bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Two Types of Personal Protective Equipment (PPE) Doffing Process: Frequency and Sites of Contamination
Authors: Jian-ping You , Sha Yang , Hong-Xia Luo , Hui-Lan Zhang
Published: May 2019

Introduction:

Personal protective equipment (PPE) is a necessary item in the period of unknown and high-risk emerging infectious disease. It is not only the necessary requirement of strict isolation, but also the last line of defense to protect medical staff.

Aim:

Compare the differences between contaminated frequency and sites under two types of PPE doffing.

Methods:

Recruited 56 health care workers (HCWs) who worked in clinical to follow the different PPE removal guidelines issued by the Chinese Center for Disease Control (CDC) and the World Health Organization (WHO) final resolution for preventing Ebola virus. Eight batches of HCWs were divided to conduct simulations of contaminated PPE removal using fluorescent lotion (Glitter Bug Potion, On Solution Pty Lt). Then we recorded the frequency and sites of contamination of personnel after removal of contaminated PPE by the method of visual observation.

Results:

According to China’s CDC process, the parts that are easily contaminated during PPE removal are: left hand and wrist (7 times), left calf (7 times), front chest center and left and right chest (6 times each) and left abdomen (5 times). Contaminated parts of the PPE process in accordance with the WHO process from high to low were: right hand and wrist (13 times), left hand and wrist (12 times), middle of the abdomen (10 times), left chest (9 times), and left abdomen (6 Times). There was no statistical difference between the two kinds of PPE piercing and removal (Z=1.177, P > 0. 05).

Discussion:

Under the guidance of the two processes recommended by China CDC and WHO, there was no significant difference in the frequency of pollution after removing PPE. It is speculated that the PPE recommendation processes issued by WHO and China CDC are effective for personal protection against fulminating infectious diseases.
Confusion, Chaos, and Bridging the Gap: A Prospective Study Gauging Disaster Triage Methodologies and Usage Across First Responder Professions
Authors: Adelman Brenna
Published: May 2019

Introduction:

Disasters are unique in that they impact all socioeconomic, class, and social divides. They are complex, hard to conceptualize and operationally define, and occur sporadically without warning. However, regardless of each disasters innate unpredictability, there is one common need that directly impacts patient morbidity and mortality: effective triage.

Aim:

Currently the United States has no uniform triage mandate. The purpose of this study is to gather descriptive data on the type of mass-casualty triage currently being utilized by first responders (Emergency Medical Services/Fire/Nurses) and improve our understanding regarding the prevalence of mass casualty triage.

Methods:

A descriptive mixed methods survey is being distributed to first responders/nurses in the Appalachian region. This survey collects respondents demographics, profession, and MCI triage data. Data will be analyzed and descriptive statistics will be generated. GIS will be utilized to graph findings and visualize local and national trends.

Results:

Results of this study are pending.

Discussion:

Organizations have addressed the need for a standard triage protocol, even going so far as to create uniform criteria which each triage system should meet. However, the literature does not describe how individual professions train their members in disaster triage, or what triage is currently being utilized in each profession. Nurses and first-responders serve as linchpins in many communities. They remain in a community, both before, during, and after a mass casualty event, but they do not perform in a vacuum. During an MCI (mass-casualty incident) their scope of practice may vary, but they have common foci: the affected community. A better understanding of the type of MCI triage that each profession is using is vital in understanding how triage is being applied, and vital in identifying gaps in application that may impact the effectiveness of field triage, and affect local and national policy, practice, and future research.
The Core Concepts of an Integrated Information System for Disaster Medical Assistance Teams: Ten-Year Experience in Taiwan
Authors: Hsien Wu Chih , Hao Lin Chien , Fu Chen Hsin , Fuh Yuan Shih Frank , Tai Cheng Ming , Kuo Chou Wei , Chieh Liu Hung , Hsien Hsu Shu
Published: May 2019

Introduction:

Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.

Aim:

In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.

Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.

Results:

During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.

Discussion:

Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
Critical Care Specific Medical Materials Preparedness in the Emergency Department for Mass Shooting Disasters
Authors: Morris Stephen
Published: May 2019

Introduction:

There has been a dramatic increase in the number of mass shootings (loosely defined as an incident with four or more indiscriminate victims) in the United States (1). Additionally, the use of high-caliber, military-style weapons, has become more common in civilian shootings. These trends should influence how emergency departments prepare for disasters, including an inventory of what critical care medical materials (supplies) are readily available in the event of a disaster.

Aim:

To demonstrate the need for the adoption of medical materials planning for disasters to account for new injury patterns from mass shootings.

Methods:

A review of injury patterns from recent mass shootings was conducted using available literature (2). The average number of victims presenting to the emergency department in these events was reviewed. Estimation of critical care specific medical materials in the emergency department required for the management of an “average” number of victims with the typical injury pattern of these events was conducted.

Results:

Some critical care specific medical materials: intubation equipment, chest tubes, and central venous catheters may be in short supply during a mass shooting event.

Discussion:

Emergency physicians must anticipate and prepare for new disaster trends such as mass shootings and high caliber weapons injuries. This includes having specialty medical supplies readily available in sufficient amount. Normal stocking of critical care specific medical materials may be inadequate in a mass shooting event based on the available literature.
Deuce and a Half with a Twist: Repurposing Old Technology to Save Lives in Swiftwater Rescue during Urban and Small Stream Flash Flooding
Authors: Jaslow Sonia , Jaslow David , Zecher Derek , Synnestvedt Ryan , Zahustecher Nathaniel , Melly Kevan , Overberger Ryan
Published: May 2019

Introduction:

Vehicles stranded in rising water account for the majority of swiftwater rescues (SWR) during urban and small stream flash flooding. Multiple simultaneous SWR incidents are commonplace during severe storms. Historically, SWR teams have pursued a “reach, throw, row, go” strategy. However, reach and throw attempts are usually futile. Boat operations and/or in-water rescue attempts can be technically complicated, time-consuming, and a drain on rescuer resources.

Aim:

To design an ideal SWR modality for use during urban and small stream roadway flooding.

Methods:

SWR objectives, strategy, and tactics were mapped against various transportation modalities to develop the safest solution for urban and small stream flood response.

Results:

High water vehicles (HWV), such as the “deuce and a half” 6 × 6 military truck, represent a new standard for SWR practicality and safety as they can reduce rescuer time in-water. HWVs are heavy and high enough to be stable on roadways in most flash flooding conditions. A properly designed emergency response package includes a fording kit, multi-directional floodlights for nighttime operations, public safety radios, and a siren that doubles as a public address system to coach victims as a rescue is initiated. Deployable ladders enable rescuer egress from and victim access to a covered lighted cargo bed that holds PPE, throw bags, and rescue rings; a deployable “boat in a bag” for victims who require ferrying; and a heated seating area where medical evaluation can be conducted while staying dry.

Discussion:

SWRs are dangerous resource-intensive incidents which account for more rescuer morbidity/mortality than all other technical rescue sub-types combined. These incidents will increase in frequency and severity worldwide due to climate change and overdevelopment. If rescue conditions are still tenable, HWVs are the most efficient and effective platform for conducting SWR from flooded roadways while decreasing safety risks to first responders and victims.
Developing a Public Health Risk Assessment Toolkit for Mass Gatherings and Trialling for an International Multi-Sport Mass Gathering Event
Authors: Bloomer Ellen , Endericks Tina
Published: May 2019

Introduction:

Risk assessment for mass gatherings (MGs) is undertaken to enable public health authorities to systematically identify and assess the generic characteristics of an MG, which introduce or enhance particular threats and develop measures to reduce or mitigate these threats. The World Health Organization Collaborating Centres on Mass Gatherings and Global Health Security (WHO CCs) produced a comprehensive guide to MGs called “Public Health for Mass Gatherings: Key Considerations” (KC2). This is being converted into an eLearning resource. A public health risk assessment toolkit is being developed by the WHO CCs to complement and guide organizers in their planning process for the health risks associated with an MG event. Preparations for the Birmingham 2022 Commonwealth Games (BCG) are underway and it is important to involve a public health element in the planning for the BCG.

Aim:

To develop a public health risk assessment toolkit for MGs and pilot it as part of the planning process for the BCG.

Methods:

Based on KC2 principles, methods included developing and finalizing a public health risk assessment toolkit for MGs. This study also piloted the toolkit for the BCG.

Results:

A toolkit will be developed. Key learning will be documented on how the toolkit can be improved. The pilot will identify the key public health risks for the BCG, and assess how to mitigate them.

Discussion:

The development of this toolkit will be an innovative contribution to the resources available for those organizing MGs. It will support organizers to conduct risk assessments and thus maximize the potential for health from the event. Piloting the toolkit for the BCG is an opportunity for validating it, and provides valuable learning for its use in future events. It will support the risk assessment process for the BCG and share learning regarding the key risks for this event.
Developing Collaboration Quality Indicators for Major Incidents in an Underground Mine
Authors: Gyllencreutz Lina , Karlsson Sofia , Saveman Britt-Inger
Published: May 2019

Introduction:

The underground mining industry has one of the most hazardous industrial occupations, and requires an increased level of preparedness for injury incidents. The most important outcome for seriously injured victims is the reduction in morbidity and mortality. Receiving effective and timely care may mean the difference between life and death. However, mines are usually located in a rural area and the incident site may be deep underground which makes it an extraordinary challenge for the rescue services. A successful rescue response in an extraordinary milieu demands a high level of inter-organizational cooperation skills at the incident site.

Aim:

To analyze statements of collaborate activities during a major incident exercise in the underground mine industry, essentially for patient outcome.

Methods:

A Delphi technique was performed, asking opinions from experts in iterative rounds to generate, understand, and form consensus on group opinion around this complex issue. The experts were personnel from disaster medicine (n=3), emergency and prehospital medicine (n=10), rescue service (n=16), and mine industry (n=9), all with operative command positions.

Results:

Three iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important inter-organization cooperation activities to optimize patient outcome from an injury incident in an underground mine. This resulted in 63 statements. The statements included information about: early alarm routines, collaborative support and efforts of early life-saving interventions, relevant resources and equipment, command and control room, and functions. In round two participants shared and communicated decisions about safety, situation awareness, and guidelines for response. All statements reached consensus among the experts in round three.

Discussion:

These inter-organizational statements are considered important by experts, and could be used to evaluate collaboration in major incident exercises. Hence, the statements can also be quality indicators for reporting results from major incident management.
Development of a New Triage Method to Prioritize Patients Arriving at the Emergency Room
Authors: Natsukawa Tomoaki , Deguchi Ryo , Akita Naoki , Uemori Sadayori , Miki Toyokazu , Kato Noboru
Published: May 2019

Introduction:

By prioritizing emergency patients, triage facilitates the timely provision of care to the largest possible number of patients arriving at an emergency room (ER). Previous triage methods include the Canadian and Japan Triage and Acuity Scales. Since these methods sort patients into five categories, multiple patients are often categorized into the same category. Furthermore, since these scales adopt original complex algorithms to determine the triage category, triage personnel need to be very familiar with the algorithm. Hence, a simple triage method is needed to prioritize ER patients.

Aim:

To develop a new triage method to prioritize patients arriving at the ER.

Methods:

Patients aged ≥13 years who arrived at the ER of Yodogawa Christian Hospital without being transported by ambulance between January 2016 and October 2018 were assessed. We analyzed correlations between the items included in the triage sheet and admission. We calculated risk ratios (RRs) of the items that were significantly related to admission. The RR of an item was considered its score, and the triage score was calculated by summing the individual RR scores for each patient. We performed receiver operating characteristic (ROC) analysis of admission and triage scores.

Results:

Among 20992 patients, 2030 patients (9.7%) were admitted to the hospital. The triage scores of all the patients ranged from 26.5 to 62.3. According to the ROC analysis, the area under the curve was 0.791 and the optimal cutoff value for the triage score was 32.7 (sensitivity: 0.74, specificity: 0.70).

Discussion:

Since this research was based on data from a Japanese secondary level emergency hospital in an urban area, our triage method can be adapted to the many ERs in Japan that share a similar background. The method used to develop this triage method can also be used to develop triage methods for ERs with different backgrounds.
Establishment of Palliative and End-of-Life Care Services in Sri Lanka
Authors: Perera Clifford , Ramadasa Udayangani , Wijeratne Chandrika , Karunanayake Panduka , Chang Thashi , Pathirana Gamini , Karunathilake Ravini , Perera Suraj , Guruge Kalyani , Randenikumara Sankha
Published: May 2019

Introduction:

Sri Lanka has a rapidly aging population with an exponential rise in chronic morbidity. There had been no parallel development of palliative and end-of-life care-specific approach in health care.

Aim:

To implement sustainable palliative and end-of-life care services in Sri Lanka through the existing systems and resources by advocacy, collaboration, and professional commitment.

Methods:

Sri Lanka Medical Association established a volunteer task force for palliative and end-of-life care (PCTF) in October 2016, which comprised of multi-disciplinary health care professionals, legal fraternity, and civil society. PCTF identified the need for sensitizing the general public on the importance of palliative care, for standard guidelines and formal training for practicing health care professionals engaged in hospital and community-based palliative care. These needs are addressed through activities of PCTF in collaboration with the Ministry of Health.

Results:

Representing the National Steering Committee of Palliative Care, the members of the PCTF were instrumental in developing the National Strategic Framework to fill the major gap of affordable quality palliative care in the country. PCTF also published the “Palliative Care Manual for Management of Non-Cancer Patients” as a preliminary guide for health care professionals. The draft document on the End-of-Life Care Guidelines has been formulated and is currently being reviewed by the relevant medical and legal stakeholders. PCTF has organized CME lectures on palliative care all over the country for health care professionals, and also conducted lectures, exhibitions, and mass media programs to sensitize the public on palliative care.

Discussion:

Within a brief period, PCTF has played a key role to recognize palliative care by contributing to policy making, training, and public sensitization in palliative and end-of-life care in Sri Lanka.
Evaluating Full-Scale Exercises to Optimize Patient Outcome in an Underground Mine
Authors: Gyllencreutz Lina , Karlsson Sofia , Saveman Britt-Inger
Published: May 2019

Introduction:

Major incident exercises are expensive to plan and execute, and often difficult to evaluate objectively. There is a need for a generic methodology for reporting results and experiences from major incidents so that data can be used for analysis, to compare results, exchange experiences, and for international collaboration in methodological development. Most protocols use data describing the incident hazards, prehospital and hospital resources available and alerted transport resources, and communication systems. However, the successful management of a rescue response during a major incident also demands a high level of command skills.

Aim:

The aim of this study was to analyze the command and collaboration skills among the emergency service on-scene commanders and the mine director for safety and security during a full-scale major incident exercise in an underground mine.

Methods:

The commander functions were observed during a full-scale major incident exercise. Audio and video observations and notes were analyzed using a study-specific scheme developed through a Delphi study, including inter-agency collaborative support and efforts of early life-saving interventions; relevant resources and equipment; and shared and communicated decisions about safety, situation awareness and medical guidelines for response. After the exercise additional interviews were made with those responsible for the command functions.

Results:

Preliminary results indicate that most decisions were not taken in collaboration. Elaborated results will be presented at the conference.

Discussion:

Command and collaboration skills can benefit from objective evaluations of full-scale major incident exercises to identify areas that must be improved to optimize patient outcome.
Evolution of United States Legislation to Facilitate Bystander Response to Opioid Overdose
Authors: Fletcher James , Molloy Michael , Hart Alexander , Voskanyan Amalia , Sarin Ritu R , Ciottone Gregory R.
Published: May 2019

Introduction:

Opioid overdose deaths in the United States are increasing. Time to restoration of ventilation is critical. Rapid bystander administration of opioid antidote (naloxone) is an effective interim response but is historically constrained by legal restrictions.

Aim:

To review and contextualize development of legislation facilitating layperson administration of naloxone across the United States.

Methods:

Publicly accessible databases (1,2) were searched for legislation relevant to naloxone administration between January 2001 and July 2017.

Results:

All 51 jurisdictions implemented naloxone access laws between 2001 and 2017; 45 of these between 2012 and 2017. Nationwide mortality from opioid overdose increased from 3.3 per 100,000 population in 2001 to 13.3 in 2016, 42, and 35 jurisdictions enacted laws giving prescribers immunity from criminal prosecution, civil liability, and professional sanctions, respectively. 36, 41, and 35 jurisdictions implemented laws allowing dispensers immunity in the same domains. 38 and 46 jurisdictions gave laypeople administering naloxone immunity from criminal and civil liability. Forty-seven jurisdictions implemented laws allowing prescription of naloxone to third parties. All jurisdictions except Nebraska allowed pharmacists to dispense naloxone without a patient-specific prescription. Fifteen jurisdictions removed criminal liability for possession of non-prescribed naloxone. The 10 states with highest average rates of opioid overdose-related mortality had not legislated in a higher number of domains compared to the 10 lowest states and the average of all jurisdictions (3.4 vs 2.9 vs 2.7, respectively).

Discussion:

Effective involvement of bystanders in early recognition and reversal of opioid overdose requires removal of legal deterrents to prescription, dispensing, distribution, and administration of naloxone. Jurisdictions have varied in degree and speed of creating this legal environment. Understanding the integration of legislation into epidemic response may inform the response to this and future public health crises.
Expand the Understanding of Response Roles: Who Really is First on Scene
Authors: Klein Kelly , Harris Curtis , McCarthy Kelli , Waltz Tawny , Prins Parker , Liu E. Liang , Swienton Raymond
Published: May 2019

Introduction:

The US, as well as many countries, are being beseeched by more natural and man-made events; both small (e.g., shootings) and geographically vast (e.g., floods). Due to a myriad of issues, traditional first responders i.e., EMS, fire department, and police cannot be expected to be the only trained lifesavers on the scene. In the US (as in many countries), it is imperative to begin the discussion to better understand the role of the “injured” and “immediate” responders and how they interact with the “first” responders.

Aim:

To open a discussion amongst disaster experts about the merits of training and subsequent promotion of a curriculum for “immediate” responders.

Methods:

Literature review.

Discussion:

After recent evaluations of events, it is postulated that there are three categories of responders: the injured, the immediate, and the first (EMS, fire department, police). The premise upon which disaster risk reduction and building community resilience are achieved begin with strengthening, empowering, and equipping local populations with the appropriate tools. This would involve education, skills, and training. With the average general public trained, and if they are one of the first two categories, then the community would not only be better able to assist themselves, but also be able to integrate into the recovery process much more quickly and fully. By doing this, they will be empowered to take care of themselves, neighbors, and community, which in turn increases local resilience.
Exploring the Utilization of Small Unmanned Aerial Vehicles (UAV) Known as Drones in Early Phase Disaster Response
Authors: Luman Jenifer , Luman Benjamin
Published: May 2019

Introduction:

Disaster Medical Response is a challenging field where opportunities for advancement are welcomed. Small Unmanned Aerial Vehicle (sUAV) technology (i.e., drones) has made enormous strides in the past few years and is poised for utilization in the early disaster response phase.

Aim:

To discuss current uses of UAVs, proposed utilization and logistical details, technological advancements, current deficits, and training.

Methods:

Our Foundation, Luman Medical, is working in the field of UAV integration for small to large scale disaster response. The concept is to equip first responders with small, relatively inexpensive, programmable drones that come equipped with hardware and software that are easy to use for inexperienced as well as skilled sUAV pilots.

Discussion:

These UAVs could increase ease and speed of deployment for early assessments of disaster area mapping, thermal imaging, ingress and egress routes, the discovery of survivors, communications, and delivery of supplies. Drone technology offers a new and growing type of tool in the disaster response arena. It is our hope to explore an integration that is easy, safe, and affordable to augment and enhance existing disaster response planning.
Identification of Preventable Death and Severe Complications in Train Crashes in Rural and Cold Environment Using a Simulation-Based Model
Authors: Aléx Jonas , Forsberg Rebecca , Nilsson Heléne
Published: May 2019

Introduction:

The use of rail transport is increasing in Sweden, as well as within Europe, and train speeds are escalating. These factors contribute to an increasing frequency of train crashes and major crashes so severe that they can be classified as disasters. There is a lack of knowledge concerning factors of importance related to the rescue operation that can influence survival rate at train crashes, especially in cold environments.

Aim:

The aim was to identify preventable death and severe complications among passengers in a train crash in rural and cold environments using a simulation-based model.

Methods:

A train crash scenario was developed based on scientific research, crash reports, and lessons observed in incidents. The scenario was set to a train with seven carriages consisting of 150 passengers that derailed in a curve in 160km/h, 10km from the hospital. In Umeå in the north of Sweden, 12 participants from seven emergency/disaster organizations joined in two preparing workshops and a real-time simulation-based train crash. The Emergo Train System (ETS) was chosen as a simulation tool. Data collection such as rescue capacities, response time, and patient surge were collected and transferred into the ETS.

Results:

The results show 17 preventable death and 9 preventable severe complications since the actions were not implemented in the recommended time.

Discussion:

The results show that an extended rescue operation can have devastating consequences especially in cold environments. Further experimental simulations are needed with defined interventions to find out how preventable deaths and severe complications can be reduced.
Improving Emergency Preparedness among Children with Special Health Care Needs in a Pediatric Infant Disease Clinic
Authors: Atti Sukhshant , Persaud Eric , Salway James , Gist Ramon , Roblin Patricia , Kohlhoff Stephen , Arquilla Bonnie
Published: May 2019

Introduction:

Children with Special Health Care Needs (CSHCNs) are at an increased risk for physical, developmental, or emotional conditions, and require special services beyond what is typically required by children. Improving emergency preparedness amongst families with CSHCNs has been advocated by the Centers for Disease Control (CDC), Federal Emergency Management Agency (FEMA), and The American Academy of Pediatrics (AAP).

Aim:

We evaluated the preparedness of children and family members, who are infected, or affected, by HIV illness and require daily medications.

Methods:

A convenience sample was used to enroll patients and their parents at a pediatric infectious disease clinic. Surveys were used to assess baseline emergency preparedness. Patients were then given an educational intervention on improving personal preparedness. Participants were provided with emergency go-kit and educational materials. Follow up was completed in 30 days to re-assess preparedness by re-administering the initial survey with additional questions.

Results:

Thirty-eight patients were enrolled and 10 were lost to follow up. Data from a total of 28 patients were used for study results analyses. Chi-squared testing was used for non-parametric variable analyses for an N < 30. Participants who designated an emergency meeting place outside of their home, post-intervention, were statistically significant-X2 (1) = 29.20, p-value <0.0001. Participants who completed an emergency information form, post-intervention, were statistically significant-X2 (1) = 13.69, p-value <0.0002. Participants who obtained an emergency kit of supplies for 3 days, post-intervention, were statistically significant-X2(1) = 8.92, p-value <0.0028. Participants who obtained a home first aid kit, post-intervention, were statistically significant-X2(1) = 12.16, p-value <0.0005. Five families obtained an emergency supply of medications, post-intervention-X2 (1) = 1.99, p-value = 0.1582. This result was not statistically significant.

Discussion:

This study demonstrates that brief educational intervention has potential to improve the preparedness of CSHCNs, including those living with HIV illness.
An Integral Hospital Response Protocol for Emergencies and Disasters from the Emergency Department
Authors: Saleme Elisa N. , De la Sierra Luz A. , Kramis Jose L. , Arguelles Pedro , Montiel Hector
Published: May 2019

Introduction:

Mexico has suffered multiple social and natural events that tested its response capacity. Hospital units of the third level of care are an axis of response and a central reference. Guaranteeing their integral and organized response promotes risk prevention and mitigation strategy in emergencies and disasters.

Aim:

To analyze the national and international regulations and the existing documents about emergency and disasters related to a hospital with the identification of the critical actors in the response.

Methods:

This research consists of a cross-sectional and descriptive study with a mixed methodology (qualitative and quantitative), that generates a protocol for response in a third level care hospital. Quantitative analysis was carried out using central tendency measurements based on a surveys (training, knowledge) performed in the hospital services that provide a critical response with the ED in emergencies or disasters (ED, ICU, Supplies, Nursing, Operating Room, Security, Hospital Admission, Crisis Committee). In the quantitative analysis, the staff were interviewed about their experience in responding to previous events (to the same critical services), recognizing importance and points of improvement with a discourse analysis methodology.

Results:

With the information collected and based on the protocols of Safe Hospital program (PAHO/WHO) we generated a protocol organized by the ED that involves massive victims.

Discussion:

Regulations oblige hospital units to have protocols of action in critical situations linked to Safe Hospital program, so it is a great tool for planning. All the surveyed personnel consider that it is important to have a plan that allows for immediate steps to ensure quality and timely patient care, considering it an ethical and social obligation. Analysis suggests that continuous training and the contribution of an operational plan per service provide security and better prognosis to the victims. The protocol includes all critical response services with a clinical practice guide.
Investigation on Level of First Aid Knowledge among Undergraduates
Authors: Run Lin , AoYu Wang , Yaqi Chen , Enjiang Lai , Hai Hu
Published: May 2019

Introduction:

First aid in a short time is the key to saving lives. As undergraduates step into society, they should have enough ability to save others. As a result, first aid knowledge and training are essential for them.

Aim:

To investigate the cognition level of the first aid knowledge among undergraduates, and to improve the training for undergraduates.

Methods:

A questionnaire was designed for this study. It includes the basic information of the test subjects, attitude towards first aid, level of first aid knowledge, etc. The subjects of the questionnaire were mainly undergraduates in Sichuan province.

Results:

There were 302 valid questionnaires. The percent correct of the first aid basic knowledge quiz was only 47.62%. Using Chi-Square tests to analyze, medical education can make a significant difference in the level of first aid knowledge. (Chi-Square=251.004, P<0.01) Additionally, 78.81% of undergraduates thought it was significant to learn and master first aid knowledge, and the most common way to learn first aid knowledge was through university (81.46%).

Discussion:

Universities should strengthen the training for undergraduates to improve their first aid skills. This is a feasible approach to promote a public level of first aid knowledge.
Issues of Which Organization is Responsible for Hospital Evacuation in Nuclear Disasters
Authors: Ogasawara Masaru , Sato Yuta , Ito Katsunori , Saito Kyoji , Ito Katsuhiro , Hanada Hiroyuki
Published: May 2019

Introduction:

At the time of a nuclear disaster, residents should evacuate from areas with high air dose rate. In the Great East Japan Earthquake, about 10% of patients died in a hospital evacuation in which medical teams were not involved in transportation.

Aim:

To determine if hospital evacuation improved after the Fukushima nuclear accident.

Methods:

This research investigates how the medical system of a nuclear disaster in Japan changed.

Results:

There are 41 hospitals designated as Nuclear Emergency Core Hospitals, and they have 53 Nuclear Emergency Medical Assistance Teams (NEMAT; disaster medical dispatching team specialized in nuclear disasters consisting of medical doctors, nurses, and radiological technologists) that can support hospitals and information in the acute phase.

Discussion:

At the time of a nuclear disaster, NEMAT is supposed to evacuate residents from the Urgent Protective Action Planning Zone (UPZ; within about 30 km radius). Tens of thousands to one million people live in this area. Hospital evacuation of more than several thousand patients is necessary. The entry of workers for transportation vehicles and lifeline restoration is limited within UPZ, so staying in a hospital is virtually impossible. There are over 2000 Disaster Medical Assistance Teams (DMAT), and many Red Cross Relief Teams; both of which are stipulated not to conduct clinical treatment in high dose areas and are not educated on nuclear disasters. Although there are Radiation Emergency Medical Assistance Teams (REMAT) consisting of doctors and technicians specializing in radiation medicine, they are few in number. They can perform dose assessment, but general medical care cannot be performed because an emergency physician is not included. Therefore, although NEMATs will conduct emergency and hospital evacuation in the affected area, the number of teams is too small to respond. The issue of which organization is responsible for massive hospital evacuation remains unsolved.
Leadership and Factors Enabled the “Group Allocation” which Preserved Pre-existing Local Social Ties in Prefabricated Temporary Housing After Great East Japan Earthquake (GEJE)
Authors: Masuno Kanako , Osaka Ken , Aida Jun , Uchiumi Yuichi , Iguchi Tsuneaki , Hirono Yoshiyuki
Published: May 2019

Introduction:

Social isolation and death alone in the prefabricated temporary housing after a disaster has been a social concern. The importance of social ties among the community has been suggested and several reports pointed out the positive effect of “group allocation” which preserves pre-existing local social ties compared to the “lottery allocation”.

Japan Red Cross Society recommended “group allocation” as a better option than “lottery allocation” on their guidelines. However, many municipalities carried out “lottery allocation” for temporary housing arrangement after the Great East Japan Earthquake (GEJE).

Aim:

To collect the information about the accelerating factors and bottlenecks when practicing the “group allocation”.

Method:

In-depth interview was conducted between August and November 2013. Interviewees were the professionals of disaster management, individuals who were involved in arranging the prefabricated housing and the residents. This research was supported by the Ministry of Education, Culture, Sports, Science, and Technology in Japan.

Results:

This study found the municipality which carried out “group allocation” had characteristics such as: (1.) the staff in charge of housing arrangement had the information about the positive effect of “group allocation”, and (2.) pre-existing community leaders were able to gather residents’ opinions, and citizens were involved in the decision making to some content.

Discussion:

Although this study is based on the experience of a limited number of key persons, it would be useful to give the insight about the possible bottleneck for the practitioners who will be in charge of housing arrangement under the disaster setting in future. Also, the relevancy and evidence about “group allocation” should be carefully examined in the context of preventing social isolation as well as various long-term effects. It would be essential that the knowledge and experience will be accumulated and shared between municipalities in a usable and comparable format.
Learning from Disasters: How Do We Share the Knowledge and Experience?
Authors: Richardson Sandra
Published: May 2019

Introduction:

Understanding the difficulties of sharing knowledge generated from disaster situations is essential to allow for a better process of disseminating the “lessons learned” from the ongoing natural and man-made situations which result in healthcare crises.

Aim:

To explore nurses ways of gaining knowledge from previous experiences, with a particular focus on earthquakes and natural disasters in the New Zealand (NZ) setting.

Methods:

Initial analysis of a series of individual, semi-structured interviews with a small group (n=10) of emergency department registered nurses from a range of geographical areas in NZ.

Results:

While familiar with the major earthquake events that have recently affected different areas of NZ (most notably Canterbury, Kaikoura, and Wellington), few could recall detailed information or lessons generated from these events. When asked about the most effective means of learning about and from disasters, the direct experience was identified as the most effective, followed by narrative retelling and vicarious experience.

Discussion:

Recognition of the value of “story-telling” in sharing information, and of the importance of offering experiences in a way that allows colleagues to experience or place themselves in the situation in a “virtual” sense is necessary for learning to occur. This involves an emotional as well as an intellectual connection to occur. There is a risk for knowledge to be lost, and lessons to be constantly “re-learned,” as each succeeding generation needs direct involvement to retain the information and insight generated. We need to tailor the medium by which this information is shared, for maximum effect.
Measuring Student Nurses’ Preparedness and Resilience for a Disaster Setting
Authors: Grimes Andrea , Rouen Christopher , West Caryn
Published: May 2019

Introduction:

Nurses have long been utilized in disaster response and recovery and they possess broad skill sets, which are critical in times of crisis. However, studies show that more than 80% of nurses who volunteered in disasters settings have no disaster education.

Aim:

This project explored the disaster knowledge, preparedness, and resilience of 2nd and 3rd-year undergraduate student nurses in a Bachelor of Nursing Science program in a regional university to garner support for the introduction of dedicated disaster nursing education, which is currently absent from Australian undergraduate nursing curricula. Whilst disaster management processes in Australia are robust and Australian health care systems have explicit plans in place, the same cannot be said for all countries and health care systems. Australian trained nurses are highly valued and actively sought in the global health workforce market. In a world marked by increasing change and instability, the lack of dedicated disaster education and skills in the largest health workforce increases the overall vulnerability.

Methods:

Data were collected using the Disaster Preparedness Evaluation Tool, the Connor-Davidson Resilience Scale, simple demographics, and a previous disaster experience questionnaire.

Results:

The results highlight important gaps in current practice and vulnerabilities in the current disaster management framework. Local students scored higher results in preparedness and resilience.

Discussion:

Student nurses are an underutilized resource in disaster preparation and by response teams around the world. With a global intent of shared responsibility and increased resilience in individuals and communities before, during, and after disaster events, dedicated capacity building of nursing staff has the potential to address key factors and simultaneously utilize an underappreciated demographic of student nurses. To the best of the author’s knowledge, this project is the first to explore disaster knowledge, preparedness, and resilience in undergraduate student nurses using validated disaster preparedness and resilience tools in Australia.
Needs of Family Survivors of Floods in Molepolole, Botswana
Authors: Maripe-perera Dorcas Basetsana
Published: May 2019

Introduction:

Floods are common worldwide and are the leading cause of fatalities. They are destructive to property, crops, and livestock, and leave survivors homeless or displaced to evacuation camps.

Aim:

To explore the needs of family survivors of floods in Molepolole, determine assistance received and needed, and identify coping strategies used to deal with the impact and effects of floods.

Methods:

Jordan (2015) model of disaster survivors’ hierarchy of needs guided the study. Purposive sampling selected six families, and seven participants from these families enrolled in the study. A pilot-tested semi-structured interview guide collected data. Data were analyzed using the content style.

Results:

The study findings confirmed that survivors of floods had immediate and long-term needs, and these were classified into basic, safety, recovery, stress reaction, grief and loss, and growth. Not all survivors were grateful for the assistance they received following floods. Survivors used varied coping strategies to deal with their stressors. The study was conducted in Molepolole, hence, the findings may not be applicable in other settings. Individuals were interviewed on behalf of the entire family.

Discussion:

There is a need for a multidisciplinary team which will keep the community at the forefront in tackling flood mitigation and developing policies specific to floods. Policies will include indigenous flood mitigation practices and will strengthen awareness of communities to improve knowledge, skills, and attitude. More research is needed on the needs of each survivor.
Needs of Patients in the Triage Category “Expectant” in Prehospital Disaster Settings: A Survey Among German Medical Incident Commanders and Palliative Care Physicians
Authors: Ripberger Gerald , Oppert Michael , Bickelmayer Jens Werner
Published: May 2019

Introduction:

The treatment of patients in the triage category “expectant” is not in the focus of the prehospital disaster medicine. The aim is to save as many lives as possible in situations with very limited resources. It is necessary to allocate the life-saving interventions to those who have the chance to survive, but there is a human right of best assistance even for those who are expected to die.

Aim:

In Germany, it is possible to use the triage category “expectant” in overwhelming disasters, so there should be preparedness for those patients, who receive this categorization. A survey was conducted to find out what the needs are of those patients.

Methods:

An online-survey was submitted to German medical incident commanders and palliative care physician in function of expert groups via their national associations.

Results:

219 physicians participated. The majority confirmed a necessity to treat those patients and to be prepared. Currently, in most of the areas, there is no preparation. The main needs are the treatment of pain, dyspnoea, fear, and loneliness. Following the “Dying person’s bill of rights” (1), the most relevant rights are:

To be treated as living human being until I die

To be free from pain

To express the feelings and emotions

To die in peace and dignity

Discussion:

Palliative care should be part of disaster medicine planning. It is not too difficult to prepare a special group of helper for the care of dying patients. Medical incident commanders and palliative care physicians agree in the majority about the necessity, so SOPs can be implemented to teach non-medics. The medics will be needed for the first aim of disaster medicine.