response to future similar disasters. However, there is no consensus among the templates developed to collect data during disasters and little is known about how to report hospital responses.

Aim:

The hypothesis was that the use of a new assessment tool for hospital response to natural disasters facilitates the systematic collection of data and the delivery of a scientific report after the event.

Methods:

A data collection tool, focused on hospital response to natural disasters, was created modifying the “Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters”,1 and tested the reaction of the hospitals involved in the response to the Central Italy earthquake on August 24th, 2016.

Results:

Four hospitals were included. The completion rate of the tool was of 97.10%. A total of 613 patients accessed the four emergency departments, most of them in Rieti hospital (178; 29.04%). Three hundred and thirty – six patients were classified as earthquake-related (54.81%), most of which with trauma injuries (260; 77.38%).

Discussion:

The new reporting tool proved to be easy to use and allowed to retrospectively reconstruct most (97.10%) of the actions implemented by hospital responders. Details about activation, patient fluxes, times, and actions undertaken were easily reconstructed throughout in-field interviews of hospital managers and patients’ charts. Patients were uniformly distributed across the four hospitals, and the hospital capabilities were able to cope with this mass influx of casualties. The Modified Utstein Template for Hospital Disaster Response Reporting is a valid tool for hospital disaster management reporting. This template could be used for a better comprehension of hospital disaster reaction, debriefing activities, and revisions.
Crisis State of Medical Readiness and Citizen Preparedness Importance for Radiological and Nuclear Incidents
Authors: Swienton Raymond E. , Liu E. Liang , Flax Lindsay A. , Klein Kelly R.
Published: May 2019

Introduction:

In 2017, members of our workgroup published on the readiness for nuclear and radiological incidents among emergency medical personnel.1 Our findings, along with a review of pertinent literature, suggest that the state of medical preparedness for these incidents is in crisis. A 2018 publication addressing nuclear terrorism preparedness relegates medical preparedness to a low priority and describes it as potentially dangerous.2 The crisis status of medical preparedness for these incidents is addressed.

Aim:

To establish a prepared medical workforce and trained public for those at risk from nuclear or radiological disasters.

Methods:

This Institutional Review Board (IRB)-approved survey published an article and used a relevant literature review.

Results:

Readiness for nuclear and radiological incidents is lacking in multiple areas including education, training, identifying medical needs, willingness to come to work, and perception of relative risk among medical personnel.1 Confounding this is recent prominent publication downplaying and discouraging medical preparedness for nuclear terrorism.2 The importance of a readied workforce and a prepared public is identified.

Discussion:

In 2013, we formed a multi-national workgroup focused on preparing health professionals and the public for clinical management of casualties during nuclear and radiological disasters. Modeling has demonstrated predictable casualty injury and illness patterns suggesting that early appropriate medical response will save lives. Readiness demands an educated, skillful, and willing-to-engage medical workforce. Our 2017 publication identified several areas that place medical preparedness at risk.1 A significant risk to medical preparedness may lie in prominent publications discouraging the pursuit.2 We firmly believe that medical preparedness is essential and begins with a prepared public.
Disaster First Responder Training: A Train-the-Trainer Veterans Program to Combat PTSD
Authors: Kincaid Jenevieve , Reno Elaine , Lemery Jay , Miner Todd
Published: May 2019

Introduction:

There are many health challenges faced by those returning from military service. Posttraumatic stress disorder (PTSD) is a serious problem in veterans. PTSD is a risk factor for suicide in veterans. Standard treatments include medication and talk therapy. Non-traditional treatments include civil service and leadership training.

Aim:

Assess the effectiveness of Veteran Focused Train-the-Trainer (TTT) Community Disaster Response and First Aid (DRAFA) Programs in promoting health, wellness, reintegration, and decreasing PTSD symptoms of veterans.

Methods:

A longitudinal cohort study was conducted using a convenience sample of veterans living in Denver, Colorado or Reno, Nevada. The sample size was over 50 (N=50+), with 25+ case-matched veterans at each location. This is an ongoing project lasting through the end of 2020. Inclusion criteria selected veterans interested in DRAFA training and education. Exclusion criteria disqualified those who are not a veteran or those unable to perform physical tasks required by curriculum. The null hypothesis was that there is no relationship between the DRAFA TTT program and the health, well-being, and reintegration of veterans back into their communities. Statistical tools used were SPSS Statistics (Version 25) and NVivo 12-12.2.0.3262. Research activities were conducted under the auspices of the University of Colorado and guided by the principles of the Institutional Review Board (IRB).

Results:

Results are being evaluated using a mixed methods impact model. The main outcomes measured health, wellness, and reintegration using Veterans RAND-12 Health Quality of Life Survey, the Military to Civilian Reintegration Survey, and a satisfaction survey. Preliminary analysis may indicate a correlation between participation in the DRAFA TTT program and improved health/wellness outcomes, better reintegration into society, and decreased PTSD.

Discussion:

There is growing evidence that expedited structured reintegration programs in community preparedness and disaster leadership roles for veterans alleviate PTSD symptoms and improves quality of life.
Key Elements of Civil-Military Disaster Rescue Operation in China
Authors: Guo Haitao , Guo Shusen
Published: May 2019

Introduction:

In China, many disaster rescue operations need cooperation between civil forces and military forces. Understanding the key elements of civil-military disaster rescue operations is a basic problem faced by Chinese rescuers and scholars.

Aim:

To summarize the key elements of civil-military disaster rescue operations in China.

Methods:

On July 17, 2016, an expert round-table meeting was held on our campus to discuss some basic problems in disaster research. The participants arrived at a consensus that the key elements of civil-military disaster rescue operation under Chinese cultural context should be carefully analyzed using Six Sigma (Why, Who, What, When, Where, and How, 5W1H)

Methods:

The minutes of the meeting was summarized into a brief report.

Results:

(1) Why to rescue - it is the responsibility of modern government to protect its people; (2) Who are the rescuers - individuals or groups with passion and ability to do such work, but they should be organized properly; (3) What to do - make vital systems of the community run normally as soon as possible; (4) When to rescue - different disasters have different laws, but it is better to render help in the golden hour; (5) Where to rescue - it depends on the input process (material, human resources, etc.) and output process (patients, waste material, etc.) of the rescue operation, not merely confined to the disaster site; (6) How to rescue - cooperation among all branches of social sectors is vital to succeed, especially civil-military cooperation. Military force is the backbone force in an austere environment.

Discussion:

The discipline of disaster medicine is developing rapidly in China. The research and evaluation framework should be established carefully. Civil forces and military forces should have an identical understanding of the same question. This abstract is only part of the research framework.
Evolving Strategy and Incident Management Systems in Hard to Reach Areas and Fragile Security Settings: The Case of Ebola Response in the Democratic Republic of Congo
Authors: Yao Nda Konan Michel , Ndjoloko Tambwe Bathe
Published: May 2019

Introduction:

DRC Ministry of Health declared the 9th outbreak of Ebola Virus Disease (EVD) in the Equator province on May 8, 2018, that ended on July 25, 2018. There were 54 cases with 38 confirmed, 33 deaths (61%), and 21 survivors in three “zones de santé” (districts). On August 1, 2018, the 10th EVD outbreak of the country was declared in the Ituri and North Kivu provinces. This one is the most important outbreak ever experienced. By November 18, 2018, 373 cases were reported with 326 confirmed and 214 deaths (58%) in two provinces including 14 “zones de santé.” While the 9th outbreak occurred in hard-to-reach areas, the 10th is occurring in fragile security settings, requiring specific strategic/operational approaches.

Aim:

To describe strategic and operational approaches including IMSs used to address these deadly outbreaks.

Methods:

A case study methodology using response strategy documents and observations was used, coupled with the use of operation review exercises.

Results:

The response strategy evolved continuously taking into account the epidemiological context, including geographical spread. It also took into account cultural, political, and sociological (community resistances) sensitivities. Conditions of pre-existing health system and services were considered. The prevailing security context (armed groups) was taken into account. The evolving situation impacted implementation of response areas including critical interventions like setting up confirmation and treatment centres, rapid response teams, and IMS structures. Areas of response were reviewed continuously, including response structures with further decentralization, outreach, or locally delegated interventions to ensure geographical access and continuity in response services.

Discussion:

Response areas to deal with EVD outbreaks are well known. However, an effective response requires a continuous adjustment of the strategy and a flexible response structures with related IMSs based on regular deep situation analysis. Social sciences still have a critical role to play for that purpose.
Helping the Helpers: A Focus on Provider Mental Health
Authors: Jaffe Eli , Herbst Raphael
Published: May 2019

Introduction:

Emergency medical services (EMS) is a high-stress profession, which can lead to deterioration in provider mental health over time. EMS providers may find themselves in a situation where they are not only treating the general public, but also each other. Until now, there has been no active training or emphasis on provider mental health. This has taken its toll and can lead to PTSD (post-traumatic stress disorder) in field providers and managers alike.

Aim:

Identifying and managing stressors is crucial to longevity in the field of EMS. Managers must have the ability to broach sensitive matters with their subordinates, and effectively debrief them following such stressful incidents.

Methods:

Magen David Adom held a two-day seminar for its administration, from which they learned signs and symptoms of PTSD, how to approach teams who had been in stressful situations, and how to properly debrief the teams. The seminar culminated in mass casualty incident (MCI) drills, where there were 4 active scenes. Scene 1 had a team that was physically injured. Scene 2 had a team which cared for the team from scene 1. Scene 3 had a team suffering from emotional stress and ceased to function. Scene 4 had only wounded civilians. The drill focused on provider emotions and used actors and props to simulate an exceedingly complex MCI situation.

Results:

Following the drill, a debriefing was held and it was found that all of the points of interest had been noted and properly dealt with.

Discussion:

Holding a successful drill assisted in providing participants with an accurate sense of such stressful situations in which their subordinates find themselves on a daily basis. The debriefing session succeeded in identifying potential stressors for field providers and teaching the participants the appropriate way to approach such sensitive matters.
Review of Effectiveness of the Foreign Medical Team Deployment in Nepal Earthquake, 2015
Authors: Pandey Ashok , Pandey Achyut Raj , Dhimal Meghnath , Jha Anjani
Published: May 2019

Introduction:

Nepal experienced a massive earthquake on 25th April, 2015 measuring 7.8 Richter scale followed by large aftershock on 12th May that further added to the destruction, especially in Sindhupalchowk and Dolakha. On request of Government of Nepal, international community extended financial and technical assistance to overcome the impact of the earthquake. Foreign Medical Teams (FMTs); now known as emergency medical team, from different countries and volunteers from within the country had helped in health service delivery.

Aim:

to get a clear picture of Strengths, Weaknesses/Gaps and Areas of Improvement that would be very important in making the response better in any future events of such scale when discussed and shared with all relevant stakeholders in Nepal.

Methods:

It was a multi-method study. Both quantitative and qualitative approaches were used to have an in-depth overview of the research question and the objectives set for the study. Records and reports relating Foreign Medical Team Coordination Committee (FMTCC) and meeting minutes of Health Emergency Operation Centre were reviewed.

Results:

Total of 8,962 deaths and 22,302 injuries occurred following earthquake of which 8,864 deaths and 21,156 injuries occurred in the most affected 14 districts of Nepal. In FGD and KIIs, most of the participants highlighted the earthquake had a huge impact on infrastructures. A large number of casualties were reported immediately after earthquake. Health facilities were overloaded with injured patients. One hundred and thirty-seven FMTs from 36 countries worked in Nepal to provide medical relief.

Discussion:

Timely preparation and readiness of the procedures to handle the FMTs including their registration process, medical licensing procedures, procedures of coordinating mechanisms with the district, case management and treatment guidelines to be followed by the FMTs are crucial to have a better health sector response including that of FMTs.
Helping Runners Under Extreme Heat: The 2017 Montreal Half-Marathon Experience
Authors: D’ulisse Nicola
Published: May 2019

Introduction:

The 2017 Montreal Half-Marathon was held on September 24th despite a record-breaking, out-of-season heatwave. The Urgences-santé Corporation (USC), Quebec’s largest emergency medical service (EMS), was tasked with coordinating and delivering prehospital response for over 15,000 runners at a time when the province’s paramedics were on strike.

Aim:

USC’s mission was to ensure runner safety under extreme conditions with limited staffing. In conjunction with the event’s medical teams, we implemented a new approach that oriented patients to the event’s clinic with the aim of limiting ambulance transports off-site and thus optimizing resources by promoting a “treat and release” principle.

Methods:

Emergency response was organized around the event’s clinic, which offered a level of care comparable to proximate emergency departments, including mass-cooling capacities. This capacity allowed us to modify provincial protocols, and thus prioritize treating patients on-site instead of transporting them to a hospital. Consequently, the prehospital response on the course could be assured with only 15 ambulances (staffed by managers) and a single team deployed at the event’s clinic, acting as transport officers. Heatstroke identification protocols were reinforced for the safety of the runners and spectators.

Results:

A total of 1,071 participants received medical attention, including 24 who were treated for a heat-related incident. On the course, 32 were evaluated by paramedics and 20 were transported to the event’s clinic. Only 7 patients were transferred from the clinic to a hospital, of which only one was for a heat-related incident. No deaths resulted from the race.

Discussion:

By anticipating and preparing for the extreme heat, the coordinated prehospital response safely reduced off-site transports, minimizing treatment delays for patients, and maximizing the use of on-site resources. We attribute this success to a strong collaboration with the race organizers, the presence of an on-site clinic, and an increase in prehospital resources.
The Impact of Japan Heatwave on Community Emergency Medicine in 2018
Authors: Iwasaki Yohei , Kasai Kosuke , Hirukawa Kenichi , Kawakami Masato
Published: May 2019

Introduction:

Due to the heatwave in Japan, the number of patients with heatstroke transported via ambulance hit the highest record according to the Tokyo fire department in 2018. Now, heatwaves are thought to be a natural disaster. Emergency medical professionals located in a Tokyo suburb covering 40,000 individuals experienced a wide range of challenges in patient care with heatstroke.

Aim:

To assess the impact of the 2018 Japan heatwave on community emergency medical service.

Methods:

Patients (aged ≥ 16 years) with heatstroke and who were transported to our hospital by ambulance from June to September of 2018 were included. Data were derived from prehospital records and electronic medical records. Weather data was referenced from a Japanese meteorological agency.

Results:

The number of all-cause cases was 1,764, and the total number of heatstroke cases was 51 (2.9%). Heatstroke cases were concentrated in July and August of 2018. The rate of males was 69%. The average age was 63 ± 23 years. Physical labor was associated with 31% of cases, such as sports in 7.8%. Hospitalization was required in 24%. ICU admission was required in 9.8%. There was no fetal case directly caused by heatstroke in this survey.

Discussion:

The risk factors of heatstroke considered to be male and elderly. About one-half of heatstroke patients were over 70 years old, and it may have been related to regional characteristics. As mentioned in the Heatstroke STUDY 2012 (Miyake, 2014), most cases which occurred inside residences were found that there was no air conditioner use. There was also an increased number of patients with heatstroke who made emergency visits by themselves. Further investigation is needed annually to estimate the effect of climate change. It is important to make a strong recommendation from public health agency about heatstroke prevention, including air conditioner use during hot weather.
Exploring Health Challenges of South Asian Women at the Evacuation Centers after Disasters
Authors: Chowdhury Tazrina , Arbon Paul , Steenkamp Malinda , Kako Mayumi , Gebbie Kristine
Published: May 2019

Introduction:

Globally, women are considered to be more vulnerable during disasters. South Asia including India, Pakistan, Bangladesh, Sri Lanka, Myanmar, and Nepal experience many disasters, and are also ranked lowest on the gender equality index. Women of these countries tend to face many health challenges while staying at evacuation centers after disasters.

Aim:

This study highlights the health challenges South Asian women face while staying in evacuation centers after disasters.

Methods:

A narrative review was conducted using the keywords, “women after disaster,” “evacuation centers,” and “emergency health care.” Literature identified from the references were also added until reaching saturation. 47 articles were obtained through Elsevier, Google Scholar, Scopus, and ProQuest.

Results:

Women in shelters in South Asian countries experienced many health challenges including genito-urinary tract infections (studies from India, Sri Lanka and Bangladesh), increased maternal mortality (Nepal and Pakistan), and sexual assault with resulting unwanted pregnancies and sexually transmitted diseases, including HIV (Nepal). Factors that contributed were the unavailability of separate toilets, inadequate sanitation, lack of sanitary supplies, and inadequate childbirth and maternity care resources. Rape victims at the shelters of Myanmar received delayed medical treatments, causing long-term health complications. Post-disaster stress and trauma were evident among women at the shelters initiated by insecurity, fear of abuse, and unfair relief distribution.

Discussion:

Women face certain challenges when staying in evacuation shelters in South Asian countries, which impacts their wellbeing after disasters. It is important to recognize women’s special requirements and to preserve women’s rights while developing disaster preparedness strategies. Socio-cultural perspectives of the disaster-prone areas should be considered at the policy planning level to ensure an effective and practical health-safety system. Additionally, further research focusing on women’s wellbeing at the evacuation centers is required to inform and overcome health challenges faced by women living in the shelters.
The Health Impacts of Toxic Remnants of War on Civilian Populations: A Scoping Review
Authors: Durham Jo , Pizzino Stacey
Published: May 2019

Introduction:

An estimated two billion people are currently affected by war, with civilian populations increasingly exposed to the hazards of armed conflict. While the effect of explosive remnants of conflict is well documented, the impacts of the toxic remnants of war on civilian health are less well understood.

Methods:

This study was a scoping review examining the human health impacts of exposure to toxic remnants of war. Toxic remnants of war refer to any toxic or radiological substances arising from military activities. In this study, however, the focus was limited to the health effects of exposure to toxic substances and explosive by-products from munitions fired, dropped, or abandoned during conflict. The following databases were searched: Embase PubMed, Scopus, and Web of Science. The Mixed Methods Appraisal Tool (MMAT) was used to assess the methodological quality of studies that met the inclusion criteria.

Results:

Common toxicants reported on were Tetrachlorodibenzo-p-dioxin TCDD, white phosphorus, depleted uranium, lead, mercury, and sulfur mustard. Common health effects included respiratory diseases as well as cutaneous, cardiovascular, reproductive, and congenital effects. Posttraumatic stress disorder, depression, anxiety, cognitive impairments, and decreased quality of life were also commonly reported. The evidence base, however, is mixed with heterogeneity in study design and outcome measures. Lack of baseline data and inadequate exposure models make establishing an adverse causal relationship between an agent and a disease challenging.

Discussion:

Civilian exposures to toxic remnants of conflict remain understudied and under-addressed. The study suggests assessment of the human health impacts of toxicants should be part of a post-conflict response, especially given the potential long-term intergenerational effects. The current lack of recognition of the human health impacts of toxic remnants of conflict also limits the amount of global resources assigned to post-conflict decontamination.
The Impact on Local Emergency Departments During a “Schoolies Week” Youth Mass Gathering
Authors: Crilly Julia , Ranse Jamie , Bost Nerolie , Donnelly Tonya , Timms Jo , Gilmour Kate , Aitken Michael , Johnston Amy
Published: May 2019

Introduction:

Community-based strategies designed to minimize the impact on local emergency services during mass gathering events (MGEs) require evaluation to provide evidence to inform best practice.

Aim:

This study aimed to describe characteristics and outcomes for people aged 16-18 years requiring emergency care before, during, and after a planned youth MGE “Schoolies week” on the Gold Coast, Australia.

Methods:

A retrospective observational study was undertaken. Presentations from all young adults to the emergency department (ED) or In-Event Health Service (IEHS) over a 21-day period in 2014 were included. Descriptive and inferential analyses were performed to compare across time and to describe characteristics of and outcomes for young adults requiring healthcare.

Results:

A total of 1029 presentations were made by youth aged 16 – 18 to the ED and IEHS over the study period (ED: 139 pre, 275 during, and 195 post; IEHS: 420 during). Patient characteristics and outcomes to the ED that varied significantly between pre, during, and post Schoolies periods included patient’s age (higher proportion of 17-year-olds), residing outside the Gold Coast region, and not waiting for treatment. All were higher during Schoolies week. Of the 24,375 MGE attendees, 420 (1.72% [95% CI, 1.57 – 1.89], 17.2/1,000) presented to the IEHS. The majority were toxicology related (n=169, 44.9%). Transportation to hospital rate was low (0.03% [95% CI, 0.01 – 0.06], 0.3/1,000) for the 24,375 MGE attendees.

Discussion:

Findings from this study support previous research indicating that MGEs can impact local emergency healthcare services. The provision of the IEHS may have limited this impact. The recipients of care delivery, predominantly males with trauma- or toxicology-related problems, warrants further investigation. Research describing the structures and processes of the IEHC could further inform health care delivery in and out of hospital settings.
Proposing a Minimum Data Set for Mass Gathering Health
Authors: Steenkamp Malinda , Arbon Paul , Lund Adam , Turris Sheila , Ranse Jamie , Hutton Alison , Munn Brendan , Bowles Ron
Published: May 2019

Introduction:

There is currently no standardized approach to collecting mass gathering health data, which makes comparisons across or between events challenging. From 2013 onward, an international team of researchers from Australia and Canada collaborated to develop a Minimum Data Set (MDS) for Mass Gathering Health (MGH).

Aim:

The process of developing the MDS has been reported on previously at the 2015 and 2017 World Congresses on Disaster and Emergency Medicine, and this presentation will present a final MDS on MGH.

Methods:

This study drew from literature, including the 2015 Public Health for Mass Gatherings key considerations, previous event/patient registry development, expert input, and the results of the team’s work. The authors developed an MDS framework with the aim to create an online MGH data repository. The framework was populated with an initial list of data elements using a modified Delphi technique.

Results:

The MDS includes the 41 data elements in the following domains: community characteristics, event characteristics, venue characteristics, crowd characteristics, event safety considerations, public health considerations, and health services. Also included are definitions and preliminary metadata.

Discussion:

The development of an MGH-MDS can grow the science underpinning this emerging field. Future input from the international community is essential to ensure that the proposed MDS is fit-for-purpose, i.e., systematic, comprehensive, and rigorous, while remaining fluid and relevant for various users and contexts.
The Sun Herald Sydney City-2-Surf Fun Run: Historical Injury Patterns and Development of a Predictive Model to Inform Health Service Planning
Authors: Heslop David , Vassil John , Winn Linda
Published: May 2019

Introduction:

The Sydney City-2-Surf is the world’s largest annual run entered by around 80,000 people. First aid planning at mass participation running events such as the City-2-Surf is an area in the medical literature that has received little attention. Consequently, first aid planning for these events is based on experience rather than evidence. The models for predicting casualties that currently exist in the literature are either dated or not statistically significant.

Aim:

The aim of this study was to characterize patterns of injuries linked to geographic location across the course of the City-2-Surf, and to explore relationships of injury types with location and meteorological conditions.

Methods:

Records for formally treated casualties and meteorological conditions were obtained for the race years 2010-2016 and statistically analyzed to find associations between meteorological conditions, geographic conditions, casualty types, and location.

Results:

The most common casualties encountered were heat exhaustion or hyperthermia (39.2%), musculoskeletal (25.4%), and physical exhaustion (10.2%). Associations were found between gradient and the location. Type of casualty incidence with the individual distribution trends of casualty types were quite clear. Clusters of musculoskeletal casualties emerged in the parts of the course with the steepest negative gradients, while a cluster of cardiovascular events was found to occur at the top of the ‘heartbreak hill,’ the longest climb of the race. Regression analysis highlighted the linear relationship between the number of heat and physical exhaustion casualties and the apparent temperature (AT) at 12pm (R²= 0.59, P=0.044). This linear equation was used to formulate a model to predict these casualties.

Discussion:

The findings of this study demonstrate the relationship between meteorological conditions, geographic conditions, and casualties. This will assist planners of other similar events to determine optimum allocation of resources to anticipated injury and illness burden.
Typhoon Preparedness Measures of the Hong Kong Public for Typhoon Mangkhut
Authors: Yeung Tiffany , Lam Eva CC
Published: May 2019

Introduction:

Climate change has brought more extreme weather events to Hong Kong. The increasing number of powerful tropical cyclones that hammered Hong Kong in recent years reminded the territory to review typhoon preparedness of the community.

Aim:

Typhoon Mangkhut slammed Hong Kong in September 2018 and caused significant devastation. Three weeks after the devastation, the Hong Kong Jockey Club Disaster Preparedness and Response Institute commissioned the Public Opinion Programme at The University of Hong Kong to conduct a survey to understand the general Hong Kong public’s typhoon preparedness measures and their information seeking behaviors.

Methods:

A cross-sectional population-based anonymous telephone survey was conducted on a random sample of 1,018 Cantonese-speaking adults aged 18 or above.

Results:

The most common typhoon preparedness measures were taping windows (45%), followed by food stockpiling (18%), and closing of doors/windows (10%). Only 2% and 1% of the respondents were prepared for water and power outage, respectively. 36% of the respondents did not take any precautionary measures. 29% sought typhoon precautionary measures information from the mass media and 31% of respondents relied on their previous experience. Other sources of information included government sources (7%) and social media (7%).

Discussion:

Though no death cases were reported related to Typhoon Mangkhut, the effect of the superstorm caused over 300 casualties, blocked roads, and transportation chaos caused by fallen trees and other debris, power and water outage, serious floods, and severely damaged public and private facilities. Around 40,000 households experienced a power outage and some residential estates were left without water. The survey revealed the lack of precautionary measures of the Hong Kong public for power and water outage. More education on typhoon preparedness, especially on power and water outage and more community-level support on localized disaster preparedness advice, would likely improve disaster preparedness for the Hong Kong public.
Mapping the Disaster Competency Landscape in Undergraduate Nursing - A Case Study of Nursing Educators in British Columbia, Canada
Authors: Mckenzie Wendy
Published: May 2019

Introduction:

In British Columbia (BC), Canada, it is increasingly commonplace for communities to experience yearly disaster events such as floods, forest fires, avalanches, and mudslides. Nurses are known to be one of the largest groups of healthcare workers and are often challenged to care for members of the public during these events. Many nurses have stated that they do not have enough education to provide quality care in a disaster role, as they received no education in their undergraduate nursing degrees.

Aim:

The aim of this study was to explore how and what nurse educators are teaching undergraduate nursing students regarding the disaster nursing role within Schools of Nursing in BC, Canada. Understanding the current practice of teaching will serve as a starting point for shaping future best practice undergraduate nursing disaster educational frameworks.

Methods:

This study used a qualitative case study methodology guided by Merriam’s procedural approach with a theoretical framework of adult teaching and learning.

Results:

The findings indicate that disaster nursing knowledge is taught either within existing global health courses or rarely is leveled throughout the program. Many challenges exist for educators, which include lack of current resources, workload restrictions, and lack of personal disaster knowledge. Content is determined by the educator. However, there is no specific model or link to disaster nursing competencies or assessment strategies. Most content is delivered didactically by the educator with some expert guest speakers or collaborative simulation events.

Discussion:

The identified priority challenge is to obtain clarity and understanding around just what knowledge is required and how it should be evaluated. Some suggestions for a specific undergraduate disaster nursing model will be presented in order to ensure that students have the foundational knowledge that they require and that our educators are prepared to teach them.
A Primary Care Role in Building Local Capacity Following Volcanic Activity in Vanuatu
Authors: Lyon Alison
Published: May 2019

Introduction:

Vanuatu is situated in the Pacific Ring of Fire. In July 2018, there was increased volcanic activity on Ambae, an island with a population of 11,000 people. Due to the destruction of food sources, contamination of water supply, and respiratory issues caused by ash fall, an immediate compulsory evacuation was ordered by the government.

Aim:

To describe the role of the primary care team response to urgent and ongoing healthcare needs of evacuees following volcanic activity.

Methods:

A non-governmental organization (NGO) primary care team of a general practitioner, nurse practitioner, and two healthcare assistants undertook the initial assessment of a group of newly arrived evacuees. This allowed the identification and management of urgent care needs. Over the subsequent weeks, the primary care clinic provided care to the evacuees. A prospective database of anonymized case files was undertaken to monitor evolving primary healthcare needs of the evacuees.

Results:

Twenty-five patients were assessed initially. Two patients required urgent transfer to a hospital for acute management. Six diabetic patients required medication supplies. There were eight hypertensive patients. Two patients required urgent BP reduction and four required medication supplies. Over the following two weeks, 104 patients were reviewed at the clinic. During this time, 45 patients were treated for respiratory tract infections. Medication supplies were replenished for antihypertensives and diabetic medications for seven patients. Opportunistic cardiovascular and diabetes risk reviews were performed and follow up arranged for nine patients.

Discussion:

The primary care team role was part of a local services collaborative approach initiated by the government. Involving local primary care clinicians in disaster management builds local capacity. Patients are able to receive continuity of care for acute and ongoing medical problems. Clinicians are able to evaluate evolving care needs and gain an improved understanding of the impact of displacement on the community.
Using Geographic Information System Analysis to Understand West Virginia’s Growing Opioid-Overdose Epidemic - What Are We Missing?
Authors: Rihter Sasha , Menke Nathan
Published: May 2019

Introduction:

The opioid epidemic is overwhelming communities across the United States. West Virginia (WV) has been devastated, heralding a 86% increase in deaths from 2012-2016, and over 1,000 deaths last year as per WV Health Statistics Center. Treatment centers and providers have emerged throughout the state to provide medication-assisted treatment (MAT). The impact of these clinics on the opioid abusing population is not yet fully understood.

Aim:

Utilizing Geographic Information System (GIS), a comparison of MAT provider locations versus regions of historical overdoses can indicate areas of deficiency. If no providers emerge in underserved counties, overdose deaths in those areas will continue to rise.

Methods:

Maps were created using current DEA-X licenses in WV registered through Substance Abuse and Mental Health Services Administration (SAHMSA). Overdose death rates were taken from WV Public Health Records from 2010-2017. Two maps and corresponding data were compared for overlap or lack thereof.

Results:

Of the 338 locations of DEA-X licenses registered, 17.5% are in Cabell County, which led the state in overdose deaths in 2017. Only 2.5% of the total providers are currently in Wayne County, which had the second highest overdose death rate. Berkeley County, which was 3rd highest, has a mere 6.5% of total providers. Comparatively, Kanawah County, home to the state’s capital, has over twice this number of providers despite consistently having at or below the state average of overdose rates. Resources are pulled towards population-dense areas or university centers, where the epidemic is present but misses counties with higher overdose rates.

Discussion:

Results show a lack of MAT providers in many of WV’s devastated counties. Treatment centers exist throughout the state but are concentrated in regions with large cities or academic centers. This distribution limits accessibility to a marginalized patient population, making improvements unlikely in WV’s future opioid-overdose death rates.