bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction of Japanese Association of Disaster Medicine (JADM) Disaster Medical Coordination Support Team
Authors: Toyokuni Yoshiki , Koido Yuichi , Kondo Hisayoshi , Mase Tomohiko , Kasai Shota
Published: May 2019

Introduction:

The Japanese Association for Disaster Medicine (JADM) Disaster Medical Coordination Support Team (DMCST) was formed in 2016 when Japan experienced Kumamoto earthquake to support other disaster medical assistance teams in terms of headquarter operation logistics.

Aim:

Introducing medical association-based disaster medical support team.

Methods:

JADM DMCST was formed by an association member who had experience in disaster medical headquarter operation and logistic support. Disaster medical headquarter tends to have a gap between acute phase and sub-acute phase due to an alternation of disaster medical assistance team. To keep disaster medical management at medical management headquarter, experienced manpower requires. JADM DMCST provided assistance to fill those gaps.

Results:

For 2016 Kumamoto Earthquake, 107 members responded as a JADM DMCST, 78 members responded for 2018 West Japan Torrential Rain Disaster. Most of the members responded to the medical headquarter of affected prefecture’s, city’s, and medical region’s headquarters. Members provided logistic support in headquarter operation, gathered medical needs information, helped medical team dispatch coordination, gathered evacuation shelter information, provided heat stroke support for evacuees, assisted deep vein thrombosis management, provided AED delivery operation, and helped statistical information analysis based on WHO standards.

Discussion:

JAMD DMCST could provide medical management support at each headquarters without time span restrictions which the most of disaster medical assistance team has. Since all members were experienced in disaster medical management, they could connect and keep providing medical assistance to the affected people. At the time of disaster, disaster medical management headquarter is always short handed due to a large amount of incoming information. All this information was managed by the support team. Although JADM DMCST contributed to support headquarter management, each member had to pay for his/her transportation, hotel, food and any devices required for headquarter operations. Therefore, improving member’s responding condition is next problem to solve.
Investigation of the Relationship Between Disaster Experiences and Disaster Measures: Potential for Specific Measures Against Disasters
Authors: Shintaku Hazuki , Kawasaki Hiromi , Yamasaki Satoko , Murata Yoshihiro , Huang Luoming , Kakehashi Masayuki
Published: May 2019

Introduction:

Japan is known worldwide as an earthquake-prone country, and large-scale landslide disasters have occurred frequently in recent years. Early preparation is essential for taking precise action in case of an emergency. People with disaster experience are often discussed in the importance of evacuation drills. However, most people have no disaster experience, so awareness of disaster countermeasures is desirable for non-experienced people.

Aim:

To clarify the concerns of non-experienced people and consider how to strengthen disaster measures as an evacuation drill host or educator.

Methods:

From February to March 2018, we enrolled teachers and parents whose children attend Hiroshima City Elementary School. Based on disaster experiences, we divided them into two groups, non-experienced and experienced, and a comparison of measures was performed between them. We used SPSS ver.22 and did a chi-square test.

Results:

There were 1,702 valid responses (145 teachers and 1,557 parents); 1,406 were non-experienced, and 289 were experienced. The issues both groups were most concerned about were “children’s safety at school” (non-experienced 61.7%, experienced 57.3%), “securing food and drink at school” (39.0%, 3.3.9%), “acceptance and distribution of relief supplies” (28.1%, 2.6.6%), and “resident evacuation” (25.4%, 2.4.0%). The experienced were most concerned with “children’s mental care” (60.2%), and the non-experienced were most concerned with “children’s safety at school” (61.7%).

Discussion:

Regardless of experience, parents tend to be deeply concerned about all things pertaining to their children. Physical safety, as well as psychological needs, were of high importance. For non-experienced, we should develop interest by focusing on children’s needs when writing manuals for disaster measures and evacuation drills. Therefore, future projects to strengthen awareness of disaster prevention for the non-experienced should focus on three key issues: “step-by-step approaches for children,” “physiological needs,” and “safety of schools and shelters.”
The Knowledge, Attitudes, and Practices of Search and Rescue Teams of Sri Lanka Army Regarding Search and Rescue as a Response to Disasters
Authors: Kumara Saminda , Semage Saveen
Published: May 2019

Introduction:

Sri Lanka Army is a valuable resource for the country as a capacity factor in disaster situations. Sri Lanka Army has established Search and Rescue teams (SAR teams) in all 25 districts.

Aim:

To describe the knowledge, attitudes, and practices of SAR teams regarding search and rescue as a response to disasters.

Methods:

A descriptive cross-sectional study was carried out from October to December 2017. Five platoons were selected randomly from high and medium risk district categories, and all five platoons were selected from the low-risk category. The total sample size was 465. A pre-tested self-administered questionnaire was employed.

Results:

The median age was 28 years. 3.2% were officers, 96.8% were soldiers, the majority (80.4%) were educated up to G.C.E. (O/L), and 62.4% were married. 52.9% of the population had undergone SAR training during the past three years in Sri Lanka, and none had undergone training outside of the country. Overall knowledge regarding search and rescue as a response to disasters seem to be good (57.2% received higher than a score of 75%). 93.8% has desirable positive attitudes. 73.5% had participated in search and rescue operation as a response to disasters. Overall practices seemed to be poor, (71.3% of the population received lower than a score of 75%). A statistically significant association was observed with a level of education (p = 0.001), designation (p = 0.004), and knowledge on search and rescue as a response to disasters. Level of education, designation, and SAR training had no significant association with attitudes on search and rescue as a response to disasters. A statistically significant association was observed with designation (p = 0.021) and practices.

Discussion:

Search and rescue drills should be carried out regularly. Knowledge of search and rescue as a response to disasters should be incorporated into training programs for officers and soldiers.
Low-Cost High-Efficiency Joint Training Program
Authors: St-Arnaud Emmanuelle
Published: May 2019

Introduction:

As the second largest metropolitan area in Canada, Montréal has its share of risks for disasters and major incidents. In such events, the interoperability of emergency services is critical to effective interventions. As the emergency medical service (EMS) for the cities of Montréal and Laval, the Urgences-santé Corporation (USC) has close ties with several emergency partners on the territory, including police and fire departments. These different organizations have joined forces to develop a tabletop exercise program (TEP) to train operational managers to initiate a better-coordinated response on joint interventions.

Aim:

The TEP was designed to enhance interoperability in the field by improving communication and the understanding of the roles, responsibilities, methods of coordination and decision-making in each of the organizations involved. The aim is for all of USC’s operational managers to participate in at least one exercise of the TEP within the first year of the program.

Methods:

Selection criteria were established to gather, for each exercise, managers that are likely to work with one another on a real intervention. The TEP was also designed in such a way that its implementation would require few resources and yield minimal impact on regular operations.

Results:

After four pilot exercises to fine-tune the approach, the program was launched on October 5, 2018. We have now run eight exercises, each involving one or more USC supervisor. The response has been very favorable from the participants as well as their directors.

Discussion:

In the short term, the TEP helps managers understand their counterparts’ key issues, and has already yielded improvements in our joint interventions. In the longer term, the program will help identify specific training needs to better equip responders.
Management of Dead in Mass Disasters: A Review of Sri Lankan Perspectives since 2004
Authors: Perera Clifford
Published: May 2019

Introduction:

Sri Lanka has experienced a multitude of natural and man-made disasters during the last five decades. Man-made destructions were common during the 30-year-long conflict period. Though the local system in the country was able to manage the dead in such circumstances, the South-Asian tsunami in 2004 highlighted the limitations and deficiencies of the system that was in place to handle the management of the dead during major disasters. Though the first Disaster Management Act was introduced in 2005, it has no mentioning regarding management of dead in mass disasters. Inappropriate handling of the dead could hinder the establishment of the identity of the dead, loss of valuable forensic evidence, and dignified burial. Hence, the families could experience difficulties in calming insurances and inheritance, resulting in economic hardships. In this backdrop, the forensic community strongly felt the necessity of stipulating best practices in managing dead.

Aim:

To critically assess the measures taken to improve the standards of managing dead in mass disasters in Sri Lanka over the past 15 years.

Methods:

The process of drafting guidelines for management of dead was initiated with a series of consultative meetings with the Disaster Preparedness and Response Unit of the Ministry of Health, the Disaster Management Centre (DMC) and the Institute of Forensic Medicine and Toxicology (IFMT) in collaboration with the College of Forensic Pathologists of Sri Lanka. A working group representing forensic and legal experts, military, police, fire brigade department, and disaster management were involved in drafting these guidelines. Further guidelines for the effective conduct of mass burials following mass disasters were also prepared and published in 2007.

Discussion:

Despite all these efforts the efficacy of managing dead in recent mass disasters is still far from satisfactory.
Mass Gatherings and Youth Peer Volunteerism
Authors: Lund Adam , Lund Nadia , Scott Ron , Yu Quinn , Chui Stephen , Turris Sheila
Published: May 2019

Introduction:

Music and sporting events are mass gatherings with unique risks related to participation. “All-ages” events, which include participants below the age of majority (18 in many jurisdictions), have been observed to have an over-representation of patient presentations in the youth category. Peer helpers may lower the barrier to seeking on-site care. Youth (peer-aged) volunteerism provides opportunities for exposure to new environments, skills, and mentorship. Medical volunteerism may promote personal satisfaction through prosocial behavior (i.e., helping others), community engagement and immersion into a potential health professions career path.

Methods:

We conducted an observational pilot feasibility study with feedback forms and semi-structured interviews. The pilot program paired youth with parents/guardians/responsible adults as health care volunteers at special events.

Results:

Youth/adult dyads volunteered for a variety of events in Canada during the 2018 event season. All participants in the “Juniors Program” completed at least a Standard First Aid course, including orientation to personal safety and confidentiality. Each pair worked in one of two areas: first aid or Festival Health (the harm reduction space at music events) providing peer-to-peer and “all-ages” support. Post-event feedback from the dyads revealed many positive experiences and universally called for more opportunities.

Discussion:

A strong volunteer base is an asset to any community. In this pilot study, the volunteer experiences were supervised by a team of credentialed health care professionals. The authors report on qualitative feedback in themes based on patient perspective, volunteer perspective, team perspective, and event management perspective. More research is needed to measure the outcomes of the Junior’s Program. More Investigation is needed to determine not only the long-term benefits of participation on event medical teams, but also to identify factors that shape a positive experience for youth, their parents, and the event participants that they support.
Misericord Injuries: Ancient and Modern
Authors: Mori Alfredo
Published: May 2019

Introduction:

The Misericord, or stabbing pike, was a frequently used battlefield implement in medieval times. The misericord was used by battlefield clerics to relieve the suffering of irreparably wounded soldiers. Its cultural parallels include the Roman gladius, the Japanese wakazashi, and the eponymous Liston knife used in pre-Victorian era surgery in England.

Methods:

This demonstration will analyze modern misericord injuries in the light of the current epidemic of long knife (or zombie knife) attacks in London and the domestic terrorist threat in Australia.

Discussion:

A review of this weapon is pertinent to the projected low-technology, low-impact, and deep-penetrating wounds expected in urban terrorism in Australia and other cities globally. The talk will emphasize field discussion, demonstration, and disarming techniques against modern misericord-type weapons.
A Mixed-Methods Analysis of the Spatial and Temporal Relationship Between Boko Haram Activity and Lassa Fever Incidence in Nigeria 2017-2018
Authors: Concilio Joan , Macgregor-Skinner Gavin , Tswabki Benjamin Suleiman , Lengerich Eugene
Published: May 2019

Introduction:

Two major public health issues facing Nigeria in 2017 and 2018 were the terrorist activity by the Boko Haram Islamist group and an unprecedented outbreak of Lassa fever.

Aim:

To determine if Boko Haram activity was temporally or spatially related to the incidence of Lassa fever in Nigeria and if so, to identify potential concurrent causes and mitigation measures.

Methods:

The study was a mixed-methods design. First, we conducted a secondary analysis of the Armed Conflict Location and Event Data (ACLED) Project for all known Boko Haram activity and of the weekly Nigeria Centre for Disease Control reports for suspected Lassa fever cases. Data were analyzed for January 2017 through June 2018. The ACLED data were spatially overlaid with suspected Lassa cases for each of Nigeria’s 36 states. Secondly, we conducted interviews with six aid workers in Nigeria regarding Boko Haram activities and Lassa fever cases.

Results:

In the study period, 596 Boko Haram activities occurred in 13 states (36.1%): 416 in 2017 and 180 between January and June of 2018. During the same period, 3,137 suspected Lassa cases were reported from 21 states (58.3%): 1,022 in 2017 and 2,115 in January through June 2018. Only one state, Sokoto, was unaffected by either issue. Aid workers reported a positive relationship between Boko Haram activity and increased negative health outcomes.

Discussion:

The investigation found little geographic overlap in Nigeria between Boko Haram activity and the 2018 Lassa fever outbreak, suggesting independence of these two issues. However, unmeasured factors, such as public fear and mistrust of governmental activities, may affect both issues. It is also critical to note that widespread co-occurrence (97.2% of 36 states) of these two issues presents significant public health, medical, and security challenges for Nigeria, calling for overarching solutions such as governmental stability and economic stimulus.
Mortality at Music Festivals
Authors: Jones Tracie
Published: May 2019

Introduction:

Fatalities at music festivals are seldom reported in the academic literature, making it difficult to understand the full scope of the issue. This gap in our knowledge makes it challenging to develop strategies that might reduce the mortality burden. It is hypothesized that the number of fatalities is rising. Building on earlier research, two further years of data on mortality at music festivals was analyzed.

Methods:

Synthesis of grey/academic literature.

Results:

The grey literature for 2016-2017 documented a total of 201 deaths, including both traumatic (105; 52%) and non-traumatic (96; 48%) causes. Deaths resulted from acts of terror (n = 60), trampling (n = 13), motor-vehicle-related (n = 10), thermal injury (n = 6), shootings (n = 5), falls (n = 4), structural collapses (n = 3), miscellaneous trauma (n = 2), and assaults (n = 2). Non-traumatic deaths included overdoses/poisonings (n = 41), miscellaneous causes (n = 36), unknown/not reported (n = 18), and natural causes (n = 1). The majority of non-trauma-related deaths were related to overdose (44%). No academic literature documented fatalities that occurred while attending a music festival during 2016 or 2017.

Discussion:

Reports of fatalities at music festivals are increasingly common. However, the data for this manuscript were drawn primarily from media reports, a data source that is problematic. Currently no rigorous reporting system for fatalities exists. In the context of safety planning for mass gatherings, a standardized method of reporting fatalities would inform future planning and safety measures for festival attendees. The hypothesis that mortality rate reporting increased was substantiated. However, the proliferation of music festivals, the increase in attendance at these events, and the overall increase in internet usage may have influenced this outcome.
Nurse Leadership in a Small Hospital in the Less Developed Country: Is It Needs or Circumstances?
Authors: Benin-Goren Odeda , Baratz Yossi , Diallo Fatoumata Binta
Published: May 2019

Introduction:

Clinic Communal de Miniera is a small hospital located in the poor Dixinn district in Guinea Conakry. The hospital functions with seven general physicians, three surgeons, one gynecologist, one dentist, and fifteen nurses. The facility provides small admitting wards for medical, gynecologist (mostly maternity), and pediatric patients. The average number of patients per day is about forty, including acute and ambulatory patients. Although there is a medical director, the daily work is run by the Head Nurse (HN) who is specialized (on spot) as an Emergency Nurse. Management of all emergency patients is based on her experience, personality and the reality of the organization.

Results:

The circumstances emphasized the gaps between the managerial needs and existent reality, and raised the HN role to a team leader. The work will present the situation in the hospital as a case study related to “non-conventional” management due to a “deferent” situation and will highlight questions related to capabilities and risk factors.
PARABORN: A Training Program for “Outdoor” Activities by Pregnant Urgent Patients for Paramedics
Authors: Jordan Vaclav
Published: May 2019

Introduction:

Spontaneous delivery is a completely physiological phenomenon. Occupational obstetric care in a hospital environment focuses on supporting the mother, the smooth progression of the baby, and the treatment of the newborn child. Occupational activities play a rather supportive and assisting role. The obstetrician and the midwife are ready to respond immediately in the hospital environment to any complications or sudden emergencies. During a birth outside of the hospital environment, there are a number of influences that can cause complications in an unprepared environment without professional assistance, endangering the condition of both the child and the woman.

Methods:

The educational concept of PARABORN focuses on situations outside the hospital environment. It is generalized and adaptable to varying geographic, economic, and cultural-political conditions of the target providers, particularly to rescue and paramedic teams. Educational concepts are specialized, interactive courses. The course includes a theoretical and practical block. In the theoretical part, the participants acquire knowledge of urgent obstetric conditions in an out-of-hospital environment including an overweight birth, bleeding, premature delivery, or a complicated delivery (non-standard position, umbilical cord prolapse, etc.). In the practical block, participants acquire the skills of acute interventions as well as methods of communication in these emergency situations. Practical training takes the form of case studies and can be tailored to the real geographic and cultural conditions in which the intervention units operate such as remote terrain, conflicts zones, etc.

Discussion:

The knowledge of the cultural and political environment is a necessary prerequisite for managing the urgent situation. Paramedics, as first responders, should have adequate training to manage maternity situations in an out-of-hospital environment where a hospital environment is not available or accessible either by choice or circumstance.
Pediatric Outpatient/Urgent-Care Emergency and Disaster Planning
Authors: Frogel Michael , Foltin George , Cooper Arthur
Published: May 2019

Introduction:

Children are frequently victims of disasters, however important gaps remain in pediatric disaster planning. This includes a lack of resources for pediatric preparedness planning for patients in outpatient/urgent-care facilities. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response.

Aim:

After creating planning resources in Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Neonatal Intensive Care Units and Obstetric/Newborn Services within NYC hospitals, the NYCPDC partnered with leaders and experts from outpatient/urgent-care facilities caring for pediatric patients and created the Pediatric Outpatient Disaster Planning Committee (PODPC). PODPC’s goal was to create guidelines and templates for use in disaster planning for pediatric patients at outpatient/urgent-care facilities.

Methods:

The PODPC includes physicians, nurses, administrators, and emergency planning experts who have experience working with outpatient facilities. There were 21 committee members from eight organizations (the NYCPDC, DOHMH, Community Healthcare Association of NY State, NY State DOH, NYC Health and Hospitals, Maimonides Medical Center and Presbyterian/Columbia University Medical Center). The committee met six times over a four-month period and shared information to create disaster planning tools that meet the specific pediatric challenges in the outpatient setting.

Results:

Utilizing an iterative process including literature review, participant presentations, discussions review, and improvement of working documents, the final guidelines and templates for surge and evacuation of pediatric patients in outpatient/urgent care facilities were created in February 2018. Subsequently, model plans were completed and implemented at five NYC outpatient/urgent-care facilities.

Discussion:

An expert committee utilizing an iterative process successfully created disaster guidelines and templates for pediatric outpatient/urgent care facilities. They addressed the importance of matching the special needs of children to available space, staff, and equipment needs and created model plans for site-specific use.
Planning for the Use of Imaging in Mass Casualty Incidents
Authors: Starkey Deborah , Elliott Denise
Published: May 2019

Introduction:

A mass casualty incident presents a challenging situation in any health care setting. The value of preparation and planning for mass casualty incidents has been widely reported in the literature. The benefit of imaging, in particular, forensic radiography, in these situations is also reported. Despite this, the inclusion of detailed planning on the use of forensic radiography is an observed gap in disaster preparedness documentation.

Aim:

To identify the role of forensic radiography in mass casualty incidents and to explore the degree of inclusion of forensic radiography in publicly available disaster planning documents.

Methods:

An extended literature review was undertaken to identify examples of forensic radiography in mass casualty incidents, and to determine the degree of inclusion of forensic radiography in publicly available disaster planning documents. Where included, the activity undertaken by forensic radiography was reviewed in relation to the detail of the planning information.

Results:

Limited results were identified of disaster planning documents containing detail of the role or planned activity for forensic radiography.

Discussion:

While published accounts of situation debriefing and lessons learned from past mass casualty incidents provide evidence for integration into future planning activities, limited reports were identified with the inclusion of forensic radiography. This presentation provides an overview of the roles of forensic radiography in mass casualty incidents. The specific inclusion of planning for the use of imaging in mass fatality incidents is recommended.
Practicing What You Preach
Authors: Raviiolo Mario , Jaffe Eli , Herbst Raphael
Published: May 2019

Introduction:

During a mass casualty incident (MCI) seminar in Rome, Italy a survey was used to gauge the self-efficacy and confidence of the participants in managing an MCI. Following the course, a follow-up presentation was held by the Torino EMS Medical Director to evaluate and debrief the Torino Railway incident that occurred one day prior. Students partook in a seminar on MCI management, as well as a debriefing of the Turin Railway accident in which they evaluated the skills used by teams on the scene to manage the incident.

Methods:

Medical students partook in a seminar to learn to manage an MCI scene, as well as a debriefing of the Turin Railway accident. Following both seminars, the students were given a survey to assess their sense of self-confidence in managing such a situation.

Results:

The mean level of self-efficacy prior to the MCI training (M=3.43, SD+0.42) increased after the training (M=3.71, SD+0.37) and remained at the same higher level (M=3.71, SD+0.51) after the medical students were exposed to the details of the Turin train accident. The overall difference between the mean self-efficacy scores in the three time frames was not found to be significant. The mean level of confidence in managing MCIs prior to the training (M=2.83; SD+0.89) increased after the training (M=3.56; SD+0.53) and remained higher following the presentation of the Turin train accident, despite a slight decrease (M=3.52, SD+0.63).

Discussion:

The participants’ surveys showed an increase in their self-efficacy and confidence following the course and follow-up presentation. It is our professional recommendation that real-life events be used in such seminars to increase self-efficacy and confidence. The topic will continue to be evaluated further.
The Problems on Your Desk: A Research Study to Define and Describe Paramedic Practice in Canada
Authors: Bowles Ron
Published: May 2019

Introduction:

Paramedicine is a rapidly evolving profession, growing from its initial role of providing emergency care and transportation of the sick and injured into a broad discipline providing a wide range of care in multiple practice settings, yet the field is relatively unexplored. Much of the research in the field centers on patient care, often from the perspective of emergency medicine. A growing body of literature describing the discipline itself is largely descriptive.

Aim:

This interactive presentation describes and contributes to an applied research project that will define and describe Canadian paramedic practice. The research will develop frameworks, common taxonomy and designs, and evidence to support development of a national Canadian Paramedic Information System.

Methods:

This two-year mixed methods study is gathering data from a literature review, stakeholder workshops, and key informant interviews. The project will develop “user cases” that explore the issues and challenges facing Canadian paramedic stakeholders and identify the information and data required to address those issues.

Results:

The presentation will present initial findings that describe core concepts, data/knowledge structures, and models that are foundational to understanding and informing current and emerging paramedic practice. It will explore this data in relation to operational needs of practitioners, operations, communities, and stakeholders to inform decision-making, guiding policy and direction, and advancing the profession. Lastly, it will develop explanatory principles, models, and relationships in a conceptual framework that describes paramedic practice.

Discussion:

The study will develop models and core data sets that guide research and support policy development at local and national levels, and inform operational and strategic decision-making. The presentation will provide an overview of the research and findings to date. Participants will engage in activities that explore the user-cases and selected findings, applying the results of the study through the lens of their own backgrounds and operational contexts.
Radiation: Preparing for the Glow That You Can’t See
Authors: Klein Kelly , Swienton Raymond , Flax Lindsay , Liu E. Liang
Published: May 2019

Introduction:

In 2013, a multinational collaboration met to improve the global and nation-specific preparedness and response in managing casualties from nuclear and radiological disasters. From this meeting, a survey was developed and distributed in both Japanese and English. The results published four years later illustrate a lack of understanding about radiation and risks to the health care provider.

Aim:

To dispel myths and increase understanding regarding trauma treatment and healthcare risks for healthcare providers during a radiologic event.

Methods:

IRB approved survey and literature review

Results:

A total of 418 surveys were analyzed. Although 44% of participants acknowledged that they had taken at least one radiological training course, the majority of the respondents were still not comfortable with radiological emergencies.

Discussion:

Despite the plethora of both online and in-person radiological training availability, healthcare providers are not comfortable with the topic. Based on information from the survey, it is important to dispel myths and educate healthcare providers so that they have reasonable expectations regarding risks and to ensure that they are comfortable coming to work. By doing this, there will be an adequate healthcare presence to help take care of patients who are not only in need of immediate trauma and radiologic exposure care but also with non-affected patients coming for emergent and scheduled health care needs.
Real-Time GIS for Health Disaster Response in the Largest Archipelagic Country
Authors: Alim Ahmad
Published: May 2019

Introduction:

Besides being located on the Pacific Ring of Fire, Indonesia is the largest archipelago country in the world. Some parts of the country are not very accessible. It raises difficulties in controlling and monitoring a disaster response mission remotely in real-time. Muhammadiyah, the Indonesian non-governmental organization (NGO) that has been responding to disaster since 1919, used Geographic Information Systems (GIS) for Health Disaster Response (HDR) in the Lombok Earthquake 2018, in cooperation with ESRI Indonesia, as one alternative to disaster response controlling and monitoring.

Aim:

To show the benefit of using real-time GIS for HDR in an archipelago country.

Methods:

While responding to the disaster in Lombok, the Muhammadiyah Health Disaster Response Team was collecting data of patient, medication, problem, need, location, and resource with computers and smartphones, inputting the data that was forwarded to the ArcGIS platform. The Health Disaster Response Team coordinator and Muhammadiyah Board monitored and analyzed the health response through the GIS dashboard in Yogyakarta, 652km far from Lombok Island.

Results:

Using real-time GIS has been useful for disaster response. It was efficient by cutting flight and other transport costs, connected by the internet, and communicative by graphic and map dashboard. It was a green approach since it was paperless, and analysis-friendly by real-time data compilation and computation.

Discussion:

One of the big gaps in disaster response monitoring seems to be real-time data. Especially in an archipelago country, it is costly, time-consuming, and resource consuming. Daily big data may be frustrating and can become “white paper syndrome.” One of the good approaches to that is GIS Web services although it must be realized that the internet connection in a rural area can be another challenge. It can be solved by in-gadget data memory that can be delivered while the internet connection is available.
Revised Hospital-MIMMS Course for Japan
Authors: Kaji Arito , Yamamoto Hiromasa , Morimura Naoto
Published: May 2019

Introduction:

HMIMMS (Major Incident Medical Management and Support: The Practical Approach in the Hospital) has been introduced by ALSG (Advanced Life Support Group, Manchester, UK) and developed for many countries for preparing to accept huge numbers of casualties at a hospital during major incidents. The original HMIMMS course has been held in Japan since 2007, produced over 1,200 providers. Japan has a crucial history of natural disasters, earthquakes, tsunamis, and typhoons often resulting in extensive damages to infrastructure and communications.

Aim:

The MIMMS-JAPAN and the Japanese Association for Disaster Medicine have joined to plan to revise the original HMIMMS course from the point of view of the difference of the type of disaster.

Method:

By the permission of ALSG, two subjects were added “Hospital Evacuation” and “Business Continuity Plan” as lectures, workshops, and tabletops to the original HMIMMS course. Before attending the course, students were required to watch e-learning for deeper understanding and time-saving. Total program was organized into two days.

Results:

Main points of modification are to:

1.

Replace a system peculiar to the UK with a Japanese system.

2.

Add unique contents of a Japanese disaster.

3.

Add the important subjects especially in Japan.

4.

Modify the presentation slides to understand easily for Japanese students. But the fundamental concept that hospital functions upon ‘CSCATTT’ is strictly preserved.

Discussion:

Newly revised HMIMMS course will start in 2019 for Japanese learners. Many reflections must be accumulated and further revisions will continue.
The Role of Emergency Medical Team: Experience Acute Response in Earthquakes and Tsunami at Palu, Central Sulawesi, Indonesia, 2018
Authors: Pramusinto Handoyo , Priambodo Agung , Dewanto Andreas
Published: May 2019

Introduction:

The natural disasters of the earthquake and tsunami occurred in Palu, on September 28, 2018, at around 17.02 WIB. The earthquake measured 7.7 magnitude with the epicenter at a depth of 10 km in the direction of 27 km northeast of the city of Donggala, followed by a tsunami along the coast of Talise town of Palu. Some of the victims of the disaster have died, and in addition to many deaths, there were reported trauma cases such as fractures, torn wounds, and other injuries where many did not receive medical help.

Aim:

To revitalize hospitals in Palu with the medical assistance team.

Methods:

Sardjito hospital formed a medical team sent to the disaster area which consisted of 22 members from various disciplines (anesthetists, orthopedic surgeons, general surgeons, neurosurgeons, internal medicine doctors, pediatricians, general practitioners, anesthesia nurses, emergency nurses, surgical room nurses, sanitarians, sterilization officer, technical officers, and nutrition officers). The ICS informed the targets of this emergency response that the following must be accomplished within 2 weeks: revitalize the health care facilities and deliver health care. The sanitarian officer coordinated dealing with the problem of the former corpse in Bhayangkara Hospital by doing disinfectants in the area of the former mortuary. Sardjito Hospital’s medical team revitalized health services in Bhayangkara Hospital by providing 24-hour emergency services and surgery.

Results:

The medical team of Sardjito general Hospital gave medical service in Bhayangkara Hospital and Torabello Regional Hospital. The total number of treated patients was 158, and most cases of surgery were orthopedics.
Standardized Measurement of Capillary Refill Time using Novel Technology
Authors: Junker Johan , Jonson Carl-Oscar , Henricson Joakim
Published: May 2019

Introduction:

In a patient going into shock, blood is redistributed from the periphery to the central circulation, making an assessment of skin perfusion useful in a prehospital setting. Capillary refill time (CRT) is the time required for a pressure blanched skin site to reperfuse. Currently, CRT is tested by manually applying pressure for 5s to the skin and observing the time before reperfusion. Guidelines state that CRT should be 2-3s in a healthy patient. Shortcomings in this procedure include lack of standardization of pressure, subjective assessment of the time for reperfusion, and not accounting for the patient’s skin temperature.

Aim:

To develop a standardized objective procedure for testing CRT in the prehospital setting.

Method:

The study protocol was approved by the Ethics Committee at Linköping University (M200-07, 2015-99-31). An electro-pneumatic device exerting constant force (9N) over 5s was developed. CRT was measured using the Tissue Viability Imager (Wheelsbridge AB, Sweden) which relies on polarization spectroscopy. To simulate hypothermic conditions, healthy volunteers were subjected to low ambient temperature (8°C). Blood loss was simulated using a custom-built lower body negative pressure (LBNP) chamber. In both scenarios, the CRT test was carried out on three test sites (finger pulp, forehead, and sternum).

Results:

CRT on the finger pulp and sternum was shown to be increased following the hypothermic conditions, but not on the forehead. Skin temperature on the three sites followed the same pattern, with the forehead being virtually unchanged. Tests performed during LBNP revealed an apparent effect on CRT following the simulated blood loss, with prolonged CRT for all sites tested.

Discussion:

A successful methodology for objective assessment of CRT was developed, which was validated on healthy volunteers following hypothermia or simulated blood loss. Ongoing work will investigate a combination of hypothermia and blood loss to more accurately simulate the prehospital setting.
Survey on the Disaster Prevention System in Rural Areas and Isolated Islands: Preparing for the Nankai Trough Earthquake
Authors: Kodama Takamitsu , Ozawa Kazuhiro , Nakagawa Takashi
Published: May 2019

Introduction:

An expert government committee in Japan decided to revise the chance of a Nankai Trough earthquake in the next 30 years from 70% to between 70 and 80% in 2017. If a mega-earthquake occurs, medical institutions in disaster regions are required to perform self-contained activities during the super-acute phase. Human damage varies depending on whether medical functions can be sustained, particularly in rural areas and isolated islands. Here we examined actual situations.

Aim:

To identify the issues of a disaster medical system in rural areas and isolated islands that need solving.

Methods:

Regarding disaster preparedness planning, we conducted a survey on 10 hospitals undesignated as disaster key hospitals of remote area medical care bases (survey group), and 69 hospitals designated as disaster key hospitals (control group) in three prefectures in the Tokai region (Aichi, Mie, and Shizuoka).

Results:

We received responses from four hospitals in the survey group and 52 hospitals in the control group. The hospitals in the survey group responded that they could accept 74 severe casualties and 85 moderate casualties. We identified problems such as insufficient stockpiling of fuel, water, and oxygen, and lack of a prioritized lifeline supply contract.

Discussion:

It was predicted that human damage would be relatively minor given smaller populations in rural areas and isolated islands in the Tokai region. However, the number of patients would exceed their acceptance capacity. Moreover, the system for sustaining infrastructure is not adequate for providing medical services. Thus, it was indicated that these regions would be isolated in terms of disaster measures. It is imperative to establish a disaster medical system in rural areas and isolated islands that lack adequate disaster medical systems to manage Nankai Trough earthquakes.
Susceptibility of Host Immunity to Infectious Diseases in the Spacecraft Environment
Authors: Tran Vienna
Published: May 2019

Introduction:

The principles of Disaster and Emergency Medicine are applicable beyond the confines of planet Earth. With the accelerating rate of climate change, natural disasters, and overpopulation, as well as the innate human appetite for knowledge and technological advancement, there has recently been an increased interest in the prospect of long-duration spaceflight with a view to colonize extra-terrestrial bodies, such as Mars. However, there is a need to understand the risk of adverse medical events in the hostile environment of space. For example, previous incidences of infectious disease and immune dysregulation during a short-term mission have threatened to jeopardize the crew dynamic and the mission objectives. The risk of infectious diseases to the astronaut is one of the many knowledge gaps that must be addressed before long-duration flight is considered.

Aim:

To review how spaceflight impacts an astronaut’s in-flight susceptibility to infectious diseases.

Methods:

Research was guided by the Microbiology section of the NASA Human Research Roadmap Program. Search terms in the University of Adelaide Library Search database collection included: “infectious diseases + spaceflight,” “astronaut + immunity,” “analog,” and “inflammatory marker.”

Results:

Studies that have been conducted in-flight and on Earth demonstrate that both the astronaut and the microbe are affected by spaceflight. Stress, microgravity, and the isolated nature of the spacecraft have been found to compromise the immunity of the astronaut, as shown by reduced T cell counts and increased viral shedding of dormant viruses. Microbes have demonstrated rapid adaptation mechanisms, including genetic mutation and increased virulence.

Discussion:

This paper identifies a significant need for further research into host immunity during spaceflight to mitigate infectious disease risk. It is recommended that in-situ studies and terrestrial space analogs are most effective and that current knowledge on the principles of wilderness and expedition medicine be applied where possible.
A Systematic Review of Earthquake-Related Head Injuries
Authors: Igarashi Yutaka , Matsumoto Narumi , Kubo Tatsuhiko , Nakae Ryuta , Yokobori Shoji , Yokota Hiroyuki
Published: May 2019

Introduction:

Earthquakes have killed around 800,000 people globally in the past 20 years, with head injury being the main cause of mortality and morbidity.

Aim:

To conduct a systematic review to determine the characteristics of head injuries after earthquakes for better disaster preparedness and management.

Methods:

All publications related to head injuries and earthquakes were searched using Pubmed, Web of Science, the Cochrane Library, and Ichushi.

Results:

Thirty-six articles were included in the analysis. Head injury was the third most common cause of injury among survivors of earthquakes. The most common injury after an earthquake occurred was in the lower extremities (36.2%), followed by the upper extremities (19.9%), head (16.6%), spine (13.3%), chest (11.3%), and abdomen (3.8%). Earthquake-related head injuries were predominantly caused by a blunt strike (79%), and were more frequently associated with soft tissue injury compared to non-earthquake-related head injuries and less frequently with intracranial hemorrhage. The mean age of patients with earthquake-related head injuries was 32.6 years, and 55.1% of sufferers were male. The most common earthquake-related head injury was laceration or contusion (59.2%) while epidural hematoma was most common among inpatients with intracranial hemorrhage after an earthquake (9.5%). Early wound irrigation and debridement and antibiotics administration are needed to decrease the risk of infection. Mortality due to earthquake-related head injuries was 5.6%.

Discussion:

Head injury was the main cause of mortality and morbidity after an earthquake. The characteristics of earthquake-related head injuries differed from those of non-earthquake-related head injuries, including the frequency of multiple injuries, and occurrence of contaminated soft tissue injury and epidural hematoma. This knowledge is important for determining demands for neurosurgery and for adequate management of patients, especially in resource-limited conditions.
Tactical EMS Deployment at the G7 Summit in Charlevoix, Quebec
Authors: St-Arnaud Emmanuelle
Published: May 2019

Introduction:

The G7 Summit was held in Charlevoix, Quebec (Canada) on June 8 and 9, 2018. The Urgences-santé Corporation (USC), in charge of prehospital emergency services in Montreal and Laval, was asked to intervene outside of its usual territory during the Summit, mainly because it has the only tactical medical team in the province of Quebec to be equipped and trained for high-risk situations.

Aim:

Part of USC’s tactical medical team was deployed to the Charlevoix region from May 29 to June 10, 2018. The team had two responsibilities: act in the event of a chemical, biological, radiological, nuclear or explosive (CBRNE) attack, and in the event of social disturbance or violence, provide care for protestors and the police officers tasked with maintaining and restoring order.

Methods:

The mission required rigorous preparation to ensure the team’s safety outside its usual area of activity while maintaining full coverage of metropolitan Montreal, where the impacts of the G7 Summit were also felt. Emphasis was placed on intensive coaching of the tactical medics, on joint training, and on the coordination of intervention protocols across EMS, fire and law enforcement.

Results:

A total of 14 tactical medics and two managers were sent to Charlevoix for the Summit. Before their departure, three joint training days were held, and our training center provided six days of training to our partners.

Discussion:

While no CBRNE incident or major social disorder occurred during the Summit, USC was able to gain more visibility and therefore reach out to different organizations on site. Close ties were developed with the Sûreté du Québec (provincial police), with whom USC now regularly collaborates during training and interventions. The lessons learned also helped consolidate our extra-territorial deployment procedures.